Care Home: 11 Station Road

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What the care home does well Staff spend time talking to the people living in the home in the way they understand so that they feel valued.Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals.There are lots of different activities on offer so that people lead an active lifestyle that they enjoy.Staff help the people living there to keep in contact with their families and the people that are important to them.People have a choice of meals that they enjoy.Staff make sure that people get the medication they need when they need it to help to meet their health needs.There are good procedures to listen to people and keep them safe from possible harm.The home is clean and well decorated so it is a nice place to live.Staff have training to help them understand how to protect the people living there from harm. What has improved since the last inspection? In addition to the use of photographs the home has also started to use video to evidence how people make choices.One person now has their own wet room that meets their mobility needs to help them be as independent as possible when showering. Staff have had more training so they know how to help people to meet their individual needs.An additional manager has been recruited to oversee the night staff. This will help to ensure their is more managerial support for people and staff at night times. Individual fire evacuation plans have been completed so that staff have the information they need on how people should be supported to stay safe should a fire occur. What the care home could do better: Only one requirement was made following this inspection. This was to make sure one of the medication cabinets was secured to the wall to make sure medication could not be taken from the home. Some recommendations were made following the inspection and these are detailed below. Information about the fees to live at the home should be updated so that people have all the information they need to make a decision about living there.Expand information about one person`s epilepsy needs in their care plan and risk assessment to make sure staff have detailed information on how to meet their needs. Improve the frequency of monitoring of fridge temperatures to make sure food is stored within safe temperatures.The fire alarms in the home needed to be checked on a weekly basis and records of the checks retained. This will ensure people are safeguarded should a fire occur. Key inspection report Care homes for adults (18-65 years) Name: Address: 11 Station Road Station Road, 11 Kings Norton Birmingham West Midlands B38 8SN The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter Date: 2 5 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 37 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 37 Information about the care home Name of care home: Address: 11 Station Road Station Road, 11 Kings Norton Birmingham West Midlands B38 8SN 01214598899/2822 01214598149 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.sense.org.uk Sense, The National Deafblind and Rubella Association Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 9 Number of places (if applicable): Under 65 Over 65 9 9 0 0 learning disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 9 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) 9, Sensory impairment (SI) 9 Date of last inspection 0 4 0 9 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home 11 Station Road is a registered care home, owned and managed by Sense, which is a voluntary organisation supporting people with dual sensory impairment and associated disabilities. It is located in Kings Norton, Birmingham and is close to a variety of shops, public transport and community facilities. The home comprises of 3 flats with two bedrooms, and 3 flats with one bedroom. All flats are self-contained and each bedroom has an en-suite bathroom. Care Homes for Adults (18-65 years) Page 5 of 37 The home also provides a communal lounge and kitchenette and a separate laundry room. There is a small staff office on the ground floor and a staff sleep in room, which is currently also being used as a working office on the second floor. There is a large communal bathroom on the ground floor, which would be suitable for someone with additional physical needs. There is a large, landscaped garden to the rear of the building with features to aid access for deaf blind people. Copies of the homes previous reports are available in the home for people to read. Care Homes for Adults (18-65 years) Page 6 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home to carry out the homes main inspection. We visited the home over one day, the home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We talked to people using the service but some were unable to tell us about the home due to their communication needs. We asked staff about these peoples needs. Care Homes for Adults (18-65 years) Page 8 of 37 We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at some areas of the home, staff and health and safety records. We sent surveys to people who live at the home, their relatives, staff and care professionals so they could tell us what they thought about the home. However not everyone returned a completed survey to us. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 37 Staff spend time talking to the people living in the home in the way they understand so that they feel valued. Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals. There are lots of different activities on offer so that people lead an active lifestyle that they enjoy. Care Homes for Adults (18-65 years) Page 10 of 37 Staff help the people living there to keep in contact with their families and the people that are important to them. People have a choice of meals that they enjoy. Staff make sure that people get the medication they need when they need it to help to meet their health needs. There are good procedures to listen to people and keep them safe from possible harm. Care Homes for Adults (18-65 years) Page 11 of 37 The home is clean and well decorated so it is a nice place to live. Staff have training to help them understand how to protect the people living there from harm. What has got better from the last inspection In addition to the use of photographs the home has also started to use video to evidence how people make choices. Care Homes for Adults (18-65 years) Page 12 of 37 One person now has their own wet room that meets their mobility needs to help them be as independent as possible when showering. Staff have had more training so they know how to help people to meet their individual needs. An additional manager has been recruited to oversee the night staff. This will help to ensure their is more managerial support