Care Home: 17 Park Avenue

What the care home does well Individuals` culture and religion were well understood so that people lived a lifestyle that met their needs. People living in the home told us the staff are `helpful` and `good`. Staff were seen to be available to the people living in the home to support them with personal care tasks or facilitate activities. People were supported to keep in touch with people that were important to them. People were able to go out on their own if they were safe to do so helping them to retain their independence. People living in the home received the support they needed to enable them to make choices and decisions about their lifestyles. People had access to a variety of health care professionals to help them keep well. Staff received the training they needed to be able to support people effectively and safely. People were clearly comfortable in the environment. What has improved since the last inspection? The systems in place for care planning and risk assessments had improved giving staff more robust information about how to keep people safe and meet their needs. Better systems had been put in place to show peoples` health care needs were being met on an ongoing basis. Medicine management had improved ensuring people received their medication as prescribed. People had more opportunities to develop their independent living skills and lead more fulfilling lives. Records showed people were receiving varied and nutritious diets. Staff recruitment procedures had improved ensuring new staff were safe to work with the people living in the home. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. There had been some improvements in the environment adding to the facilities available and the comfort of the people living in the home. What the care home could do better: All the necessary information should be available to help people decide if the home is suitable for them. Staff must follow risk management plans to ensure the safety of the people living in the home. The home must have a registered manager so that the people living in the home can be assured the home is run in their best interests. The quality of the service being offered to the people living in the home needs to be regularly reviewed. Evidence must be available that all the equipment used in the home is safe. Key inspection report Care homes for adults (18-65 years) Name: Address: 17 Park Avenue Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND     The quality rating for this care home is:   one star adequate 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 9 0 6 2 0 1 0 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 35 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: 17 Park Avenue Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND 01215233712 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): faisalazam@london.com Park Avenue Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 22 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: Mental Disorder, excluding learning disability or dementia (MD) 22 Date of last inspection Brief description of the care home 17 Park Avenue is a care home for up to 22 adults that are experiencing mental ill health. The home is situated close to local amenities such as shops, places of worship and public transport links. There are six shared bedrooms and ten single bedrooms, none of which have en suite Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 22 1 4 0 1 2 0 1 0 Brief description of the care home facilities. There is one large combined lounge/diner on the ground floor and a rehabilitation kitchen has recently been installed for the use of the people living in the home. The home has a passenger lift and there is ramped access to the front of the building. Some adaptations have been made to bathrooms to enable people with a physical disability to shower and bathe. Information is shared with people who live at the home during house meetings and there are leaflets describing how to make complaints available in the entrance hall. Many of the people living in the home do not speak English as a first language. The staff team have the skills collectively to communicate with people in their first languages. The range of fees charged for living at the home was not detailed in the service user guide. People should contact the home direct for this information. Care Homes for Adults (18-65 years) Page 5 of 35 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: one star adequate 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 focus of inspections undertaken by us, the Care Quality Commission (CQC) 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 provisions that need further development. This is the second key inspection of this service this inspection year. It is recommended that this report is read in conjunction with the report from the previous key inspection which was undertaken on January 14th 2010. Due to concerns around the care planning, medicine management and risk assessments that were raised at the last key inspection a random inspection was undertaken at the home in April 2010. This was to monitor the homes progress. During that visit we looked at care records, risk assessments, medicine management and observed staff interactions. Some of the findings from that visit are included within this report. Care Homes for Adults (18-65 years) Page 6 of 35 This inspection was carried out by two inspectors over one day. The inspecting pharmacist visited the home on a different day to look at the management of the medicines in the home. 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 and 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. During the course of the inspection we spoke with five of the people living in the home, the acting manager, deputy manager, the responsible individual and four staff to get their views on the home. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 35 All the necessary information should be available to help people decide if the home is suitable for them. Staff must follow risk management plans to ensure the safety of the people living in the home. The home must have a registered manager so that the people living in the home can be assured the home is run in their best interests. The quality of the service being offered to the people living in the home needs to be regularly reviewed. Evidence must be available that all the equipment used in the home is safe. 