Care Home: 14 Podsmead Road

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What the care home does well All of the care files we examined contained a wide range of care plans which identified people needs, provided staff with instructions on how to meet those needs and were regularly reviewed by the manager. The service provided in the home is led by the needs of the people living there. People lead active lifestyles and staff support them to do this where needed. The home is decorated to a good standard throughout and meets peoples current needs. Staff receive the training required to meet the needs of people in the home. Health and safety procedures and staff training minimise potential threats to people. What has improved since the last inspection? Information gathered as part of staff recruitment now meets the criteria of these regulations and therefore does not put people living in the home at unnecessary risks. Staff have completed training in Dementia awareness to enable them to meet the needs of a person in the home. What the care home could do better: The home`s Service User`s Guide must be updated to accurately reflect the home to ensure that a potential new admission has the appropriate information. People living in the home are being put at unnecessary risks as there are limited risk assessments in place to support activities they may be involved in. The manager should ensure that all staff receive supervision at regular intervals. The manager needs to implement a system of effective quality assurance procedures to ensure that they are able to monitor how the service performs and enable improvements as required. Key inspection report Care homes for adults (18-65 years) Name: Address: 14 Podsmead Road 14 Podsmead Road Gloucester Gloucestershire GL1 5PA     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: Paul Chapman     Date: 0 3 0 6 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 26 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 26 Information about the care home Name of care home: Address: 14 Podsmead Road 14 Podsmead Road Gloucester Gloucestershire GL1 5PA 01452314262 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: podsmeadcare@hotmail.com Mr D Solanki care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The home can accommodate up to five adults who have a learning disability. The home is an adapted house and situated in Podsmead, which is approximately two miles from Gloucester city centre. The service users accommodation is on three floors and comprises of a lounge, dining area and kitchen. The bedrooms are single and there is a bathroom and toilet on the ground and first floors. There is a garden at the back of the property and this has been developed and now provides a pleasant and accessible area for the service users. In the garden there is an aviary, a fishpond, a patio area and level lawns. 5 Over 65 5 Care Homes for Adults (18-65 years) Page 4 of 26 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: Before completing 2 site visits to this service we (the CQC) sent the registered manager questionnaires to distribute to people living in the home and staff to complete. In addition to questionnaires the registered manager also completed an AQAA (Annual Quality Assurance Assessment). This document asks a provider to rate themselves against the National Minimum Standards (NMS) for their service. A service provider will be asked to provide evidence of what they do well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). When we arrived for our 1st site visit unannounced we spent some time completing a Care Homes for Adults (18-65 years) Page 5 of 26 tour of the premises, examining files and speaking with staff. The manager was busy in attending a meeting, we therefore arranged to return at a mutually agreeable time to look at staffing and other management responsibilities. In addition to these elements we were also able to interview a member of staff. People living in the home have communication difficulties and we were unable to seek their opinion of what they thought of the home. We spent a period of time with people in the home and staff, this provided us with evidence respectful, friendly and supportive relationships between staff and people in the home. Questionnaires were received from the relatives of some people in the home, and all of the comments were really positive about the service being provided in the home. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 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 8 of 26 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. The homes Statement of Purpose accurately reflects the homes current management structure. Evidence: There have been no new admissions to the home since the previous inspection was completed. A recommendation of the previous inspection was for the Statement of Purpose to be reviewed to accurately reflect that there is a new service provider. This has been done. Looking at the Service Users Guide we noticed that some of the information was out of date. It becomes a recommendation of this inspection report that the manager reviews the Guide and updates it as required. We have not made a judgement about the homes ability to assess the needs of people being admitted to the service as there is no recent evidence to support this Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: process. Care Homes for Adults (18-65 years) Page 10 of 26 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. Peoples care needs are identified in their care plans which provide staff with guidance to meet peoples needs consistently. Care plans are reviewed regularly and updates are made as required. People are empowered to make decisions about their lives. Risk assessments need further development to ensure that people are not put at unnecessary risks. Evidence: We examined the care files for 3 people living in the home. This showed that each person had a range of care plans developed by staff to meet their needs. Each plan identifies the persons needs and the action required by staff to support them consistently in meeting that need. People have communication difficulties and we saw a number of documents that had been adapted into an easy read format to enable people to understand them. It is recommended that the manager continues to develop further documents in an easy read format. Each of the care plans we examined was reviewed regularly by staff and there was good evidence to support judgements based on the daily notes completed by staff for each person. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Due to peoples communication difficulties we were unable to ask them directly about the choices they were able to make. We spent time with them observing their relationships with staff and the other people they live with. This gave us the opportunity to witness how people were able to communicate with staff what they would like to do, or want. It showed that staff were respectful, caring and there was genuine friendships. Other examples of people making decisions in their day to day life included a range of activities they were involved in and the food they eat. The AQAA completed by the manager highlights that more formal risk assessment must be completed. Speaking with the manager they explained that they have implemented a new format for risk assessment. We examined the range of assessments completed to date and it was agreed that although a range of areas have been assessed there is a need to develop this area substantially. An example of where further risk assessment is required is to meet a persons needs around eating. It becomes a requirement of this inspection report that the manager reviews all of the risk assessments and develops new assessments as required. We received completed CQC surveys from relatives/friends of people living in the home. These showed that people believed their friends/relatives were being well looked after. Speaking with staff about the atmosphere in the home they stated, It is just like a family and there is a great amount respect amongest individuals. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead active lifestyles and staff provide support to enable this to happen as required. The menu in the home is chosen by the people living there. Evidence: From reading the daily notes written by the staff and speaking to them it was clear that the following activities take place regularly: - People attend day services for between 2 and 4 days a week (the manager is working with the local authority to review these arrangements), people are involved in cookery and riding groups, 1 person works at a local furniture re-cycling project and there is a social club that is used by people each week. In house people enjoy watching TV and DVDs, listening to music, doing jigsaws and completing art and craft type hobbies. We also saw examples of staff supporting people to access the local community regularly. 1 person in the home has a friend that visits each month and takes them out. This Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: gives the person the opportunity for 1 to 1 time. Other people in the home are visited by their family and friends, and people also visit their families. People living in the home accompany staff when they go food shopping. Each morning there is a range of cereal, toast, etc available. There is always 2 options available at each meal time and people are given the choice about what they would like to eat. For lunch people tend to have sandwiches. We looked at the current menu which showed that people were offered a good range of choice and that healthy options were available. Snacks and drinks are available as people want them. Care Homes for Adults (18-65 years) Page 14 of 26 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. Peoples personal care and health needs are addressed appropriately therefore people are not put at unnecessary risks. Medication administration is well managed and this minimises potential risks to people in the home. Evidence: As identified earlier in this report we found a good range of care plans in place and these included care plans to meet peoples personal care needs. As with all of the other care plans they provided staff with a good level of detail to enabling them to meet peoples needs. Care files we examined provided us with good examples of people being supported by other health professionals as required, and staff following guidelines to meet peoples health needs as required. Medication administration was examined and seen to be managed effectively therefore not putting people living in the home at unnecessary risks. All staff receive training before they are able to administer medication to people in the home. The previous inspection report made a recommendation that as required medication should have Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: a protocol for staff to follow. This has been completed. Care Homes for Adults (18-65 years) Page 16 of 26 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 and their friends and relatives are able to make a complaint if they are unhappy. Peoples finances are well managed by the staff and this minimises potential risks to people living in the home. Evidence: The home has a complaints procedure. No complaints have been made to the manager since the previous inspection was completed. Surveys completed by relatives and friends stated that they knew who to speak too if they were unhappy and understood how they could make a complaint. Observations during our site visit were that people appeared happy. We examined records for the income and expenditure of people living in the home. None of the people living in the home manage their own finances and this is overseen by the staff team. The previous inspection report made a recommendation that personal monies are regularly audited by 2 staff, records we examined showed this was now being done. Care Homes for Adults (18-65 years) Page 17 of 26 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. The home provides people with a comfortable and homely environment that meets their current needs. Evidence: We completed a tour of the premises with the deputy manager and saw all areas of the home. Downstairs there is a lounge with French windows leading to the rear garden. In the lounge is a digital TV, DVD player and sound system. The room is decorated to a good standard and meets the current needs of the people living in the home. There is a separate dining room that is situated next to the kitchen. The kitchen has been re-fitted with a good quality kitchen. There is a door leading from the kitchen to the laundry/utility room. The garden can also be accessed from the kitchen. To the rear of the home is a good-sized garden with a patio and garden furniture. There is also an old Avery that is no longer used. All of the bedrooms we saw were decorated to a good standard and reflected peoples interests and hobbies. None of the doors have locks, and the manager explained that people have been asked whether they wanted locks (all replied that they did not). This is reviewed annually. The