Care Home: 115 Gough Road

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What the care home does well People`s needs are assessed before they move into the home so they can be confident their needs will be met there. The staff team know people who live in the home well and have learned skills to communicate with them effectively. This helps them understand people`s needs. There are lots of different activities on offer so that people lead an active lifestyle that they enjoy. The home is good at supporting people to keep in touch with their friends and relatives so that they maintain relationships that are important to them. People get the food they need and like to help them stay healthy and well. Records that explain how to care for people are well written so that people are cared for in a way they like and need. The home is making sure that vulnerable people are well protected from possible harm to keep them safe. Staff are recruited and selected in ways that ensure safe skilled individuals are employed. Staff have the training they need so they know how to support the people living there. The home has in place a quality monitoring system based on seeking the views of the people living there so they decide how improvements are made. What has improved since the last inspection? Meetings are being set up within SENSE for staff from their homes to attend called `The culture club`. This is intended to be a forum for staff to discuss how cultural needs can be met and to discuss areas of good practice. The way that medicines are managed has improved so that people are having the medication they need to stay healthy and well. Some improvements have been made to the premises so that it is better maintained for the people who live there. Emergency evacuation plans have been completed so that staff know how to evacuate people safely in an emergency. What the care home could do better: 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.Assessments need to be completed before people participate in a new activity that could pose a risk to their safety, to make sure people`s well being and safety is promoted. Training on people`s specific health conditions, for example epilepsy, should be included in the homes induction for new staff to make sure they have the knowledge they need to meet people`s health needs. The complaints procedure should be amended to show our new address so that people can contact us if they wish to make a complaint and should be displayed where it is more visible to visitors to the home. Planned repairs and refurbishment as detailed in the homes environmental action plan need to be completed so that people have a nicer place to live. Systems to ensure the fire alarms are tested weekly need to be improved to ensure where a test is missed this is identified quickly and testing of the alarms can be arranged to ensure they are working. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gough Road, 115 Gough Road, 115 Edgbaston Birmingham West Midlands B15 2JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Gough Road, 115 Gough Road, 115 Edgbaston Birmingham West Midlands B15 2JG 01214466744 01214466289 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sense, The National Deafblind and Rubella Association care home 5 Number of places (if applicable): Under 65 Over 65 0 0 learning disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home 5 5 115 Gough Road is a large detached Victorian house situated in a quiet residential road in Edgbaston. Public transport is close by and the home is approximately two miles from the city centre of Birmingham. The home provides care and support services to five adults with learning disabilities and a sensory impairment. Gough Road currently accommodates five men. The accommodation is spacious and includes a large reception hall, lounge, dining room, kitchen, office/meeting room, laundry and a ground floor bedroom with ensuite facilities. Four further bedrooms, (one of which is ensuite), two bathrooms and a toilet are situated on the first floor. The home has a second floor, which is inaccessible to people who live there, and provides a storage area and a staff sleeping in room. The garden has been developed so that the top area includes a large patio area which is accessible to people and contains garden furniture and a range of plants. The lower part of the garden is extensive and cannot be used as it is overgrown and unsafe. This area is securely contained so that people are not Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home placed at risk of possible harm. Information on the range of fees is not provided in the generic service user guide but people who currently live at the home have their own individual guides that records the fees they pay. Copies of our previous inspection reports are available in the home on request. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. Our previous visit to the home was on 26th March 2008. The focus of inspections we, the commission, undertake 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, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 6 of 32 (AQAA) completed by the acting manager. This provides information about the home and how they think it meets the needs of the people living there. We sent out surveys to care professionals but none were returned to us. Surveys were sent to the home for eight staff to complete. Three staff surveys were sent back to us prior to our visit to the home, a fourth was received after we visited the home. We also sent four surveys to care professionals but none were returned. Two of the people living in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, 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 at parts of the home, and a sample of care, staff and health and safety records were looked at. Due to peoples limited communication we were unable to ask them for their views of the home but we did observe some care practice to see what it was like to live there. The acting manager and staff on duty at the time were spoken with. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 32 Assessments need to be completed before people participate in a new activity that could pose a risk to their safety, to make sure peoples well being and safety is promoted. Training on peoples specific health conditions, for example epilepsy, should be included in the homes induction for new staff to make sure they have the knowledge they need to meet peoples health needs. The complaints procedure should be amended to show our new address so that people can contact us if they wish to make a complaint and should be displayed where it is more visible to visitors to the home. Planned repairs and refurbishment as detailed in the homes environmental action plan need to be completed so that people have a nicer place to live. Systems to ensure the fire alarms are tested weekly need to be improved to ensure where a test is missed this is identified quickly and testing of the alarms can be arranged to ensure they are working. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with some of the information they need to help them decide if they would like to live there. Peoples needs are assessed before they move into the home so they can be confident their needs will be met there. Evidence: The home has a statement of purpose and service user guide in place, these are documents that should tell people all about the home to help them decide if they would like to live there. The service user guide is available in a variety of formats to include pictorial and audio, to make the document more accessible to people who live in the home. Reports completed by the homes area manager in January and February indicated that these documents needed to be updated. We looked at the service user guide, each person who lived at the home had their own copy and their was also a generic version for people thinking of moving to the home. The guide did not record the full range of fees and did not have our correct address. The generic version was very short and did Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: not contain much information about the services the home provides. The home has an action plan that records that the guide is to be updated, this needs to be done to make sure people have enough information about the home. There have been no new admissions since the last inspection and there are currently no vacancies. There are systems in place to ensure that individuals needs are assessed before they move into the home and that people have an opportunity to visit and stay over prior to making any decisions about whether to move in. Referrals from people who may wish to live at Gough Road are received by a Referrals and Information officer based at Senses regional office. There is a national policy for referrals, which is followed to assess that peoples needs can be met by the home prior to admission. This should assist people to feel confident that the home they choose is suitable for them. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have most of the information they need so they can support people in the way that the individual chooses and needs, so ensuring their safety and well being. Evidence: The home has a Practice Development Worker (PDW) who works to support the staff team with the development of peoples care plans and risk assessments. The care plans for two people were sampled. Both contained information about how staff should support people to meet their communication, social, cultural, spiritual, health, personal care, dietary and mobility needs. The records sampled showed that monthly meetings had been held to review care plans and risk assessments so that it was clear they remained relevant to peoples individual needs. Pro-active strategies (meaning taking action before problems occur) were in place for challenging behaviour, this meant that reactive strategies to Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: challenging behaviour were reduced (things staff need to do when the person becomes upset). Records and discussion with the acting manager show that SENSE is developing systems to help enhance how peoples cultural needs are met. Meetings are being set up within SENSE for staff from their homes to attend called the culture club. This is intended to be a forum for staff to discuss how cultural needs can be met and to discuss areas of good practice. There was some good information in care plans giving details about the person needs and how the choice of each person was to be met by staff. There was good information about what the person likes and dislikes which is important as the people living in the home have difficulty with communicating their needs. People who live at Gough Road have specific needs with regard to communication. The care plans sampled were detailed and explained clearly how staff should support the person to make decisions and choices by use of objects and sign language and how to understand the persons expressive communication skills. We spoke with two members of staff, who described a range of techniques used by the team to assist their understanding of peoples communication so that their choices are respected. During our visit we observed staff communicating with people and offering choices through varied communication methods including speech, signing, gestures and objects of reference such as using a small plate to communicate that it was lunchtime. Records included individual risk assessments that stated how staff are to support individuals 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 rock climbing, ice skating and for areas of risk such as choking, challenging behaviour, the use of physical intervention, accessing the kitchen, health needs, accessing the community and travel in the homes vehicle. One person at the home had recently started going swimming, however a risk assessment had not been completed prior to the commencement of the activity. An assessment needs to be completed to make sure the person is as safe as possible whilst swimming and is not put at risk of harm. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home experience a meaningful lifestyle that promotes their independence and is reflective of their individual needs. Evidence: Each person has a weekly activity schedule that has been developed according to their preferred activities and routines. The activity plans were seen to vary from week to week so that people have opportunities to do different things that they like. Daily records were sampled to check that people had regular opportunities to take part in things they enjoy doing. During our visit staff were planning peoples holidays. Staff told us that two holidays were being organised so that people could have a holiday that meets their personal preferences. The home has its own vehicle and several people went out with staff support during Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: our visit to the home. Records showed that people undertake many activities such as swimming, ice skating, rock climbing, shopping, eating out, cooking and visits to local places of interest. Each activity had a corresponding activity plan which included details of how they prefer to be guided and a plan to communicate to each person what is going to happen during the activity.There was evidence that people take part in domestic skills so that they develop and maintain independence in their day-to-day lives. For example, time is planned for people to shop for and cook a snack or dessert of their choice. Records are kept which describe peoples responses to activities, which staff confirmed aided future planning. The home has a sensory room, which is equipped with light panels, vibro seating, musical instruments, a stereo system and textured walls. Staff told us that people spend time relaxing in there and enjoy using the room. From observation of care plans, menus and from discussion with staff it was evident that peoples cultural needs were understood and planned for. Festivals such as Christmas and Eid are celebrated and one persons birthday had recently been celebrated. The home is good at supporting people to keep in touch with their friends and relatives. Within the care plans sampled there was information about peoples relatives birthdays, so that cards and presents could be sent. The home has a visitors policy and staff commented that relatives have regular contact either by telephone or in person. Sense has a family liaison officer whose role is to support and advise families or to advocate for people who have no input from relatives. An annual family weekend is also organised by SENSE. This is an opportunity for peoples families to meet up socially and also an opportunity for them to meet and speak with SENSE senior managers. 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. Alternative choices are available, staff told us that if people do not like the choices on offer then an alternative is always provided. A range of food had been offered including Sunday roasts, Halal and soft consistency meals, which is reflective of peoples cultural and health care needs. Separate fridges and freezers are available for the storage of Halal products. We had the opportunity to eat lunch with people at the home. People were appropriately supported by staff and were encouraged to be as independent as possible throughout the meal. Care Homes for Adults (18-65 years) Page 16 of 32 Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at the home are met so ensuring their well being. Evidence: Care plans stated how staff are to support individuals with their personal and health care needs. 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 care records for two people and also looked at the health care records for a third person in regard to a specific health condition. Each person has a Health Action Plan (a document that explains what a person needs to do to stay healthy and the health care services they need to access to do so). The plans sampled described the persons needs and how they communicate pain so that staff can identify if a person is unwell. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: People who live at the home have a range of health care needs and sampled records showed that they maintain regular contact with health care professionals. The outcomes of appointments had been clearly recorded so that staff had up to date information about each persons health. One person has epilepsy, clear guidance was available to staff on the support they needed. Staff at the home had received training in epilepsy last year from the epilepsy specialist nurse. We spoke with two staff who had not had this training as they had started working in the home after the training took place. Whilst one of the staff was aware of the action that was needed to keep the person safe should a seizure occur the other member of staff was not fully aware of the action to take. We looked at the homes induction plan for new staff and this does not include epilepsy. However the annual quality assurance assessment completed by the home does record that further epilepsy training is planned. At the last inspection we identified that some improvements were needed to the medication systems in place. At this visit we found that the administration of medication has improved. Medications are stored securely and records maintained of medication administration. 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. 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 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, staff who are not trained told us they do not administer medication. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures in place to listen to peoples concerns and complaints and safeguard them from the risk of harm. Evidence: We have not received any complaints about this home in the last twelve months. The home has a complaints log to record any complaints it receives, this records that the last complaint they received was in 2007. The home has a complaints procedure in place, available in a variety of formats to include audio and visual. We looked at the complaints procedure and saw that this needed updating to include our new address so that people would know how to contact us if they needed to. Complaint information was available in the home but was not clearly on display for visitors to the home, the deputy manager said she would ensure this information was in a more visible place for visitors. As well as being able to report concerns directly to the managers SENSE also provides a free phone number for people to use to report any concerns they may have. Surveys that we received from staff show that they know how to respond should people wish to make a complaint. Because of peoples level of understanding and communication needs people would generally rely on staff and relatives to pick up on Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: when they were unhappy via their behaviour or body language. Minutes of staff meetings show that it has been discussed with staff how to raise a complaint on behalf of people who live at the home. Systems in place to safeguard people from the risk of harm show that this is given high importance. As stated previously a national free phone number is provided to people where they can raise concerns if they wish to, as well as using the usual channels within the home. Records sampled show that staff have received training and also complete an annual questionnaire about safeguarding people to make sure they know how to do this. Safeguarding is also discussed with staff during supervisions with their manager. Staff spoken with during our visit generally knew what to do to keep people safe if they suspected someone had been abused. Training records show that staff have received training in managing peoples behaviour and the use of physical intervention. The records and discussions with staff show this is used as a last resort and to protect people from harm. 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 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience 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 an environment that meets their needs and planned refurbishment of areas in the home will offer people a more pleasant place to live. Evidence: Gough Road is situated in a residential area approximately two miles from Birmingham City Centre. There are local amenities such as shops, cafes and restaurants nearby, which is important to the people who live there as they enjoy using these facilities. We looked at parts of the home during our visit. The home was at a comfortable temperature, clean and no unpleasant odors were noticed. Shared space consists of a lounge, separate dining room and sensory room, all of which are located on the ground floor. The building is spacious and has been decorated so that door frames and handrails are painted in contrasting colours to assist people with a visual impairment to move more freely around their home. Objects of reference are situated in key places, such as on doorways to help people locate rooms and equipment. The decor and carpets in several areas of the home are quite worn in appearance and the kitchen units require replacement as they are damaged in places. Refurbishment work that is needed is identified in the monthly reports of the area manager to the Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: home. There have been delays in getting the required work done, however SENSE do not own the premises and have a landlord. The annual quality assurance sent to us before our visit records that some work to improve the premises has been completed and an action plan has been devised for the outstanding work. It also stated We aim to continue in pursuing support from the housing association to rectify and action outstanding maintenance issues and this will be completed on a formal level. Discussion with the acting manager indicates that new carpets for the home are on order and that new kitchen units are being chosen. Work will be undertaken in the home whilst people are away on holiday so as to reduce any disruption to them. Bedrooms are located on both the ground and first floors of the home and are all of a good size so that people have space for their personal belongings. Bedrooms were personalised with peoples personal effects and reflected peoples gender, age and culture. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development generally 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: We observed staff working with people who live in the home and considered their interaction to be both friendly and respectful. Staff skills and knowledge about the people they were supporting were evident throughout observations during the inspection. Over 50 of the staff have acheived an National Vocational Qualification in care so that people are usually supported by staff who have the right qualifications. The records of three of the staff who work there were looked at. These included the required recruitment records including evidence that 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. Surveys and discussion with staff indicate that there are usually enough staff on duty to meet peoples needs. However one staff commented that the home used to many agency staff, another commented that there could be better organisation of shifts so Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: that regular staff are on duty. There were no agency staff on duty on the day we visited. Discussion with the acting manager indicates that agency staff have been used to cover for staff holidays but that the home tries to use regular agency staff. We looked at the staffing rota and this showed that usually there were enough permanent staff on duty but on limited occasions there were more agency/ casual staff on duty than permanent staff. The acting manager said that