Care Home: 1 Whitehall Road

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well The home provides a comfortable and domestic home that blends in to the community, providing a domestic ambience as well as ample space to allow individual`s privacy. Staff we spoke to showed an interest and commitment to the people living at the home and interaction with the latter was seen to be appropriate and positive. We saw that the staff have compiled detailed individual plans that set out what they need to do for individuals, this as far as possible with their involvement or based on their preferences. We saw that people`s independence is encouraged, with consideration given to risks and the need to promote their choice. The manager we found to be committed and enthusiastic as to the promotion of a quality service that maintains and improves outcomes for individuals living at the home. This reflected the interaction we saw between staff and individuals living at 1 Whitehall Road, which was positive, with consideration seen to be given to their choices in respect of day-to-day lifestyle. What has improved since the last inspection? There have been numerous environmental improvements around the building with redecoration of all bedrooms, lounges, a refitted kitchen and such like.DS0000004843.V374890.R01.S.docVersion 5.2There is far more information available in alternative formats such as audio and pictorial. The manager has promoted the best interests of individuals through liaison with social services departments. There is a more stable staff team and support for the staff has improved through such as structured supervision. Monthly monitoring of the home has increased with audits of the homes environment by one manager as well as the usual monthly visits by other senior management. What the care home could do better: There are no required improvements, the following good practice recommendations: Staff would benefit from training and or guidance in nutritional assessment (to ensure any poor dietary intake can be easily identified) and some areas of mental health such as schizophrenia. Some risk assessments could be more detailed in respect of such as potential choking incidents; overall control of infection and identifying the suitability of the first aid training provided to staff (in regard to the needs of people living at the home). Information on the home should contain information on the cost of the service to assist people looking for a service. To be clearer as to how staff are expected to promote continence by producing guidelines for staff that reflect the practices in the home. To ensure that the home knows all staff member`s full working history to ensure any gaps in employment are for valid reasons. Key inspection report CARE HOME ADULTS 18-65 1 Whitehall Road Cradley Heath West Midlands B64 5BG Lead Inspector Jon Potts Unannounced Inspection 27th February 2009 08:50 DS0000004843.V374890.R01.S.doc Version 5.2 Page 1 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. DS0000004843.V374890.R01.S.doc Version 5.2 Page 2 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 DS0000004843.V374890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Whitehall Road Address Cradley Heath West Midlands B64 5BG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01384 357933 info@Inshoresupportltd.com Inshore Support Miss Julie Dawn Pringle Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000004843.V374890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 3 The maximum number of service users who can be accommodated is: 3 12th March 2007 Date of last inspection Brief Description of the Service: 1 Whitehall Rd is an adapted end terraced property that was refurbished for the purpose of providing long-term care for three younger adults with a learning disability. The house is positioned in an established residential area within walking distance of the centre of Cradley Heath. Accommodation briefly comprises of three single bedrooms (two which are ensuite), bathroom, two lounges, dining room and kitchen. The building has a small rear garden area. The home is managed by Inshore support, a company that has a number of small homes that have similar aims and objectives to Whitehall Road. The staffing in the home consists of a manager, senior support and support workers. The staffing ratio is at least one staff member to one resident at day and night, although this is higher for support within the community. The home has an appropriate cars allocated for the transport of the residents. The current charges whilst available in individual contracts are not detailed in the homes Statement of Purpose. DS0000004843.V374890.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people that use this service experience excellent quality outcomes. We carried out this unannounced inspection over one day with the focus on the homes performance against the key national minimum standards for younger adults. We tracked the care for one of the three individuals living at the home. (This involving looking at all the documentation in respect of their care and cross checking this with outcomes). We also observed of staff practice, talked to staff, the registered manager and examined staff and management records. We had some limited discussion with some of the individuals living at the home. We also considered all the information we had received about the home since the time of the last key inspection including their annual quality assurance assessment; senior mangers monthly visit reports, our last random inspection and such like. What the service does well: What has improved since the last inspection? There have been numerous environmental improvements around the building with redecoration of all bedrooms, lounges, a refitted kitchen and such like. DS0000004843.V374890.R01.S.doc Version 5.2 Page 6 There is far more information available in alternative formats such as audio and pictorial. The manager has promoted the best interests of individuals through liaison with social services departments. There is a more stable staff team and support for the staff has improved through such as structured supervision. Monthly monitoring of the home has increased with audits of the homes environment by one manager as well as the usual monthly visits by other senior management. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. DS0000004843.V374890.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000004843.V374890.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 may use the service would have access to the information about the home with the possible exception of the range of fees for the service prior to assessment. The homes phased admission procedures are appropriate in assisting people to find out about the home in a more direct way. EVIDENCE: 1 Whitehall Road was set up to accommodate three individuals on a long-term basis and as such admissions to the home are infrequent, none having occurred since before the last key inspection. The manager is however aware of the how to ensure admissions are carried out on a phased, planned basis this so as to ensure any prospective resident has the opportunity to sample the service prior to moving in (through a gradual introduction to the home including day visits and overnight stays). This would also ensure that the management have time to assess the homes ability to meet an individuals assessed needs. This approach is supported by the homes procedures, which draw from practices outlined in the National Minimum Standards for younger adults. DS0000004843.V374890.R01.S.doc Version 5.2 Page 9 We saw that there is an individualized Statement of Purpose and Service users guide that we noted has been subject to some review since the last inspection of the home, with the manager telling us that she was looking to develop this with photographs of the home. We heard an audio version of information about the home that had been recorded by one of the homes staff, this spoken in a reasonable and clear pace that assisted understanding of the information. The afore mentioned documents/tape we saw/heard contain information about the homes aims and objectives and philosophy as well as procedural information (such as how to complain) in accordance with legal expectations. We saw that some of the documentation (such as terms and conditions of residency) has also been adapted to include pictorial cues. We saw that there is clear information in the individuals contracts, this showing the range of fees for the individual although this information is not currently detailed in the service users guide of statement of purpose as should be the case. We noted that a copy of the statement of purpose/service users guide is included in each case file. We advised the manager that to allow ready access provision of a copy in an individual’s room might be more appropriate. From previous inspections we have seen that admissions are not made to the home until a full needs assessment has been undertaken. All the individuals living at the home are funded through care management arrangements, and the manager has been proactive in requesting reviews from social workers. All individuals have received recent reviews with one exception (this due to inclement weather), although this has been rearranged for the near future. We saw that staff have reassessed the needs of individuals at the home through use of inshore assessments formats (the ones we saw detailed and thorough, considering a full range of potential areas of need), these a tool for updating the individuals care plans. DS0000004843.V374890.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 home promotes individuals involvement in decisions about their lives wherever possible and encourages their participation in planning the care and support they receive through preferred means of self-expression. EVIDENCE: The individuals living at 1 Whitehall Road have difficulty communicating their wishes verbally this meaning that staff use a variety of methods to ascertain their preferences and choices. In discussion with the manager and staff and through observation we saw that staff are open to the various ways individuals express themselves. We saw that there are individual communication plans in place that give simple cues as to how to talk to an individual, this written in a person centered style as is the rest of the individual’s plan. This reflected the practice we saw in the home. There is also use of lifestyle assessments, DS0000004843.V374890.R01.S.doc Version 5.2 Page 11 pictorial information (such as questionnaires, activity plans), and detailed behaviour monitoring records (with this seen as form of communication). The home was seen to have detailed individual plans that cover a wide range of the individual’s needs that are clearly drawn from and reflect the assessment process. Whilst detailed these plans are written so as to be easily understood by the staff so that they can provide consistent care to individuals. We did note that staff have signed to say they have read and understand these plans. Individual plans we saw had clearly identified goals and there was evidence in reviews and supporting documentation of how the staff worked towards achieving these with the individual. We saw that the manager has been proactive is requesting the involvement of social workers for reviews of individual’s care, and the records of the reviews we saw reflected positive outcomes for the individuals. Tracking of areas of one individual’s plan showed us evidence that this is followed into practice as we saw within supporting records, observation and discussion with staff and the manager. Observation of individuals also supported the information that the manager gave us on the day. We saw that care plans are supplemented by comprehensive risk assessments, these available with pictorial cues, with these taking into account the individual needs of the service users. There are regular reviews of the individual plans and risk assessments. There is scope to develop the homes risk assessment for one individual in respect of the potential for them choking, this to highlight what intervention staff would need to take should this occur (for example in respect of first aid intervention). The current risk assessment does focus on how to prevent choking occurring due to such as ‘cramming’ of food. We saw that there is clear detail of limitations within case files and we heard that the home has considered the impact of the mental capacity act and deprivation of liberty safeguards in reviewing these limitations, this through best interest meetings with other professionals. We saw documentation to evidence this was the case for some individuals. The manager is also currently working with the social services department to identify how and where deprivation of liberty safeguards will apply to individuals living within the home. DS0000004843.V374890.