Care Home: 1 - 2 Meade Close

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What the care home does well Most of the people who use the service are unable to communicate verbally. We saw lots of evidence to demonstrate that the manager and staff used information from a variety of sources, and their professional skills, to establish people`s choices and needs by observation of body language and facial expressions. People`s needs were assessed before they moved in. This meant that they and their relatives were assured that their needs could be met. People`s relatives and staff were happy with the manager, who was observed to be respectful and professional when helping people. One relative talked about the manager being, "very nice", that you can, "go to her with anything", and that she "makes you welcome and tells you everything". Staff were well-trained and supported which meant that they were confident in their work. We saw from the way that staff interacted with people, and from people`s body language, that people were happy with the staff. One person`s relative said that the staff were, "very good", and that their relative was, "very happy". Health and safety checks were regularly maintained, so that people`s safety and welfare was protected. What has improved since the last inspection? The manager had worked hard to address twelve good practice recommendations made at the last inspection, which included recommendations about record-keeping, people`s day-to-day choices, access to activities, medication records, staff training records, staff training in the protection of vulnerable adults and infection control procedures, and fire safety practice. Throughout the inspection process, we got feedback from staff to say that the running of the service has improved since the last inspection because of a review of the management structure. This had resulted in better direct access to the manager, rather than information being passed to the manager through a coordinator. Staff said that management was, "more open", "more flexible", and, "much more open to suggestions". One member of staff concluded that the manager, "Motivated the whole team a lot more, people get to go out and enjoy things like everybody wants to". What the care home could do better: The manager needed to make sure that care plans always detailed all the needs and support requirements of people who use the service and how those needs are to be met. Information recorded at the monthly review of people`s care needs should be used to review and amend the care plan and risk assessments, so that staff always have up-todate information to enable them to support people and to minimise risks in everyday life.Information about each individual`s likes and dislikes concerning food should always be recorded, so that staff always have the information they need to offer people the food of their choice. Menus should always detail all the mealtime options and alternative choices. The complaints procedure should be available in a format that all the individual people using the service can understand, so that people who are unable to communicate verbally, are supported to raise concerns. The investigation and outcome of all complaints should always be recorded, so that any patterns in problems can be clearly seen and addressed. Overall, the recruitment practice was robust, but it could be improved by always taking a detailed staff employment history so that people who use the service are supported by staff who are being vetted to ensure the protection of people. A quality assurance audit should be undertaken annually and the outcomes published to ensure that the manager has information from all relevant parties which will allow her to develop the service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 - 2 Meade Close 1 - 2 Meade Close Urmston Manchester M41 5BL     The quality rating for this care home is:   two star good 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: Sylvia Brown     Date: 2 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 1 - 2 Meade Close 1 - 2 Meade Close Urmston Manchester M41 5BL 01617468313 01617468343 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) : SCOPE care home 8 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 8 8 All service users will fall within the category of learning disability but may have an associated physical disability. Date of last inspection Brief description of the care home Meade Close is a registered care home managed by SCOPE which provides 24 hour residential support to eight people who have a learning disability and profound physical disabilites. The home is located in Urmston and is close to public and local amenities. The premises consists of two purpose built bungalows, each accommodating four people. All the bedrooms are single occupancy and have been equipped with aids and adaptations. The home has been adapted to meet the physical needs of people using the service. Each bungalow is fully wheelchair accessible and parking bays are located close to each house. The home has its own minibus, to assist in supporting people to access public resources. A third building is used for administration purposes. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home The current range of fees is from £ 1,111.64 to £1,221.60 per week, depending on needs. Information about the service can be obtained from the service user guide. This is a booklet given to all people who are planning to use the service which provides them with information about what they can expect from the service. Alternatively, information can be obtained directly from the manager, either in person, or by telephone. