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Inspection on 10/06/09 for Welbeck House

Also see our care home review for Welbeck House for more information

This inspection was carried out on 10th June 2009.

CQC found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Welbeck House is of a size that helps it to be homely and part of the local neighborhood.People who live at Welbeck House like living there and in most cases can decide what they want to do and when they want to do it.People who use the service are supported by staff that have a good understanding of their needs and want to improve the quality of the service.Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in people`s health care needs well and seek help from others wherenecessary (such as community nurses, doctors and such like).

What has improved since the last inspection?

Individual`s support plans are now more detailed and describe how needs in respect of their health and welfare will be met. This helps staff to provide support in such a way as to ensure people are happy with the care they receive.Checks that identify hazards to the individual have improved, meaning staff and people living at the home are more aware of risks.Checks of what makes the individual unhappy are also better meaning staff are more aware of what might upset people. Staff better understand what they should do if they think people are not safe from abuse.Recruitment practices that protect people from unsuitable staff are now better.Staff are now better trained in areas such as how to give medication and how to administer first aid.

What the care home could do better:

The way medication is stored at the home could be safer.There are some things that may cause individuals to harm themselves such as unsteady toilet frames, a loose outdoor step, and a shower that leaves water on the bathroom floor.People who live at the home say they can`t afford to do the activities they want to due to having to pay for transport. There are also things which stop them enjoying the activities they want to do on a weekend. People say that the reception on televisions could be better.The information about the home, this in a book that tells people how the service works (called a service users guide) is not up to date.

Key inspection report Care homes for adults (18-65 years) Name: Address: Welbeck House 42 Welbeck Avenue Bushbury Wolverhampton West Midlands WV10 9LS The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jonathan Potts Date: 1 0 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. They reflect the things that people have said are important to them: 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 Care Homes for Adults (18-65 years) Page 2 of 35 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 35 Information about the care home Name of care home: Address: Welbeck House 42 Welbeck Avenue Bushbury Wolverhampton West Midlands WV10 9LS 01902681909 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) : Arcare (West Midlands) Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection A bit about the care home Welbeck House is registered with the Care Quality Commission to provide accommodation and personal care for a maximum of three adults with a learning disability. Arcare (West Midlands) Limited is the registered provider and the responsible individual is Dr Raj Sharma. The post of registered manager is currently vacant. There is an acting manager in place at present, who is to apply for registration Care Homes for Adults (18-65 years) Page 4 of 35 subject to completion of her probation period. The property is a traditional semidetached house and is situated in an urban area of Bushbury, providing access to local amenities and public transport. The building is in keeping with the local community. Accommodation is provided over two floors comprising: Two single bedrooms with a bathroom on the first floor and one single bedroom with en-suite facility on the ground floor. Communal areas include a lounge, dining room and kitchen. Disabled access from the front of the property is enabled through the availability of a ramp and handrails. There is a small enclosed garden to the rear of the house. The homes stated philosophy is to Maintain a high standard of care, respecting individuality, privacy, residents dignity and independence at all times. First and foremost a happy and secure environment within the home. The home has books available that tell people what the service is and how it is provided. These do not include the current range of fees for the service though, for which contact would need to be made with the home. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 35 How we did our inspection: This is what the inspector did when they were at the care home Our surprise visit to Welbeck House was carried out over one day, and followed review of all the information we have received about the service over the 12 months since the last main inspection. This included information sent to us every year by the care provider and information from different organizations. We have assessed the homes performance against key standards and looked at outcomes for people living at the home. This was carried out by us talking to 2 people using the service, and asking staff about these peoples needs. We also looked at care plans, medical records and daily notes for these 2 people. This is called case tracking. We also toured the building, looked at a number of management records and talked to management and staff. We received three completed questionnaires from people living at the home. What the care home does well Care Homes for Adults (18-65 years) Page 7 of 35 Welbeck House is of a size that helps it to be homely and part of the local neighborhood. People who live at Welbeck House like living there and in most cases can decide what they want to do and when they want to do it. People who use the service are supported by staff that have a good understanding of their needs and want to improve the quality of the service. Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in peoples health care needs well and seek help from others where Care Homes for Adults (18-65 years) Page 8 of 35 necessary (such as community nurses, doctors and such like). What has got better from the last inspection Individuals support plans are now more detailed and describe how needs in respect of their health and welfare will be met. This helps staff to provide support in such a way as to ensure people are happy with the care they receive. Checks that identify hazards to the individual have improved, meaning staff and people living at the home are more aware of risks. Checks of what makes the individual unhappy are also better meaning staff are more aware of what might upset people. Staff better understand what they should do if they think people are not safe from abuse. Care Homes for Adults (18-65 years) Page 9 of 35 Recruitment practices that protect people from unsuitable staff are now better. Staff are now better trained in areas such as how to give medication and how to administer first aid. What the care home could do better The way medication is stored at the home could be safer. Care Homes for Adults (18-65 years) Page 10 of 35 There are some things that may cause individuals to harm themselves such as unsteady toilet frames, a loose outdoor step, and a shower that leaves water on the bathroom floor. People who live at the home say they cant afford to do the activities they want to due to having to pay for transport. There are also things which stop them enjoying the activities they want to do on a weekend. People say that the reception on televisions could be better. The information about the home, this in a book that tells people how the service works (called a service users guide) is not up to date. Care Homes for Adults (18-65 years) Page 11 of 35 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jonathan Potts 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 12 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 13 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. Individuals that maybe looking to move into the home have their needs thoroughly checked and are able to test drive the service. Evidence: We saw that the home has books that tell people who the service is for and how the service works (called the statement of purpose/service users guide)that the acting manager has told us in the information that she sent to us are in need of update. From sight of this document we noted that the fees detailed within it do not match the range that the provider currently charges people, meaning that this needs updating so that it is correct. The review of these books needs to involve the individuals currently living at the home so they can say what they wish about how it is presented and whether they can understand the contents easily. We saw that individuals are given copies of contracts with the home, although these again would benefit from update. We noted in the contract that we looked at that there is still reference to the NCSC (a former regulatory body no longer in operation) and the additional charges do not refer to transport as a charge not included in the fee. Comments about the presentation of this document would apply in the same way as they Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: would to the homes book about how the service works (service users guide). The acting manager told us in the information that she sent us that people only move into the home after comprehensive checks during which the individual has chance to test drive the service. As someone has moved has moved in recently we were able to see that this did not take place until these checks had taken place. We saw that the home has undertaken thorough checks drawing on information from other involved agencies. We noted that the introduction to the home was gradual, and the individuals visits took place over a period of time commencing with such as stopping for a meal, progressing to an overnight stay. We saw that the individual was involved in meetings with agencies involved in their care, including staff from Welbeck House, this to check that they wanted to move into the home, and that Welbeck House could meet their needs. We saw that there was a multi agency review about a month after the individual moved into the home, this to check the success of the placement based on the individuals, representatives and staff views. We did note that whilst the admission process did consider the ability of the home to meet the individuals needs in some depth, this was not confirmed in writing (pre admission) by the home to the individual (or representative) as should be the case. From questionnaires we received from individuals living at the home all of them told us they wanted to move into the home (two having lived there for some years), although there was a mixed view over whether they had enough information to be able to decide about moving in. Care Homes for Adults (18-65 years) Page 15 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. Individuals are involved in most decisions about their lives and play an active role in contributing to the planning of their care and support. Evidence: We saw that management have changed the format of the homes care plans so that they detail the full range of an individuals needs and present as an informative tool for staff, this so that they know what they need to do to meet peoples needs. It was clear from the checks(assessments)that we saw that individuals and significant others have been involved within these, and through this process have contributed to the care plans that we saw. The plans we looked at contained detail as to the individuals communication needs. Based on previous comments we have made, we have seen a noted improvement in the clarity and range of the individual plans at the home, these covering a far wider range of needs and drawing from suitable checks. Whilst we noted only the acting manager had signed the plans, our discussion with staff showed that they have a good working understanding of them, and as a result know how they should provide care for the Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: individual. We also noted that the staff we spoke to had a good understanding of why strategies had been adopted in relation to care of specific individuals. We looked at the risk assessments relating to individual plans and these again we saw have improved, with areas of risk identified through checks which supported the individual plan of care. We saw that developments in the individuals day to day life have been used to inform planning, an example of this such as how observation of behaviours has led to improved risk assessment and behaviour plans, these identifying triggers and the factors staff need to be aware of when working with the people. We discussed care planning with the acting manager and she was clear as to where she felt these could be developed further, as we saw was been developed with person centered plans, these reflecting how the individual wants their care delivered. We discussed the use of pictorial plans, and the acting manager stated that she had discussed such with one individual who had said they did not want this as they felt it was not appropriate for them as adults. For others the acting manager stated that she