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the 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 living at the home are encouraged to make choices about their lifestyle and supported to develop their life skills. Social, educational, cultural and recreational activities are tailored to meet those that the individuals express a wish to be involved in, or enjoy. EVIDENCE: We discussed individual’s lifestyles with the manager, who stated that these have improved since the last key inspection with an increased focus on individuality, with lifestyles catering for what the person wants rather then generic activities for the resident group as a whole. Whilst saying lifestyles had improved the manager had a wish to develop these further on an individual basis. We noted that there have been some difficulties providing community activities on occasion due to staffing levels (which the manager notified, and DS0000004843.V374890.R01.S.doc Version 5.2 Page 13 updated us of), although these have occurred at times of inclement weather, which has lessened the impact. In discussion we have been made aware of how the manager is addressing these issues. We saw during the course of our visits to the home that staff do encourage individuals to have involvement in daytime activities that they enjoy and choose with the support of staff, this through the aid of pictorial activity guides and the offering of choices by staff. The activities the individuals were involved in at the time of our visit matched those detailed in the activity plans, these plans including a range of activity that matched their assessed likes and dislikes. The manager did tell us that she is looking to change the layout of one room so each individual has their own space (what was termed comfort zone) so that they can pursue their own individual activities when wished without interruption. One of the strengths of the home, highlighted by the manager, was is position close to community facilities that the staff were able to access, this including shops, health and community services. We noted that there is some restriction in respect of daily routines this due to the need (as highlighted in assessments) for the individuals to have a planned routine and to avoid potential boredom, which the manager was clear, could be a precursor to challenges to the staff. We saw that where there are restrictions in place (such as staff opening mail) there was a written agreement in place. These were signed by representatives of the individual (for example social worker). The manager stressed that staff do encourage individuals to have involvement in domestic routines, and build on tasks to develop their abilities, such as helping to make drinks as was seen to be the case during the course of the visit. We saw in the individual plans that there is detail as to how the home will maintain contact between individuals and their relatives. This maybe through the home-taking individuals out by car or through relatives visiting the home. We saw that the homes visitors’ policy is on clear display in the home, and would be accessible to any visitors. The staff have ascertained residents likes and dislikes based on the foods they chose to eat. Records of foods provided to individuals show that the menu is varied with a number of choices including healthy options, with the meals balanced and nutritional and catering for the varying dietary needs of the individuals. We discussed nutrition with the manager and she said that they had given thought to how to encourage healthy eating, this through healthy foods (so as to include fibre and five a day input). As people are given a choice the homes menu is seen as a guide rather than a set menu, this appropriate in such a small home. For those individuals who need support during mealtimes, including those who have swallowing or chewing difficulty staff give assistance in accordance with clear documented strategies, understood by the staff. DS0000004843.V374890.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 health and personal care that people receive is based on their individually assessed needs, and staff interaction with individuals shows respect for their dignity and privacy. EVIDENCE: From observation we saw that staff are aware of and we saw respect individual’s preferences, allowing them to make choices, this through verbal and non-verbal communication; the latter used to confirm choices given. The home has a mixed gender staff group that is predominately male which helps as all the residents are male and allows choice in respect of such as intimate personal care like bathing. The culture and ethnic background of staff also reflects that of the individuals living at the home. The staff responses to the individuals living at the home that we saw at the time of our visit were appropriate and reflected what we saw in individual plans. A number of staff have achieved a vocational qualification in care (NVQ 2 or 3). Input in respect of training relating to such as nutrition would be beneficial, this to fit in with DS0000004843.V374890.R01.S.doc Version 5.2 Page 15 the introduction of nutritional assessments. As one of the individuals living at the home has an underlying mental health condition it would be helpful if staff