for people and staff at night times. Individual fire evacuation plans have been completed so that staff have the information they need on how people should be supported to stay safe should a fire occur. Care Homes for Adults (18-65 years) Page 13 of 37 What the care home could do better Only one requirement was made following this inspection. This was to make sure one of the medication cabinets was secured to the wall to make sure medication could not be taken from the home. Some recommendations were made following the inspection and these are detailed below. Information about the fees to live at the home should be updated so that people have all the information they need to make a decision about living there. Care Homes for Adults (18-65 years) Page 14 of 37 Expand information about one persons epilepsy needs in their care plan and risk assessment to make sure staff have detailed information on how to meet their needs. Improve the frequency of monitoring of fridge temperatures to make sure food is stored within safe temperatures. The fire alarms in the home needed to be checked on a weekly basis and records of the checks retained. This will ensure people are safeguarded should a fire occur. Care Homes for Adults (18-65 years) Page 15 of 37 If you want to read the full report of our inspection please ask the person in charge of the care home. If you want to speak to the inspector please contact Kerry Coulter West Midlands Region Citygate Gallowgate Newcaste Upon Tyne Ne1 4PA Tel 0300 616161 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 16 of 37 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 17 of 37 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 most of the information they need so they can make a choice as to whether or not they want to live there. A full assessment of peoples needs is completing before they move in so they can be sure that the home can meet their needs. Evidence: We looked at the information available for people wishing to move into the home to see if they would be able to make a decision based on the information provided. The information can be made available in different formats, written, CD Rom, audiotape, and picture form to ensure people identified needs have been accounted for. The service users guide tells people what service is provided and by whom, what qualifications the staff hold, the history of the organisation and what the person moving in to the home can expect. People have their own copy of the guide that has information personal to them regarding how much it costs to live at the home. However information on the range of fees to live at the home should be included in the general guide so that people thinking of moving to the home have a general idea of how much it costs to live Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: there. One person has moved into the home since we last visited the home. Records and discussions with staff showed that a full assessment of the persons needs had been completed before they moved to the home. The persons family had the opportunity to be involved in this. The assessment was very detailed and person centred, taking into account their personal preferences. Care Homes for Adults (18-65 years) Page 19 of 37 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. Staff have the information they need so they can support people in the way that the individual chooses so ensuring their safety and well being. Evidence: The records of two of the people living there were looked at. These included an individual care plan that stated how staff are to support the person to meet their needs and help them achieve their goals. There was good information in care plans giving details about the person needs and how the choice of each person was to be met by staff. The information in each persons care plan enables a consistent approach to the support given. One persons care plan recorded that they had epilepsy. Their care plan would benefit from more information about the support they need should a seizure occur. There was excellent information about what the person likes and dislikes which is important as the people living in the home have difficulty with communicating their needs. Evidence was available to show that people are involved where possible in their care Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: planning meetings. For one person we saw photographs of them choosing who they would like to participate in their person centred planning meeting. There were also photographs of the person undertaking their person centred planning with staff. The annual quality assurance assessment told us that in addition to the use of photographs the home has also started to use video to evidence how people make choices. Daily records gave information about the person daily activities, such as going out, what activity they had completed during the day and most importantly how they had been in themselves. Each person has a core team of staff who meet on a monthly basis to review the well being of the person and ensure their care plans are up to date. People living at the home are generally unable to communicate verbally and so staff have to use alternative methods of communication with people. Peoples care plans have some good information about the support people need to make choices for themselves. Staff spoken with had a good understanding of peoples communication methods. We saw staff assisting people to make choices for themselves during our visit using a variety of different communication methods. For example one person was shown pictures of two different activities for them to choose from so they could spend their afternoon doing what they wanted to. One person told us that they had chosen to have a lie in that morning and that it had been nice. Records included individual risk assessments that stated how staff are to support people to take risks in their day to day lives whilst ensuring that they can be as safe as possible. Risk assessments had been completed for activities such as swimming and rock climbing and for areas of risk such as choking, challenging behaviour, the use of physical intervention, accessing the kitchen, health needs and accessing the community. One person had a risk assessment regarding their preference to spend time alone. The assessment did not take account of the persons epilepsy however the specified frequency of checks directed in the assessment should help to keep the person safe. Care Homes for Adults (18-65 years) Page 21 of 37 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. Arrangements ensure that people living there experience a meaningful lifestyle that ensures their self-esteem and well being. People are offered a healthy diet and enjoy their meals. Evidence: Care plans sampled stated the