Care Home: 1101 Bristol Road

What the care home does well There had been little staff turnover at the home which was good for the continuity of care for the people living in the home. Staff had received training to ensure they could care for people safely. People had good care and rehabilitation plans in place with good guidelines for staff to follow to help people meet their aims and lead independent lives. People were safeguarded by the robust risk assessments that were in place. There were good opportunities for people to socialise and take part in a variety of activities ensuring they led fulfilling lives. Wherever possible ongoing contact with family and friends was enabled and encouraged if this was what people wanted. The people living in the home took part in planning the menus, shopping for them and helping to cook wherever possible. The menus were varied and nutritious and people confirmed they were changed when they requested. Cultural diets were catered for when necessary. The people living in the home were listened to and their views were acted on. The home was well managed and in the best interests of the people living there. What has improved since the last inspection? Care plans had been further improved and included more details about the preferences and abilities of the people living in the home ensuring they received person centred care. The issues raised at the last inspection in relation to the management of medication had been addressed ensuring people received their medication as prescribed. Some of the people living in the home had been put on the electoral role so they were able to exercise their rights to vote. The ground floor of the home had been refurbished due to flooding and provided people with a very good standard of accommodation. A comprehensive quality monitoring system had been put in place to ensure the home was being run in the best interests of the people living there. What the care home could do better: The manager should ensure that all the information available for staff about how to support the people living in the home is current and consistent. This will ensure people receive consistent person centred support. Staff should take care to record exactly what happens when there are incidents of challenging behaviour and how they managed these. This will show incidents are being managed safely and appropriately. Records should be kept of the food served to the people living in the home to show they receive a varied and nutritious diet. The address and phone number for the Commission should be updated in the service user guide. This will ensure people have the correct information should they wish to contact us. Fifty percent of staff should be qualified to NVQ level 2 or the equivalent. This will ensure there are appropriately qualified staff available at all times to meet the needs of the people living in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 1101 Bristol Road 1101 Bristol Road Birmingham B29 6LX     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: Brenda ONeill     Date: 2 1 0 5 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 31 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 31 Information about the care home Name of care home: Address: 1101 Bristol Road 1101 Bristol Road Birmingham B29 6LX 01214781847 01214775463 nicola.archer@birt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Brain Injury Rehabilitation Trust care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 8 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: Physical disability (PD) 8 Date of last inspection Brief description of the care home Bristol Road is a purpose built home, which provides residential accommodation on both the ground and first floors. The home provides both long term and short-term placements to people who have sustained a brain injury. The purpose of the service is to support and assist the people who live in the home in their every day living tasks, to assist rehabilitation back into the community and to promote their independence as much as possible. On the ground floor is a laundry, dining area and a communal lounge where people can Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 8 Brief description of the care home sit and socialise. Meals are prepared in the main kitchen that is open at all times. To the front of the building there is ample parking for vehicles. To the rear of the building there is a paved/grassed quadrangle where people can sit out during good weather. On the first floor there is an independent flat where one person can be accommodated and comprises of a kitchen and a lounge area. The flat enables the person to live independently with support if needed and is part of that persons rehabilitation back into the community. There is a good supply of assisted bathing facilities and toilets strategically located throughout the home. The communal areas and bedrooms are pleasantly decorated, are personal to the individual and has good natural lighting. The fees payable vary according to the individual needs of the person using the service. There is a financial assessment completed by the relevant authority to determine if a top up payment is required in addition to funding from the local authority. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was on June 12th 2007. An Annual Service Review was undertaken in July 2008 when we decided that the home continued to provide good outcomes for the people living there and we did not need to bring forward the key inspection. This inspection was carried out over one day. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last annual service review. This included notifications received from the home. These are reports about things that have happened in the home that Care Homes for Adults (18-65 years) Page 6 of 31 they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The manager should ensure that all the information available for staff about how to support the people living in the home is current and consistent. This will ensure people receive consistent person centred support. Staff should take care to record exactly what happens when there are incidents of challenging behaviour and how they managed these. This will show incidents are being managed safely and appropriately. Care Homes for Adults (18-65 years) Page 8 of 31 Records should be kept of the food served to the people living in the home to show they receive a varied and nutritious diet. The address and phone number for the Commission should be updated in the service user guide. This will ensure people have the correct information should they wish to contact us. Fifty percent of staff should be qualified to NVQ level 2 or the equivalent. This will ensure there are appropriately qualified staff available at all times to meet the needs of the people living in the home. 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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. There is information available for people to help them decide if the home would be suitable for them. The care needs of the people who use the service are fully assessed before they come to live in the home. This ensures all parties can be confident that the needs of the person can be met. Evidence: Each of the people living in the home has been issued with a comprehensive service user guide that details what the service offers and what people can expect from the home. The information is revised regularly and includes the individual fees for each person. It was noted that the address and phone number for the Commission were incorrect. This should be addressed so that people have the correct information should they wish to contact us. The files for two of the people living in the home were sampled during the course of the inspection. These showed that comprehensive assessments had been undertaken before the people moved into the home even though they had been living in another home owned by the organisation prior to their move to Bristol Road. Due to the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: complex needs of the people who use the service, other health care professional and relatives were involved in the decision-making process when people moved into the home. Care Homes for Adults (18-65 years) Page 12 of 31 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. Care and rehabilitation plans included good detail of how staff were to support people to lead an independent lifestyle and acheive their aims. Risk assessments were in place ensuring people were safeguarded in their every day lives. People were enabled and supported to make decisions about their lives on an ongoing basis. Evidence: The care for two of the people living in the home was tracked during this inspection. The support needs of the two people varied considerably. One person was very dependent on the staff for support with physical needs as well as cognitive impairments the other person was quite independent in relation to physical care. Both the individuals had care and rehabilitation plans in place that detailed their aims and goals and how staff were to help them acheive these. For example, one person had very detailed guidelines for staff to follow in relation to his morning routine which detailed what he was able to do for himself and what staff needed to do for him. For example can brush his own teeth but is unable to dress himself. There was detail Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: about the manual handling needs of the person and what his preferences were in relation to his personal care. In some instances there were some discrepancies about preferences, for example, the rehabilitation plan stated he liked a wet shave but his guidelines said he preferred an electric shave. Due to the cognitive impairments of this person he may not remember from day to day what he wants, prefers or likes therefore this detail needs to be correct to ensure choices and preferences are maintained. The rehabilitiation plans for the other person had very clear aims, for example, to be able to walk to the shops independently and to learn the names of a further five staff. To help him acheive these aims there were clear guidlines for staff to follow to support him. General progress being made on the aims detailed in the care or rehabilitation plans was monitored in monthly team meetings and by the psychologist on site. All the plans in place had been reviewed recently. There were clip boards in the office for each of the people living in the home for staff to use to fill in charts and forms that were in use. These included a lot of information that was no longer applicable to people and some that was quite out of date. It was important that if these clip boards were to be used then the most recent information was was put on them for staff to follow to ensure consistency of support. Both files sampled included numerous risk assessments that detailed how staff were to reduce the risks people were exposed to. These included such things as suicide, self harm, aggression, absconding, non complinace with medication, cooking and so on. All the guidleines in place for rehabilitiation plans also detailed how risks were to be minimised. For example, when staff were to be concerned if someone had not returned when going to the local shop and what they should do. Any presenting behaviours due to cognitive impairments were being monitored and staff were generally completing ABC charts which detailed all aspects of the behaviour and how it was managed. There was one recording which stated one of the people living in the home had been confused, aggresive and agitated there was nothing to indicate how staff had managed this and no ABC chart had been completed. This was discussed with the acting manager and he agreed this was a poor recording and would mean nothing to staff reading this. The people living in the home were involved in setting their own goals and making choices in their everyday lives as much as was possible. Staff were heard talking to people about what they wanted to do and what was on their programmes for that day. Where necessary the preferences and choices of people were recorded in their care/rehabilitation plans. We were told that the home had provided everyone with Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: information about advocacy services. One of the people living in the home had a hearing impairment but was able to be understood by staff in everyday decisons, for example, what he wanted to eat or drink. To enhance the decision making process further for this person there were interpreter sessions three times a week which enabled him to fully contribute to planning menus and his weekly programme. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements in place, for socialising and activities to ensure the people living in the home experience a meaningful lifestyle. People were satisfied with the catering arrangements that were in place at the home. Evidence: The people living in the home were offered a wide variety of activities both within the home and in the community which were tailored to the individual needs and preferences of each person. Each person had a weekly timetable that was a combination of both leisure activities and activities to help them develop independent living skills. Activities included shopping, cooking, laundry, meals out, playing pool, spending time with staff, structured sessions with the psychologist, activities with family and friends and so on. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: There was evidence on files that one person had tried an educational placement but this had been unsuccessful due to cognitive impairments but the same person had had a successful voluntary work placement. Staff were trying to expand the activities people were involved in all the time. We sat in a planned meeting with the people living in the home where they were asked about what they would like to do in relation to activities. They were asked for suggestions for fund raising, were they happy with the changes made to the menus after the last meeting, did they know how to find out who was cooking that day and so on. Five of the people living in the home took part in the meeting and all were encouraged by staff to contribute. One of the people living in the home was being encouraged and enabled to take more control of his life by having appointments and sessions entered into the calendar on his mobile phone with an audible reminder. One activity that had not been available to the people in the home at the time of the last inspection was the right to vote. At the time of this visit two people had been put on the electoral role. Wherever possible ongoing contact with family and friends was enabled and encouraged. Files included details of all contact the home made with families and vice versa and of when the people living in the home contacted family. Some people went out regularly and stayed with their families. One person had been out overnight the night before the inspection and stayed with family. Another person in the home spoke to us about his wife visiting him on a regular basis. The people living in the home took part in planning the menus, shopping for them and helping to cook wherever possible. The menus were varied and nutritious and people confirmed they were changed when they requested. Cultural diets were catered for when necessary. People were satisfied with the food available to them. They also confirmed they enjoyed going out to eat and having take away meals. There were no records being kept of the meals being provided to the people living in the home. It was recommended these records were kept so that it could be shown that people received a varied and nutritious diet and that choices were available on an ongoing basis. Care Homes for Adults (18-65 years) Page 17 of 31 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. People were having their personal and health care needs met in a way that suited them. The system in place for the administration of medication ensured people received their medication as prescribed. Evidence: The personal care needs of the people living in the home varied considerably. Some people were able to tend to all their own personal care others were reliant on staff for help with this. Personal care needs were detailed in peoples care plans and the support they needed from staff was also detailed. As mentioned previously some inconsistencies were noted in the recording of one persons preferences in relation to personal care. Generally care plans were well detailed and personal preferences recorded, how privacy and dignity were to be ensured and any issues in relation to gender appropriate care. This ensured people were cared for in a way that suited them. Staff were observed using preferred terms of address and personal care was delivered in the privacy of the peoples bedrooms, to preserve their dignity. People were seen to Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: be dressed in ways suited to their ages and their personalities. There was ample evidence that people were having their health care needs met and that they had access to health care professionals when needed. Records showed that people saw G.P.s, chiropodists, opticians, occupational therapists, physiotherapists and psychologists as and when necessary. One of the people living in the home was attending a pre arranged hospital appointment on the day of the inspection. Peoples needs in relation to pressure care and continence were detailed in their care plans. There were also very clear guidelines for staff to follow in relation to ongoing illnesses such as epilepsy. The guidelines detailed what signs the staff should look for that may indicate a seizure was imminent and records of these were being kept. The individual concerned was also being encouraged to monitor his own condition and record on his chart when there were any signs. Medication was being administered via a monitored dosage system. This was well managed and ensured people received their medication as prescribed. We were told that only trained staff administered medication. A random audit of the system was undertaken. Medication was being acknowledged when received into the home and signed for when administered. All the balances that were checked were correct. The issues raised at the last inspection had been addressed including, creams were being signed for when administered, all medication was booked in and the homely remedies policy had been agreed by the G.P. It was noted that the