had some training or guidance to assist their knowledge and understanding of how this influences the individual’s health. We also noted that whilst some of the individuals have continence difficulties there was no policy on continence promotion at the home, although in respect of outcomes, namely management of individual continence we found this to be managed satisfactorily. The care plans we saw set out how the staff are to encourage independence through encouraging individuals to be involved in their own care where possible. We saw from records that the home is generally proactive in maintaining individuals access to community healthcare services and have responded to health related issues as identified in individual plans. There has been one incident last year where there was a delay in seeking appropriate health care although we have seen that steps have been taken to ensure this does not reoccur, and lessons learnt, with the manager making sure staff are fully aware of the consequences of not seeking prompt health care. From information provided to us at the time we saw that the manager responded robustly to this issue. Nutritional assessments we saw are not in place and should be introduced (with use of such as B.M.I. and MUST to identify if there is an issue based on weight and height). There was however clear evidence that the staff monitor weights on a regular basis, and there are no concerns at present in respect of weight loss or poor nutrition. The manager and staff in discussion showed an excellent awareness of what the individual’s health care needs are although we did note that there was no joint health action plan completed with health service. This is an issue that the management has identified as needing action and to this end has tried to action this with the Primary Care Trust, although with no success to date. We noted that it has been identified that there is a potential risk of choking for the individual whose care we tracked and whilst the monitoring arrangements to ensure that this does not occur are very clearly detailed it would be helpful to include detail as to the action staff should take if they were to choke. From discussion with staff they told us they have received training within first aid input in respect of response to choking incidents. The home has an efficient medication policy and procedure as well as practice guidance, this having been subject to review since the last key inspection. Staff that administer medication have received training that allows them to understand their roles and responsibilities (this evidenced by certificates), and there is a range of information about medication available at the home for reference, with easy read versions for individuals. We saw that there are clear medication plans in place for each individual that build on good practice and what triggers need to be in place for as required medication. None of the DS0000004843.V374890.R01.S.doc Version 5.2 Page 16 individuals living at the home is able to self medicate safely although as far as possible their consent or that of representatives has been the obtained to the home managing medication. The home has obtained clear permissions from the individuals G.P. in respect of the administration of homely remedies such as paracetomol and cough mixture. We looked at medication records and found these to be accurate and up to date although we did note that when medication is administered two staff sign to evidence this. The manager needs to ensure that it is clear which staff is signing to evidence administration and which is the witness. The home does regular checks on medication, with clear documented records of the same kept, as we saw. The last check of the homes medication by a contracted pharmacist indicated that no issues of concern had been identified. DS0000004843.V374890.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 at the home are alert to any indications of individual’s dissatisfaction and representatives are made aware as to how to make complaint. The homes practices ensure that individuals are as far as possible kept safe and protected. EVIDENCE: We saw that the home has a complaints procedure that is up to date and clearly written as well as been easy to understand. We saw that a simple pictorial format has been produced, this readily accessible within the home. Whilst communication difficulties may mean that direct complaint by individuals living at the home when they have concerns may not occur, we saw that relatives are reminded of the homes complaints procedure on a regular basis (this sent out with annual questionnaires for example). The manager also told us in discussion that staff are reminded to be observant for changes in behaviour that may indicate dissatisfaction on behalf of an individual, this in accord with what staff told us. Issues that have arisen prior to the last key inspection from neighbours have now been resolved with no further complaints received in the last 2 years. There have been no recent complaints received by the home or us recently, although the manager understood the value in complaints as a form of feedback. Well documented behaviour records did show what possible precedents to any behaviours maybe, this an indicator of possible concerns that may exist. DS0000004843.V374890.R01.S.doc Version 5.2 Page 18 The policies and procedures regarding protection of individuals we saw are satisfactory and are readily available to staff. These are supported by copies of the local authorities procedures that are also available to staff in the home, these supported by easy read versions and flow charts as to what actions staff need to take. The manager is clearly aware of when incidents require external input and has demonstrated this in practice when raising safeguarding alerts since the time of the last key inspection, this in accordance with local authority procedures. We noted that the staff record any injuries in individual’s records, these on body maps. The incident of challenging behaviours we also saw is well documented with