was looking at on going communication with people about their care as the way forward, this as we saw was the case through regular meetings, reviews and checks. The three individuals that completed our questionnaires stated that they made decisions about what they did in the day, evening and two stated this was also the case at the weekend, one saying this was not the case. Individuals ability to make decisions they could follow through was seen to be influenced by factors outside of the immediate home environment as detailed in the lifestyle section of this report. Care Homes for Adults (18-65 years) Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involved in decisions about their lifestyle and can develop life skills, although a number of factors can limit an individuals access to the community and chosen activities. Evidence: The individuals living at the home are all involved in supported activities through day training centres where they take part in various occupational activities. The individual that has recently moved into the home has continued with the day placement they attended prior to admission. The acting manager told us of ways in which communication between the home and training centres is maintained, this supported by records that we saw. We have been made aware that due to changes in transport arrangements the individuals have responsibility for funding their traveling arrangements to the training centres, this following the cessation of free transport. This has impacted on the money that individuals have to fund activities outside of training centre attendance, especially as the payment Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: for provision of external activities is not seen as an expense the provider includes within the fees for living at the home. We saw that the impact of this is greater for one individual due to the fact that they need transport that is able to take a wheelchair, and that when within the community they need a staff member to help them on a one to one basis, which is not possible when there is only one member of staff on duty at the home. In real terms this impacts on the people living at the home on Saturdays, this as they are at training centres in the week, and we were told that Sunday is seen as a time for chilling out and relaxing at home. The staff have discussed what community activities individuals would like to pursue, although as previously stated where there is a preference to attend such as football matches an individuals limited funds do impact upon their choices, beyond which transport and available staff (as an escort) are an issue. Discussion with the acting manager and staff showed a wish to address these issues so as to improve outcomes for individuals. In discussion with the area manager he said that he would look at the feasibility of wheelchair friendly transport that could be used for taking people out on a daily basis, although as discussed the funding for such would need to be resolved. We did advise the acting manager to pursue discussion around funding and mobility benefits with the individuals allocated social workers. We are aware that the home does encourage independent travel as one individual is able and supported by staff to use local public transport. We noted that the home is documenting the activities individuals are involved with, although these are currently recorded in a communal record. Individualized activity records and plans would be better. We saw that an overall activity plan (with pictorial images) was on display in the dining room. We saw that the home supports individuals in maintaining contact with family and friends although the homes policies in respect of this area of practice are limited and would benefit from expansion (such as the visitors policy). This would be important in ensuring that information about the organizations expectations as to promoting good practice in encouraging/maintaining family links and friendships is clear to staff and people living at the home. We saw that people living at the home are able to move around freely, and are able to participate in household tasks if they wish (we saw people making themselves drinks).People told us that they can make decisions about what they do in the home and we saw that the acting manager consults people on a regular basis through meetings, this to discuss such as meals, activities, and any matters that may impact of people (such as the movement of furniture). We also saw that keys to bedroom doors are available to individuals. We saw that the staff have explored peoples dietary preferences in checks and these we saw are also discussed in regular meetings with people. The home was seen to have a Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: planned menu, although this maybe open to change dependent on individual choices. The acting manager told us how this had been planned with use of menus provided from training centres, this to help with the reduction of repetition, balancing of healthy diets and such like. One individual commented in a questionnaire they returned to us that the food choice was good, this reflecting comments from people when we spoke to them. The acting manager made us aware that there are some limitations in involving people with the shopping, this as it is the usual practice of the provider to encourage this to be done on line. Discussion at the time of the inspection did indicate that flexibility in respect of food shopping could be improved, this to allow people to shop for specific items that they liked. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals health care needs are checked and there is follow up on any areas which compromised a persons well being. Some aspects of medication management presents a degree of risk. Evidence: Two of the individuals living at the home told us through questionnaires that staff treat them well, this supported by us meeting and talking to people living at the home who told us that they are happy with the care that is provided. Interaction that we observed between the individuals and staff was seen to be appropriate and positive, with such as staff seen to sit with people (rather than stand) and face them when talking to them. We saw that it was clear in care plans what personal support staff are to provide, and how this was to be provided, with the staff we spoke to clear as to what they should do. We saw that there has been involvement from specialist support services where required (such as occupational therapy) and the outcomes have informed the way personal care is provided. We saw from records that individuals health care needs are clearly identified and support to access