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 35 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 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user guide should be updated to include all the current and necessary information that people would need to help them decide if the home could meet their needs. It should be made available in appropriate formats. Evidence: The service user guide and statement of purpose for the home had been updated recently. However the service user guide which would be the document issued to people considering moving into the home did not include all the information they would need to help them decide if the home was suitable for them. For example, there was no detail of the fees charged at the home, what the terms and conditions of residence were and the contact details for the Commission were not included. Some of this information was available in the statement of purpose. The acting manager had improved the documents to some extent with the addition of some pictures that made them more accessible to the people living in the home. There were copies of the service user guide available in different languages but these were hand written and we were told these had not been updated. These needed to be current and readily available as English was not the first language of many of the people living in the Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: home. We were told by the acting manager that they were pursuing a translating service to facilitate this. The pre admission procedure was looked at for one person who had moved into the home on a four week trial basis. Records showed that an assessment of the individuals needs had been undertaken by the deputy manager where the person was living before admission. The assessment was quite comprehensive and covered areas such as physical well being, mental health, diet, communication, some cultural needs and hobbies and interests. There was also a personal recovery plan available from the mental health team involved in the admission. This gave details of the persons history, needs and risks. The information available would have enabled the staff at the home to determine if they were able to meet the needs of the individual. We were told the person had not visited the home prior to admission but her family and social worker had been to have a look around. The person concerned did not want to talk with us therefore we could not confirm if she was happy with the admission arrangements however she appeared settled and generally content. The social worker involved with the individual also commented that she had settled well and the home were meeting her needs. The individual was on a four week trial period which would give her adequate time to see if she liked the home and thought it could meet her needs. Care Homes for Adults (18-65 years) Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements were in place to ensure people received the support they needed safely and in the way they preferred. Evidence: Care plans were in place in the files we sampled. Care plans are individualised plans about what the person is able to do independently and states what support is required from staff in order for the persons needs to be met. We looked at two peoples care files in detail and partly reviewed another. The detail in the care plans had improved a great deal since the last key and random inspections. There was much more detail included about how people wanted to be cared for, what their choices and preferences were and where they needed staff support. Care plans in place included personal care, communication, cultural and religious needs, diet and activities. The detail in the care plans should ensure people receive their care in the way they want. For example, one persons care plan detailed they liked to wear both traditional and English clothes, their preferred language and Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: what languages they understood. Records showed and staff told us that this person was changing clothes frequently and staff were heard to speak to the person in their preferred language. This person did not want to talk to us about her care however she appeared quite content. One person had some very good details of how staff were to communicate with them and the persons ability to understand what was said to them. Also available for staff was a very good collection of pictures to promote more effective communication with people. There were some details in the care plans of peoples cultural needs, for example, preferred languages and places of worship. However these could be further developed, for example, for one person the care plan stated wears traditional clothes. Staff were from different cultural backgrounds and could not be expected to know the cultural needs of all the people living in the home. These needed to be clearly detailed in the care plans to ensure peoples needs were met. There were several risk assessments in place for the people living in the home. The areas covered by these included, access to the community, behaviour, manual handling, personal care and health related issues. The detail in the risk assessments was generally quite comprehensive and told staff how they were to reduce any risks to ensure people were kept safe. Some of the people living in the home had some behaviours that could be difficult to manage. Staff spoken with were able to tell us how they managed these behaviours to ensure that the people living in the home and themselves were kept safe. What they told us was consistent and cross referenced to the management plans ensuring people were kept safe. Some of the risk assessments could have been further developed, For example, one stated if putting herself or others in danger permissible to use restraint policy immediately but did not say what this was. Staff spoken with stated they had been told they must never restrain the people living in the home and they never did. The policy was seen and it stated that only staff specifically trained could use restraint. This information needed to be included so that staff were very clear and it could be assured people would be kept safe. One person had a well detailed moving and handling plan in place that detailed a handling belt should be used. All staff that were spoken with did not mention using the handling and told us they held this persons hands to help them walk. We did not see this person moved but did discuss the issue with the acting manager who confirmed the handling belt should be used. Staff must Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: ensure they follow