Inspection on 16/04/09 for Sycamore House

This inspection was carried out on 16th April 2009.

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

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

Other inspections for this house

Sycamore House 23/04/08

Sycamore House 21/11/07

Sycamore House 17/04/07

Sycamore House 26/10/06

Sycamore House 15/06/06

Sycamore House 20/12/05

Sycamore House 21/07/05

Sycamore House 23/11/04

Sycamore House 29/04/04

Sycamore House 27/01/04

Sycamore House 16/12/03

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Sycamore House 2a/2b Havelock Road Tyseley Birmingham West Midlands B11 3RG     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: Kulwant Ghuman     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Sycamore House 2a/2b Havelock Road Tyseley Birmingham West Midlands B11 3RG 01217074622 01217078172 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Marblefield Limited care home 28 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 28 No other service users suffering with dementia will be admitted to the home. Of the 18 service users over 65 years there are 5 named individuals who suffer from dementia and continue to be accommodated at Sycamore House until such time that the home is no longer suitable. That the home is registered to provide care for up to 18 service users who are over 65 years of age and up to 12 service users who are over 53 years of age and who had a mental health disorder. The home may accommodate one named service user aged 48 years at time of admission who is suffering from enduring mental health issues. Date of last inspection Brief description of the care home Sycamore House offers residential care for up to 28 people who suffer with a mental health illness. It caters for a mixed client group, including service users over 65 years of age in need of care due to old age and mental health. The home is not registered to people who suffer with dementia. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home The home does not offer nursing care. Since the last inspection the proprietor has employed a separate manager who is responsible for the day to day running of the home. The home is situated in a residential street, close to public transport links to the city centre. There are some small local shops within walking distance. The property is an extended and converted building that offers communal lounges and dining space on the ground floor and bedrooms spread over the ground and first floors. There are eleven bedrooms with en-suite shower facilities. The remaining rooms continue to have shared bathing and toilet facilities. The kitchen and laundry facilities are on the ground floor and are not generally accessed by the people living in the home. There is a shaft lift connecting ground and first floors on one side of the building only. There is a garden area to the side of the property and parking is on the street. There was no information about fees in the service user guide and individuals will need to ask the home for this information. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection to this home was carried out on 23rd April 2008. This inspection was carried out over one day and the home did not know that 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 Care Homes for Adults (18-65 years) Page 6 of 32 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, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were 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. We sent 5 Have your Say surveys to people who use the service, 6 to staff and 4 to relatives. Surveys were returned to us by 4 of the people living in the home, five staff and one relative. What the care home does well: What has improved since the last inspection? What they could do better: There were still improvements to be made to the level of information included in the care plans and risk assessments. The risk assessments needed to be cross-referenced to the care plans to ensure that the staff were aware that they needed to refer to these in order to provide safe and appropriate care. Care Homes for Adults (18-65 years) Page 8 of 32 The admission process needed to be improved so that the manager had access to all the information about individuals needs, visits to the home were arranged and pre admission assessments were carried out before the decision to admit people into the home were made by the manager. The people living in the home needed to have access to activities that met their individual needs throughout the year, both in the home and outside. It is recommended that a specific budget is set aside for this. The manager needed to ensure that staff understood what safeguarding meant and what actions they would need to take to keep people safe. The manager needed to ensure that the fire alarm tests were carried out and recorded as evidence that they had been undertaken on a weekly basis. 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 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given information about the home but the home could not evidence that they had been given the opportunity to visit the home before they decided whether the home would be suitable for them. It could not be evidenced that the needs of the people moving into the home were fully known before they moved in. This could leave them at risk of not having their needs met adequately. Evidence: The AQAA told us that the service user guide had been updated. The three files sampled did not evidence that a service user guide had been given to the people so that they knew what they could expect from the home. Two Have your say surveys returned to us indicated that the individuals had received information about the home, one of them said the doctors and nurses told me all about Sycamore House. The admission process for three people who had moved into the home since the last Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: inspection was looked at. The evidence that we saw did not indicate that the process was well managed giving people the opportunity to have a look at the home before they moved in and the home to determine if their needs could be met at the home. The admission details on the files showed that the Resident Long Term Need Assessment and Care Plan was completed on the day of admission or the day after. Care plans from social workers and the Care Programme Approach care plans were not received before the individuals were admitted. This shows that the manager had not been able to carry out an assessment of the individuals needs before deciding that they should move into the home. This could leave both the staff and the person moving into the home at risk. The terms and conditions of living at the home had not been completed for two of the people whose care was looked at. This meant that they did not know how much was being paid for the placement and who was responsible for paying it. For the third person this had been completed and it showed the amount to be paid and who was responsible for paying it. The completed terms and conditions stated that there were