Care Home: 180 Bromwich Road

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What the care home does well New people would be supported to visit and try out the service before moving in. People can spend time doing things they like at home and they are helped to stay in touch with their families. People are offered choices about what they do each day. They go out regularly and have holidays at least once a year. People are well supported with their health care needs and their tablets are looked after safely. The house is warm, homely and safe. People have private bedrooms that they have made comfortable. People said they like the staff. Some have known people for a long time. Proper checks are made on new people who come to work at the home. Staff are offered the training they need to help them do a good job. What has improved since the last inspection? People are being given more information in a way that helps them understand it. There are less restrictions on people about their home. People are getting more involved in normal domestic and kitchen activities. Food is now being prepared freshly for each meal. There is a better balance of male and female staff. What the care home could do better: The number of people the home is for could be reduced from six so people have more room in shared areas. Peoples` care plans need to include the correct guidance for staff. Personal goals could be clearer and followed up more closely. Improvements are needed to parts of the house to make them homely. New staff need to be found so the team can become stable. The staff team and the manager need to work together for the benefit of the residents. The owners need to give staff up to date policy guidance so they know what is expected of them. Key inspection report Care homes for adults (18-65 years) Name: Address: 180 Bromwich Road 180 Bromwich Road Worcester Worcestershire WR2 4BE     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: Jean Littler     Date: 0 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 180 Bromwich Road 180 Bromwich Road Worcester Worcestershire WR2 4BE 01905428030 01905429731 h5021@mencap.org.uk www.mencap.org.uk Royal Mencap Society care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 6 Date of last inspection Brief description of the care home Bromwich Road is run by the Royal Mencap Society, which is a registered charity and is one of the largest providers of services for people with learning disabilities in the United Kingdom. The house was converted to a home in 1990 and provides accommodation with personal care for up to six people with a learning disability. They may also have additional special needs. The home is located in a residential area of Worcester less than two miles from the city centre. Public transport, shops and leisure facilities are within easy reach. Information about the service is provided in a statement of purpose document and a service users guide. The fee for the service is as agreed by Mencap and service users funding local Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 Brief description of the care home authority. People who live at the home have to pay in addition for their own clothes and toiletries, social activities, college fees and any luxury items. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We spent six hours in the home. The manager, Ms Clarke, was not on duty so the staff helped with the inspection. We spoke with two staff and looked around the house. Some people who live at the home spoke to us and showed us their bedrooms. One resident, two relatives, five staff and two health workers returned surveys to give us their views. We looked at records such as care plans, medication and staff rotas. Care Homes for Adults (18-65 years) Page 6 of 31 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 Care Homes for Adults (18-65 years) Page 7 of 31 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available to help any interested parties decide if they want to live at the home. A new persons needs would be carefully assessed and they would be enabled to trial the service. Evidence: The required information documents are provided, which include a statement of purpose and a service users guide called, Choice of Home. Ms Clarke has reviewed this in the last year and it contained up to date information and contact numbers. The guide is available in user-friendly formats, such as pictorial. No new residents have been admitted since the last inspection. There had been six residents but two passed away in recent years. Ms Clarke said she has been having discussions with the providers about admitting one more person. She agreed with our view that the communal areas are quite small for six residents, and felt five should be the maximum. She described in the AQAA that a full assessment would be carried out for any Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: interested persons needs. They would be given the chance to trial the service though coming for short visits as part of a staged transition. This is good practice as it gives the current residents the chance to meet the person and find out if they could live comfortably together. She said there is a Family Charter and the aim is to work positively with families during the assessment and transition stage. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be fully confident that information in their care plan is up to date. There was some evidence that risk assessments do not reflect the guidance staff are being given and are over protecting residents. People are being supported to make choices and this process is being further developed. Evidence: A sample of two peoples care plans and records were looked at. There is a person centred approach to care planning and the information includes appropriate information about their needs, skills, preferences and the support people need. Staff said the plans are being revised at the moment. Discussions indicated that some of the information was now out of date, for example risk assessments indicated that the kitchen needs to be kept locked. Staff spoken with said this restriction mainly applied to a previous resident and the new kitchen door did not have a lock. They did not think one was needed and said it was positive that greater involvement in food and drink preparation is being encouraged. Ms Clarke is Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: reviewing risk assessments in staff meetings, however, as it is important to have correct guidance in place for staff this process needs to be prioritised. Discussions indicated that restrictions such as this have been lifted under Ms Clarkes management. This is positive, however some evidence of risk adversity was still seen, for example, one man is made to hold his small pet rabbit in thick rubber gauntlets. The rabbit has not bitten him and he is missing out on the sensory experience of stroking a furry pet that many people enjoy. Ms Clarke said the plans are being reviewed six monthly and people are being enabled to choose who attends their planning meetings. The last minutes found for one person were from June 2008, however a worker said there had been a recent meeting. Minutes should be in care plans and action points clearly transferred into a plan. Each person has a keyworker to support them with planning. She gave examples of person centred goals that have been actioned. These included one resident going on a cruise as he likes big ships, another has been to a York railway museum and Mini rallies as he likes engines. She plans to focus on supporting people to express their dreams and ambitions so they can be supported to make them become a reality. Some people have behavioural management plans to guide staff to respond positively when they become angry or frustrated. Staff said incidents now occur very rarely and physical restraint is not needed. The incident reports seen confirmed this. A community nurse and behavioural nurse gave positive feedback i.e. they seek advice, follow recommendations, communicate well on clients progress. They are flexible and creative about how to meet peoples needs; They are person centred and are always very effective in actioning monitoring and reporting back. Ms Clarke has attended diversity training and said there is now a diversity officer in the organisation. Whilst there are no specific or cultural differences amongst current residents, gender issues are considered in relation to staff supporting then with personal care. Staff were observed to offer people choices during the day in an unrushed way that did not influence them. Surveys also indicated that staff feel people are treated with dignity and their choices are respected. The resident spoken with said he can usually do what he wants and he makes plans with his keyworker. The further development of the person centred planning process should help facilitate greater life choices. All staff should attend training on the Mental Capacity Act. Information about the new Deprivation of Liberty Standards was seen in the home. Care plans contain a statement on peoples lack of ability to give consent. This should be developed into a Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: care plan about what decisions people are able to make for themselves and those they need support with, through best interests meetings. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported to take part in activities they enjoy and to mix in the community and maintain links with their families. The home provides food people like whilst healthy options are promoted. Evidence: On the inspection day one person was spending the day at a day centre that he attends five days a week. One went out shopping for his birthday with his keyworker and was involved with some food shopping. Another went to a health appointment. While people were at home staff offered them choices of how to spend their time, for example holding their pet rabbit, listening to music. People seemed relaxed at home and moved around freely. Ms Clarke reported that she is encouraging staff to involve residents in normal life tasks within the home. In the past she feels staff have done things for them and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: around them. An example given was that one man enjoys food preparation so he is making the pudding for everyone once a week. Records showed people are involved in tidying their bedrooms, hovering and washing up. Staff confirmed that staffing can be arranged flexibly around peoples planned activities. For example three staff work on Sundays as two people like to attend church. One said even when only two staff are on local pub trips can take place. Some people attend college courses, art sessions and community facilities such as the snoozelen sensory centre are used regularly. Daily records confirmed people are going out almost every day. Trips to the pub, walks, meals out, drives, and normal activities such as haircuts were some of the activities noted. Two are now involved in their own banking. One visits family each weekend and people enjoy a local disco. One man said he has chosen to pay for satellite TV to be fitted so he is having to cut back on other activities that cost money, but he feels this is worth it as he likes football. As mentioned person centred planning has led to individualised activities being arranged, such as pet ownership and a trip to see an Elvis tribute band. Ms Clarke reported that as only two staff could drive the minibus so a large car has replaced this so more staff can take people out. Staff on duty confirmed that the car was suitable, although extra staff sometimes need to follow in their own cars when a larger group was going out. Some staff raised concerns in their surveys about the moving and handling arrangements when assisting one person to use the car. A risk assessment was not seen relating to this or to how people are to be supported to use the kitchen facilities, so Ms Clarke is advised to complete these to guide staff. One of the staff on duty explained that holidays have been arranged for everyone. One person is going to Torquay and another has a cruise planned as they enjoyed a previous experience of this. Feedback indicated that people living at the home are supported to maintain links with their families. Most people have regular contact with relatives and a record is kept of this. Two relatives returned