the plans in place to ensure people are moved safely. The care plans gave some examples of where people were able to make decisions, for example, their preferred activities. Staff spoke to us about people making decisions on a daily basis about what they wore, what they ate and where they went. People were able to manage their own money if they were able or with support from staff. People could choose to attend medical appointments on their own as long as this did not put them at any risk. One person spoken with told us he chooses to stay in his room most of the time and goes out when he wants. Care Homes for Adults (18-65 years) Page 15 of 35 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 were being offered more opportunity to experience a lifestyle that is meaningful and meets their needs and expectations. People were offered a range of food that met their cultural needs and preferences. Evidence: The opportunities for people to develop their independent living skills had been enhanced since the last key inspection. A rehabilitation kitchen had been installed in the home and several of the people living there were seen to use this facility, with staff support, during the inspection. We were told by staff and by the people using the home that they very much enjoyed this facility and some people told us they were cooking their own meals others just making snacks and drinks. One person told us he does all his own shopping and cooking and is given a budget to enable him to do this. Photographs and a slide show on the television also showed that the people living in Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: the home had become involved in gardening and were growing some fruit and vegetables. People seemed to be enjoying being involved in this and clearly was giving them a more fulfilled life. People were seen to come and go from the home during the day some going out on their own others with staff support. One person told us they had been to the park and the Gurdwara another had been to the doctors other people had just been out for a walk. Records showed and staff confirmed that people were going out more to use local facilities such as shops, restaurants, places of worship, the library and parks. This ensured people were leading more fulfilling lives. The acting manager and deputy manager spoke to us about some people being introduced to a local day centre and local colleges coming out to assess what educational opportunities they could offer the people living in the home. They were also pursuing leisure cards for people so that they would be able to use the local swimming pool free of charge. This showed the opportunities for people to lead more fulfilling lives were being explored and enhanced. People had their own activity plans and there was also one for the home. One individual plan that was seen stated the person liked helping around the house setting and clearing tables, liked Asian television programmes and music. Records showed this person was carrying out these activities as well as joining in the homes activities. This showed she was able to spend her time as she chose doing what she liked. Individuals were supported to keep in touch with people who were important to them such as friends and families. Care plans included details of who people wanted to keep in touch with outside of the home. Staff spoke to us about one person having visitors that she very much enjoyed but if they phoned her she would often decline to speak to them. A range of food was offered to the people living in the home including vegetarian and Halal meals which is reflective of peoples cultural needs. There was a list of the foods available on the board in the dining room and people could choose from these on an ongoing basis. People often chose different particularly with the new kitchen in use when they were being supported to cook their own food. Staff were aware of and care plans detailed the foods people liked and any diets, for example, diabetic or soft diets. This ensured people received the foods they liked but Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: also what they needed to stay healthy. The records of food eaten by the people living in the home had improved. From these it could be determined that people received a varied and nutritious diet. Care Homes for Adults (18-65 years) Page 18 of 35 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 systems in place to make sure people stay healthy and well had improved and ensured the well being of the people living in the home. Evidence: The needs of the people living in the home in relation to personal care varied considerably. Some people needed very little support with their personal care others were very dependent on staff for support with this. The care plans in relation to personal care had improved and included much more information about peoples needs, preferences and what they were are able to do for themselves. This information would enable staff to ensure peoples independence was maintained and that they received their care in the way that suited them. For example, one person was very reliant on staff for support, his care plan stated he preferred a shower and would hold the shower head himself and were to give him the mirror when shaving. Although the person concerned was not able to confirm this happened staff told us this was what he did. This ensured he received his care in the way he wanted. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Staff were aware of the issues in relation to gender sensitive care. Male staff were very clear that they did not give personal care to the female people living in the home and that there were always female staff on duty. This ensures the choices and the dignity of the people living in the home are upheld. The care plans and management plans in place for peoples physical and mental and well being had improved considerably. The management plan for one persons diabetes was well detailed and records confirmed that this had been followed when the persons blood sugars fluctuated. This person was also at risk of developing pressure sores due to their immobility. There was a plan in place to avoid this which detailed the use of a pressure cushion and repositioning every two hours. Staff spoken with were very clear about this persons care and how they avoided them having sore skin. One person who had recently moved to the home had an ongoing health problem that was clearly detailed in the care plan with the signs and symptoms staff were to be aware of. Staff spoken