facilities for making drinks and refreshments. There were no facilities in the home that would enable the people living there to be able to make drinks and refreshments. This should either be removed from the terms and conditions or these facilities made available in the home. The needs assessment was quite basic and did not include much information about how staff would meet them. For example, one stated, can be anxious due to mental disorder but not how this anxiety would present or how the staff were to deal with it. Another stated, is physically well, has suffered cellulities in the past and also suffering from mental disorder and becomes anxious due to the mental disorder. For staff who have not had mental health awareness training terms such as manic depression or paranoid psychotic illness may have no meaning and leaves them with no understanding for why certain behaviours may be shown by individuals and what they might mean and how they should respond to them. Following the inspection we have been informed that mental health awareness training for all staff had been arranged and more advanced training was being arranged for the senior care staff to undertake. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans needed more detail to ensure that the staff knew how to support the people living in the home. The people living in the home had not been involved in drawing up the care plans and risk assessments. Evidence: We were told that the Resident Long Term Need Assessment and Care Plan document was the care plan. There was no evidence that this document had been drawn up with reference to the Care Programme Approach(CPA). We were told that the manager had not seen the CPAs for anyone except one person who had not yet moved into the home. It was very important that the manager accessed this document so that she could determine whether the needs of the individual could be met at the home. The CPA includes information about the mental health status of individuals and indicates the relapse indicators and risks so that the home can plan for how these can be incorporated into Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: the care plan. The people whose care was tracked during this inspection were fairly independent in meeting their own personal care and required only prompting to ensure it was undertaken. There was not enough information regarding issues such as health. For example for one person the care plan said the individual had cataracts on both eyes and this had been referred to the GP. There was no information on how this affected the individual and what staff needed to do to assist the individual. Another stated assertive and overactive sometimes because of mental state. Is disorganised at times. There was no further information about what this meant or what staff needed to do. There were some risks identified for the individuals and these stated how they were to be managed, for example, falls. However others were vague. For example, aggression, due to her mental state she becomes aggressive when she is manic. Instructions for staff included make sure she is safe while she is aggressive and keep things away those can harm to herself and others. This does not say what the individual was likely to do, or how she and the other people in the home would be kept safe. As stated earlier, there was little information available for staff regarding the mental health of the people living in the home, what would indicate that the individuals were in relapse or what the staff should do in this situation. Nutritional assessments were in place but they did not cross reference to the care plans and reading the assessment they did not identify that food and fluid charts were to be maintained. One person did have fluid and food charts in place but there was no evidence that anyone was reviewing these records to monitor whether the intakes were sufficient. There was no evidence to indicate that the individuals had been involved in drawing up the care plans and risk assessments. The manager needed to ensure that individuals were involved in these so that they could direct their care wherever possible and so that they knew what was likely to happen in the event of a mental health relapse. Despite the shortfalls in the records reviews by social workers indicated that people had settled well in the home and they were happy with the care provided and relatives were happy with the support too. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Some people were able to manage their own finances but some were not. In these instances the owner held the monies that were sent to the home from solicitors, families or from the Local Authority. There were adequate records available for these monies with receipts for any expenditures made on their behalf. The manager told us that the owner dealt with all financial matters and that she would request money from him if this was needed. It was recommended that a small amount of money was left accessible to staff so that they could provide impromptu treats such as ice cream on a sunny day. Meetings were held where the views of the people living in the home were taken. Minutes of these meetings showed that peoples views about activities and meals were taken. The home needed to develop ways in which the people living in the home could be further involved in the day to day running of the home. They could be further involved in deciding menus, setting tables, cleaning their rooms and being involved in some ways in the recruitment of new staff. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who spent the majority of their time in the home were not provided with activities that met their needs on a consistent basis. The people living in the home could be more involved in the day to day running of the home. The people living in the home received a diet that met their needs. Evidence: The people living in the home fell into two distinct groups. Some were independent enough to be able to go out regularly on their own, make their needs known and make decisions regularly for themselves about what they did and when. Others were physically frail and tended to spend most of their time in the home. These individuals were dependent on the staff in the home to ensure that there were meaningful activities for them to undertake. Activities sheets in the home showed that there had been several trips out during the summer of 2008. The manager had arranged Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: activities such as therapy afternoons and make overs, and, activities nights playing bingo and karaoke. Since the summer there had not been many activities apart from the Christmas celebrations. There needed to be a balance of activities in the home and outside to ensure that individual needs were met. The proprieter should ensure that there is a specific budget for organising activities for the people living in the home. There were few opportunities for the people living in the home to develop there independent living skills but some people were able to undertake their own personal care. There were regular visits