detail as to the exact behaviours and possible precedents to the occurrence to help with understanding as to any specific trigger or cause. There are behaviour plans in place that followed low arousal techniques meaning that physical restraint would be a last resort, with the preferred method of tackling behaviour verbal redirection. There are limited occasions where physical restraint is used for protracted periods, this a matter that has been discussed with social services. Due to the nature of the challenges we have been informed that the use of such restraint is seen as appropriate although the manager is exploring the use of consultants to carry out assessments and look as to whether other methods to deal with such challenges (that possible endanger other individuals and staff) can be devised. We did note that all staff have received training in MAPA (management of potential and actual aggression), this input identified as a core area of training. Staff are given input in adult protection as a part of their induction although the manager stated in the AQAA submitted to us that she feels some staff could have a better understanding of safeguarding procedures. To this end we noted in some of the supervision records that we have seen that protection and safeguarding are one of the matters discussed with staff. The provision of formal adult protection training from the local social services department in respect of joint agency procedures maybe also be useful. . DS0000004843.V374890.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home presents a comfortable and homely environment that is appropriate for community living. The building is well maintained and spacious, allowing individual’s ample privacy. EVIDENCE: 1 Whitehall Road is a traditional end terraced property adapted for use from a domestic dwelling and as such blends in well with the local community and fits in with the principals of normal home living. There is no indication from outside to indicate that the house is anything other than a domestic dwelling. We saw that the physical environment has been well maintained and is pleasantly decorated inside and out. We saw that there has been on going redecoration to maintain the property with all the premises with the exception of the hallway, stairs and landing redecorated recently. This redecoration has included the fitting of new flooring, new kitchen units and new settees. We saw DS0000004843.V374890.R01.S.doc Version 5.2 Page 20 one individual’s room has been painted with glow in the dark paint and complementary decoration to provide additional stimulation. We saw that there are monthly building audits by the company’s general manager as well as the responsible individuals visits and the former highlights any general issues in respect of building maintenance and repair. The layout of the building allows for individuals to have ample space and privacy, with some bedrooms having ensuites. There are three sitting areas in the home (one next to the kitchen) that allows each individual to have space to themselves when they want it. We saw that bedrooms contained numerous personal possessions, and reflect the individual personalities of the people using them. We saw from servicing records that equipment used at the home was maintained and the certificates for maintenance of the building are up to date. We saw that staff document water temperatures on a regular basis. We saw that the home has reference in some of its risk assessments to infection control practices that cover food cross contamination and laundry. There is scope to further develop an action plan for the home in respect of infection control; this to highlight what the home does to ensure all issues in respect of this area of practice are well managed. We did however note the building was clean, there were no unpleasant odours and personal protective equipment was readily available to staff (this we saw to used appropriately). We also saw documented records relating to cleaning of the property and regular health and safety checks. DS0000004843.V374890.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are available in sufficient numbers to ensure individuals are safe. With little exception recruitment practices protect individuals. Staff are generally well trained with any gaps in such identified by management. EVIDENCE: We have been notified by the manager on a couple of occasions of issues where see judged there have been staffing shortages due to staff having left, sickness and such like although based on the staffing rota’s we saw there was sufficient staff available to ensure individuals living at he home are safe, the main impact been the ability of the staff to ensure community activities were maintained. The manager has however been honest as to the difficulties encountered and is also taking steps through recruitment to ensure that these issues are addressed. At the time of our visit to the home the staffing levels had improved and the recruitment of two additional staff are set to improve the situation further. The manager did however consider the employment of ‘safe ‘ staff as critical, meaning they were only to commence work after receipt DS0000004843.V374890.R01.S.doc Version 5.2 Page 22 of a full enhanced disclosure. The retention of a core group of longstanding staff has however helped with the consistency of care. We saw the homes training plan and this showed that staff have received training in a number of mandatory areas such as first aid, moving and handling. The manager told us there is a need for adult protection training for staff. It was however pleasing to see that training for staff in vocational qualifications is continuing this helped by the company recruiting a dedicated training facilitator and gaining accreditation as a training assessment centre. We also saw (from records) and heard from new staff that the company has an induction that complies with national standards. Staff we spoke to confirmed that they had been given induction folders and had completed these with comment to the fact that they felt well supported through their induction period. The home we have seen has a satisfactory recruitment procedure and from sight of the files for two staff we saw that these evidenced that these procedures are generally followed in practice although one did not have details of their full working history and we discussed with the manager the need to ensure that there is verification of why the person left their last social care employer, the later said to be done but not recorded. The manager stated that there have been some difficulties with a negative attitude from some staff in respect of one to one formal supervision. Sight of records of supervision did however show that these followed a robust format. There was clear evidence that the manager planned for these sessions so that they could be seen as a useful learning tool. DS0000004843.V374890.