Inspection on 27/01/09 for Primrose Place

This inspection was carried out on 27th January 2009.

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

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

Other inspections for this house

Primrose Place 02/02/07

Primrose Place 20/02/06

Primrose Place 20/06/05

Primrose Place 03/03/05

Primrose Place 14/12/04

Primrose Place 29/12/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Primrose Place 34 Somerset Road Handsworth Birmingham West Midlands B20 2JD     The quality rating for this care home is:   three star excellent 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: 2 7 0 1 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Primrose Place 34 Somerset Road Handsworth Birmingham West Midlands B20 2JD 01215540440 01212412597 david@primroseplace.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Nelam Kaur,Mr David Cobley care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Sensory impairment (SI) 5 Date of last inspection Brief description of the care home Primrose Place is a Victorian style semi-detached house located in Handsworth Wood. It lies in a quiet residential neighbourhood, close to local amenities including shops, parks and bus routes. The service offers quality accommodation for up to five adults with sensory impairment and/or learning disabilities. There is a comfortable lounge with sensory equipment and large separate dining and activities room with a piano. There is a kitchen, which the people living in the home can access. A separate laundry room is at the rear of the kitchen. There are five single bedrooms, two of which have en-suite facilities. Those people who dont have these facilities have access to a Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 0 5 5 Brief description of the care home bathroom and separate toilet. Off road parking is available for one car at the front of the house. To the rear of the house is an easily accessible garden with a lawn, shrubs and trees. There is also an attractive blocked paved area leading to the summer house. The home is decorated in bright colours with touch indicators in the ledges and handrails to enable the people living there who are visually impaired to get around the premises. The specific fees charged at the home were not included in the service user guide but there was a statement stating that fees were agreed with the admitting authority who would be responsible for paying for them. Care Homes for Adults (18-65 years) Page 5 of 35 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: three star excellent 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 carried out on February 2nd 2007. Following this an Annual Service Review was done on January 21st 2008 when we sent satisfaction surveys to one of the people living in the home, the families of the people living in the home and some of the health care professionals involved in their care. The home also completed and returned to us the Annual Quality Assurance Assessment. From the information we received we decided the home continued to provide an excellent service to the people living there and that we did not need to bring forward the next inspection. This key inspection was carried out by one inspector over one day in January 2009. During the course of the inspection the care for one of the people living in the home Care Homes for Adults (18-65 years) Page 6 of 35 was tracked and was briefly looked at for another. This involved looking at care plans, risk assessments and daily records for the individuals and observing practice in the home. We also looked at medication management, one staff file, training records, staff rotas and some health and safety documentation. A tour of the home was also undertaken. During the course of the inspection we spoke with the manager, deputy manager, two staff and three of the people living in the home. Prior to the inspection the manager had completed and returned to us the Annual Quality Assurance Assessment (AQAA) for the home which gave some further information and is referred to in this report. No complaints or adult protection issues had been raised with us about the home since the last key inspection and none had been lodged directly with the home. What the care home does well: The home has consistently demonstrated that it offers the people living there a very good service. The people living in the home had extensive care plans that detailed their needs and how these were to be met. These were regularly reviewed and updated as necessary. There were numerous risk assessments in place for the individuals in the home for such things as accessing areas of the home and any activities they took part in. There were also detailed behavioural guidelines in place. The guidelines included the early warning signs of any behaviours, what may be the triggers and how staff were to respond. The people living in the home had access to a good range of activities both in the home and in the community. There were good systems in place to enable staff to communicate with the people living in the home. The personal and health care needs of the people living in the home were met in ways that suited them. All the people living in the home had contact with other people who could raise any concerns on their behalf, for example, families, advocate and day centre workers. There was information on care files in relation to how the people living in the home would indicate if they were unhappy. Staff were well trained and available in adequate numbers to ensure that the needs of the people living in the home could be met. Staff were very positive about the training they had received comments included: I have completed in house training and gone to outside companies to complete any training that is required relevant to my position. I had induction on how the home is run and each individual resident and their needs. Training was given in the home through videos. I was sent on courses for first aid, food hygiene, infection control, equality and diversity, recording and communication, NVQ 2 in social care. The training has been excellent. I have been offered a large range of training which has really helped me in my job. The home is a large domestic dwelling and as such provides the people living there with a very homely atmosphere. The quality monitoring system that was in place ensured the service was run in the best interests of the people living in the home and that it was continuously improved. Care Homes for Adults (18-65 years) Page 8 of 35 The health and safety of the people living in the home and the staff were very well managed. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 9 of 35 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 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 11 of 35 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. There was information available for people wanting to move into the home to help them decide if it was suitable for them. People could visit the home before moving in to see if they liked it. The needs of the people living in the home were assessed on an ongoing basis to ensure they could be met by the home. Evidence: The statement of purpose and service user guide for the home are a combined document. It is updated on an annual basis or earlier if necessary. The document included all the information people would need to help them decide if the home could meet their needs. The specific fees charged were not included but there was a statement stating that fees were agreed with the admitting authority who would be responsible for paying for them. The service user guide/statement of purpose was available in a variety of formats, for example, large print, picture format and could be made available in braille if requested. A copy that had been issued to one of the people living in the home was Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: seen and this was in large print. There had been no new people admitted to the home for a considerable amount of time however the home had an extensive admissions policy and procedure. People were able to visit the home before moving in to see if they liked the home. One of the surveys returned to us by one of the people living in the home stated I came to visit a few times. Two files for the people living in the home were sampled. Records showed that the people living in the home had, wherever possible, been involved in drawing up extensive Person Centred Plans (PCPs). These detailed all their needs, likes, dislikes, preferences and so on and how staff were to meet these. The PCPs were regularly reviewed and updated to ensure they remained current. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home had comprehensive person centred care plans and risk assessments that detailed how all their needs were to be met and how any identified risks were to be minimised. Evidence: The AQAA returned to us prior to the inspection stated The care planning process is as person centred as possible, and keyworkers play a central role in facilitating this. Where there are severe communication difficulties, this process may be based on observations and liaison with those that know the individuals best. Each of the people living in the home had Person Centred Plans which had been written from their perspective. Two of these were looked at, one in some depth the other briefly. Both included extensive information about the needs of the people living in the home, their likes, dislikes and preferences and so on. There were also care files which included additional information about the people living in the home. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: The PCPs we looked at were written from the point of view of the people living in the home. Due to the complex needs of the people living in the home they had not been able to contribute greatly to the PCPs but information had been drawn from the people who had worked with them for a considerable amount of time and families. Areas included in the PCPS were an overview of the person, what was essential and important to them, their likes and dislikes, what they enjoyed doing and what staff needed to know to be successful in supporting them. One of the PCPs included very good information about the importance of textures to the individual and how this affected what they wore. The clothes worn on the day of the inspection were in line with this. It was also important this person was able to find the objects which I find stimulating, brightly coloured tins, wind mills, pocket radio. These were seen in the home and were accessible to the individual. There was also clear guidance about communication, for example, one person used picture folders to indicate to staff what they wanted and these were seen in the home. Another persons PCP stated speech can be hard to understand if you have not known me for long. Concentrate on what I am saying and ask me to repeat myself and you should start to pick it up. One of the PCPs seen included very detailed information about the persons daily routines. These had been broken down into small captions with pictures which were very easy for staff to read and follow. The other PCP did not have these and the daily routines were written in the care file and although well detailed it was recommended that they be added to the PCP to ensure consistency. One of the PCPs was clear about the persons cultural background in relation to what they should not eat and the place of worship they could be attend. The PCPS also detailed what other documents staff would need to refer to to successfully support the people living in the home, for example, behaviour management plans, teaching programmes and health care managment plans. The care files included additional information about the people living in the home, for example, the signs that would be shown if people were worried, upset or unwell. There were management plans in place for any challenging behaviours which detailed the types of behaviour, how