home had quite a lot of homely remedies and although there was guidance for staff to follow in relation to administering these they could not be audited. Staff were signing when administering the homely remedies and entering on peoples MAR (medication administration records) charts but there was no running balance for any of the homely remedies. This was discussed with the staff and before we left the home this was being addressed. It was also noted that the medication trolley was quite overcrowded as one person had a lot of creams in the trolley. It was recommended that some of the creams were kept in the individuals bedroom if it was safe to do so to give more room in the trolley and also would give staff easier access to the creams. Care Homes for Adults (18-65 years) Page 19 of 31 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 living in the home were listened to and their views acted on. The training staff had received and the systems in place in the home ensured the people living there were safeguarded. Evidence: The home has a complaints procedure that is available in a variety of formats, for example, pictures and large print. Everyone has received a copy of the procedure. The home have acknowledged it is difficult to know how much of the procedure would be retained by the people living in the home. Interactions between the staff and the people living in the home were very good. People were very comfortable in the presence of the staff which would give them the confidence to raise any issues. It was evident throughout the inspection that staff listened to the people living in the home, for example, in the service user forum, monthly meetings with key workers and everyday occurrences. One person returning to the home was clearly quite unhappy and had forgotten some of the events from the previous day staff were seen to address this with him appropriately. Part of the quality monitoring system in the home was to audit if people feel complaints were taken seriously. This scored less than the staff would have liked during the last audit. Action had been taken to address this by ensuring complaints were encouraged during the service users forums that they were minuted and feedback was given on any issues raised at the next meeting. This was seen to Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: happen in the forum when staff asked people if they were happy with the changes to the menus since the issues were raised at the previous meeting. We had not had any complaints lodged with us about the home since the last key inspection. There were policies and procedures on site in relation to adult protection and we were told staff had received training in this topic. No adult protection issues had been raised with us about the home or directly with the home. There was a system in the home for helping people to manage their money if necessary. Some people were able to manage some of their money others needed total support in this area. Some of the people had help from families and had only small amounts of money kept in the home for which appropriate records were being kept. The acting manager acknowledged it had not been possible to open bank accounts for some of the people living in the home. Their money was being paid into an account for the organisation then drawn out as needed. Clear records were being kept of any income or expenditure and although not an ideal situation it was the only way people could be guaranteed access to their money. Where possible the people living in the home signed for their own money. Care Homes for Adults (18-65 years) Page 21 of 31 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 are provided with a warm, comfortable and safe home to promote their wellbeing and individual needs. Evidence: In September 2008 due to very heavy rain fall the ground floor of the home was severely flooded. All the people living in the home and the staff had to be evacuated by the fire brigade and moved temporarily to another of the organisations homes. People did not return to the home until February 2009 after the ground floor had been totally refurbished. The home is over two floors. On the first floor there is a staff office, sleeping in room and an independent living flat. The flat was not occupied at the time of this inspection. The rest of the accommodation and facilities are on the ground floor. There is ample communal space in the home with a large lounge and dining room. Both areas are very comfortable and well furnished. The dining room also houses the pool table that the people living in the home use. There was also another room that could be used for activities such as arts and crafts. There is a large open plan kitchen that is accessible to wheelchairs. It has some work Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: surfaces and a cooker at wheelchair height so all the people living in the home can take part in meal preparation and cooking. We were told all bedrooms were the same size and layout. One bedroom was seen. It was a good size and allowed for the use of wheelchairs and a hoist if necessary. The room was nicely personalised to the occupants choosing and it was clear he had a favourite football team. All the bedrooms had en-suite facilities of toilet, wash hand basin and floor level shower. In addition to the en-suite facilities in the home there were additional toilets and a fully assisted bathroom with a Parker bath for those who preferred to have a bath. The laundry was appropriately located and equipped to enable the people living in the home to be supported to do their own laundry. There were systems in place for the disposal of continence aids. The home has a garden but this had been spoiled by the flood water. The acting manager, staff and the people living in the home were in the process of re cultivating the area. The home is wheelchair accessible throughout and has aids and adpatations to meet the needs of the people living there. The home was clean, odour free, comfortable and safe. Care Homes for Adults (18-65 years) Page 23 of 31 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 people living in the home were supported by a stable staff team that were