she would ensure in future that the ratio of permanent staff to agency/ casual staff was increased. The majority of staff spoken with and staff surveys received indicated that staff were happy with the training on offer.The registered provider (SENSE) offers a rolling programme of staff training so that staff have regular opportunities to complete both mandatory sessions and that which is relevant to peoples assessed needs such as communication awareness and working with deaf/blind people. Training records showed that staff had received training that includes health and safety, first aid, protecting vulnerable adults, food hygiene, physical intervention, challenging behaviour, moving & handling, fire, medication, infection control and working with deaf blind people. This ensures that they know how to meet the needs of the people living there. The checking of staff files showed that staff receive formal supervision at regular intervals to offer them the support they need to carry out their work and to receive feedback on their performance. Staff meetings are also held regularly to discuss how the home is running and feedback any important issues to staff. Discussion with the acting manager also indicates that a team building day is schedules for April. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and usually peopleshealth and safety is promoted and protected. Evidence: The home has a registered manager who is currently on maternity leave, therefore the deputy manager is undertaking the acting manager role. The acting manager has a National Vocational Qualification at level 3 and is experienced in working with people who have learning disabilities and sensory impairment. Discussions during the visit show that the acting manager has a good understanding of the needs of the people at the home. The homes annual quality assurance assessment was sent to us when we asked for it and had been completed to a good standard. Staff spoken with during our visit said the acting manager is approachable, can raise any concerns with her, acting manager is always asking how i am, have been very well supported and would feel confident in raising any concerns and manager and deputy are both very approachable. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: 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. Records sampled showed that other quality assurance audits are in place such as the regular reviewing of care plans, risk assessments and activities undertaken by people. Data is collected on a monthly basis that summarises all heath and safety issues, notifications of incidents to us, accidents and near misses. It also provides information on service activity levels, both in the home and community based. Staff who lead each shift have responsibility for checking hot water temperatures to make sure they do not pose a scalding risk and checking fridge and freezer temperatures to ensure that food is stored safely. Records were seen to evidence that these tests had been completed on a regular basis. Certificates were available to show that gas and electrical installations in the home were safe and did not put people at risk of harm. A letter from the West Midlands Fire Service, dated April 2008 recorded that fire precautions in the home had been found to be satisfactory. At this visit we found that records showed that the fire alarm system had been serviced to make sure that it was working properly. Fire drills had been carried out regularly to make sure staff know what to do should a fire occur in the home. Staff spoken with said they had done fire training. Records show that a few staff needed fire refresher training and this has been scheduled for April.Usually the fire alarms are tested weekly but they had not been done recently. The acting manager was aware that the tests had not been completed and told us about new arrangements she was implementing to make sure they were not missed in the future. At our last visit to the home we identified that evacuation plans were not in place for people who live at the home. Evacuation plans have now been completed so that staff know what support each person needs to evacuate the home in an emergency. A recent monthly report by the area manager identified that there was a screw sticking out of the wall in one persons bedroom and that this needed removing. It was disappointing that when we visited this had not been done and could have put the person at risk of injury. The deputy manager ensured that this was made safe when we brought it to her attention. Care Homes for Adults (18-65 years) Page 27 of 32 Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Assessments need to be completed before people participate in a new activity that could pose a risk to their safety. To ensure people are protected from risks to their health and well being. 16/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to include more information about the home to include the range of fees to live there so that people have the information they need about the home. Training on peoples specific health conditions, for example epilepsy, should be included in the homes induction for new staff to make sure they have the knowledge they need to meet peoples health needs. The complaints procedure should be amended to show our new address so that people can contact us if they wish to make a complaint. The procedure should also be displayed where it is more visible to visitors to the home. Page 30 of 32 2 19 3 22 Care Homes for Adults (18-65 years) 4 33 The numbers of agency / casual staff on duty should not exceed the numbers of permanent staff so that people are supported by staff who know their needs well. Systems to ensure the fire alarms are tested weekly need to be improved to ensure where a test is missed this is identified quickly and testing of the alarms can be arranged to ensure they are working. 5 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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