they were to be discouraged, what the triggers were and how staff were to respond the behaviours. All incidents of challenging behaviour were recorded by staff including the actions and consequences. The records clearly showed staff were following the management plan. There were risk assessments and management plans in place for such things as showering, moving around the home, Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: bathing, swimming and receiving visitors. There were also staff supervision risk assessments which indicated how many staff were needed for activities. The people living in the home were enabled to make decisions for themselves wherever possible and staff had different communication methods to use to help with this, for example, symbols and pictures. One of the people living in the home who was able to complete a survey stated I choose my own clothes and what to eat and what to do. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were encouraged and enabled to have an independent lifestyle as far as was possible. Their rights and responsibilities were recognised in their every day lives. The catering arrangements at the home met with the needs of the people there. Evidence: There was detailed information in care plans as to what the people living in the home enjoy and dont enjoy being involved in. Individual choices were respected and catered for on a daily basis allowing and enabling activities both within the home and the wider community. On the day of the inspection two of the people living in the home were out at a day centre, two went out shopping during the day, another was in for most of the time but Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: did have an appointment at the doctors and was going out to an activity during the evening. One of the people living in the home had a great interest in music and this was seen to take up much of their time while in the home listening to the radio and CDS, singing and playing musical instruments. Also on the day of the inspection a therapist visted the home and some of the people living there enjoyed a massage. The people living in the home were seen to be encouraged to do things such as make their own breakfast, help with the laundry and help tidy up around the house. Activity plans were in place for the people living in the home. The one for the person whose care was being tracked included such things as swimming, cooking, outings, personal shopping, personal activities, radio, palying the organ, singing, exercise session at a centre, laundry and room tidying. Daily records showed these activities did take place and staff included comments as to how people had reacted to activities. Care files included a section entitled bank of experience which detailed any new experiences people had had. These included last years holiday, garden party, variety of visits to stately home, black country museum, Chinese state circus, art festival, fire work display and so on. The records indicated how the individuals had reacted and if they had enjoyed the experience. There were numerous photographs of the activities and trips out that people had been involved in around the home. The people living in the home also had an individualised teaching programme in plan. The programmes were agreed at the six monthly reviews and designed to help people achieve a specific aim either to improve their independence or their quality of life in general. The aim for the person whose care was being tracked was to be able to change their bed linen and remake their bed. There was a detailed plan in place of what staff were to try and achieve with the individual and how they were to do this. There were monitoring charts in place that showed what had been achieved on an ongoing basis. Comments recieved from staff about the lifetsyles of the people living in the home were very positive these included: It helps the residents to reach their full potentail and also helps them develop their skills by providing them with a large range of activities. Visitors are made to feel welcome. Most importantly the service users are cared for very well, from feeding, to buying their clothes, to outings and activities, every need is considered for each individual client. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Contact with families, friends and advocates were detailed in care files and daily records showed when people had seen their families and so on. Any specific issues that needed to be addressed when people were receiving visitors were detailed in their care files. The manager also discussed with us that one family had said they would like a news letter from the home. He was now doing this to keep people in touch with what was going on at the home. The menus in the home were planned on a weekly basis. Staff along with the two people living in the home that were able met on a weekly basis and planned the menu for the coming week. Menus were based on the likes, preferences and cultural needs of the people living in the home. The manager spoke of trying to encourage healthy eating and how specific plans had been put in place to try and discourage excessive weight gain. The person whose care was being tracked had a tendency to put on weight so at the review the issue had been fully discussed and an action plan drawn up with the agreement of the individual. This detailed the types of food that were to be discouraged and when sweet foods were to be given. This was seen to be followed on the day of the inspection. There were clear records of the foods being served to the people living in the home and these showed people had a varied and nutritious diet and that cultural needs were being met. Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people living in the home were being met in a way that suited them. The medication administration system was generally well managed however some improvements were required to ensure the people living in the home were receiving their medication as prescribed. Evidence: The needs of the people living in the home varied in relation to personal care. Their needs were detailed in their daily routines and the information included details of what people were able to do for themselves and what staff support they required. Daily records showed that the people living in the home were receiving the support with their personal care as detailed in their care files. People were seen to be dressed in way they liked , for example, one person was very fond of broaches and was seen wearing these. For another person the texture and fit of clothing was important and they were seen to be dressed appropriately. The health care needs of the people living in the home were comprehensively documented. Health action plans documented any health care needs in relation to such Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: things as sight, mobility, weight and so on. The person whose care was being tracked had specific action plans in plan for maintaining there weight at an acceptable level and a minor ongoing health concern. This person also had a very comprehensively detailed seizure management plan which detailed for staff the different types of seizures the person may have, for example, vacant episode, what staff should be watching for and at what point medical intervention must be sought. All seizures were being recorded by staff as to what happened and their duration. Files included general medical notes where staff recorded things such as when PRN (as and when necessary medication) had been administered and any general comments about health. The outcomes of any visits to or from health care professionals were very well detailed and showed that all health concerns were closely monitored and followed. There was evidence that people attended appointments at GPs, hospitals, dentists, chiropodists and saw more specialised health care professionals such as psychiatrists as necessary. Some very positive comments were received from medical professionals about the care home these included: Very responsive to changes in treatment. Pro-active team. Management forthcoming with information. Gives residents choices and adapt to what is best for them. General day to day care is excellent. Home environment tailored to each residents preferences. Medication was being administered via a 28 day monitored dosage system. We were told staff were not allowed to administer medication until they had been appropriately trained. Medication was recorded and signed for on the MAR (medication administration record) when received into the home. Any balances remaining in the home at the end of the 28 day cycle were brought forward to the next MAR chart ensuring a complete audit trail. Some of the boxed medicines were audited during the inspection. There were discrepancies in two of those audited where the amounts remaining in the home did not tally with what had been received into the home and what had been administered. One type of medication had two too many tablets another was two short. The reason for this could not be explained. There were written protocols in place for staff to follow detailing when they should administer PRN medication. We were told there was no controlled medication being administered in the home at the time. There were some homely remedies in the home which the G.Ps had agreed to the people living in the home having when necessary. These were recorded Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: individually when administered but there was no running balance kept of what remained in the home. To enable these to be audited easily it was recommended that a running balance was kept. Care Homes for Adults (18-65 years) Page 22 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were robust systems in place to ensure the people living in the home were safeguarded and any complaints were managed appropriately. Evidence: No complaints had been lodged with us or at the home since the last key inspection. The complaints procedure was appropriate and available in different formats if required. One of the people living in the home had a copy in large print. All the people living in the home had contact with other people who could raise any concerns on their behalf, for example, families, advocate and day centre workers. There was information on care files in relation to how the people living in the home would indicate if they were unhappy. The person living in the home who completed a satisfaction survey indicated they knew who to speak to if they were unhappy and named the manager, deputy manager and key worker. The surveys returned to us by staff at the home showed they were very clear about the homes complaints procedure including the time scales for responses and that complaints could be referred to us if necessary. There have been no adult protection issues raised in relation to the home since the last inspection. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: The AQAA for the home stated We have clear Adult Protection Procedures (including whistleblowing), compatible with the multi-agency guidelines. This is included in the staff handbook. All staff have attended a two hour training session on Abuse in Care Homes, including training video, written questions and discussion. We also have policies & procedures in place regarding behaviour management, physical intervention and safekeeping of residents money & valuables which are designed to minimise the risk of abuse. The training support staff had undertaken in this topic was not included on the training matrix for the home but it was shown for the managers. It is strongly recommended that this be included so that it is easy to identify when this needs updating. The manager of the home was very aware of how vulnerable the people living in the home were. We had lengthy discussions about one of the people living in the home whose behaviour continued to raise concerns as it posed a risk for others. All appropriate steps had been taken to safeguard