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is lead by a qualified, competent and motivated manager that ensures the maintenance of good outcomes for individual’s living at the home, this with the assistance of robust quality monitoring. EVIDENCE: The home currently has a recently registered manager that has experience of working at Whitehall Road for a number of years, formerly been the deputy manager at the home. We are aware that the manager has achieved suitable qualifications and discussion with her through the visit to the home showed that she has an excellent awareness of the needs of the individuals living at the home and a genuine enthusiasm to improve the service to the benefit of residents. The manager was also realistic as to the barriers that may prevent DS0000004843.V374890.R01.S.doc Version 5.2 Page 24 the achievement of her aims, but was also able to present solutions and problem solve. It was good to see that she accepted the responsibilities that the post of manager presented and saw the fulfillment of these as key. We discussed the support provided by the company and we were told that the manager has sufficient management time; although there was acceptance that this can be difficult if there are any staffing issues. Outcomes from this inspection do suggest that the manager has, with little exception, managed the home effectively. One area that illustrates this is the involvement in discussing deprivation of liberty safeguards with social services following on from her training in the same. The responsible individual for the company provides supervision for the manager and we saw regular monthly reports relating to their statutory monthly visits to the home, this to check the quality of the service. We have seen evidence that Inshore support has achieved accreditation to the quality standard ISO 9002 and the manager told us that work has commenced towards ISO 4001 (environmental management). We saw that the home has a business plans (available in pictorial format) and the Annual Quality Assurance assessment we received was detailed and informative, with information reflecting what we found at the time of our visit. We saw within the responsible individual’s monthly visit reports that there was a clear trail of issues raised and corrective actions identified to addressed these. The home has a health and safety policy that meets health and safety legislation and requirements. Checks show that health and safety records are generally up to date this including accident reporting. We saw a number of environmental risk assessments that were satisfactory. There is a need to carry out a risk assessment to establish what level of first aid training the home requires however, this to assess the risks present at the home, the needs of the residents, situational factors (such as response times to 999) so that the staff have training that is appropriate to potential risk. We also note that access to one freezer is through the homes laundry area (in the cellar) this needing risk assessing to ensure that transfer of foods does not present any danger. It was noted that there was a need to ensure the temperature of this freezer is also monitored more closely to ensure it maintains an acceptable temperature. We saw that the homes records are overall in good order (see comments re any exceptions) and maintained as such. Input from the responsible individual in respect of such as safekeeping records is seen as a worthwhile safeguard in terms of protecting individuals living at the home. DS0000004843.V374890.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 3 X 2 X DS0000004843.V374890.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. YA1 2. 3. 4. 5. 6. 7. YA30 YA34 YA19 YA19 YA19 YA19 Refer to Standard Good Practice Recommendations To included the possible range of fees for the service in the homes statement of purpose so that this is available to any people looking to access care at the home. To provide staff with input into nutritional training in conjunction with the introduction of robust nutritional assessment tools. To ensure that risk assessment relating to individuals possibly choking, detail what response is expected from staff in the event this should occur. To provide staff with training/guidance on the impact of schizophrenia on an individual’s mental health To devise a policy/procedure detailing how staff are to promote individual’s continence, in accordance with current practices. To develop an action plan in respect of management of infection control. To ensure that the home verifies an employees full working history and the reason they left their last social DS0000004843.V374890.R01.S.doc Version 5.2 Page 27 8. YA42 care employer. To ensure that first aid training is provided in accordance with a risk assessment that is to be carried out to decide what level of training is needed to meet the needs of individuals. DS0000004843.V374890.R01.S.doc Version 5.2 Page 28 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA B1 2DT National Enquiry Line: Telephone: 03000 616161 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. DS0000004843.V374890.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!