leisure and social activities that people enjoy and how much staff support they need to be able to do these. There was a weekly activity plan in place for both people whose care was being tracked. During our visit we saw staff offering people choices of activities they wanted to do, using communication aids such as pictures of the activity. There were numerous pictures around the home showing people taking part in their planned activities. Records sampled and discussion with staff confirmed that the people living in the home participate in a broad range of valued and fulfilling activities that reflect their preferences and are appropriate to their needs. These included going out for meals, rock climbing, swimming, shopping, visits to parks, going to Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: the pub, day trips and cooking. People also have the opportunity to go to Church if they want to. It is an area of good practice that staff at the home undertake an evaluation of the activities people participate in. This helps them to make sure people are enjoying the activities provided. One person told us that he had been on a day trip to Weston Super Mare and had really enjoyed it. The home has three vehicles to transport people to activities, some people also use public transport to assess community based activities. Records and discussions with staff show that people who enjoy going on holiday are offered the opportunity to have one. This is planned with staff taking their wishes and preferences into consideration. Records and discussions with staff show that a high importance is placed on promoting and maintaining contact with peoples relatives. Care files included information of when staff were to send birthday cards and so on to family members. All contact with families was detailed on personal files. SENSE also has a family liaison officer whos role it is to facilitate working with families. They have held a family weekend at a local hotel in the past and this provides an opportunity for relatives to keep up to date with SENSE plans, meet with staff and other relatives. Peoples food likes and dislikes are recorded in their care plan. We looked at the menus for the home and these showed that meals are varied, culturally appropriate and nutritious. People were involved in making choices about the meals they want. They are involved in the shopping and preparation of the meals with support by the staff in their own flat, so maintaining their independence as much as possible. Records of food intake were maintained and people weighed on a regular basis to monitor that they were taking a nutritious diet. Care Homes for Adults (18-65 years) Page 23 of 37 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 needs of the people living there are met so ensuring their well being. Evidence: People live in their own flats and staff provide support on an individual basis, so providing the level of care they require. The majority of staff were supporting people in a manner that reflected they were adults. However on some occasions one staff called the person they were supporting a good boy. Information about the support people required in order to maintain personal hygiene was included in their care plan. The people living there were well dressed in appropriate styles to their age, gender, cultural background and the activities they were doing. Attention had been paid to individuals personal care indicating that people had the support they needed so ensuring they felt good about themselves. We looked at the health records for two people. Each person had their own health action plan so that staff know what support they need to keep healthy. It is good practice that due to some peoples limited verbal communication care plans detail how the person might alert staff to them being unwell. Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: Records sampled showed that health professionals are involved in peoples care where needed. Records showed and staff said that they work with other professionals to ensure individuals well being. People attend health check ups with the dentist, optician and chiropodist to ensure their health needs are met. We saw records for one person that showed they had complained of toothache. Evidence was available to show that this had been acted on by staff and dental treatment obtained. There was a chronological record of interventions by health care professionals and outcomes were usually recorded. We found one omission where it was recorded that the GP had requested a urine sample from the person. There was no follow up information about this. Staff told us that this was because they had been unable to get a sample. This needs to be recorded. Individuals weight was being monitored and eating and drinking screenings were undertaken and any particular needs in relation to diet were detailed. One person who had recently moved to the home had been weighed by the practice nurse. Their records need to show if this weight is healthy or not so that staff can make sure the appropriate action is taken if they are over or underweight. The Annual Quality Assurance told us that the home had been successful in helping two people to lose weight as part of a weight loss programme. We looked at the records for one of these people. This person had managed to lose a significant amount of weight over several years and had now been discharged from the dietitian service. Peoples medication is stored in a locked cabinet in each persons flat. In one of the flats the cupboard was not secured to the wall and the manager was not aware of this. When we brought this to their attention they told us they would arrange for the cabinet to be secured. At the front of each persons Medication Administration Record (MAR) there is a photo of the person so that unfamiliar staff would know who to give the medication to. There are also clear directions on how each person likes their medication to be administered. MARs sampled had been signed when medication had been given indicating that medication had been given as prescribed. Protocols were in place for people who are prescribed medication on as required basis. This means that staff have information about why and when this medication needs to be given. The majority of staff at the home have received training in administering medication, and only staff who have had training give medication. Care Homes for Adults (18-65 years) Page 25 of 37 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. Suitable arrangements are in place to deal with any complaints, concerns or allegations that are raised with clear policies and procedures, so ensuring people are protected. Evidence: The home has a complaints procedure in place. This can be made available in a variety of different formats to