surveys which were overall very positive. Comments included, They take care of all his needs and he appears very happy; This has been a stable placement and my son has been empowered and supported to achieve things some people did not think were realistic. Although I do feel staff have strived to meet his needs I feel he does struggled with the shift pattern, staff turnover, and management changes. Ms Clarke reported that when she started the main meal was being prepared by the Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: night staff for the following evening. This has been changed so food is prepared freshly as it is required. Staff on duty said there is always enough food and there were stocks in place for the next few meals and more shopping was being done that morning. Staff explained that a weekly menu is drawn up and each resident is encouraged to pick a favourite meal to be included. Ms Clarke said work is being developed so food choices can be offered in a visual way with photographs. The meal observed was relaxed and sociable and the menu showed a mixed diet is being offered. Ms Clarke reported that two people have had advice about their health and through healthy options being offered they have lost weight. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported to meet their personal and health care needs and staff make sure that appropriate health care input is obtained. Their medicines are managed safely for them by trained staff. Evidence: The care plan and records sampled showed the personal support each person living in the home needs and their preferred morning and night time routines. Daily records are kept of the actual support they have received. Most people require a high level of assistance and health needs as well as personal care needs. Everyone was seen to be well presented and appropriately dressed. They are supported by their keyworkers to choose and shop for their own clothes. Care records include information for staff about specific and general health related conditions such as epilepsy and wound care. Most of the daily notes related to health issues and outcomes from health appointments were being noted. Specific health professionals are involved where needed, such as district nursing and psychiatry. Feedback from staff and relatives indicated that health issues are taken seriously. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Relatives said they are always told if there are any concerns. Staff said health appointments are prioritised. Recent records showed a district nurse had been unhappy when staff had taken the resident concerned out having forgotten a nurse visit was due. Staff felt they have been appropriately trained to meet peoples health needs. There was evidence that people have had regular check ups with dentists, opticians and medication reviews with their GP or consultant. Each resident has a Health Action Plan that was current. In both plans seen the mens health section had not been completed. Consideration needs to be given to how monitoring can be achieved for conditions specific to each gender, such as testicular, prostrate and breast cancer. There is a medication policy and procedure that had been reviewed in January 09. Each person has details in their personal file of all the medication they are prescribed and their consent to treatment and medication as would be agreed by them, if they are capable, or their relative or relevant person on their behalf. No one living at the home currently self administers. An audit of the medication management systems showed that appropriate storage is in place with each persons medication kept separately. Items outside the monitored dose system had been dated when opened. Administration records were generally clear and doses had been given as prescribed. Ms Clarke reported that all staff have received accredited medication training. She reported a medication error appropriately to us. The management of one persons Warfarin could be improved. A monthly stock control sheet showed that large quantity are being held e.g. 300 tablets. The current regime is noted on the chart but staff decide each day how to make up the dose from 1mg or 3 mg tablets. The guidance would be clearer if each different dose had a separate row on the chart with every other day blocked out when alternating doses are required. The way the dose is to be made up should be clear on the chart to reduce the risk of staff errors and to better facilitate an audit trail. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. External people feel able to raise concerns and have confidence these will be acted upon. More work maybe needed to ensure residents feel able to express their views. Appropriate safeguarding arrangements are in place. Evidence: Mencap introduced a new complaints and compliments procedure in 2007. This includes a user friendly system called, Im talking are you listening, that is designed to enable all service users to use a complaints process more effectively and through questionnaires. Ms Clarke said she plans to develop a pictorial Easy Read complaints poster. The surveys returned from relatives indicated that people felt able to raise concerns and had confidence that appropriate action would be taken. Some residents would need others to raise a complaint on their behalf, so staff are given guidance about how to observe them carefully for signs of any unhappiness. One resident said he originally found Ms Clarke intimidating. He thought they now got on, like a house on fire, however he still seemed unsure if he had the confidence to openly make a complaint. People do spent quality time with their keyworkers and it is hoped that this link will help concerns get picked up quickly. Staff reported that one person does not particularly like living with the others. It is positive that this is now being addressed with him through person centred planning, Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: which is being enabling him to consider his future. Ms Clarke reported in the AQAA that one complaint had been received in the last year, but that this was not upheld. A complaint was sent to us from an anonymous member or members of staff, just prior to the inspection. The information was used to inform the inspection plan, however the points relating to residents welfare were not substantiated or backed up by other staff. There have not been any safeguarding issues raised since the last inspection. All staff attend a training session as part of their induction about safeguarding vulnerable adults called Protect and Respect. There are policies provided in relation to service users protection that includes whistle blowing. The staff spoken with were clear about their responsibilities to report any concern immediately. They felt there was an open and professional culture in the home and that abuse of any kind would not be tolerated. Ms Clarke needs to ensure she is familiar with the Worcestershire multi-agency safeguarding procedures and referral process and make referral information available to staff for when she is on leave. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a clean and comfortable home that meets their needs. The manager is now addressing the areas that need to be improved. Evidence: The home is situated on the outskirts of Worcester on a main bus route into the city. Shops, churches and other leisure facilities are within easy reach. It was first opened as a care home in 1990 and was originally two police houses, with a kitchen extension. The home is a detached house and has a parking area, patio, and large gardens at the back. There are six single bedrooms, two of which are on the ground floor. None have en-suite facilities. One ground floor room is suitable for a wheelchair user, it has wide doors and one leads into a communal bathroom with an assisted bath. The home has two bathrooms and a shower room that was not in use. The lounge is comfortably furnished, however it is quite small, certainly for six residents and their carers. There is a television and stereo for communal use. There is separate modern dining room with good quality furniture. The conservatory has a chair and a television in it, but it seemed to be mainly used for storage and was unhomely. There is a laundry room that is appropriately equipped. There is an office area in the middle of the upstairs corridor which detracts from the homeliness of the environment. The Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: home seemed reasonably clean and there is a cleaning rota for the care staff to follow. Ms Clarke said in the AQAA that residents are now being encouraged to get involved with household and domestic tasks. The bedrooms seen had been personalised. One man had agreed to have a specific design painted on his ceiling and walls that glows in the dark. This was finished on the day and he was clearly very pleased with the effect. The bedroom doors do not have locks. One man confirmed that he liked his door open most of the time and did not want a lock. Suitable locks should be fitted if requested in the future. At the last inspection it was noted that some stained carpets needed replacing and the bathrooms need refurbishing. This is still the case, however Ms Clarke reported that quotes are being obtained for the carpets, some communal areas have been redecorated and the residents are now being encouraged to have personal items around their home. Some fire doors have been replaced. Suitable aids have been provided for specific residents. Arrangements are in place for servicing and maintenance of equipment. Staff said these are effective and gave the example of the oven recently being repaired promptly. Radiators are covered and water temperature checks are carried out. The fire extinguishers had been serviced in 2009. There is a front and rear garden. Ms Clarke is working on improving these. The back garden would be made more homely if the car parking area was separated from the area used by the residents. Infection control arrangements are in place, such as protective clothing. Ms Clarke reported that only two staff have attended infection control training. This should be provided for all staff unless it has been included under the health and safety training. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by sufficient staff who are suitably trained and supervised. The team works consistently and communicates effectively. There are appropriate recruitment procedures. Evidence: There is a minimum of two staff on duty during waking hours and at night one worker is awake. Ms Clarke works office hours and so is available to assist if needed. When needed a third worker is put on duty to facilitate activities and the many health appointments. The staff spoken with said these levels are suitable and if they need a third worker for a planned activity Ms Clarke has told them just to ask. There is a reasonable balance of male and female care staff and those spoken with said there are enough drivers to facilitate outings. There have been three staff changes in the last year. An experienced worker is leaving soon, but she intends to continue on the bank team. There has not been the full staff compliment during the last year for various reasons, long term sick, maternity leave, secondment and vacant hours. No agency staff have been used but bank staff are used regularly to cover the rota. The impact of this situation on residents has been reduced because there is a team of bank staff who know the residents well, several of whom have previously been permanent members of staff. At times there are just two bank workers on duty. A worker spoken with said he completes the rota and has no concerns about this situation as the bank staff are Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: very experienced and appropriately trained. Ms Clarke said she had full confidence in the bank workers and has completed a risk assessment about them working unsupervised. She is currently trying to recruit more staff. Ms Clarke reported in the AQAA that the providers have robust recruitment procedures and all new staff have been appropriately checked before they start. She is aiming to increase the residents involvement in staff recruitment. We were unable to see these records as Ms Clarke was not in the home. The file sampled at the last inspection demonstrated that the procedures had been followed, and staff did confirm