the people living in the home. There was clear guidance on managing the behaviour to reduce the risk to others, numerous other professionals had been involved over a period of time. The people living in the home were unable to manage their own finances. The systems in place at the home to help them with this were robust. The manager of the home was the appointee for three of the people there. This is not an ideal situation but is a long standing arrangement and the records showed that this was very carefully managed. There was a financial profile for each person showing what benefits they were entitled to and the manager ensured these were paid into the bank. All withdrawals from the bank were receipted, recorded and cross referenced to bank accounts. Receipts were available for expenditure. Small amounts of money were available at all times that staff could access when taking people out or for purchasing items needed. This expenditure was also receipted and recorded. The manager was satisfied that all the people living in the home had access to money when required. The staff recruitment procedures were robust and safeguarded the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 35 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 lived in a homely and well-maintained environment. Their individuality was promoted in terms of personalised rooms which were equipped to meet their needs. Evidence: The home is very much a large domestic dwelling and as such provides the people there with a very homely atmosphere. Communal space consists of a lounge, dining area and kitchen. All were well furnished and decorated. The carpet in the dining area was stained however the manager was well aware of this and told us the flooring was to be replaced in May when the people living in the home will be on hoilday. In the meantime they were doing their best to keep it clean. The lounge was particularly pleasant, very light, with sensory equipment, for example, a projector that projected images onto the wall giving a very calming atmosphere. Since the last inspection the kitchen had been refitted and was very modern, clean and tidy. The people living in the home had access to the kitchen at all times. The home has a well maintained garden with furniture and a swinging seat available Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: for the use of the people living in the home. Adaptations have been made around the home particularly in relation to visual impairment, for example, sensory indicators to warn of potential hazards and colour contrasting throughout. The home is assessed on an annual basis by the RNIB to ensure it is still an appropriate place for people with visual impairments. There are five bedrooms in the home which varied in size. One bedroom was on the ground floor the others were on the first floor. Two of the bedrooms have en-suite showers. All the bedrooms were very different and had been decorated and furnished to suit the occupants. One of the people who was able to state what she wanted had her room decorated in her favourite colour. An artist had been commissioned to paint some bright canvasses with specially chosen designs for some of the bedrooms. The home has one bathroom and toilet located on the first floor and an additional toilet on the ground floor. These appeared to meet the needs of the people living in the home. Also on the ground floor of the home is an office, laundry and staff toilet. The laundry was small but adequate for the size of the home. It was noted that the sink in the laundry was very worn and was not able to be cleaned effectively. This needed to be replaced at the earliest opportunity. There is a second floor to the home. This was not toured but we were told this was where staff slept in and also had some additional office space. Care Homes for Adults (18-65 years) Page 26 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good staffing levels were being maintained by a well trained staff team that could meet the needs of the people living in the home. The recruitment procedures were robust and ensured the people living in the home were safeguarded. Evidence: The rotas for the home showed there were always two staff on throughout the waking day and more staff are brought in if activities call for this. For example, on the day of the inspection one of the people living in the home had an evening activity planned and a third staff member was on the rota to facilitate this. The managers hours were supernumery to the care rota. The home also had a deputy manager therefore during the week there were often four staff in the home. There were no waking night staff on duty in the home however one staff member stayed up quite late and ensured all the people living in the home were settled and then slept in in the home. The manager told us that the people living in the home were very settled during the night and did not need any assistance but should this change the rota would be changed. Some of the staff had worked at the home for a considerable amount of time which Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: was good for the continuity of care of the people living in the home. We were told that agency staff were never used as it was not appropriate for people who did not know the people living in the home to work with them. The home had numerous bank staff employed by them that regularly worked at the home. Observations throughout the day showed that staff had very good relationships with the people living in the home and knew how to communicate with them. There were training matrixes available for all the staff working at the home including managers and bank staff. These showed that all staff undertook a vast amount of training. The manager told us that it was just as important for the bank staff to have good training to ensure they could care for the people living in the home appropriately. The file for a fairly new member of bank staff was sampled and this showed she had undertaken full