include pictures and compact disc. As well as being able to report concerns directly to the managers SENSE also provides a freephone number for people to use to report any concerns they may have. The care plans for the people living in the home detail their abilities in relation to raising concerns. There was also detail of how staff would know if any of the people living in the home were unhappy. Because of some peoples level of understanding and communication needs people generally rely on staff and relatives to pick up on when they were unhappy via their behaviour or body language. We have not received any complaints directly about this home in the last twelve months. The homes complaint log recorded that they had received one complaint, however this did not relate to the care provided by the home. Records had been kept of what the home had done in response to the complaint. There is currently an ongoing adult safeguarding issue at the home. SENSE notified us of this and have followed the local authority multi agency guidelines in response to the issue to ensure people are protected from the risk of abuse. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: Systems in place to safeguard people from the risk of harm show that this is given high importance. As stated previously a national freephone number is provided to people where they can raise concerns if they wish to, as well as using the usual channels within the home. SENSE has a national team that monitors all incidents of reported abuse and there is a regional investigations officer in post. Records sampled show that staff have all received training and also complete an annual questionnaire about safeguarding people to make sure they know how to do this. This could be improved if one of the managerial team signed the questionnaire to show if staff had completed it satisfactorily or not. Staff spoken with during our visit knew what to do to keep people safe if they suspected someone had been abused. However a few days after our inspection an incident occurred that should have been reported to us and the local authority under safeguarding procedures. This was not reported as quickly as it should have been and it was reported to us by the general manager on their return from annual leave. The general manager has told us that the reasons for the delay in reporting will be investigated. The organisation had clear guidelines in place in relation to challenging behaviours to ensure the people living in the home were safeguarded. Staff have training in relation to managing challenging behaviours where they learn safe and non harmful control and restraint techniques. The staff at the home also had the support of a behaviour management team that advised them on how to manage any presenting behaviours. The finance records of one of the people living there was looked at to ensure that their money was being looked after appropriately and was safe. Receipts were kept of all purchases, these matched the amounts stated on the individuals finance records. Staff check that peoples money is correct at the change over of each shift and regular audits are completed by the providers representative. Care Homes for Adults (18-65 years) Page 27 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a generally clean, well decorated and safe home that meets their individual needs. Evidence: The home consists of six separate self contained flats. Each flat is self contained providing a lounge/dining room, separate kitchen, a bedroom and en suite bathroom facilities all with baths/showers. One persons ensuite has recently been converted to a wet room to meet their mobility needs. In addition to the flats, there is a large communal dining/recreation room and kitchen and also separate toilet with communal shower area. The home was at a comfortable temperature and no unpleasant odors were noticed. The home was seen to be well maintained. Bedrooms were decorated and personalised according to each persons preferences and needs as recorded in their care plan. Some people had bedrooms with lots of personal effects whist others had rooms that were quite sparse. One person showed us their bedroom which was quite sparse in appearance, however they indicated they were happy with their room. Their preference for this was recorded in their care plan. The home provides a physical environment that meets the specific needs of the people Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: who live there. Tactile images are provided around the home and there are colour changes to handrails, sockets and light switches making them more visible to people with sight impairment. We found that in general the home was clean and infection control procedures were in place to include satisfactory hand washing facilities. Worktops in one of the kitchens are now a little tatty in appearance. Some areas of the laminate is chipped exposing the chipboard beneath. This makes these areas difficult to fully deep clean and do not promote good infection control. Staff spoken with told us that the kitchen has already been measured up for new units and worktops to be fitted. The homes Annual Quality Assurance Assessment also recorded that plans were in place to replace two kitchens in the home. We looked at the records of fridge temperature monitoring in two of the flats. In one of the flats these were being done daily but in the other flat the frequency needed to improve to make sure food is being stored at a safe temperature. Care Homes for Adults (18-65 years) Page 29 of 37 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. The arrangements for staffing, their support and development ensure that the needs of the people living there are met. The recruitment practices help to ensure that the people living there are safeguarded from abuse. Evidence: Staff skills and knowledge about the people they were supporting were evident throughout observations during the inspection. More than half of the staff team have an National Vocational Qualification in Care. This helps to ensure staff have the right skills and qualifications to meet the needs of the people living there. Staff were pleasant and helpful throughout our visit to the home. During the waking day there are at least seven staff on duty and at least four staff on duty overnight, staffing arrangements at the time of our inspection appeared satisfactory to meet peoples needs. Where there are any shortfalls in staff these are usually covered by regular staff or SENSEs own casual staff, so ensuring continuity of care to people. Surveys received from staff indicate there are usually enough staff on duty to meet peoples needs. The recruitment documentation for two new staff was sampled. All the required documentation was available and this showed that all the