Care Home: 2 & 10 Grove Road

What the care home does well Staff know the people living there well and understand how to listen to them. This helps staff to meet people`s individual needs. Plans that explain how to care for the people living there are well written so that staff know how to support individuals. Staff help the people living there to do as much for themselves as they can to be as independent as possible. There is a choice of healthy food so that people are supported in their diet to keep well.Grove Road, 2 & 10DS0000016795.V375268.R01.S.docVersion 5.2The people living there go out and do things they enjoy with staff that know them well. Staff have training to help them understand how to protect the people living there from harm and understand how to help them keep well. Staff help people to develop their skills and experience new things so improving their quality of life. Staff take notice when people seem unwell so that they get the help they need to be well. The home is well decorated and furnished making it homely and comfortable for people to live in. Equipment in the home is often tested to make sure it is working and safe to use. What has improved since the last inspection? There are risk assessments that help people do things safely so that staff know how to make sure that people are safe when taking risks. Records about people`s medicines are filled in properly to make sure they have their medicine when they need it. All medication is given as prescribed by the doctor so that people`s health needs are met. Staff do not work too many hours without a break. This helps to ensure that the health and welfare of the member of staff and the people living there is not affected. The statement of purpose had been updated so that people who may want to live there have the information they need to make a choice about this. Care plans are in place when people have an injury or infection so that staff know how to support them to meet their needs. Staff follow individual`s care plans to make sure their health needs are met. The people living there are offered the opportunity to go out in the evenings if they want to so that their lifestyle is similar to other people their age. The people living there do not pay for meals from their own money as this is included as part of the fees they pay. The garden in house 2 has been finished so that people can enjoy using it. Some repairs have been done so the house is comfortable and safe to live in.Grove Road, 2 & 10DS0000016795.V375268.R01.S.docVersion 5.2Fire drills happen more often so that people have a chance to practice getting out of the house to safety if there is a fire. What the care home could do better: Budgets should ensure that there is sufficient money so that individual`s needs can be met. All staff should have training so they know how to reduce the risks of cross infection. Key inspection report CARE HOME ADULTS 18-65 Grove Road, 2 & 10 Kings Heath Birmingham West Midlands B14 6ST Lead Inspector Sarah Bennett Unannounced Inspection 30th April 2009 09:25 30/04/09 Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 2 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 Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grove Road, 2 & 10 Address Kings Heath Birmingham West Midlands B14 6ST 0121 441 3221 0121 441 3541 Paul.McDonald@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association Mr Paul McDonald Care Home 8 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Learning disability (8), Sensory impairment (8) registration, with number of places Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care home only 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) 8 Sensory Impairment (SI) 8 of the following age range: 2. from 18 years or age and above The maximum number of service users to be accommodated is 8 Date of last inspection 21st May 2008 Brief Description of the Service: Grove Road is located in a small cul-de-sac in a residential area of Kings Heath. The Home comprises of two purpose built properties each accommodating up to four people who have a learning disability and sensory impairment. Grove Road is within reasonable walking distance of the main shopping area of Kings Heath, where there are numerous shops, public houses, restaurants, churches and recreational amenities. There is a large park close by and public transport is easily accessible. 2 & 10 Grove Road is on opposite sides of the cul-de-sac. Each house has a lounge and a separate dining room, a modern fitted kitchen and a small laundry room. The administrative office is located at number 2 and the staff sleeping in room at number 10. Number 2 also benefits from a conservatory, which gives additional space. Each person has their own bedrooms that is decorated and furnished to reflect their individual interests and personalities. There are bath and shower facilities in the upstairs bathroom plus separate toilets on the landing and on the ground floor. Both homes are comfortable and well furnished and there are many aids and adaptations related to sensory and other disabilities. There are four men living at number 2 whilst at number 10 there is a mixed gender group. The people living there have diverse cultural backgrounds, which are reflected in the choice of decoration and furnishings. Both properties have rear gardens. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 5 Information is shared with the people living there by use of objects of reference to enable individuals to make choices and map out their location within the home. The service users guide stated that the fees charged to live there are negotiated with the funding authority on an individual basis following an assessment of the person’s needs. The fees include the costs of rent, utility charges, personal care, laundry and food, activities and up to £300 towards an annual seven day holiday. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by two people living there. This involved establishing individual’s experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records were looked at. The registered care manager, unregistered care manager and staff were spoken with. What the service does well: Staff know the people living there well and understand how to listen to them. This helps staff to meet people’s individual needs. Plans that explain how to care for the people living there are well written so that staff know how to support individuals. Staff help the people living there to do as much for themselves as they can to be as independent as possible. There is a choice of healthy food so that people are supported in their diet to keep well. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 7 The people living there go out and do things they enjoy with staff that know them well. Staff have training to help them understand how to protect the people living there from harm and understand how to help them keep well. Staff help people to develop their skills and experience new things so improving their quality of life. Staff take notice when people seem unwell so that they get the help they need to be well. The home is well decorated and furnished making it homely and comfortable for people to live in. Equipment in the home is often tested to make sure it is working and safe to use. What has improved since the last inspection? There are risk assessments that help people do things safely so that staff know how to make sure that people are safe when taking risks. Records about people’s medicines are filled in properly to make sure they have their medicine when they need it. All medication is given as prescribed by the doctor so that people’s health needs are met. Staff do not work too many hours without a break. This helps to ensure that the health and welfare of the member of staff and the people living there is not affected. The statement of purpose had been updated so that people who may want to live there have the information they need to make a choice about this. Care plans are in place when people have an injury or infection so that staff know how to support them to meet their needs. Staff follow individual’s care plans to make sure their health needs are met. The people living there are offered the opportunity to go out in the evenings if they want to so that their lifestyle is similar to other people their age. The people living there do not pay for meals from their own money as this is included as part of the fees they pay. The garden in house 2 has been finished so that people can enjoy using it. Some repairs have been done so the house is comfortable and safe to live in. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 8 Fire drills happen more often so that people have a chance to practice getting out of the house to safety if there is a fire. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 People using the 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 the information they need so they can make a choice as to whether or not they want to live there. Arrangements ensure that the needs of individual’s would be assessed before they move in to ensure they can be met there. EVIDENCE: Records sampled included a service users guide that gave the person the information about the home they needed. It included photographs and was written in an easy read format making it easier to understand. The statement of purpose included the information that prospective service users would need so they can make a choice as to whether or not they want to live there. It stated that it was available in different formats so that it would be accessible and easier to understand. Since our visit the statement of purpose had been updated to include the current information about the home and how people can contact us if they need to. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 11 The AQAA stated that the people living there have done so for several years. Therefore, the standard relating to assessment of people’s needs before they move in was not looked at during this visit. There were no vacancies. However, one person had been assessed as needing to move from the home as their needs had changed. A vacancy had been identified for them at another home managed by Sense where their needs could be better met. Their records showed that they had a transition plan in place. The other home had completed assessments to ensure the person’s needs could be met there. They had visited the home regularly to meet the other person living there and staff. A living diary has been completed to record their reactions so it is clear whether or not this is where they want to live and if their needs can be met there. The registered care manager said that the person has not been allocated a social worker so they are planning to meet with all the people involved with the person moving the following week. They will decide whether or not it is fair on the person to continue with the visits when without a social worker the placement cannot be agreed. They have also been referred for an independent advocate but as yet have not been allocated one to help ensure their ‘best interests’ are being considered in this move. Records sampled included an individual contract between the home and the person. This stated the terms and conditions of their stay including their rights and responsibilities. One person’s contract was not signed. It should be signed by a representative of the person to show that they agree with the terms and conditions of their stay. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the information they need so they can support individual’s to meet their needs safely so ensuring their well being. EVIDENCE: The records of two of the people who live there were looked at. These included an individual care plan that detailed how staff are to support the person to meet their needs and achieve their goals. The plan centred on the person and how they would prefer to be supported. They detailed the things important to the person, who should support them, the things they like and the things they do not like. The plan stated how staff should communicate with the person. None of the people who live there are able to communicate verbally or through formal Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 13 communication methods. Staff identify what people want by recording and responding to the individual’s responses, their expressions and behaviour. Staff attempt to develop individual communication methods for each individual. They liaise with the person’s family or people who know the person well to help identify the things they like. Plans stated how staff are to support the person with their mobility. Some people are very active and physically fit so have no mobility difficulties. However, due to their visual and hearing impairment they may need to be guided to move around particularly when out in the community. Plans detailed how staff are to ‘guide’ the person so they can be as independent as possible but also safe. They included information as to how to support the person in different environments that they are likely to spend time in. Care plans had been updated as a person’s needs had changed. If the person’s needs remained the same they are reviewed every six months to make sure they are still effective in meeting the person’s needs. The person, their family if appropriate and people that know them well are involved in their care plan. The AQAA stated and records sampled showed that each person has monthly ‘Core Team’ meetings where staff review the previous month and plan for the next, this is clearly documented. A ‘Core Team’ of staff is allocated to work with each person so that there are usually staff on duty that know the individual well and are involved in planning the support they need. Minutes of these meetings showed that what the person has been doing is discussed and what can be done to make things better if things have not worked well. Records sampled showed that people are given choices about what they do. Some people use tactile symbols or objects that help them to tell staff what they want to do or where they want to go. Records included detailed individual risk assessments. These ensure that people are supported to take risks in their daily lives whilst being as safe as possible. These are regularly reviewed and updated where the person’s needs may have changed. Staff are asked to sign to say they have read these so they know how to support the person safely. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there experience a meaningful lifestyle that meets their individual needs. EVIDENCE: Records sampled showed that people are supported to do the activities they enjoy. People who enjoy going out are supported to do so at least once every day. Records showed where people had been offered opportunities to do activities but had not wanted to do them. Records showed that some people regularly go to the Sense resource centre where there is a sensory room, masseur and IT suite. They also go to cinemas, rock climbing, horse riding, swimming pools, sensory rooms, masseurs, parks, shops, pubs. The AQAA stated and records showed that people are given Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 15 opportunities to try new experiences and activities. Since the last inspection support from staff to access activities outside of the home has been more flexible where people want this. One person enjoys walking and climbing. Staff said that they supported this person to climbed Snowdon last year. This year they are planning and training for climbing Ben Nevis. Given the needs of the people living at the home staff are to be commended for the support they give to individual’s so they can achieve the things they want to do and live fulfilled lives. During the morning in house 2 there was a music session run by one of the staff. People who did not want to take part in this went out with staff and did other activities such as going for long walks and to the café. Some people from house 10 came to join in the music session. People were clearly enjoying participating in this. Staff said that a range of music is used during these sessions so to give people different experiences. The AQAA stated and staff said that last year they supported two people in to go on holiday for the first time in years. They went on individual holidays to Center Parcs. One person returned there this year to celebrate their 40th birthday, where they particularly enjoyed using the spa bath. People who wanted to have been on holiday in the last year. There are guidelines for supporting a person to plan a holiday, which were very detailed. These included helping the person to choose the holiday so they do the things they want to. The AQAA stated that in the last year one person had stayed at their relatives house overnight for the first time in many years. Every year Sense holds a family weekend at a local hotel. This helps families who come from different areas of the country to have an opportunity to meet together and to visit their relative. This was held the weekend before. Staff said that relative’s of four of the people living there attended. One person had returned to stay at their relative’s house with them and was still away at the time of the visit. Throughout the day people were observed to be encouraged to be as independent as possible and records showed that people make drinks, go shopping for their toiletries and for food and help to prepare snacks. At the last inspection ‘gates’ were put at the kitchen doors to prevent people from entering as it was thought that people were at risk when in the kitchen. These have now been removed. Staff said that one person still finds it difficult when they can smell the food cooking as they think it is going to be served immediately. However, staff are managing this so as to keep the person safe. Staff involved people when preparing lunch, talking to them about what they were doing and asking them what they wanted. Food records sampled showed that people have a varied and nutritious diet that includes fruit and vegetables. Staff said that the food budget had not been Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 16 increased in line with rising food costs and that sometimes it can be a struggle to provide the meals that people prefer particularly meat dishes. Because of the amount of activity that people do which helps them to keep well they can eat large portions of food. For example, one person regularly had six weetabix for their breakfast and then had a cooked lunch and cooked meal in the evening. This needs to be considered when planning food budgets so that people can get the nutrition they need. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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 ensure that individual’s personal care and health needs are met so ensuring their well being. EVIDENCE: The people living there were well dressed in individual styles that reflected their age, gender, cultural background and the activities they were doing. Attention had been given to individual’s personal care so helping to ensure their well being. The AQAA stated and records sampled showed that staff support people to buy their own clothes and toiletries so these suit the individual and they have a choice in these. Records stated what gender of staff the person would like to support them with their personal care. These statements also stated the importance of staff who Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 18 know the individual to support them so that their needs regarding their personal care are met and their privacy and dignity is respected. Care plans were very detailed as to how to support the individual with their personal care. They included how to encourage the person to be as independent as possible. Records sampled included an individual health action plan. This is a personal plan about what support the person needs to meet their health needs and what healthcare services they need to use. These included pictures and photographs making them easier to understand. They included how the person communicates that they are in pain or unwell so that staff know how to monitor the person for this as they are unable to communicate this verbally to staff. Plans showed staff how to care for the individual’s skin and where appropriate this reflected the person’s cultural needs. Records showed that each person has an annual health check with their GP to ensure that any underlying health needs can be detected so they can get the help needed to meet their health needs. Records showed that staff supported people to go to the GP when they are unwell and to have regular eye, hearing and dental checks. Where appropriate people had regular chiropody treatment. The AQAA stated that the Speech and Language Therapist trained the Practice Development Worker (PDW) who works in the home to support the production of mealtime guidelines using a pictorial format and this includes annual screening of people for dysphagia (swallowing difficulties). Records sampled showed that the guidelines were detailed so to help prevent the risk of people choking. Mealtime guidelines included how to support the person to know it is mealtime using symbols so they know what is happening and have some choice in what they eat and drink. Records for one person showed that they were weighed regularly and had input from the dietician where needed to help them to be at a weight that was needed to meet their health needs. The other person’s records stated that they had been weighed monthly until December last year, then only one since. Their weight had remained stable and within the correct range for them to be well. However, a significant loss or gain of weight can be an indicator of an underlying health need so it is necessary to monitor individual’s weight regularly. The AQAA stated that all staff are to have epilepsy training in the next year and some staff have had diabetes training. This ensures that staff know how to meet the health needs of the people living there. Since our last visit the administration and storage of people’s medication has improved. Medication was stored and administered appropriately and accurately helping to meet individual’s health needs. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 19 At the front of the person’s Medication Administration Record (MAR) there is a photograph of them so that unfamiliar staff would know who to give the medication to. It also states how they take their medication so that staff know this. Some people are prescribed as required (PRN) medication and protocols were in place stating how, when and why this should be given so it is not misused. The AQAA said that staff have training in the ‘Care of Medicines’ and they are assessed annually on their competency. It also said that managers complete regular medication audits so they can check that people’s medication is administered as prescribed. Records of these audits were looked at and showed that medication is given as needed to ensure individual’s health needs are met. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 ensure that the views of the people living there are listened to and they are protected from abuse and harm so ensuring their well being. EVIDENCE: Since our last visit the home have not received any complaints and we have not received any complaints about the service provided there. The complaints procedure includes pictures making it easier for people to understand how they make a complaint. The AQAA stated that Sense have a national 0800 free complaints phone line helping people who are unhappy with the service provided to make a complaint. . Because of the needs of the people who live there their behaviour can sometimes be regarded by other people as ‘challenging’. Records sampled included very detailed guidelines as to how staff are to support the individual with these behaviours. This helps to minimise the risks to the individual and to other people. Staff had signed to say they had read them and they had been regularly reviewed and updated where the