community health care services is enabled, this including community nurses, dentists, opticians and such like. We saw that the home has checked the individual health Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: care needs of people and we saw clear evidence of follow up seen. An example of this was that staff made sure any risk of skin break down is checked and suitable aids used to prevent this happening. What we saw supported what the acting manager said about the ways the staff support the promotion of good health, this on the day and within the information she sent us before our visit to the home. Recording and risk checks also showed that the home has identified areas where there may be concerns in respect of individual health, these a sign for staff as to what to be aware of. We looked at the homes medication procedures. These would benefit from expansion and review in line with professional (Royal Pharmaceutical Society) guidelines for social care settings. Key areas where we noted more detail would be beneficial is in respect of what to do if medications are given in error and management of controlled medications ( we saw that some are prescribed to people at the home). We saw that medications are currently stored in a filing cabinet which is unacceptable, especially as the home has controlled drugs. In addition the use of a controlled drugs book would be seen as good practice in regard to use of such controlled drugs. With these exceptions, medication records we saw are well kept and we saw that staff have, or are completing accredited medication training. The acting manager has carried out competency checks on all staff in respect of giving medication, but did highlight the fact that such a check has yet to be carried out on how she gives medication. This would have to be carried out by such as her manager. We saw that checks of individuals medication is carried out by appropriate health personnel. We noted that the homes contracted pharmacist has not completed an audit of the homes systems for the management of medication and the acting manager was advised to contact them to request such an audit. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to express concerns and have confidence that their concerns will be listened to and dealt with. Staff practices protect individuals from abuse. Evidence: We saw that the home has an appropriate complaints procedure available on display in the home, this supplemented by a pictorial procedure found in individuals case files. From 3 questionnaires we received from individuals, two told us that they are aware of the homes complaints procedure with all three saying they knew who to speak to if unhappy. One stated that staff listen to them and another said they do sometimes. The home nor ourselves have received any complaints about the service since the last main inspection. We are also aware that the individuals living at the home also have regular contact with social care and health staff outside the home (such as community nurse, adult training centre staff and such like) whom they could raise concerns with if not comfortable with the homes staff, although from what they told us they do feel able to approach the staff. We saw that the home has a safeguarding procedure in place as well as the local social services procedures, which we saw the homes procedure does not reference, even though staff would need to follow it. We did discuss the procedure for referral of suspected abuse and how the home promotes the safety of the individuals living at the home with the acting manager and staff, who showed a good understanding of what their responsibilities are. We discussed an incident (in respect of challenging behaviour) that had occurred at Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: the home and the acting manager and staff gave us a good verbal explanation as to what had happened and what they had done as a result, this to protect individuals living at the home. This reflected the records relating to the incident as well as behaviour plans. The acting manager showed us an incident form that was been brought into use, this to help with the monitoring of an challenging behaviours. We saw that the home has a restraint policy that says this would only happen as a last resort, although we did suggest to the acting manager that it would be appropriate to update this in accordance with mental capacity guidance, a copy of which the home has not currently in place for reference as should be the case. It was stated in the information the acting manager sent us that the staff at the home needed training in adult protection and challenging behaviour although we saw that this has been partly actioned since she told us this. The staff still need training in the implications of deprivation of liberty safeguards for their practice however, this also recognized by the acting manager. We saw that the home has appropriate procedures in place in respect of the handling of individuals monies, although these are overseen by peoples representatives. We saw that any moneys kept by the home on behalf of the individual are appropriately recorded and balanced with the monies kept. There are no inventories of individuals property in the home though, which we have advised the acting manager to compile and review on a regular basis (this to ensure that there is no doubt as to what the individual owns and what is the property of 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall physical design and layout of the home is suitable in meeting the needs of the individuals that live there but the overall presentation of the environment could be better. There is some potential for risk present from some aspects of the environment. Evidence: Welbeck House is in an established residential area, blending in with other properties around it. The size of the home also lends itself to the creation of a homely environment. The last visit by the Fire Prevention Officer was in December 2008, the only point identified the need to ensure there is a regular review of the homes fire risk assessment. We also discussed food safety with the manager and we are aware following contact from Environmental Health that the acting manager requested them to visit for advice relating to such as food risk assessments. Environmental Health have not told us of any concerns relating to food safety at the home. We saw that the home has a plan for redecoration and refurbishment in place although we noted that there are a number of areas where some attention is needed to improve the general decorative standard of the home, this in regard to such as the exterior paintwork (which is pealing) and the generally uncared