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 peterchart Poor Adequate Good Excellent How we did our inspection: This report was written on behalf of the Care Quality Commission. Therefore, throughout the report the term, we, is used. This key unannounced inspection included a site visit. The manager and staff at the home did not know that the visit was going to take place. In June 2009, an Annual Service Review (ASR) was done, as part of the lead up to this inspection. This involved the manager filling in an annual quality assurance assessment (AQAA), and the relatives of are and people who use the service and staff filling in surveys to tell us their views of the home. We then considered this information, and all the other information we had received about the service, so that we could decide when we needed to visit the home to do a key inspection. The outcomes for people who used the Care Homes for Adults (18-65 years) Page 6 of 33 service at that time were good. This reassured us that people at the home continued to be happy with the way they were supported at the home and that they continued to receive a good service and this helped us to plan the timing of this inspection. Prior to this inspection, we sent surveys out again to people who use the service and staff so they could tell us what they thought about the service. Three of the staff returned their surveys. Comments from these surveys are included in the report. We asked the manager of the service to complete an AQAA again. This form gave the manager the opportunity to tell us what they feel they do well, what they needed to do better and what had changed since the last key inspection and ASR. This helps us to determine if the management of the service see the service they provide in the same way that we see it. The form was well completed and the manager was able to tell us what plans there were to develop the service. All of the key inspection standards were assessed at the site visit and information was taken from various sources. This included observing care practices, talking with people who use the service, their relatives, the manager, a senior manager and other members of the staff team. Two people were looked at in detail to learn about their experience of the service from when they first used it to the present-day. A selection of records were looked at, including medication records, training records and care records. What the care home does well: What has improved since the last inspection? What they could do better: The manager needed to make sure that care plans always detailed all the needs and support requirements of people who use the service and how those needs are to be met. Information recorded at the monthly review of peoples care needs should be used to review and amend the care plan and risk assessments, so that staff always have up-todate information to enable them to support people and to minimise risks in everyday life. Care Homes for Adults (18-65 years) Page 8 of 33 Information about each individuals likes and dislikes concerning food should always be recorded, so that staff always have the information they need to offer people the food of their choice. Menus should always detail all the mealtime options and alternative choices. The complaints procedure should be available in a format that all the individual people using the service can understand, so that people who are unable to communicate verbally, are supported to raise concerns. The investigation and outcome of all complaints should always be recorded, so that any patterns in problems can be clearly seen and addressed. Overall, the recruitment practice was robust, but it could be improved by always taking a detailed staff employment history so that people who use the service are supported by staff who are being vetted to ensure the protection of people. A quality assurance audit should be undertaken annually and the outcomes published to ensure that the manager has information from all relevant parties which will allow her to develop the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before moving into the home, so they know that their needs can be met. Evidence: In the AQAA the manager stated, we collate information on peoples needs and wishes from appropriate and professional people along with families . To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to two people from the point of their admission to the present time. We also talked to the relatives of people using the service and staff and looked at the information in surveys that three of the staff had filled in. Information is provided to the relatives/advocates of people who are considering moving to the home. This information is provided in the statement of purpose and the service users guide. We saw that these documents provided a range of information Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: about what a person can expect from the service and a copy of the service users guide was held on each individuals file. Most of the people who use the service have limited verbal communication. The manager explained that this is the reason that information is provided to their relatives/advocates. It was recommended that information about the service is always provided in a format suitable for the people for whom the home is intended. (e.g. pictures, video, audio, or explanation). We talked to the manager and staff about the admission process. They confirmed that people are always invited to visit the home to have a meal and an overnight stay, so that they are involved in the decision to live there. We looked at the assessments for two of the people who use the service and we saw that there was careful planning for the admission, which included assessments being completed by appropriate professionals, e.g. the occupational therapist. Therefore, information was detailed and thorough to enable a care plan to be formed. Three members of staff who completed a survey said that they were always (2), or usually (1), given up-to-date information about the needs of the people they cared for. The relative of one of the people who use the service talked about how happy this person was since they had been admitted to the home and concluded that it was, a very nice place, for them. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from choices to enable them to exercise day to day control over their lives and from having their personal care needs met in the way they preferred and with respect for their privacy and dignity. Evidence: In the AQAA the manager stated that, we have individual care plans that are built up from information from the service user, families, health professionals, social workers and advocates where needed. These plans are done in a person centered way to ensure outcomes are met for the individual. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to two people from the point of their admission to the present time. We also talked to the relatives of people using the service, the manager and staff, and looked at the information in surveys that three of the staff had filled in. We saw that care plans were written from the point of view of the person using the Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: service and we saw clear evidence of a strong focus on staff obtaining the views of people who had limited verbal communication, by observing their body language and facial expressions. Care plans we saw reminded staff about the way the person would wish to be treated and the way they may be feeling when they were supported with personal care. Examples were the statements in a care plan, tell me what you are doing and I will help as much as I can, and, I like to help as much as I can, please remember that. Most importantly, care plans contained clear advice to staff about how they should approach and communicate with each individual and how to provide reassurance and respect for their dignity when delivering personal care and one member of staff stated that,everybody is given dignity and respect. This is good for people using the service. Since the last inspection the manager had also introduced,communication passports, for three of the people using the service. We saw that these were based on information from family, professionals and staff and described how people made their choices and wishes known when they could not communicate verbally.The communication passports included sections on, important things you need to know, and, how I communicate. It was recommended that these, communication passports, should be put in place for all people who are unable to communicate their needs and choices verbally. Some aspects of the care plan were very helpful as they described the routines of a person through the 24 hours of the day. However, as was the case at the last inspection, the care plans we saw would benefit from more detail and a recommendation was made about this. The manager explained that staff had recently had training in, person centred planning, and that she planned to review all care plans in the light of this training. We saw risk assessments which addressed a range of risks and we saw that each persons progress, including the outcome of any healthcare visits and activities they had taken part in, was reviewed on a monthly basis. However, this process was not always used as an opportunity to review the care plan and the risk assessments. The dates of care plans and risk assessments and their reviews were often missing and this was confusing. Overall, the manager agreed with the recommendation that a full audit of each persons file was conducted and that files were organised in such a way that information could be retrieved more easily. All of the people who use the service had individual bank accounts. To enable them to have maximum involvement in using the bank, the manager had lobbied the local bank to put a ramp in place so that people who were wheelchair users could access the building. As people were not able to sign for their money, the signatures of two Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: members of staff were used in every transaction made on behalf of an individual and the individual went to the bank in person to withdraw money. The relatives of people who use the service that we spoke to were pleased with the care received. One person said that they had, no worries at all, and that they were, very pleased Ive got (them) in here, as they were, very happy. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from choices to enable them to exercise day to day control over their lives. However, their preferences would be better met by providing alternative choices of food. Evidence: In the AQAA the manager stated that, central to our belief is that all disabled people should live an independent life. The manager also stated that plans for improvement in the next 12 months included, to pay more attention to inclusion, equality and diversity needs, and to, ensure that service users have a full and stimulating lifestyle that is person centred to them. To assess whether this was the case, we observed the interactions between people and staff, talked to peoples relatives and staff, and looked at the programme of activities. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: We found that the practice of obtaining detailed personal information on admission enabled staff to understand what was important to each individual. The manager said that at the time of the previous inspection, the service did not provide individuals with the holidays of their choice. The manager added that they knew what they needed to do to address this and had made changes so that in 2008 and 2009, everybody had a holiday to a place of their choosing. This included holidays to the Norfolk Broads on a barge, to the Lake District, to Blackpool and to Butlins in Skegness. We saw evidence to demonstrate that a number of outings had taken place in 2009 which included outings to Blackpool, Southport, theatre shows, the MEN, Tatton Hall, and boat/barge trips. At the time of the visit, we saw that two people were excited about going to a show that evening supported by two members of staff. We also saw evidence that two other people had been to the theatre on the previous evening. The manager explained that day-to-day activities included the use of the sensory corner, toys, games, going out to do personal shopping and enjoying coffee and meals in the local community. The manager, staff