Care Home: 10 Melbourne Road

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What the care home does well Information is available to help people decide if this service provides what they are looking for. People`s needs are assessed, so that their care and support can be properly planned. They have detailed, "person-centred" care plans: this means that staff have good guidance about how to support people in the ways that suit them best. Staff encourage people to do as much for themselves as their individual abilities allow. This helps them keep the skills they have and get the chance to learn new things, so as to promote their independence. People are supported each day to do things they value and go to places they like: they are also helped to keep in touch with the people who are important to them. They have opportunities to shop for and prepare their food and choose what they want to eat, so that they can enjoy their meals and mealtimes. They get on well with the staff that look after them. People are treated well, and their rights to privacy and dignity are respected. Staff refer to other professionals, to make sure that people get the advice and support they need to stay healthy and well. People can be confident that their concerns are listened to and taken seriously. They are supported to stay safe from abuse, self-harm or neglect. The service takes care to make sure that people employed to work at the home are fit for their jobs. Staff have regular opportunities for training, to make sure they have the knowledge and skills they need to do their jobs well. The Manager and staff team continue to work hard to develop the service for the benefit of the people using it. Important checks on equipment are carried out regularly, so that people living and working in the home are supported to stay safe. What has improved since the last inspection? One requirement and three recommendations were made at the last inspection: these have all been met. Work to develop people`s care plans continues, so that they get supported in ways they like, and helped to achieve the things they say are important to them. The service continues to develop documents in more accessible formats, to make them easier to understand for people who may have difficulty reading. Work has been done to make sure that people`s rights under new legislation (Mental Capacity Act and Deprivations of Liberties Safeguards) are protected and promoted. One of the people using the service is being supported to explore other options for support and accommodation. This is so his rights are safeguarded and his independence promoted.The service continues to furnish and maintain the house to a high standard, so that people can enjoy the benefits of living in a homely and comfortable environment. The organisation has appointed a full time training co-ordinator, so that staff opportunities for learning and development can be managed more effectively. What the care home could do better: During our visit we noted some maintenance and repair jobs around the house, and these are detailed in the report. However, it should be acknowledged that standards of maintenance and repair remain very high. The staff training and development plan could be improved, to support the organisation`s efforts to manage this more effectively. This will ensure that staff have all the knowledge and skills they need to do their jobs well. Arrangements for formal supervision and appraisal of staff need to improve. This will ensure that they can get all the support they need to do their jobs well. Key inspection report Care homes for adults (18-65 years) Name: Address: 10 Melbourne Road 10 Melbourne Road Halesowen West Midlands B63 3NB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gerard Hammond     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Care Homes for Adults (18-65 years) Page 2 of 28 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 Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 10 Melbourne Road 10 Melbourne Road Halesowen West Midlands B63 3NB 01215013389 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: info@inshoresupportltd.com Inshore Support Limited care home 3 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: 3 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) 3 Date of last inspection Brief description of the care home 10 Melbourne Rd provides long term care to 3 adults with a learning disability, all who are currently male. The house is sited near Halesowen in an established residential area. There is easy access by car to a range of local facilities. Staff also have access to a car for transporting the residents between venues. The house is a large semi detached property that has been adapted for its current use and consists of two living rooms, a kitchen and dining area. There are three single bedrooms one an ensuite. There are sufficient bathrooms and toilets available. The main stated aim of the home is to provide a service that reflects the expectations of the residents: identifying and fulfilling their individual needs by means that are Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 3 Brief description of the care home valued by society; this in order to develop and support individual and personal experiences and characteristics which are culturally valued and maintained. There is a staff group that consists of a manager, senior support and support workers. 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 home should be contacted directly for current information about fees and charges Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The service was last inspected on 05 February 2007. This is the homes first key inspection in the current year 2009-10. We gathered information from a number of different places to help us make the judgements found in this report. The Manager sent us a completed Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment about how well the service is doing, and provides some numerical information about it. We visited the home and met two of the three people that use the service. We sent surveys out to residents, members of their families and to staff working at the home. Unfortunately, we were unable to meet the Manager when we visited the home, as she was absent on sick leave. However, we spoke with the person in charge and other members of staff on duty that day. We looked at records including personal files, assessments and care plans, staff files, safety records previous inspection reports and other documents. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? One requirement and three recommendations were made at the last inspection: these have all been met. Work to develop peoples care plans continues, so that they get supported in ways they like, and helped to achieve the things they say are important to them. The service continues to develop documents in more accessible formats, to make them easier to understand for people who may have difficulty reading. Work has been done to make sure that peoples rights under new legislation (Mental Capacity Act and Deprivations of Liberties Safeguards) are protected and promoted. One of the people using the service is being supported to explore other options for support and accommodation. This is so his rights are safeguarded and his independence promoted. Care Homes for Adults (18-65 years) Page 7 of 28 The service continues to furnish and maintain the house to a high standard, so that people can enjoy the benefits of living in a homely and comfortable environment. The organisation has appointed a full time training co-ordinator, so that staff opportunities for learning and development can be managed more effectively. 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. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to help them decide if this service provides what they want. Their strengths and needs are thoroughly assessed, so that their care and support can be properly planned. They have written contracts, so that all parties are clear about their responsibilities. Evidence: The Manager told us that the home has a current Statement of Purpose and Service Users Guide when she returned the Annual Quality Assurance Assessment (AQAA) to us. We saw pictorial copies of these when we looked at peoples personal files. These documents provide important information about what the service provides and who it is for. We looked at peoples files to check that their strengths and support needs had been assessed. There have been no new admissions to the home since the last inspection. We saw that peoples files contained detailed and comprehensive assessments, and that these have been kept under regular review. This provides a sound basis for planning to meet their support needs properly. We also saw that people had copies of Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: a current contract for their care and support on file. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have detailed care plans so that they get the support they need in ways they like. They are encouraged to take risks responsibly, so they can be supported to stay safe. They get the help and support they need to make choices and decisions about things that are important to them. Evidence: We looked at peoples personal files to see how their care and support is planned and managed. Their records contained detailed care plans, and we saw that these had been kept under review. This means that important information is kept up to date. We also saw that good use is made of read and sign sheets. This helps to make sure that staff keep themselves informed about important changes and developments in peoples plans. We saw that a lot of work has been done to make peoples care plans more personcentred. This helps to ensure that the individual concerned is the focus of the plan at all times. This involves finding out the things, people and places that work / dont Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: work for each individual. Being clear about what they each consider to be their dreams or nightmares helps to make sure they can get the support they want in the ways that suit them best. We saw that care plans were supplemented with pictures. The individuals concerned had helped to choose these, so that they could be directly involved in creating their plans. The people who use this service have high level and complex support needs. We saw that their care plans included guidance about supporting them through episodes of difficult or challenging behaviour. Plans included strategies for preventing such episodes and were drawn up with the involvement of a range of professionals specialising in this area. We saw that plans were supplemented with detailed risk assessments. This helps to ensure that people get the support they need to stay safe. During our visit to the home, we were able to directly observe staff offering choices to people about what they wanted to do for the day, going out and what they wanted to eat and drink. Peoples records provide further evidence that the service is proactive about promoting individuals rights through the Deprivation of Liberties Safeguards, and involving independent advocates and other professionals where this is appropriate. Care Homes for Adults (18-65 years) Page 13 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the support they need to do things they value, go to places they like and keep in touch with the people who are important to them. They can choose what they want to eat each day, and enjoy their mealtimes. Evidence: As reported above, we saw members of staff supporting people to decide how they wanted to spend their day. The complex nature and high level of individuals support needs mean that rigidly structured activity programmes do not suit them best. The home is staffed to provide a minimum of 1:1 support for people to carry out the activities of their choosing on a daily basis. We looked at peoples activity records and saw