Care Home: 10 Beeches Road

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 10 Beeches Road 10 Beeches Road Rowley Regis West Midlands B65 0BB     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: Jonathan Potts     Date: 0 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 10 Beeches Road 10 Beeches Road Rowley Regis West Midlands B65 0BB 01215594384 N/A Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Inshore Support Limited Name of registered manager (if applicable) Bhanisha Whiting Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 2 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2 Date of last inspection Brief description of the care home 10 Beeches Road is home for two physically able younger adults who have a learning disability with additional mental health needs. The home is an extended two bed roomed terraced property near the centre of Blackheath, sited in an established residential area. The house offers a choice of lounge areas, a reasonably sized kitchen/dining area and two large single bedrooms, one a full en-suite. The property is generally well presented and is furnished in a domestic style. There is a staff group that consists of a manager, senior support and support workers. Care Homes for Adults (18-65 years) Page 4 of 32 care home 2 Over 65 0 2 Brief description of the care home There are waking staff available 24 hours per day. The manager is responsible to a service manager and directors of Inshore support who have a number of homes of similar size and purpose. The staffing ratio is currently at least one staff member to one resident at day (in house) and one to two at night. The home only accommodates long stay placements and does not accept emergency admissions. The residents are currently male but the home will accept referrals from either gender. The home does not cater for adults with mobility difficulties. The mission statement of the home is to support the individual to attain personal independence, choice and responsibility in a homely environment which expresses unconditional acceptance and tolerance and is committed to friendship and growth The current charges for residency are not at present detailed in the homes statement of purpose. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We carried out this unannounced inspection over one day with the focus on the homes performance against the key national minimum standards for adults. Evidence was drawn from a number of sources and included tracking the care for one of the two individuals living at the home. This involved looking at all the documentation in respect of their care and cross checking this with outcomes, observation of staff practice, discussion with staff, the registered manager and review of staff and management records. We had some limited discussion with one 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. Care Homes for Adults (18-65 years) Page 6 of 32 Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There are areas where there is scope for improvement, the most critical as detailed below: - There is a need for training of staff in respect of Makaton ( to assist development of non verbal communication), the Mental Capacity Act (including deprivation of Liberty and the impact this may have on limitations for individuals), Adult protection and nutrition (the latter to tie in with review of nutritional assessments). Care Homes for Adults (18-65 years) Page 8 of 32 - Medication records need to clarify which member of staff is administering and which member of staff is witnessing the giving of medication and the frequency of administration for any as directed medication. - Staff records should show reasons why they left their last social care employer and verify their full working history, this to ensure that new staff are safe. - There is scope to develop an action plan relating to the management of infection control within the home. - Whilst the provider has achieved ISO 9002 accreditation for 10 Beeches the quality monitoring records we saw show scope for improvement, so as to show clear evidence of review and where appropriate corrective action has been taken. - That first aid training is provided in accordance with a risk assessment that clarifies what level of training is needed to meet the specific needs of individuals. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 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 however appropriate in assisting people to find out about the home in a more direct way. Evidence: 10 Beeches Road was set up to accommodate two 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. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: 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 some adaptation into pictorial format. The aforementioned documents we saw 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 service although this information is not currently detailed in the service users guide or 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 individuals room may be more appropriate, although sight of a questionnaire completed by an individual did indicate that they had seen information about the home in the form of a service users guide. 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 we saw that staff have reassessed the needs of individuals at the home through use of inshore assessment formats. We also saw that there has been input from social services where they have reviewed individuals placements. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and are encouraged to participate in planning the care and support they receive where possible. Evidence: The individuals living at 10 Beeches have a varying degree of communication difficulty that means the staff use a variety of methods to ascertain their preferences and choices. We saw that there are communication plans in place that give simple cues as to how to talk to an individual, this written in a person centred style as is the rest of the individuals changing days book, which we saw one individual had clearly contributed to. There is also use of lifestyle assessments, pictorial information (such as questionnaires, activity plans), and detailed behaviour monitoring records (with this seen as form of communication). Discussion with the manager did indicate that one individual is making more use of non verbal communication (i.e hand gestures) and stated that training of some of the newer staff in such as Makaton would be useful. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Building on the changing days books which give a picture of the individual the home was seen to have detailed individual plans that cover a wide range of the individuals needs that are drawn from 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 however note that whilst it is the homes policy to have staff sign to say they have read and understand these plans many of the staff have not signed. The manager stated she was aware of and dealing with this. 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 also saw that the individual plans reflect the homes assessments. Tracking of areas of one individuals 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 with these taking into account the individual needs of the service users, with regular reviews of the individual plans and risk assessments. We saw that there is clear detail of limitations within case files although the home does need to consider the possible impact of the mental capacity act and deprivation of liberty in reviewing these limitations. The manager was aware of the changes in the mental capacity act and stated that she was booked on training. One member of staff has had training in the same. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience 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 services are able to make choices about their lifestyle and are supported to develop their life skills. Social, educational, cultural and recreational activities are provided that cater for individuals expectations with choices offered by staff on a daily basis. Evidence: We saw during the course of our visit to the home that staff do encourage individuals to have involvement in daytime activities that they enjoy and choose with the support of staff. We saw one individual assisted to chose activities through options given to them by staff. We saw that there are pictorial activity guides for both individuals living at the home on clear display in the homes dining area. We saw staff spending time with the other individual and based on facial expressions/body language and the fact that they were participating we judged that they were enjoying the activity. The Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: activities the indivdiuals were involved in at the time of our visit matched those detailed in the activity plans, these plans including a range of activity that included exercise (through such as trampolining) and domestic routines (laundry). 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. We did note that there is some flexibility within this however and we saw staff offer individuals choices on a number of occassions. We saw that where there were restrictions in place (such as staff opening mail) there was a written agreement in place signed by the individual or representative. We saw in the individual plans that there is detail as to how the home will maintain contact between individuals and their relatives. This involves where necesary, taking an individual in their car to their relatives home. We saw from records that this was clearly recorded and reflected the individuals activity plan. There is scope for relatives to visit the home and we saw that the homes visitors policy is on clear display, and would be accessible to any visitors. The staff have ascertained residents likes and dislikes based on the foods they chose to eat and the records of foods provided to residents showed that the menu is varied with a number of choices including healthly options. The meals are balanced and nutrional and cater for the varying dietary needs of the individuals . We saw that the staff do involve individuals in discussion as to their choice of foods, this when we saw and heard staff offering individuals options. The meals we saw served during the time of our visit were appropraite with such as ample fibre in the diet. Sandwiches that we saw prepared at lunchtime were available in good portions and complimented by salad and fruit. We discussed nutrition with the manager and she said that they had given thought to how to encourage healthy eating, this through such as fruit yoghurts and smoothies which the individuals living at the home enjoyed. As people are given a choice the homes menu is seen as a guide rather than a set menu, this appropraite in such as small home. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individually assessed needs, and staff in response to individuals respect their dignity and privacy. Evidence: We saw the home has suitable procedures in place in respect of the promotion of effective personal care. The homes policies and procedures set out how the service is to address these. We saw that the individual plans set out what peoples personal and healthcare needs are and detail how they are to be met by staff at the home. From observation we saw that staff are aware of, and we saw respect, individuals preferences. They allow them to make choices, this through verbal and non verbal communication, the latter used to confirm choices given. The home now has more male carers which helps as all the residents are male, thus allowing individuals choice in respect of such as intimate personal care like bathing. 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 Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: such as nutrition would be beneficial. Questionnaires the home has given to one of the individuals at the home confirm that the staff staff treat him with dignity and respect and call them by their preferred name. The care plans we saw set out how the staff are to promote independence through encouraging individuals to be involved in their own care, this as we saw and as was documented in monitoring records. We saw from records that the home is proactive in maintaining individuals access to community healthcare services and have responded to health related issues as identified in individual plans. Whilst nutritional assessments could be more robust (with use of such as B.M.I. and MUST to identify if there is an issue based on weight and height) there was clear evidence that the staff monitor weights on a regular basis. The manager and staff in discussion showed a good awareness of what the individuals health care needs are although we did note that there was no joint health action plan completed with the local 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 PCT, although with no success to date. The home has developed an efficient medication policy and procedure as well as practice guidance. 