appropriate checks had been undertaken before the person had started work at the home. This included evidence that Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: a satisfactory Criminal Records Bureau (CRB) check had been completed to help ensure that people are not put at risk of having unsuitable staff working with them. Induction training for new staff was organised centrally by SENSE and includes areas such as protection, first aid, equality, values, diversity, working with deaf/blind people, communication manual handling, medication, challenging behaviour etc. Staff also complete modules over the six month period that have a question and answer section. Staff also undertake an induction into the home and receive a starter pack and this was recorded for a new member of staff. Surveys received from staff indicated they were happy with the training on offer. The training matrix for the home indicated staff had undertaken training in numerous topics including manual handling, health and safety, first aid, food hygiene, care of medicines, infection control, protection and fire safety. Staff also undertook training in topics specifically related to the people they were caring for such things as communication, challenging behaviour and working with deaf blind people. Where there were gaps in training staff had been booked to attend the training they needed. Training records did not show that staff had received training about epilepsy. However staff said they had training and sampled supervision records supported this. Staff meeting minutes showed that regular meetings are held so that staff know about any changes to the needs of the people living there and within the organisation. Staff receive supervision but records show that previously this has not always been regular. However in recent months action has been taken to make sure staff have regular supervision. Regular supervision is important for staff as it enables them to reflect on practice and identify their training and development needs. Care Homes for Adults (18-65 years) Page 31 of 37 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. Management arrangements usually ensure that the home is well run and in the best interests of people living there. Evidence: Currently the home is without a registered manager and a general manager was taking overall responsibility. Discussion with the general manager indicates that the manager of the home is due to return from secondment in October and that they will then be applying to be registered with us. The management arrangements in the home usually consists of a registered manager who oversees the whole complex and three unregistered managers who have responsibility for two flats each. Recently an additional unregistered manager has been recruited who will oversee the night staff. The home was running smoothly and the staff were confident in their roles and were able to answer any questions asked of them. Staff were very aware of the needs of the people living in the home and ensured the home was run in their best interests. Whilst the home is usually well managed, as stated earlier in this report a safeguarding incident was not Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: reported as quickly as it should have been during the time the general manager was away from the home on annual leave. We received the homes annual quality assurance assessment when we asked for it and this was completed to a good standard, recording where the home intended to make improvements. A representative of the provider visits the home, usually on a monthly basis to assess the quality of the service provided. Reports made following each visit were very detailed and showed consultation with staff and observation of care practice in the home. The general manager usually undertakes these visits. They have recognized that as they are currently overseeing the home in the absence of a registered manager it would be more appropriate for someone else to carry out these visits. Therefore the last visit to the home was undertaken by a different general manager. The home has an extensive quality assurance system with self assessment and audits of all areas. Recently audits have been undertaken for health and safety, financial and staff recruitment files. Every two years a full quality assurance assessment is undertaken, people, staff, relatives and care professionals are consulted as part of the process. Recently the home used a staff suggestion box and minutes of staff meetings showed that staff suggestions and been listened to and where appropriate, acted on. The health and safety of the people living in the home and the staff were usually well managed. Staff received training in safe working practices and the home was safe and well maintained. The AQAA indicated that the servicing of the equipment in the home was up to date. The in house records for the checks on the fire system were sampled. These were generally up to date however it was noticed that there was the odd occasion when the fire alarm had not been tested weekly. The general manager was aware of this and had brought it to the attention of the staff but practice now needs to improve. Staff check the temperatures of the hot water regularly to make sure that people are not at risk of being scaled. Records showed that temperatures were safe. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 37 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Ensure medication cabinets are secured to the wall. 30/09/2009 To make sure the cabinet and medication cannot be easily taken from the home. 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 The service user guide should be updated to make sure that people interested in moving to the home have information about the range of fees to live there. Expand information in one persons care plan regarding their epilepsy so that staff have the information they need to meet their needs. Expand information in one persons risk assessment regarding their epilepsy to make sure staff have all the information they need to keep them safe. Review systems in place to help to ensure safeguarding 2 6 3 9 4 23 Care Homes for Adults (18-65 years) Page 35 of 37 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 incidents are reported to us and the local authority quickly in line with safeguarding procedures. To help ensure people are fully protected from abuse. 5 30 Improve the frequency of monitoring of fridge temperatures to make sure food is stored within safe temperatures. The fire alarms in the home need to be checked on a weekly basis and records of the checks retained. This will ensure people are safeguarded should a fire occur. 6 42 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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