with did not seem to know about this. This was discussed with the acting manager. We were told the person had not shown any of the signs of this illness, for example, drinking excessive amounts of water, since being at the home. However it was important that staff should know about it in case it happens in the future so that they can ensure this persons well being by getting them prompt medical attention. Care plans included good information about peoples mental health and how staff would know if this was deteriorating and what they should do. This should ensure peoples mental health is monitored on an ongoing basis. People were being weighed on a regular basis to ensure they were not losing or gaining significant amounts of weight which could be a sign of underlying health concerns. Records showed that peoples health care needs were being monitored and followed up as necessary. For example, one persons health care plan identified they needed to see the dentist and the optician this had been done. The people living in the home spoke to us about going to the clinic for their injections. Records showed that people were attending appointments at the GPs, clinics, dentists and opticians. The recording of attendance at appointments and the outcomes had improved making it easier to track that peoples health care needs were being met. The pharmacist inspection lasted just over one hour. Four peoples medicines, Medicines Administration Record (MAR) charts and care plans were looked at. One Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: senior care assistant and the deputy manager were spoken with. All feedback was given to the manager and responsible individual. The reason for the pharmacist inspection was to check compliance with the Statutory Requirement Notice served on 17th May 2010, following the last pharmacist inspection on 8th April 2010. Due to the poor and in some instances dangerous medicine management in the home seen at that inspection the home was required by 7th June 2010 to 1. Make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home 2. Ensure that accurate records are maintained of all medications received into the Home and where discrepancies are found take appropriate action to rectify the problem. Four additional requirements were also left following that inspection. The manager and staff have worked hard to improve the medicine management to a safe level and all the requirements were fully met. This was commended. All the medicines were stored in a locked medicine trolley used to transport the medicines to the people in the home. This was clean and tidy and well organised so it was easy to identify individual peoples medicines, reducing the risk of error. Surplus and some more potent medicines were kept in a designated locked metal cabinet. Any medicines requiring refrigeration were stored in a separate locked refrigerator. The temperatures of both the room and refrigerator complied with current guidance to ensure their stability. The home saw the prescriptions before they were dispensed and used a copy of them to check the medicines and MAR charts received into the home for accuracy. The quantity of all medicines received had been recorded enabling audits to be undertaken to demonstrate whether the medicines had been administered as prescribed. Hand written MAR charts were well written and easy to understand and included all the relevant details required. The home had introduced a quality assurance system, whereby staff counted the medicines dispensed in traditional bottles or boxes, twice a day. While this system was lengthy and time consuming, it had improved medicine management to a good standard. Audits indicated that the medicines had been administered as prescribed Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: and records reflected practice. The care plans included details about the peoples clinical conditions to support their care. Each member of staff had signed to say they had read each care plan. Medicines prescribed on a when required basis had supporting protocols detailing their use, so they would only be administered as the doctor prescribed and not routinely. One senior care assistant spoken with had a reasonable knowledge of the medicines he handled. The deputy manager had a good understanding of what the medicines were for and also the peoples clinical conditions. Care Homes for Adults (18-65 years) Page 22 of 35 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. Arrangements generally ensure that the views of the people living in the home are listened to and that they are safeguarded from harm. Evidence: The complaints procedure for the home was on display in the entrance and available in a variety of languages to reflect the needs of the people living in the home. The procedure had also been made available in pictorial format for people who may require this. There were good interactions between staff and the people living in the home. People were very comfortable in the presence of the staff and were seen going to them for a variety of things during the inspection and staff being attentive. This would give the people the confidence to raise any issues. The home had had one complaint raised with them by one of the people living in the home. This had been investigated by the acting manager and resolved to the complainants satisfaction. This showed people were listened to and their views acted on. Staff spoken with confirmed they had received training in the protection of vulnerable adults. They were able to tell us what constitutes abuse and what they would do if they witnessed or suspected any events of abuse. This should ensure people are safeguarded. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Systems were in place for helping people to manage their money where they needed support with this. Records for this were sampled and showed that all income and expenditure was recorded. Where purchases were made on behalf of the people living in the home receipts were available. All the balances of the money held that were checked were correct. The acting manager told us about one person who she felt did not have access to her own money due to some issues with the family. The acting manager had reported this to the appropriate social worker and asked for a review so this could be followed up to ensure this person had access to their money. The systems in place should ensure peoples money is spent appropriately and that they are safeguarded from abuse Issues were raised at the last key inspection about poor staff recruitment which could have lead to people not being fully safeguarded. This had been improved at the random inspection and the improvement had been sustained at this inspection. This should ensure only the appropriate people are employed to work with the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 35 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 provided the people living there with a well maintained and comfortable environment in which to live. Evidence: 17 Park Avenue is situated off the Soho Road area of Hockley in Birmingham. The home is well placed for access to local amenities such as places of worship, public transport routes, shops, cafes and restaurants. This is important for the people who live there as they enjoy accessing community based activities. We toured the communal areas of the home and saw three bedrooms. There had been some further improvements made to the environment since the last inspection. these included the installation of a rehabilitation kitchen. We saw that this was being well used by the people living in the home with the supervision of staff. This meant people had the facilities to make their own drinks and snacks and cook some of their meals if they were able. This enhanced their independence. Further improvements had also been made to the garden with the addition of further seating for the use of the people living in the home. More plants and vegetables/fruits had been planted and people were being encouraged to take part in gardening activities. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: New flooring had been fitted on the corridors upstairs in the home making the environment more pleasant for people. The carpet on the stairs was wearing but it was planned for this to be replaced. We were shown one bedroom that was being totally refurbished to enable the occupant to live more independently and was to include an en-suite shower facility and small kitchen area. The person who was to occupy this was very happy that it was being done as he told us he preferred to spend time on his own in his room. The other bedrooms we saw were generally adequately furnished and decorated and people were satisfied with them. It was noted that the bedrooms did not have a lockable facility to enable people to lock away any personal possessions. There were a range of toilets and assisted bathing/showering facilities located throughout the home for ease of access for those living there with a physical disability. These facilities were being given a face lift as they had been quite basic making them pleasanter environments for the people living in the home. The home was generally clean and people were comfortable and satisfied with the environment. Care Homes for Adults (18-65 years) Page 26 of 35 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. People are supported by well trained staff who have a good understanding of their needs. Recruitment procedures were robust and ensured only the appropriate people were working with the people living in the home. Evidence: Staff turnover at the home had been relatively low since the last key inspection which was good for the continuity of care for the people living in the home. At the time of the random inspection in April the staffing levels had been improved. This had been sustained. We were told there were four support staff on duty throughout the day with additional senior staff, cleaning staff and chefs. The home also had two dedicated activities coordinators, one was on duty during the morning and another during the afternoon. The rotas seen generally agreed with what we had been told but they did not include the activity coordinators. They should be included so that the rotas give a true reflection of what staff are on duty each day so that it can be ascertained there are enough staff to meet the needs of the people living in the home. The relationships between the people living in the home and the staff were seen to be friendly and people were comfortable in the presence of the staff. We were told by the Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: people living the home that staff were helpful and good. Staff were seen to be available to the people living in the home to support them with personal care tasks or facilitate activities. Staff spoken with were able to tell us what the needs of the people living in the home were and how they supported them to meet their needs. This ensured people had their needs met as they wanted. The staff recruitment procedures had improved at the time of the random inspection. This had been sustained. The recruitment records for two new staff were sampled. These showed that all the required checks had been undertaken on staff before they started work at the home including criminal records bureau checks (CRBs)and two written references. The systems in place should ensure that only suitable people are employed to work with the people living in the home. Staff spoken with told us about their training. They were satisfied they received the appropriate training to enable them to meet the needs of the people living in the home. They told us they had undertaken training in topics such as protection of vulnerable adults, medication administration, food hygiene, manual handling, fire safety and mental health awareness. The training matrix for the home confirmed these topics had been undertaken and others such as diabetes awareness, report writing and equality and diversity. Other training courses were scheduled to take place throughout the year. The training arrangements in place ensure that staff have all the necessary skills and knowledge to support the people living in the home appropriately. It was noted that the training matrix was blank for six staff. These staff were on the previous matrix and it was known they had completed a lot of training. This was discussed with the deputy manager who was to address this and ensure all staffs training was on the matrix. The files sampled for the two new staff only showed an orientation induction for one person who had started at the home very recently. The other file did not show any induction training. The deputy manager told us this person was undertaking induction training in line with the specifications laid down by Skills for Care. Evidence should be kept on site of this so it can be shown staff have received the appropriate induction training to enable them to support the people living in the home. Care Homes for Adults (18-65 years) Page 28 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs a sustained, stable