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. Neither of the individuals living at the home is able to self medicate safely although as far as possible their consent and that of their representative has been 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 paracetamol and cough mixture. We looked at medication records and found these to be mostly 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 are signing to evidence administration and which is the witness. The home does regular checks on medication, with documented records of the same kept, as we saw, although there has been no recent audit by the contracted pharmacy, this a matter that the manager was pursuing. We found one loose label for medication which the manager disposed of at the time. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: We also noted that there was one prescribed cream that was written up to be administered as directed. The manager needs to clarify with the pharmacy or G.P. as to the exact frequency this should be administered. Whilst the home does not currently hold controlled medication the manager has identified the need to consider more secure medication storage in case individuals medication changes. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 have access to methods by which they can express dissatisfaction and the homes practices ensure that they are 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 questionnaire completed by one individual did however indicate that they knew who to complain to if they had a concern. Behaviour records did show what possible precedents to any behaviours may be, this understood by staff to be another indicator of possible concerns that may exist. The incident of challenging behaviours in comparison to previous years it was stated by the manager has decreased, written ABC records looked at for the last 2 months supporting this contention. 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. The manager is clearly aware of when incidents require external input with it noted that there has been a recent Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: issue due to a complaint, that led to the home making a safeguarding referral in accordance with local authority procedures. Discussion with the manager and another staff member showed that they had a good awareness of what steps to take in the event a safeguarding matter arose. We noted that the staff record any injuries in individuals 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 staff understanding as to any underlying 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. Staff are given input in adult protection as a part of their induction although we saw that only four staff have received formal adult protection training based on the homes training plan. All staff have however received MAPA (training in management of aggression). Discussion with the manager indicated that a better awareness of the implications of the mental capacity act would be beneficial this to include input on the changes to this act in respect of deprivation of liberty. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience 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 individuals living there ample privacy. Evidence: 10 Beeches Road is a traditional 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, with some areas redecorated recently such as the one individuals bedroom. The home also has a new cooker and vaccum cleaner. We saw that there are monthly building audits by the companys general manager this supporting the responsible individuals visits. The former highlights any general issues in respect of building maintenance and repair, such an audit been carried out at the time of our visit. The manager has identified the areas where redecoration and refurbishment is needed but did state in the AQAA that staff at the home should have more say in the furniture purchased so that it is appropraite for the home (i.e colour co-ordinated). It was stated that at present the general manager chooses the furniture. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The layout of the building allows for individuals to have ample space and privacy, both having their own large bedrooms and individual downstairs lounges sharing a kitchen/dining area. We saw that bedrooms contained numerous personal possessions, these consistent with those we found recorded on inventories when sampled. 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 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 with the exception of one occasion when not worn for food preparation, this corrected at the time). We also saw documented records relating to cleaning of the property and regular health and safety checks. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience 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 support people that use the service and recruitment practices generally protect individuals. Areas of training needed have been identified by the manager. Evidence: From sight of staff rotas and comparison of these with the staff on duty at the times of our visit we saw that there is sufficient staff to cater for the assessed needs of the individuals living at the home. At the time of the visit there was 3 staff and the manager on duty and discussion with the manager in respect of staffing indicated that the use of staff at another of the companies homes of similar size and purpose that the manager has responsibility for has allowed for staff to be interchangeable in times of staff shortage, this avoiding the need for agency staff. The manager did state that she had some concerns with staff turnover last year and was looking at ways in which they could monitor this, and the reasons why, this so as to identify any possible trends. We saw the homes training plan and this showed that staff have received training in a number of mandatory areas such as first aid, food hygiene and moving and handling. Areas identified as needed included race and disability, supervision (for seniors) and deprivation of liberty. We also noted the need for adult protection training for staff. It Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: was however pleasing to see that that the home has well in excess of the required level of vocational training for staff, this including NVQ level 2 and 3. From discussion with the manager we have been made aware that the company now has its own training officer and is an accredited 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 were working through these and had, or were going to attend a weeks induction training. 