that they are given the opportunity to go out each day. They use local shops, pubs and restaurants, visit the cinema and use the local library. Staff encourage them to include regular exercise in their routines, Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: with varying degrees of success. One person likes to be particularly active: he goes swimming, out for walks and rides a bicycle. He also goes bowling. Peoples ability to take part in organised activities may be affected by their state of health, mood, behaviour, attention span or ability to concentrate, at any given time. Staff know that they have to be patient and flexible in their approach in order to give people the support they need. We saw that staff were sensitive in the way in which they offered choices to people and encouraged them to do things. Staff work hard at trying to support people to be as independent as their individual abilities allow. They are encouraged to take part in day-to-day tasks around the house, including tidying and cleaning their rooms, preparing and cooking food, and so on. Two people are being supported to develop their skills in managing their money more effectively. The options for one person to move into supported living are currently being actively investigated. Each person meets regularly with his designated key worker to plan activities and discuss any concerns. We saw that people are supported to keep in touch with families and friends where this is possible. One person spends a number of days and nights at his parents home each week. This special arrangement shows that the service is able to respond flexibly to meet peoples needs and wishes. Another person visits his brother on a regular basis. People have also been supported to go away on a holiday of their choosing. We examined the food stocks in the house and saw that these were adequate and included fresh produce. We saw that a main shop for groceries was scheduled for later that day. The home provides a rolling four week menu, which is drawn up in consultation with the people using the service. We saw that records showed that people enjoy a balanced diet, with plenty of variety and choice. A pictorial version of the menu is also available to support choices. The small size of the home means that it is easy to provide alternatives if required. We saw staff asking people what they wanted for lunch and for their evening meal. Mealtimes are flexible, according to each persons preferences. Care Homes for Adults (18-65 years) Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are well cared for. They get the support they need to help them stay healthy and well. Evidence: When we visited the home we saw that people were well dressed in clean clothing of good quality that was age and gender appropriate. It was clear that they had received the support they needed with their personal care and hygiene. We were able to observe interactions between staff and residents. They have a good rapport with each other and are clearly comfortable in each others company. We saw staff give support in a warm and friendly manner, and show sensitivity to peoples moods, needs and wishes. We saw that staff treated people respectfully and recognised their rights to privacy and dignity. Conversations with staff showed that they have a good understanding of what works best for each person and how to engage them effectively. As reported above, peoples care plans are detailed and comprehensive, so that staff have clear guidance about how to give support. Each person has a designated key worker that takes responsibility for ensuring that they are happy with the support they are receiving, on a regular basis. We saw notes of key worker meetings on peoples personal files. These covered making plans for activities, menu Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: and food choices, money matters, relationships, any concerns or worries (as well as what made people happy)and health and fitness issues. All of these things show that the service takes positive action to make sure that people are happy with the support they receive. We saw that people have health action plans in place, so that they get the support they need to keep important appointments. Records show the involvement of peoples doctors and a wide range of health and other professionals in peoples care. We could see that the service makes referrals appropriately and liaises with health and social care agencies, to ensure that people receive the advice, treatment and support they need. Their personal files include records of regular weight monitoring, epilepsy management plans and monitoring, behaviour support strategies and interventions, and monitoring of sleep patterns. Care plans also show that the service has a positive attitude to encouraging people to take regular exercise. In the Annual Quality Assurance Assessment (AQAA) the Manager told us that people have received an annual health check and that staff have completed training in nutrition support. We looked at the way the service manages peoples medication. None of the people currently using it is able to do this independently. Records show that two members of staff are involved each time medication is given. One administers and the other witnesses: this helps to minimise the risk of administration errors. We saw that the Medication Administration Record had been completed appropriately. Most of the medication is dispensed in blister packs, and we could see that it had been given as recorded. We also sample checked medication that is not dispensed in this way: we saw that the stocks held tallied with the record. Staff complete stock checks and medication audits each week. There is a register to show which member of staff is holding the drugs cupboard keys, and a list of specimen signatures of all staff administering medication is kept with the record. The home keeps copies of prescriptions and there is a record of all medication received from and returned to the pharmacy. We saw that written protocols are in place for PRN (as required) medicines, so that staff have clear guidance about when these should be given. We saw records of independent audits carried out by the local pharmacist, showing no problems. All of these things show that the service seeks to follow accepted good practice: this helps to ensure that people get the support they need to stay healthy and well. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns are listened to, taken seriously and acted upon. The service takes positive action to protect people from harm and keep them safe. Evidence: Previous inspection reports show that the home has appropriate policies and procedures in place covering complaints and safeguarding (adult protection). We saw that these are also available in pictorial format. The homes Annual Quality Assurance Assessment (AQAA) shows that no complaints have been received during the past twelve months: we have not received any complaints about this service either. As reported above, the home takes positive steps to consult with people regularly through key worker meetings, to check that they have no concerns. Peoples levels of learning disability and complex support needs mean that formal complaints procedures have limited relevance to them. Staff understand that peoples behaviour, general demeanour or body language provide important insights into whether they are upset or worried about anything, and respond accordingly. The home also consults with peoples families through the quality assurance processes and involving them in reviews where appropriate. These things show that the service promotes an open culture for dealing with peoples concerns and complaints. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: We looked at staff records and saw that the recruitment and selection of people to work at the home is robust. Records included important checks with the Criminal Records Bureau (CRB): these things show that the home takes action to ensure that people working there are fit for their jobs. Staff records also show that staff have completed MAPA (management of potential or actual aggression) training. This teaches them to handle episodes of difficult behaviour and techniques for preventing issues escalating, to promote peoples safety. Records also showed that most staff have completed safeguarding training also. We talked to them about this. All of the staff we spoke to were able to show that they understand the types and different forms that abuse can take. They also showed that they understand their responsibilites and the action they should take in the event of witnessing or suspecting abuse. The Annual Quality Assurance Assessment (AQAA) shows that the service has made one safeguarding referral. This arose as a result of concerns about the relationship and accompanying behaviours of two of the residents. As a result of this, a best interest meeting has been scheduled, so that options to address the issues can be explored. These things show that the service is proactive about ensuring that people get the support they need to be protected from harm and stay safe. Care Homes for Adults (18-65 years) Page 19 of 28 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. People enjoy the benefit of living in a comfortable, safe and homely environment Evidence: Previous reports show that the home is equipped and furnished to a high standard, and this continues to be the case. We looked around the house with a senior member of staff, and people were happy to let us look in their rooms. Each person has his own bedroom, situated on the first floor. These are accessed via the stairway, so the home is not suitable for people with significant mobility support needs. This is not an issue for the people currently using the service. All of the rooms are individual, and people are encouraged and supported to personalise them. We saw pictures and ornaments, peoples own TV, DVD and CD players, and family photographs in evidence. All of the rooms are a good size. One includes en-suite bath, shower and toilet facilities. The other two people have access to their own separate toilet and bathing facilities on the first floor also. The homes office is on this floor as well. Shared spaces on the ground floor include the main lounge at the back of the house, and a smaller lounge at the front. People showed us that they had been busy working Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: with staff to decorate the house ready for Christmas, and were looking forward to the usual festivities. We saw that the settee in the main lounge is in need of repair or replacement, and this was identified in the Annual Quality Assurance Assessment also. The carpet in this room is also in need of cleaning. It has to be acknowledged that the behavioural support needs of the people using this service put additional wear and tear on the homes fixtures and fittings. The kitchen and separate dining room are at the back of the house. We noted that the floor covering in the kitchen was recently damaged and is in need of repair: staff told us that this has been reported. We also saw a warning sign relating to the hot temperature of the water from the tap in the kitchen sink. We recommend that this be fitted with a regulator, to remove the risk of any scalding accidents. It should be acknowledged that people only access the kitchen under supervision, and the likelihood of this is judged to be low. We saw that cleaning materials and potentially hazardous substances were stored securely. The house was fresh, clean and tidy. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Important checks are carried on staff before they start work at the home, to ensure they are fit for their jobs. Arrangements for managing staff supervision need to improve. This is to ensure that they get all the support they need to do their jobs well. Evidence: We looked at staff records to see how recruitment is managed in the service. All of the files we looked at contained completed applications with previous employment histories, written references and checks with the Criminal Records Bureau. They also included statements of employment particulars, and declarations relating to offences and physical health. These things show that the service takes action to ensure that people employed to work at the home are fit for their jobs. The Annual Quality Assurance Assessment (AQAA) shows that seven out of thirteen staff (54 ) hold qualifications at NVQ level 2 or above. Training for staff is managed centrally within the organisation. We saw a training matrix displayed on the office wall, and this provided evidence that training is offered systematically, as shown in previous inspection reports. In particular we noted that there were significant gaps in training for fire safety and food hygiene training. As the Manager was not available on the day we visited, it was not possible to verify whether or not the matrix was fully up to date. Staff confirmed that they received regular opportunities for training and that Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: this was positively promoted within the organisation. The Annual Quality Assurance Assessment (AQAA) shows that a full time training Co-ordinator has now been appointed. It is recommended that the staff training and development plan be developed. This should show (for each member of staff) all training completed and qualifications gained. The plan should show clearly when refreshers are due, and when these are scheduled. This should provide the Manager with an instant overview of staff training and development needs, and assist with planning and management of future training provision. We saw that there were sufficient staff on duty to meet the assessed needs of the people who use the service. As reported above, the high level and complex nature of peoples support needs mean that a minimum of 1:1 ratio is required. Available records for formal supervision were variable, but fell short of the suggested National Minimum Standard (at least six meetings in every twelve month period, pro rata for part-time staff). The small size of the home means that issues tend to be dealt with as they arise on a day-to-day basis, and staff said that they felt well supported by colleagues and managers. However, it is important that staff are supervised formally, with written records kept of each meeting. It is recommended that the arrangements for formal supervision (to include an annual appraisal of performance and development) are reviewed. This is to ensure that staff get all the support they need to do their jobs well. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run for the benefit of people using the service. Their views are actively sought so that these can guide service development. Important checks on essential equipment are carried out regularly, so that people are supported to stay safe. Evidence: Unfortunately, the Registered Manager was on sick leave on the day we visited the home. The Annual Quality Assurance Assessment (AQAA) and the last inspection report show that she is appropriately qualified (NVQ level 4 and Registered Managers Award) and has five years experience of managing the home. The last report shows that she has sound knowledge of how to carry out effective management of the home, communicating a clear sense of direction to the staff, and showing a clear understanding of the needs of the residents. The report also shows that she is seen as approachable and supportive by the staff team. Members of staff we spoke to during our visit confirmed this. In the Annual Quality Assurance Assessment (AQAA)the Manager told us that she enjoys good support from senior managers within the organisation. We saw that reports of visits by them, required under Regulation 26 Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: (Care Homes Regulations 2001, had been completed regularly. There is an established system in place for quality assurance and monitoring of the service, and this is directly linked to the National Minimum Standards for care homes. Records showed that people using the service, their family members and relatives, and a range of professionals involved in their care are consulted regularly. The Annual Quality Assurance Assessment (AQAA) also shows that the organisation holds the Investors in People award. We looked at a sample of safety records in the home. These showed that regular checks and servicing had been carried out on equipment and installations relating to fire safety. Staff complete a health and safety audit in the home every week. Certificates were in place for gas and electricity appliances, and checks on temperatures of fridges and freezers, water outlets and cooked food are done regularly. These things show that the service takes action to ensure that people living and working in the home are supported to stay safe. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 28 Replace the settee in the main lounge area and clean the carpet, so that the high standard of fixtures and fittings in the home is maintained for the comfort of people living there. Repair the floor covering in the kitchen and fit a regulator to the hot water tap in the kitchen sink. This is to ensure that people continue to be supported to stay safe. Develop the staff training plan to include information about all training completed and qualifications gained (with dates) and show when refreshers are due and scheduled. This is to ensure that staff have all the knowledge and skills they need to do their jobs well. Ensure that staff receive regular formal supervision and an annual appraisal of performance and development. Keep written records of all meetings. This is to ensure that staff get all the support they need to do their jobs well. 2 28 3 35 4 36 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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. 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