from a local church and one of the people living in the home was being assisted to go out to a church. The people living in the home were able to go their bedrooms when they wanted. The owner of the home had provided televisions in most of the bedrooms so that they could watch the television in the lounge or their bedrooms. People could sit in the two lounges or dining room. People could have keys to their bedrooms so that they could lock their doors when they were not in them and maintain privacy. The staff were respectful in their interactions with the people living in the home. People were able to have visitors to the home, some went out with their friends and relatives. Meals were not observed during this inspection but the menus provided showed that there was a variety of meals provided. The menus did not show a specific choice of meals however, staff confirmed that the people living in the home were told what the meals were during the morning and if they did not want it something else was prepared for them. Staff spoken to during the day were aware of people who did not eat very well and how they were to be supported. Weights were monitored to ensure that people were not losing weight. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 looked well cared for and were assisted to have their personal and health care needs met. The management of medicines in the home was good ensuring that the people living in the home received their medicines as prescribed. Evidence: The people whose care was tracked during this inspection were all fairly independent in managing their personal care. The records showed that people were supported where they needed assistance. The care plans for these individuals were not clear about what assistance was needed however, as they were able to direct their care it meant that they would be able to say what they wanted. There were people in the home who would not be able to make it clear due to their confusion and in these cases the care plans needed to be clear about how the staff should assist the individuals. Staff told us that where male staff were assisting women living in the home they would always call a female member of staff to assist with personal care. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: The people seen during the day all looked well cared for and each had their own style of dress. It was evident that the people living in the home were having their health needs met. There was regular contact with chiropodists, district nurses, psychiatric nurses and doctors as needed. The management of medicines in the home was good. There were no gaps in the medicine administration records(MARs). Medicines were appropriately booked in. The people handling the medicines had received appropriate training. The only issue that needed addressing was the need for individual protocols to be put in place where people were to be given medicines as and when required. This would ensure that the staff were made aware of the situations when the medication could be given, how much should be given and the time that needed to be left between doses. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 felt that they knew how to raise concerns and that they were confident they would be listened to. The manager needed to ensure that any issues raised are looked into as soon as possible after they have been raised. Evidence: No complaints had been raised about the service with us since the last inspection. There had been none recorded at the home either. Some daily records indicated that someone living in the home had stated that some money had gone missing from their bedroom. There was nothing to indicate that this issue had been followed up. Surveys returned to us indicated that the people living in the home knew who to contact if they needed to talk about something. One person said there was a complaints procedure in the hallway and they would talk to Az or Marie. The other surveys indicated that people felt that the staff listened to them and acted on things appropriately. One safeguarding issue had arisen at the home however the local authority decided that there was no case to answer and no action was taken. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Not all the staff in the home had a good understanding of safeguarding. The manager needed to ensure that people working in the home understood what safeguarding meant and what their responsibilities were. The records kept in the home ensured that the people living in the home were safeguarded from financial abuse. The manager has been proactive in ensuring that we have been informed of any issues arising in the home. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home now provide very good accommodation that is homely and comfortable. The remaining areas of the home need to be brought up to a similar standard. The home meets the needs of the people living there. Evidence: The refurbishment of the old part of the building was complete. This part of the building was suited to people with full mobility, unless they occupied a ground floor bedroom, as there was no lift to help them access the first floor. All the bedrooms in this part of the building had en suite facilities consisting of toilet, wash hand basin and walk in shower. This helped to promote the privacy and dignity of the people living here. The bedrooms in the other part of the building did not have en suite facilities and the only changes made to those bedrooms was that some of them had had a television fitted in them since the last inspection. The communal areas of the home had had new furniture and furnishings including chairs, curtains, television and had been painted in a light colour so that it was more Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: airy and homely. The bathing facilities in the new part of the building had had some new fixtures including fitted grab rails. The floor tiles could not be properly cleaned and the the temperature of the hot water in the shower and bath was over 43 degrees and presented a risk of possible scalding to the people living in the home. Since the inspection we have been informed that a new shower had been fitted and the hot water regulator fitted to the bath had been replaced. The shower on the first floor had tiles that were coming away from the wall and which could potentially cause an injury to someone if they fall off. The bathing facilities, in general, were not very homely and did not add much comfort to the bathing experience. There were adaptations such as grab rails and passenger lift to assist people with additional mobility needs. An emergency call system was in place so that people could summon assistance if needed. The toilet outside the small lounge was out of order meaning that people living in the home only had one communal toilet accessible near to the communal areas. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels meet the needs of the people living in the home. The recruitment process needed to be robust to ensure that the people living in the home were not put at risk. The manager needed to ensure that the skills mix of staff could meet the needs of the people living in the home. Evidence: The staffing rota showed that there were three care staff on duty throughout the day in addition to the manager, cook and domestic assistant. At weekends there were three care staff but no manager and no cook. One of the care staff undertook the cooking. The files of three new staff were looked at. The three staff were attending training as part of a two year sandwich course. Sycamore House was providing the training placement for the individuals. The files showed that the individuals had completed application forms following their arrival in the country. References and police clearance were provided from their country of origin as much as three months before they started their employment. Two of the people had started their employment at Sycamore House before the POVA Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: clearance had been obtained. It is acknowledged that it was unlikely that much would show up on the POVA first due to the short time they had been in the country but people should not be employed until the POVA first has been received. One of the files showed that the individuals were undertaking induction training that was in line with the Skills for Care competencies. One of the individuals told us that they were shadowing other staff as part of their induction. All staff needed to undertake training in mental health awareness to ensure that they understand the needs of the people living in the home. Following the inspection we have been informed that mental health awareness training for staff has been arranged and further indepth training is being arranged for the senior care staff. This will ensure that the staff understand the needs of the people living in the home. The manager needed to ensure that the language skills of the staff enabled them to communicate adequatley with the people living in the home to be able to understand what they wanted. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home had improved and the atmosphere was one of openness and respect that enabled the people living there to be able to express their views. Evidence: Since the last key inspection the manager had been registered with the Commission. The atmosphere in the home was much more pleasant with the people living in the home being able to access the manager as they wanted. There were better interactions between the staff and the people living in the home. Some people who never used to come downstairs were seen sitting in the lounge. Some of the people living in the home preferred to sit in the dining room and they seemed comfortable sitting there. The home were currently using the Annual Quality Assurance Assessment sent to the home by us to complete as their quality assurance system. This issue was discussed Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: with the manager who was also carrying out some surveys. The results of these surveys and any audits carried out by the manager needed to be formulated into a development plan for the home that showed how the home was doing and how it was going to continue to improve. Health and safety was generally well managed in the home. The fire records were checked and it found that the weekly fire alarm tests had not been recorded since 6.3.09. The hot water from the shower and bath on the ground floor were checked and found to be too hot. The water temperature needed to be restricted to 43 degrees to ensure that people living in the home were not at risk of scalding. The manager needed to ensure that care plans and risk assessments were improved to include the mental health needs of the people living in the home and ensure that she has access to the CPA for details of relapse indicators. The proprietor needed to ensure that the manager had access to these documents and had a say in the people who were admitted to the home. This would ensure that any new people admitted into the home were able to visit before admission to ensure that they would fit in with the other people living in the home. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The decision as to whether the home can meet an individuals needs must be arrived at only after all the relevant information has been gathered. This will ensure that the people moving into the home are assured that their needs can be met. 01/06/2009 2 34 19 The registered person must ensure that the recruitment process is robust. This will ensure that the people living in the home are safe from harm. 01/06/2009 3 42 23 The manager must be able 24/05/2009 to evidence that weekly testing of the fire alarms are undertaken. This will ensure that the equipment is maintained in good order. Care Homes for Adults (18-65 years) Page 29 of 32 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 Evidence that the service user guide has been given to the people living in the home should be kept. This will ensure that everyone moving into the home is provided with all the relevant information. Pre admission visits to the home should be encouraged and records kept of any assessments carried out. This will show that people have been able to visit the home to ensure it suits their needs. Terms and conditions should be completed for everyone when they move into the home. This will ensure that people moving into the home know what service will be provided and how much is being paid for them. Care plans need to inform staff what the individuals needs were, what the objectives for them are and how they should be assisted. It is recommended that a small amount of money is made available to staff so that individuals could be supported to make impromptu decisions when the provider was not available in the home. Management plans need to be in place for all identified risks to ensure people are kept safe. Activities should be organised to meet the individual needs of all the people living in the home. A specific budget should be made available to organise activities. This would enable the people living in the home to make realistic arrangements for activities. Protocols should be in place for medicines to be given as and when required. This will ensure that the staff are consistent in when they gave the medication. Any issues raised by the people living in the home should be investigated and records kept. This will assure the people living in the home that they are listened to and appropriate actions are taken. All staff should have training in safeguarding so that they can protect the people living in the home. The manager must ensure that the skills mix of the staff enable the people living in the home to be understood so that their needs can be met. 2 4 3 5 4 6 5 7 6 7 8 9 14 14 9 20 10 22 11 12 23 33 Care Homes for Adults (18-65 years) Page 30 of 32 13 39 A report should be developed that shows how the home is going to be developed based on the views of the people who have an interest in the home. Care Homes for Adults (18-65 years) Page 31 of 32 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 32 of 32 - 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!