in their surveys that appropriate checks on them had been carried out. Ms Clarke reported in the AQAA that all staff have a training profile and that she reviews these during supervision sessions and plans for any gaps. There is an induction programme for new staff to ensure they have underpinning knowledge relating to their role. Staff feedback indicated that they are offered a lot of appropriate training in areas such as valuing people, confidentiality, communication, autism awareness, epilepsy and adult protection. Core safety training is also provided with refreshers in areas such as fire safety, food hygiene, health and safety, medication and moving and handling. Currently of the ten permanent staff five hold an NVQ award. Some of the bank staff are also qualified. Staff spoken with had not attended any training on visual impairment. As one resident has these needs this is recommended. Staff confirmed that Ms Clarke has been providing staff with regular supervision sessions. Staff meetings are being held every month and staff said they can raise issues and ideas openly. The staff were open and welcoming and appeared to be well motivated and to work together in the best interests of the people living in the home to enhance their lifestyles. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being managed in the best interest of the people living there. Area were there are shortfalls are being addressed by the new manager. Evidence: A deputy manager was managing the home at the time of the last inspection. Ms Clarke was appointed as acting manager in July 08. She reported that she was only confirmed in post on 1st July 09. She has relevant experience and is appropriately qualified. She said she had delayed applying to become registered with CQC because of this and because the providers were considering applying to cancel the registration of the care home. Regardless of these issues Ms Clarke should have submitted an application promptly as it is an offence to manage a care home without doing so. The providers are a national organisation and are fully aware of the requirements of the law. She has now applied. The previous manager was in post for many years. The temporary arrangements during the last year and the transition to a new management approach has caused some frictions in the staff team. Staff spoken with said she is a good administrator Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: and does encourage staff to come to her with any issues. Feedback in surveys indicated that some staff felt she could communicate more effectively and develop her people management skills to help staff feel more valued. Ms Clarke has made changes to the culture and administration systems but there was evidence that the outcomes were positive for the residents. The office systems seemed well organised and the message book and diary showed professional communication between the team. The diary showed prompts for staff to get extra food for the bank holiday, ordering medication supplies etc. Ms Clarke had left staff clear contact numbers for managerial support while she was on annual leave. The AQAA had been well completed and showed Ms Clarke had a good understanding of the areas that needed to be further developed. Mencap operate a formal system to monitor service quality. This includes the required monthly visits from an area manager when all aspects are audited over time linking into a continuous improvement plan. Ms Clarke had a detailed plan on display and evidence around the home indicated this was being actioned. The providers have recently launched a new initiative called, What Matters to Me, these standards are being discussed during staff meetings. Ms Clarke reported in the AQAA that many of providers policies have not been reviewed since 2006. This shortfall was raised at the last inspection. The guidance in place for managers and staff needs to reflect current legislation and good practice guidelines. National providers should have the capacity to review policies every year. Systems to manage health and safety risks are in place. Ms Clarke did not include dates for servicing in the AQAA, but a sample of information seen on the day indicated appropriate arrangements are in place. Suitable staff training is arranged, however, if only two staff have been on an infection control course this should be prioritised. There was evidence that the contents of first aid boxes were being routinely checked. As mentioned, under care planning, risk assessments relating to the support residents need are being updated but this process should be carried out more quickly. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 6 Consider reducing the number of places offered to four or five. Improve monthly summary reporting and ensure information about the last review meeting is in the care plan along with a care plan about how any agreed action plan is to be managed. Review care plans and risk assessments in a timely manner and ensure they give the correct guidance to staff and do not impose unnecessary restrictions on people. Continue to promote oportunities for devlopment and montior progress more closely. Ensure health action planning covers the monitoring of health conditions specific to each gender, such as testicular, prostrate and breast cancer. Review the way Warfarin is managed to try and improve the system. Complete plans to upgrade the environment and ensure a system is put in place so areas are refurbished in a timely manner. Page 29 of 31 3 6 4 5 11 19 6 7 20 24 Care Homes for Adults (18-65 years) 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 8 9 10 30 35 37 All staff should attend infection control training. Provide training on visual impairments. The providers need to ensure managers of their services apply for registration in a timely manner that complies with the law. The providers need to set up a system to ensure policies are kept under regular review so they are in line with current legislation and good practice. Complete a risk assessment relating to the new vehicle and to residents involvement in the kitchen. 11 41 12 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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