person’s needs had changed. Records sampled showed that staff looked at incidents that had happened and identified any reasons for the person behaving in a particular way. For Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 21 example, staff identified when they were out in the community with a person that their behaviour became ‘challenging’ when they were walking on uneven ground. They moved to even ground and the behaviour stopped so improving the person’s well being. Sometimes staff have to use physical intervention when a person’s behaviour becomes difficult. All staff receive training in this so they can use this as little as possible and in a safe a way as possible. Individual’s risk assessments included the risk to the person of using this and how staff can support the person to reduce any risks. Records showed that staff monitored incidents so they can learn from them and help to prevent any future incidents. A record of people’s belongings is kept so it is clear what possessions each person has. This makes it easier to identify if things should go missing. Finance records sampled show that people have an individual bank account that their benefits are paid into regularly. Money is held securely in the home and records showed that it is spent on personal items not on things that should be provided by the home. Receipts are kept of all purchases and these cross referenced with the person’s records indicating that people’s money is being spent appropriately. Staff records showed and the AQAA stated that staff have training in how to protect the people living there from abuse. They have this training as part of their induction and then have a refresher every three years. The AQAA stated and staff records sampled showed that during staff supervision protection is a regular discussion point to ensure their ongoing knowledge and awareness. The Registered Care Manager has received training in the Mental Capacity Act 2005. This Act came into force in April 2007 and requires an assessment of the person’s capacity to be completed when making a decision about their welfare if there is any doubt that they lack capacity. If they do not have the capacity to make this decision an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. Other staff are to have training in this so they know the implications of this legislation for the people living there. Staff are also having training on the Deprivation of Liberty Safeguards. This ensures that people who live in a care home are not being cared for in a way that deprives them of their liberty. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26,29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, homely and comfortable environment that meets their individual needs. EVIDENCE: The AQAA stated that some communal rooms have been redecorated as well as some bedrooms. It said that new furniture had been ordered in both houses. Both homes were well decorated and furnished in contemporary styles reflecting the age of the people who live there. Since our last visit the ‘gates’ at the entrances to the kitchens had been removed so that people can access the kitchen independently. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 23 Each person has their own bedroom. Bedrooms looked at were decorated and furnished to suit that tastes and interests of the individual. Where people wanted several possessions they had them. Some people did not want too many personal possessions in their bedroom and this wish was respected by staff. Each bedroom had a personal tactile board on the door that reflected the person’s interests making it easier for the person to locate their room. The AQAA stated that the work on the garden of house 2 had been completed so it was now more accessible for the people who live there to use and a Summer House was provided in the garden. Staff said that they plan to turn this into a sensory room. New sheds had been delivered the day before and the things currently stored in the Summer House would be moved to there. Staff said that new garden furniture was being ordered. A trampoline was provided for the people who live there to use. Aids and adaptations are provided where needed to meet the needs of the individuals who live there. The Practice Development Worker assesses how the environment meets people’s needs through their individual vision, hearing and mobility assessments. Tactile marker’s, colour scheme contrasting and trails are in place so that people can find their way around their home. One person’s vision has recently deteriorated and dado rails have been put around the walls of their home with colour contrasts on the walls to help increase their confidence in finding their way around. The home was clean and free from offensive odours making it a pleasant place for people to live in. The AQAA stated that sixteen out of twenty one staff had received training in infection control so they know how to minimise the risks of cross infection. All staff should receive this training. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development ensure that the needs of the people living there are met. EVIDENCE: The AQAA stated that twelve of the twenty one staff employed have completed National Vocational Qualification (NVQ) level 2 or above in Care. This exceeds the standard that at least 50 of staff have achieved this qualification ensuring they have the skills and knowledge to meet the needs of the people living there. The AQAA stated that both homes are now fully staffed. Since the AQAA was completed one staff has gone on maternity leave, another staff is now only working casual shifts and another is off sick long-term. However, Sense have recruited a Bank Co- ordinator who manages the shifts that need to be covered across all the homes. Rotas showed and the managers said that this has Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 25 reduced how many agency staff are used. Rotas showed that vacancies are covered by people doing ‘casual’ shifts and this is usually staff that know the people living there well. This is important as one person’s records sampled stated that the things important to them are a ‘consistent and familiar staff team.’ Rotas showed that staff do not work excessive hours without a break so they get rest between shifts helping them to support people well. Staff meeting minutes showed that these are held most months. Staff discuss the needs of the people living there and are updated with any changes. Staff are asked to sign they have read minutes so that if they have missed a meeting they can be kept updated. The records of three of the staff who work there were looked at. This included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been completed to ensure that ‘suitable’ people are employed to work with the people living there. Records sampled showed that when staff first started working at the home they completed an induction so they know how to meet the needs of the people living there. The AQAA stated and records sampled showed that new staff shadowed and mentored by experienced staff. Records sampled showed that staff receive the training they need to be able to meet the needs of the people living there. Staff have refresher training every three years so they are updated with any changes to ‘best practice’ and relevant legislation. The AQAA stated that ‘casual’ staff receive the same training as contracted staff so they also know how to meet people’s needs. Staff have formal supervision with their manager generally every month so they are well supported in their role. The Quality Auditor was auditing staff supervision records in house 10. They said they found these to be very good and staff had regular supervision. This included waking night staff, which can be very difficult to achieve because of their work pattern. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the 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 management arrangements ensure that the home is well run so the health, safety and welfare of the people living there is promoted and protected ensuring their well being. EVIDENCE: The home has a registered care manager (RCM) and an unregistered care manager (UCM) who work together to manage the homes. The UCM is now based in house 2 and the RCM is based in house 10. This change helps them to get to know all the people living in both homes as the homes are registered as Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 27 one. Both managers work extra to the rota so they can concentrate on management tasks but both do support people with activities so there are more staff available to support people to do these. The AQAA stated that the RCM has achieved NVQ level 4 in Care and the Registered Manager’s Award. The UCM has achieved NVQ level 3 and had almost completed NVQ 4. This ensures that the managers have the skills and knowledge to manage the home in the interests of the people who live there. A representative of the provider visits the home regularly to ensure that is meeting the National Minimum Standards and the needs of the people living there. Reports of these visits were detailed and showed that the representative visits at different times of the day to assess what it is like to live there at all times. Reports were not available for every month although staff said that monthly visits did take place. These should be available in the home so that staff know what action they need to take to improve the home for the people living there. House 10 were beginning the Sense Quality Audit process. This takes place every three years. The Quality Auditor was visiting the home in the afternoon to meet with the manager and make arrangements for the audit to be completed. The process includes questionnaires being sent to the people living there, their family and the local authority that funds their placement at the home to get their views on the service provided. Records sampled showed that gas and electrical appliances are tested as often as they should be to make sure they are safe to use. Fire records showed that a new fire panel had been fitted that week to the alarm system and as a result of this the manager was updating the fire procedures so that staff would know what to do if the alarm sounded. Staff regularly test the fire equipment to make sure it is working. Regular fire drills are held so that staff and the people living there can practice what to do if there is a fire. The fire risk assessment is updated every year to ensure that the risks of there being a fire are minimised as much as possible. There were individual guidelines for each person who lives there as to how they would need to be supported if there was a fire. Staff test the water temperatures to make sure they are not too hot which could put people at risk of being scalded. Records showed that these were within the correct temperatures so that people were not at risk. Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 4 30 2 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Version 5.2 Page 29 Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations The rising costs of food should be considered when setting food budgets and these should be adjusted accordingly. This will ensure that the nutritional needs of the people living there can be met so ensuring their well being. Individual’s weights should be regularly recorded so to monitor any underlying health needs and ensure the person’s well being. All staff should have training in infection control so they know how to minimise the risks of cross infection making it a hygienic place for people to live in. Reports of monthly visits by a representative of the provider should be available in the home. This is so that staff know what action they need to take to improve the home for the people living there. 2. 3. 4. YA19 YA30 YA39 Grove Road, 2 & 10 DS0000016795.V375268.R01.S.doc Version 5.2 Page 30 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: 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). 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