for exterior which presents as untidy and suggests a lack of investment. The front of the house does however have ramped access that is suitable for a wheelchair. We also noted such as some stained Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: carpets and a kitchen that lacks a degree of storage space (due to the lack of wall cupboards). The lack of lower level worktops for people who may need to sit whilst preparing food could also be seen as a barrier to independence. We noted that there are some relatively easy to address issues that could possibly compromise safety, this including a loose step (by the back kitchen door), a wardrobe that was not secured, a loose toilet surround (ground floor en suite) and a shower that leaves water on the bathroom floor (this identified as an issue by the provider). We saw that servicing certificates relating to the safety of the house are all up to date (these relating to such as the buildings electrics) this with the exception of a check of the gas boiler in the home. This was raised with the area manger who has provided evidence of servicing shortly after our visit, this confirming the installation is safe. We did see that bedrooms are personalized and discussion with one individual indicated that he was to have his room redecorated. One individual we spoke to made reference to the very poor reception for their TV in their bedroom, this seemingly an issue as it was fitted with an indoor aerial and is a digital TV. The area manager stated that they would look into the possibility of having a digital aerial fitted. The home was seen to have a PC that was been connected to the broadband on the day of our visit, this for the benefit of people living there as well as staff (for work purposes). We noted that the radiators around the home are not currently covered and due to the age of the individuals living at the home the acting manager was advised to risk assess the hot surfaces these present in regard to possible burns, this possibly becoming more of a risk as individuals become older. We saw that overall the home was clean and there were no unpleasant smells. We saw that staff have an awareness of the homes procedures in respect of such as the temperatures they should use for washing soiled linen. Staff have received training in infection control. We saw that the home now has liquid soap and paper towels available although we did advise that the correct dispensers are made available for putting the paper towels in, this in preference to leaving them on such as shelves. The acting manager stated in the information that she sent us that staff are working toward good infection control and are supporting individuals living at the home to achieve this, evidence of this seen in their case files. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are better trained, skilled and usually available in sufficient numbers to support individuals with their chosen lifestyles. Evidence: We looked at the homes staffing Rota and found that this was consistent with the staff on duty. There is usually one staff member available to support the three individuals living at the home, with some doubling up at the point of staff handover. Based on the comments from individuals we spoke to this is usually sufficient to allow staff to meet their needs within the home. Issues arise at the point staff maybe looking to take individuals out on community based activities, this as one person needs 1:1 support with mobility needs (as identified by an occupational therapist in their checks). This would based on what is identified in the activity programme be an issue on Saturdays, although the acting manager said that staff are flexible and will come in to help provide the necessary support. This is not identified on the staffing Rota however, and would not seem to be a routine planned arrangement. The home does not however use agency staff which is positive in maintaining consistency, this as care plans have identified that some individuals do not like change, as would be the case with staff they are not used to. We saw from sight of the homes training plan that the staff at the home have a good Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: level of training, this including vocational qualifications (this further evidenced by our sampling of certificates in staff files). The acting manager has identified where staff need further training and whilst it was stated in the information that she sent us that training has been hampered by a lack of money (due to the vacancy at the home at that time) this situation was said to be improving, as we have seen. In discussion with the acting manager she told us that there is scope to improve staff knowledge and skill in challenging behaviour and the mental capacity act, and that she is looking to source this training. We discussed with one member of staff what training they had undertaken recently and this showed that they had been supported to participate in a number of courses recently. The home has had a very limited turn over of staff, and the only new member of staff to have been employed since the last key inspection is the acting manager. We looked at the records related to her recruitment and this showed us that suitable and robust recruitment checks had been carried out by the provider before her employment at the home. The acting manager also confirmed that these checks had been carried out, this in accordance with the homes recruitment procedure which was acceptable, although could be more robust in reference to the induction of new staff. We did however see that the home has an induction package that reflects national standards. We required the home to improve their recruitment practice at the time of the last key inspection, and we have seen that this has now been done, this so as to protect the individuals living at the home. The acting manager stated in the information that she sent us that she has is bringing staff support meetings (supervisions) up to date and ensuring that there are more regular meetings of all the staff. We saw evidence of this in staff files and through sight of minutes of staff meetings. Care Homes for Adults (18-65 years) Page 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home has shown improvement over the last year although identification of potential risks to individuals could be better. The home listens to the views of people living at the home, although response to these could be improved in regard to such as community access and transport. Evidence: The home has been without a registered manager since 2007 with the position filled by a number of managers in acting capacity. The current acting manager has been employed to work at the home earlier this year and is currently completing a six month induction. She has shown us that she has experience at a senior level in care homes over a number of years. She also showed us that she has appropriate qualifications and some experience of working with people with a learning disability. She sent us the information we required prior to our visit to the home and this showed us that she has a understanding of where the service needs to improve, and the barriers that may prevent this. There is a need for the acting manager to apply for registration, this to ensure that the home has more stability in respect of management arrangements. We agreed with the acting manager/area manager that this would be completed by the end of August 2009 (to coincide with the end of the acting managers probationary period). Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: The area manager for the home has also changed since the last key inspection, and has only been in post for a relatively short while. From discussion with the acting manager and area manager it was apparent that there are no separate budgets for each unit, both thinking this would be useful in identifying the financial viability of individual homes, and consequently whether each manager was working within or outside of their budget. The home now has full occupancy and the acting manager was of the view that the homes budget is appropriately managed. Based on discussion with the acting manager more clarity as to her accountability in the management of the home would be beneficial in regard to those areas where she has responsibility for decision making, and where she would need to refer to the area manager for a decision. We saw that there are regular management meetings from records kept by the acting manager, although it would be helpful to have formal minutes of these so that it is clear as to what decisions have been made. We heard, and saw evidence of how the acting manager has gained the views of individuals living at the home, this through meetings and one to one discussion. This has enabled the acting manager to send us information that, based on other evidence we have gathered, is accurate and honest as to the homes performance, with those areas we have identified as needing improvement reflecting what people have told us. We have also noted that management has been responsive to what we have told them, in that concerns about the servicing of the gas boiler have been addressed quickly, and that the acting manager has contacted Environmental Services for advice about food safety. There is however concern that the management has not identified the need to ensure such as regular gas servicing, an unsteady toilet surround and the need for better medication storage without our input. We looked at how the home handles individuals monies, and have found that records relating to monies in safe keeping are well documented and balanced with monies that are safe kept. There are however no records of individuals property within the home, this to ensure that there is no doubt as to what the person owns, and what belongs to the home. We saw that the home has procedures relating to safe working practices that are acceptable these supported by records of health and safety checks and senior managers visit records. Staff training records also show that training within the scope of safe working practices is provided to the staff team. Risk assessments have been developed as have records, which have improved since the last main inspection. We noted that policies and procedures are also in place, although review of these into a more logical order so as to assist peoples access would be appropriate. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes  No  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 31 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 Description 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 Description Timescale for action 1 13 16 31/08/2009 To make suitable arrangements for individuals living at the home to engage in community activities outside of day centre attendance. This is to ensure individuals can pursue their chosen lifestyle and activities when they wish. 2 20 13 To provide suitable and safe 31/07/2009 storage for drugs within the home, this to reflect the type of drugs held. This is to ensure that medication is stored safely and access is restricted to those persons who should have access. 3 29 13 To repair or replace the unsteady toilet surround in the downstairs en suite toilet. 31/07/2009 Care Homes for Adults (18-65 years) Page 32 of 35 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 Description Timescale for action This is to ensure that there is no risk of injury to an individual living at the home due to this defective equipment. 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 2 To confirm in writing to any individuals moving into the home, or their representatives, that based on assessment the home is able to meet their needs. To review the contract of residency so that it is up to date, includes information about all possible additional charges and is available in formats that individuals currently living at the home find acceptable. To detail the activities that people are involved with on a daily basis in individual records and plans To expand the homes policy relating to the maintenance of family links and friendships. To look at ways in which individuals living at the home can be more involved in food shopping. To request an audit of the homes systems for the management of medication from the contracted pharmacist for the home. To record the stock and administration of any controlled drugs in a controlled drugs register Individual’s property should be recorded within inventories, these to be reviewed on a regular basis. To obtain a copy of the code of practice for the Mental Capacity Act 2005 for use at the home. To risk assess any potential hazards to individuals living at Page 33 of 35 2 5 3 4 5 6 12 15 16 20 7 8 9 10 20 23 23 24 Care Homes for Adults (18-65 years) 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 the home from hot surfaces such as radiators or hot pipes. 11 12 13 14 24 24 26 33 To progress the homes redecorative and refurbishment programme. To ensure that wardrobes are secured so that there is no risk of them falling forward. To fit a digital aerial so that individuals are able to get a good TV reception on their TVs. To formalize on the staffing rota how staff are allocated to support individuals with community activities on the weekend. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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