management team to ensure it is managed in the best interests of the people living there on an ongoing basis. Evidence: The home has not had a registered manager for some time and there have been a succession of acting managers at the home. These ongoing changes have clearly affected the running of the home in the past. At the time of the random inspection in April another acting manager had been appointed and the previous acting manager had reverted to his role of deputy manager. These management arrangements remained the same at the time of this inspection. We were told that the acting manager was waiting for the return of criminal records bureau check (CRB) and then her application for registration would be forwarded to the commission. It is important that the home has a registered manager and that some stability is maintained at the home to ensure it is managed in the best interests of the people living there. The acting manager and the deputy manager were working well together and several improvements had been made that benefited the people living in the home in respect Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: of their safety and receiving support in the way they wanted. These included improved care plans and risk management plans, the medicines management had greatly improved and people were having more opportunities to lead fulfilled lives and develop their independent living skills. The management team need to be clear with visiting professionals about who is the manager of the home. Nurses visiting the home had been told that the deputy manager was the manager. This needs to be addressed due to issues of accountability and who professionals should be contacting and giving feed back to. There had been little progress made on developing any quality monitoring systems in the home. The acting manager stated they are in the process of setting up a system that will audit the service against the required minimum standards but as these are due to change they are looking at the new standards and regulations due in October. There are some in house monitoring tools for such things as daily records, medication and safety checks. Staff were having meetings with the people living in the home and a variety of topics were discussed including activities, menus, the care in the home and so on. However as the minutes to the meetings were not followed up at the next meeting it was difficult to see if peoples views and opinions of they wanted had been followed up. The people living in the home are given satisfaction surveys on a regular basis but none of the information from the audits or surveys is collated and the home does not have a development plan. This is needed to show how they intend to improve the service on an ongoing basis for the benefit of the people living in the home. The health and safety of the people living in the home and the staff was generally well managed. Staff were receiving regular training in safe working practices to ensure people were kept safe. The records in the home that we sampled showed that the equipment used was regularly serviced to ensure it was safe to use. The in house records for the checks on the fire system were sampled these were up to date and showed that fire drills were undertaken on a regular basis so that staff knew how to keep people safe in the event of a fire. It was noted that one of the people living in the home was deaf and had a vibrating pillow to alert them if there was a fire. The checking sheet for this stated it should be done every two weeks, it was not being done this regularly. Staff needed to check with the fire officer how often they should be doing this to ensure the person is entirely safe. We receive very few notifications of accidents or incidents in the home. When discussed with the acting manager she stated they had not had any accidents or incidents that would need reporting. However there had been at least one incident where one of the people living in the home had been threatened with violence by Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: another. These incidents need to be reported to us so that we can be assured they are managed in the best interests of the people living in the home. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 12 Staff must follow the moving 30/07/2010 and handling plans that are in place. This will ensure people are not put at risk of harm. 2 37 8 An application for the 31/07/2010 registration of the manager must be forwarded to the Commission. This will assure people living in the home that someone has day to day responsibility for the management of the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to include all the current and necessary information that people would need to help them decide if the home could meet their needs. It should be made available in appropriate formats. Care Homes for Adults (18-65 years) Page 33 of 35 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 2 6 Care plans should include all the individual needs of the people living in the home and include how staff are to support them to meet their needs. This will ensure people receive person centred care. All the relevant information should be included in risk management plans so that it can be assured staff have all the information they need to keep people safe. Staff should be aware of the symptoms of illnesses of the people living in the home. This will ensure people get prompt medical attention when needed. Bedrooms should include a lockable facility so that people can lock away personal effects if they wish. Fifty percent of staff should be qualified to NVQ level 2 or the equivalent. This will ensure staff have all the necessary skills and knowledge to support the people living in the home. Rotas should be a true reflection of what staff are working in the home on a daily basis. This will ensure there are adequate numbers of staff available. The training matrix for the home should show that all staff have had all the appropriate training to care for the people living in the home. The frequency for checking fire safety equipment should be agreed with the local fire officer. The commission should be notified of any incidents in the home that affect the well being of the people living in the home. This will ensure they are managed in the best interests of the people living there. 3 9 4 19 5 6 26 32 7 33 8 35 9 10 42 42 Care Homes for Adults (18-65 years) Page 34 of 35 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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