bathroom and toilets are decorated to a good standard and meet peoples current Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: needs. Speaking to the manager they explained that they plan to purchase some sensory environment equipment for 1 of the people living in the home. The home was clean and hygienic. Whilst we completed the site visit we met with the owner of the home who explained that planning permission had been granted top extend the home. This will provide greater ground floor accommodation for people with physical disabilities. The owner of the home will be contacting the CQCs registration team to discuss his proposal. Care Homes for Adults (18-65 years) Page 19 of 26 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 homes recruitment procedure minimises potential risks to people living in the home. Training is available to all staff and minimises the risk of peoples needs not being met in the home. Staff supervision sessions are inconsistent and need to be completed at regular intervals. Evidence: The previous key inspection report made a requirement that the when new staff were employed that they must complete a CRB (Criminal records Bureau) and POVA (Protection of Vulnerable Adults) checks before they commence employment. We examined records for staff employed since the previous inspection, this showed that this requirement is now being met. The 2 staff files we examined met the criteria specified in the regulations. A recommendation of the previous inspection was that staff should complete training in dementia awareness. Speaking to the manager they stated this had been completed. When we asked staff about the training available to them they said it is excellent. The deputy manager was unfortunately leaving on the day we completed our second visit but had recently completed an NVQ level 4 in management/managers award. Other staff we spoke with confirmed they had completed their induction training when they started at the home. Staff spoke to us about them currently Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: completing a medication administration course (to enable them to administer medication in the home), and that once they had completed this they will be starting their NVQ level 3 in Social Care. The manager stated that they identified the training required by staff to meet the mandatory requirements of working in a registered establishment, and the needs of people living in the home. Records and conversations with staff supported this. Staff supervision by the manager was assessed. Records of previous supervisions showed that when they are completed they are thoroughly recorded, but there is a shortfall in the frequency of when staff receive supervision. This was admitted by the manager and they recognise that it is an area that needs to be addressed. It becomes a recommendation of this inspection report that the manager ensures that staff receive regular supervision sessions. The manager stated that they have moved away from completing annual staff appraisals and now complete development plans with staff. These identify future training requirements and set goals. Both of the staff we spoke to agreed that communication amongest the team is really good, this is due in part to it being a small team. But also because it is a settled team that clearly work together. The manager states in the AQAA that they intend to continue improving this area over next 12 months. Care Homes for Adults (18-65 years) Page 21 of 26 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 manager is highly qualified and has a comprehensive knowledge of the needs of people living in the home. Quality assurance procedures need further development to ensure that they provide a range of opinions about the service being provided at the home. Health and safety procedures and practices minimise potential risks to people in the home. Evidence: The manager is registered with the CQC. They are a registered General and Mental Health Nurse and have completed the Registered Managers Award. The registered manager was the owner of the home for many years. We spoke to the manager about quality assurance review in the home. As identified in the last inspection report it is difficult to use questionnaires with people in the home as they do not understand them. Bearing in mind peoples disabilities the manager should identify a method of seeking peoples opinions about the service they receive. We spoke with the manager about other methods of quality review, they explained that they have thought about asking the opinions of other professionals involved in Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: the home. This is a good practice and becomes a recommendation of this inspection report. The manager stated that they use the AQAA as part of the homes quality assurance process as it allows them to review practices and identify future goals. The manager understands quality assurance processes need to be reviewed and developed to become effective. The manager highlights this throughout the AQAA. There are a wide range of policies for the home that cover the topics specified in the regulations. Looking at a sample of these policies showed that a large number had been reviewed in the past 6 months. The manager stated that policies are kept under constant review. There are a range of health and safety procedures in place to minimise potential risks to people in the home. These include regular checks completed by staff, environmental risk assessments and information on good health and safety practice. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 The manager must review all of the risk assessments and develop new ones to meet other identified risks. Failure to review current risk assessments and develop new assessments may put people at unnecessary risks. 07/08/2009 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 2 1 6 The manager should review the Service Users Guide and update the information that is now out of date. The manager should continue to develop more easy read documents to enable people to understand more of the documents that relate to their care. The manager should ensure that staff supervision sessions are completed at regular intervals. The manager needs to review the quality assurance procedure to ensure that they seek a range of opinions (including people in the home) about the quality of the service being provided. 3 4 36 39 Care Homes for Adults (18-65 years) Page 25 of 26 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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