induction training in line with the specifications laid down by Skills for Care. The matrixes indicated staff had undertaken training in numerous topics including, fire procedures, food hygiene, medicine management, health and safety, infection control, visual impairment, managing challenging behaviour, epilepsy and autism. All the permanent staff at the home had NVQ level 2 or above and some of the bank staff also had this qualification. Comments received from the staff about their training were very positive and included, I have completed in house training and gone to outside companies to complete any training that is required relevant to my position. I had induction on how the home is run and each individual resident and their needs. Training was given in the home through videos. I was sent on courses for first aid, food hygiene, infection control, equality and diversity, recording and communication, NVQ 2 in social care. The training has been excellent. I have been offered a large range of training which has really helped me in my job. The recruitment documentation was sampled for one person who been employed at the home since the last inspection. All the required documentation was on site and this showed that generally all the appropriate checks had been undertaken prior to the person commencing their employment. We were told by the manager that he disposed of the POVA first checks when the CRB checks arrived due to data protection. It was Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: recommended that some record of the POVA first check was kept until seen by us so we can be assured they are obtained where necessary. The staff file sampled showed that staff receive supervision with managers at more than the required level of six times per year. Again staff surveys were very positive about the support they receive from the managers in the home comments included, My manager arranges supervisions with each member of staff which takes place every 6 weeks to see how well we are coping, any concerns and any questions we may have. We discuss everything to do with my work and I get feed back also. It helps me to know that I am doing my job properly. We are given feed back on how we are doing and how we can improve if we are weak at something. Care Homes for Adults (18-65 years) Page 29 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was very well managed and in the best interests of the people living there. Evidence: The manager and deputy manager of the home are also the owners. They set up the home almost 10 years ago. Both were present throughout the inspection and were very receptive to any comments made by us. Both were appropriately qualified for their roles and ensured they updated their training as needed. There were very good relationships between the staff and the managers and staff commented they found them very supportive and approachable. The managers had worked with people with a learning disability and visual impairments for a number of years. They showed a very good knowledge of the needs of the people they were caring for and their interactions with them were very good. The home is annually quality assured by Visibly Better, an external body that runs an Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: accreditation scheme operated by the RNIB. They undertake a comprehensive annual assessment against a wide range of standards for visibly impaired people. The home also undertakes a yearly internal quality survey to obtain views from staff, relatives, advocates, and other visiting professionals. The survey covers the quality of environment, staff, care and management. This is used to obtain feedback which is then analysed and the outcome is used to produce an action plan for the coming year. This ensures the home is continually improving the service for the people living in the home. The health and safety of the people living in the home and the staff were very managed. Staff received training in safe working practices, all the required risk assessments and management plans were in place and the home was safe well maintained. The AQAA indicated that the servicing of the equipment in the home was up to date. The 5 yearly electrical wiring check had been carried in the home since the last inspection. The in house records for the fire system were sampled. These were all up to date and also showed that fire drills were undertaken regularly and that the people living in the home were included in these. The home continue to notify us of any incidents or accidents in the home as required so that we can be assured they are being managed appropriately. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 20 13 Where there are any 02/03/2009 discrepancies in the amounts of medication remaining in the home when cross referenced to those received and what has been administered this must be fully investigated. This will ensure the people living in the home are receiving their medication as prescribed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 It is recommended that all PCPs include details of the daily routines of the people living in the home in caption form to ensure consistency and that they are easy for staff to follow. It is recommended that a running balance is kept of the homely remedies medication that is kept in the home. This will ensure the medication can be easily audited. It is recommended that the training staff have undertaken in adult protection issues is included on the training matrix Page 33 of 35 2 20 3 23 Care Homes for Adults (18-65 years) so that it is easy to identify when this needs updating. 4 30 The sink in the laundry should be replaced as it is worn and difficult to keep clean. This will ensure good infection control in the home. It is recommended that some record of the POVA first check is kept until seen by us so we can be assured they are obtained where necessary. 5 34 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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