and a relative we spoke to felt that access to activities was much improved since the previous inspection. The manager said that as well as changing the culture of being too protective of people and supporting them to make choices and take risks, staffing levels had been reviewed so that staff deployment was led by peoples needs and preferences. Staff confirmed that this was the case and that they felt so much happier about the fact that they can spend one-to-one time with people and that there is enough staff for them to have impromptu outings with people when they ask them, e.g. going to the shops. We saw that there is an open visiting policy and peoples relatives confirmed that they were made welcome. One relative said that the manager and staff, make you very welcome, and that the manager, tells you everything. The manager said that there is a three-week fixed menu to maintain good nutrition and a balanced diet. We saw the main meal being served in one of the bungalows. The atmosphere was relaxed and unhurried as there were enough staff to serve the meals and support people. Three of the four people who lived there had their meals minced or liquidised . These meals were seen to be served in an appetising way. The threeweek menu did not have details of desserts offered. The manager said that they dont record options for desserts and that people have, whatever is in the fridge, and added that, staff know what individuals like. Although some peoples files had their Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: preferred food listed, others did not. A recommendation was made about recording peoples likes and dislikes and about the need to record choices offered and the range of desserts. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were met in the way they preferred and with respect for their privacy and dignity. Evidence: In the AQAA the manager stated that all people, are registered with their preferred GP, a dental clinic and optician; all service users have access to other relevant professionals such as speech and language, a chiropodist, district nurses, dietician and physiotherapist. All health care and social needs are met by a well-trained staff team in accordance with individually stated preferences. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to two people, talked to peoples relatives, the staff and the manager and looked at the information in surveys that three of the staff had filled in. When we looked at the files for two of the people using the service, we saw lots of evidence to demonstrate that their health needs were met by a range of healthcare professionals. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: We saw that medication was dispensed from a monitored dosage system kept in appropriately secured drug cabinets. Records, including the records of controlled drugs, were well maintained. We observed medication being dispensed to place in a peg feed and we spoke to the two members of staff that were dispensing the medication. Both of the staff said that they had received training in the administration of medication and felt confident in what they were doing. We saw that two members of staff are involved in the administration of medication into a peg feed to provide a double check for accuracy. Photographs of each person for whom medication was being administered, and some basic details of their needs were seen, including instructions for using peg feeds to dispense medication. It was recommended that a care plan which detailed each persons specific needs concerning their medication, what it is prescribed for, and any possible side-effects was completed. The manager felt that this would prove helpful and said that the recommendation would be implemented. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples relatives were confident that the manager and staff would listen to their concerns and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. Evidence: In the AQAA, the manager stated that, all complaints and concerns are listened to whether they are deemed to be of a protection matter or not, as sometimes the complaint or concern can be around discrimination. To see if this was the case, we looked at policies, procedures and records and talked to peoples relatives, the manager and the staff. We saw that a copy of the complaints procedure is held in each persons file. This was in a written form and could not readily be accessed by people using the service. It was recommended that the complaints procedure was available in a format, e.g. using pictures, that all the individual people using the service could understand, so that people who were unable to communicate verbally, were always supported to raise concerns. The service did not have a record of complaints for the last 12 months. The manager explained that they tend to deal with complaints as and when they happen and do not always record the outcome. It was recommended that these complaints and the action Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: taken should be recorded to demonstrate the way the home deals with complaints positively. A recommendation was made at the previous inspection to the effect that staff should have training in dealing with complaints. The manager agreed that this would prove helpful and that she would access this training. Staff spoken to said that the manager listens to complaints and concerns and that they could approach her with anything. The manager said that she,wants to know whats going on, as, I cant do anything about it if I dont know whats going on. We concluded that there was a positive, open and honest approach to complaints, but that the recording procedure needed to improve. We saw that copies of the protection of vulnerable adults procedures were readily available at the home. We also saw evidence to demonstrate that a safeguarding referral by a member of staff had been dealt with appropriately by referring it to the adult protection team at Trafford Borough Council. We saw evidence to demonstrate that staff had received training in the protection of vulnerable adults and all three staff who filled in a survey said that they knew what to do if anybody had concerns about the home. Finally, when asked about making complaints, the relative of one of the people said that they could, go to the manager with anything. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a warm, clean, safe and well equiped and maintained environment. Evidence: In the AQAA, the manager stated that, the bungalows are purpose-built and meet the needs of the service users. All service users have the equipment needed to lead their own lives as independently as possible. We were taken on a tour of the building, which included the bedrooms of the two people whose care wed looked at closely. We found that both bungalows were warm, homely and well-equipped to meet individual needs. We saw that a range of equipment, including ceiling mounted hoists and appropriate adaptations to promote independence in bathrooms and toilets, were provided. The home was clean and no unpleasant smells were noted. Antibacterial soap and gel was used to promote infection control. However, in one toilet there was no towel and in another toilet there was a cloth towel. It was recommended that paper towels are placed in all bathrooms and toilets in the interests of infection control. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The manager explained that people are involved in the choice of colour schemes and personal items in their rooms with the help of their family. One example was having pictures of boats on the wall in one persons room, which reminded them of the time that they used to go and look at boats with their family when they were younger. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good 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 benefit from support provided by experienced and committed staff. Overall, the recruitment procedure is robust enough to protect people and the need for a necessary improvement was recognised by the organisation. Evidence: In the AQAA the manager stated that, Meade Close believes that the key to providing a quality service is about staff, the composition and management of the team and is committed to their personal development. To see if this was the case we looked at the recruitment procedure, staff files and training records and we talked to peoples relatives, the manager, and the staff. We saw that the recruitment procedure includes potential staff completing an application form, being interviewed, providing references and the manager ensuring that a Criminal Records Bureau (CRB) check was undertaken for each staff member employed. This ensured that people were cared for by staff that had been vetted. When looking at staff files, we saw that a full employment history wasnt always taken to identify any gaps in employment. It was recommended that all applications were carefully checked to make sure that a full employment history was provided. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: We saw that staffing levels at the home had been improved since the last inspection to better meet the choices and needs of people. The manager explained that at the time of the last inspection, there were two staff in each bungalow, but that when most of the people were out, the remaining people were moved to the bungalow where staff were available. The manager said that in the light of recommendations made at the last inspection, staffing deployment had been reviewed so that there are always two members of staff on duty if there were any people in the bungalow in which they lived, so that people no longer needed to be moved to the other building. Staffing rotas had also been reviewed so they listed all staff training, accompanying people on appointments and supporting people with activities. Staff rotas also included the full names of staff, which bungalow they were working in and who was the designated, responsible person, on a shift. Other improvements included a commitment to not using agency staff so that people have continuity and better outcomes and flexibility in staffing levels. One example of this was that on the recent Bank Holiday Monday, there were three staff working in one bungalow supporting four people, so that people could be taken out. Since the last inspection a training matrix had been developed which showed that staff had received recent training which included training in infection control, health action planning, person centred planning, deprivation of liberty, and mental capacity. The service employs 19 staff, 15 of whom have the National Vocational Qualification (NVQ) Level 2. All three staff who completed surveys said that they were being given training which was relevant to the role, helped them to understand and meet the individual needs of people and kept them up-to-date with new ways of working. All three staff said that their induction covered everything they needed to know to do the job when they started very wellg or mostly. One member of staff commented that,Meade Close is an excellent service to its customers/users. Staff are well-trained and supported. Another member of staff said that the service has a, good staff team and the management team have improved greatly. The relative of one person said that staff were, very good, and, very nice and that they felt relieved that their relative was well cared for by the staff. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ran the home in the best interests of people who live there and their safety and welfare was promoted. Evidence: In the AQAA, the manager stated that, we have a wide range of policies and procedures which ensure the health, safety and welfare of the service users and staff, and that, the manager has a good knowledge of the service and service users. To see if this was the case we looked at records and spoke to peoples relatives, the manager and staff. The manager has been manager of the service for nine years. She holds the registered managers award, the internal verifiers award, the NVQ assessor award, the advanced management of care award and a health and safety qualification. Her training record demonstrated that she regularly updates her skills and training and had recently attended training in deprivation of liberty and mental capacity. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: The manager works a 35 hour week and said that she prefers to work flexibly as needed to see people using the service at all times of the day and to attend meetings concerning their care. She concluded that flexible working enabled her,to get a view of the service. Throughout the inspection process, we got feedback from staff to say that the running of the service has improved since the last inspection because of a review of the management structure and better direct access to the manager, rather than information being passed to the manager through a coordinator. Staff said that management was, more open, more flexible and much more open to suggestions. One member of staff concluded that the manager, motivated the whole team a lot more, people get to go out and enjoy things like everybody wants to. Finally, we saw that all interactions between the manager and staff, and between the manager and people who use the service, were respectful, caring and professional. The manager recorded information in the AQAA which demonstrated that health and safety procedures and checks were carried out at the home. When looking at fire safety records, we saw that the manager had addressed a recommendation made about five practice made at the previous inspection and that there was lots of good practice which protected vulnerable people from the risk of fire. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 It is strongly recommended that information about the service is always provided in a format suitable for the people for whom the home is intended. (e.g. pictures, video, audio, or explanation). This is necessary to ensure that wherever possible, people are fully involved in the decision. It is strongly recommended that a full audit of each individuals file is conducted and files are reorganised in such a way that information can be retrieved more easily. This is necessary to ensure that information about peoples needs is readily accessible. It is strongly recommended that care plans clearly detail all the needs and support requirements of people who use the service and how those needs are to be met. It is also recommended that information recorded at the monthly review of peoples care needs is used to review and ammend the care plan and that all reviews and amendments of the care plan are signed and dated. This is necessary to ensure that staff are consistently aware of the current needs of people and when changes in need occurred, so that their support of each individual is always based on current information. 2 6 3 6 Care Homes for Adults (18-65 years) Page 30 of 33 4 7 It is strongly recommended that the, communication passport, is in place for all people who are unable to communicate their needs and choices verbally. This is necessary to ensure that staff always have information to enable them to understand and act on individuals nonverbal communication. It is strongly recommended that all risk assessments, including those concerning medication, are reviewed as part of the monthly review of each persons care needs and that the outcomes of these reviews are recorded and the risk assessments are amended to reflect the changes. This is necessary to ensure that staff always have up-to-date information to enable them to support people to minimise risks in everyday life. It is strongly recommended that the homes menu should always detail all the mealtime options and alternative choices, including the choice of desserts. This is necessary so that people always have their preferences met. It is strongly recommended that information about each individuals likes and dislikes concerning food are consistently recorded. This is necessary to ensure that staff always have the information they need to offer people the food of their choice. It is strongly recommended that a care plan which details a persons specific needs concerning the administration of their medication, what it is prescribed for, and any possible side-effects was completed. This is necessary to ensure that people receive their medication in the way that they prefer. It is recommended that all staff are trained in the use of the services complaints procedure. This is necessary to ensure that staff are confident in dealing with, and recording, concerns and complaints raised by people. It is strongly recommended that the investigation and outcome of all complaints is recorded. This is necessary to demonstrate that any concerns raised by people, their relatives and friends are fully investigated and that any patterns in problems can be clearly seen and addressed. It is strongly recommended that the complaints procedure is produced in a format, e.g. using pictures, that all the individual people using the service can understand. This is necessary to ensure that people who are unable to communicate verbally, are supported to raise concerns. It is strongly recommended that a detailed employment history is consistently taken, including specific dates, to enable the manager to check for gaps in employment. This Page 31 of 33 5 9 6 17 7 17 8 20 9 22 10 22 11 22 12 34 Care Homes for Adults (18-65 years) is necessary to ensure that people who use the service are supported by staff who are being vetted to ensure the protection of people. 13 39 It is stongly recommended that the manager undertakes quality assurance audits annually, which are based on seeking the views of people who use the service, their family and friends, staff and stakeholders within the community and publishing the outcome of the audits. This is necessary to ensure that the manager has information from all relevant parties which will allow her to develop the service. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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