able to meet their needs. The recruitment procedures in the home were robust and ensured people were safeguarded. Evidence: There had been little staff turnover at the home since the last inspection which was good for the continuity of care for the people living in the home. We met several staff throughout the day and they were able to tell us about the needs of the people living in the home and the support they needed. The people living in the home were very comfortable in the presence of the staff and relationships between them were seen to be very friendly. The rotas for the home showed that there were generally three support staff on duty throughout the waking day plus another staff member who supported one person on a one to one basis. The managers hours were supernumery to the care rota and there was also an assistant psychologist in the home Monday to Friday. These levels seemed to meet the needs of the people in the home at the time and enabled staff to spend time with people on a one to one basis either in the home or out in the community. There was no training matrix for the home so it was difficult to determine the level of Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: training staff had had overall. However some individual training records were sampled and it would seem that staff have a substantial amount of training including fire awareness, first aid, manual handling, NCI, adult protection and food hygiene. It was evident from the staff files seen that new staff undertook induction training in line with the specifications laid down by Skills for Care. The AQAA stated that only 3 of the 13 staff employed at the home have NVQ training but another 6 are working towards this. The acting manager confirmed that the information given on the AQAA was correct. It was recommended that the home have a training matrix that shows what training staff have had as a whole and when it is due to be updated. This will ensure there is an easy way of identifying staff training needs. The recruitment records for two staff were sampled. These showed recruitment was robust and all the required checks were undertaken before people started work at the home including, two written references, CRB and POVA checks and medical questionnaires. Care Homes for Adults (18-65 years) Page 25 of 31 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 was being managed in the best interests of the people living there. The health and safety of the people living in the home and the staff was well managed. Evidence: The registered manager for the home had been off work for some time. The assistant manager was the acting manager at the time of the inspection. He had a considerable amount of experience in caring for people with brain injuries. He showed a good knowledge of the needs of the people living in the home. He spoke about the difficult time people had had when they had to move out of the home and then back due to the flood. He said people coped very well and it did not have too much of an adverse effect on them but all seemed pleased to back in the home. People told us they like it better at this home as it is quieter. There was a comprehensive quality monitoring system in the home. Quality audits were undertaken by the organisation against organisational and legal standards which resulted in an action plan for the manager to follow to address any shortfalls. The people living in the home regularly completed satisfaction surveys which covered Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: areas such as choice of activities, privacy, standard of food, complaints and so on. The outcome of the surveys was posted in the dining room in the form of a graph so that people could see how the home was doing. Most areas featured quite favourably. Those that scored lower had an action plan in place to address the shortfalls. Staff at the home tried hard to involve the people living in the home in the running of the home wherever they could, for example, staff recruitment and fire training. People were regularly consulted at meetings and by key workers about the quality of the service and what improvements could be made to things such as, food, the environment and activities both in the home and in the wider community. The health and safety of the people living in the home and the staff were well managed. Staff had had training in safe working practices. There was evidence on site that where necessary equipment had been serviced. The in house checks on the fire system were all up to date and fire drills were being undertaken on a regular basis. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The address and phone number for the Commission should be updated in the service user guide. This will ensure people have the correct information should they wish to contact us. The manager should ensure that all the information available for staff about how to support the people living in the home is current and consistent. This will ensure people receive consistent person centred support. Staff should take care to record exactly what happens when there are incidents of challenging behaviour and how they managed these. This will show incidents are being managed safely and appropriately. Records should be kept of the food served to the people living in the home to show they receive a varied and nutritious diet. It was recommended that some of the creams in the medication trolley were kept in the individuals bedroom if safe to do so. This would give more room in the trolley and staff easier access to the creams. 2 6 3 9 4 17 5 20 Care Homes for Adults (18-65 years) Page 29 of 31 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 6 32 Fifty percent of staff should be qualified to NVQ level 2 or the equivalent. This will ensure there are appropriately qualified staff available at all times to meet the needs of the people living in the home. It is recommended that there is a staff training matrix for the whole home so that it is easy to track the training for staff and when it needs updating. 7 35 Care Homes for Adults (18-65 years) Page 30 of 31 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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