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. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been some flux in the management of the home due to the manager having extended leave although this has clearly not had any detrimental effect on the maintenance of good outcomes for individuals living at the home. Clarity in respect of the quality assurance auditing process could be clearer so as to demonstrate the overall positive outcomes we found. Evidence: The home currently has a registered manager that has experience from working within the providers homes for a number of years at a senior level and is currently managing 10 Beeches and another small home in the immediate locality. We discussed with the manager as to whether she had attained an appropriate management qualification and she said that due to her leave completion of this had been interrupted. Completion of this should now be seen as a priority. There was some concerns expressed as the manager had not long returned from extended leave, with some difficulties encountered on her return in respect of Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: handover of information. It was felt that the handover to her on her return could have been more comprehensive although she felt that she was now in a better position as had now had chance to catch up with the developments that had occurred in her absence. The manager is supported by a deputy in management of the two homes, with them usually working at opposite sites/differing times. The only concern that we had was that there may be insufficient time for handover between the two of them and that this needs to be built in to the management rota. The manager was however confident that this issue would be addressed in time. The manager in discussion was however knowledgeable as to the needs of the individuals living at the home and any potential barriers to the smooth running of the service as well as current national developments. 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. The manager was aware of the need to ensure continued training of staff in mandatory areas related to safe working practice. The outcomes in respect of the service to individuals we have seen is positive however and standards have been maintained by staff. We have seen evidence that Inshore support has achieved accreditation to the quality standard ISO 9002, although the evidence of quality monitoring we saw at 10 Beeches could be better, as the homes Quality assurance checklist, that bench marks its performance against a range of standards (based on national minimum standards), did not carry an audit trail, such as dates when standards were assessed, what evidence was used etc. The manager did tell us that the way the company is looking to assess quality standards is under review and this will involve the home benchmarked against the overall standards drawn from such as company wide customer and stakeholder feedback. We saw that individuals views are obtained through such as questionnaires (these available in pictorial format), meetings and day to day communication. Discussion with the manager, this also confirmed in part by the AQAA we received from the home, did highlight that they are aware of the strengths and weaknesses of the service, and had strategies to address these. We did see a business plan that the home had produced which was acceptable. 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 however 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 Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: present at the home, the needs of the residents, situational factors (i.e response times to 999) so that the staff have training that is appropriate to potential risk. 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. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 To clarify the frequency of administration for any as directed medication. This is so that it is clear as to the exact frequencies prescribed medications (including creams) should be administered. 31/05/2009 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 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 services. To provide staff with makaton training or similar to assist understanding of, and development of non verbal communication with individuals. To review limitations for individuals in light of changes to the mental capacity act. To provide staff with input into nutritional training in conjunction with the introduction of robust nutritional assessment tools. 2 6 3 4 7 19 Care Homes for Adults (18-65 years) Page 30 of 32 5 20 To clarify in medication administration records which member of staff is administering and which member of staff is witnessing the giving of medication. To ensure that all staff have formal training in adult protection, preferably sourced from the local social services department if possible. To ensure that the home verifies an employees full working history and the reason they left their last social care employer. To ensure that quality assurance records show a clear audit trail in respect of audits and corrective actions taken as a result. 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. 6 23 7 34 8 39 9 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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