Care Home: 20 Waterloo Road

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What the care home does well Staff know the people living there well. Staff support people in they way they want and need to ensure their well being.People are supported to do the things they enjoy and staff support people to develop their interests.Staff support people to go on holiday every year to the places they want to go to. People said they enjoyed their holidays and had a good time.People are helped to keep in contact with their family and friends so they can maintain relationships that are important to them.Staff support people well with their personal care to help them to feel comfortable and good about themselves.Staff work well with other health professionals to benefit the people living there and help to meet their health needs.The home is well decorated and furnished so it is homely and comfortable for people to live in.Bedrooms are personalised and reflect the tastes and interests of the individual.Equipment in the home is regularly checked so that it is safe to use. What has improved since the last inspection? Information about how much it costs to live there has been included in the Service User Guide.Health action plans have been introduced to help improve health care planning to help people to stay healthy.Some rooms have been redecorated so they are cleaner and the home is more comfortable.Staff have had more training in giving medication to help make sure they do this safely.Staff regularly check the temperature of the hot water to help make sure people do not get scalded when bathing.Staff have had first aid training to help them know what to do if someone is hurt.People have been asked their views of the home to make sure it is being run in the way they want. What the care home could do better: Care plans and risk assessments need further development to make sure staff know how to support people.Menus should be improved to help increase the variety of meals on offer to people.Health action plans should be improved to improve health care planning to help people to stay healthy.Improve the policy and procedure for washing dirty laundry in the kitchen to reduce the risk of infection.Records of training undertaken by the staff team should be improved to fully show all the training that they have done.The fire risk assessment should be more detailed to show how the home keeps people safe from fire. Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Waterloo Road 20 Waterloo Road South Yardley Birmingham West Midlands B25 8JR 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: Kerry Coulter Date: 1 6 1 2 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 38 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 38 Information about the care home Name of care home: Address: 20 Waterloo Road 20 Waterloo Road South Yardley Birmingham West Midlands B25 8JR 01217074673 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) : mohan_roger@hotmail.com Mr Rajeshwar Mohan,Mrs Manju Mohan care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 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) 3 Date of last inspection 1 7 0 2 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Up to three people with learning disabilities can live at the home. The house is a three bedroom terraced in the South Yardley area of Birmingham. The home is close to bus routes and local shops. Care Homes for Adults (18-65 years) Page 5 of 38 On the ground floor is a front lounge, which gives access to the street via the front door of the house. There is a further lounge / dining room leading through to the kitchen at the rear of the property. The bathroom and toilet are on the ground floor, and these are accessed through the kitchen. On the first floor are three single bedrooms, two of which are quite small. The stairs are quite steep, so this house would not be suitable for people with mobility problems. Care Homes for Adults (18-65 years) Page 6 of 38 To the rear of the property is a long garden, with a lawn and patio area with seating. The home has a service user guide that says the fees to live at the home are £440 to £868. Our previous reports are available in the home on request. Care Homes for Adults (18-65 years) Page 7 of 38 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 Care Homes for Adults (18-65 years) Page 8 of 38 How we did our inspection: This is what the inspector did when they were at the care home This inspection was carried out by one inspector in one day. We gave the home a few hours notice of our visit. This was because everyone had been out when we first went to the home. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We met with people who live at the home and they told us what they thought of the home. We also asked staff about peoples needs. Care Homes for Adults (18-65 years) Page 9 of 38 We looked at the care plans, health records and daily notes for two people. This is called case tracking. We also looked at all parts of the home, staff and health and safety records. We received surveys from people who live at the home, two of their relatives and one staff. Some of their comments are included in this report. What the care home does well Staff know the people living there well. Staff support people in they way they want and need to ensure their well being. Care Homes for Adults (18-65 years) Page 10 of 38 People are supported to do the things they enjoy and staff support people to develop their interests. Staff support people to go on holiday every year to the places they want to go to. People said they enjoyed their holidays and had a good time. People are helped to keep in contact with their family and friends so they can maintain relationships that are important to them. Staff support people well with their personal care to help them to feel comfortable and good about themselves. Care Homes for Adults (18-65 years) Page 11 of 38 Staff work well with other health professionals to benefit the people living there and help to meet their health needs. The home is well decorated and furnished so it is homely and comfortable for people to live in. Bedrooms are personalised and reflect the tastes and interests of the individual. Equipment in the home is regularly checked so that it is safe to use. Care Homes for Adults (18-65 years) Page 12 of 38 What has got better from the last inspection Information about how much it costs to live there has been included in the Service User Guide. Health action plans have been introduced to help improve health care planning to help people to stay healthy. Some rooms have been redecorated so they are cleaner and the home is more comfortable. Care Homes for Adults (18-65 years) Page 13 of 38 Staff have had more training in giving medication to help make sure they do this safely. Staff regularly check the temperature of the hot water to help make sure people do not get scalded when bathing. Staff have had first aid training to help them know what to do if someone is hurt. People have been asked their views of the home to make sure it is being run in the way they want. Care Homes for Adults (18-65 years) Page 14 of 38 What the care home could do better Care plans and risk assessments need further development to make sure staff know how to support people. Menus should be improved to help increase the variety of meals on offer to people. Health action plans should be improved to improve health care planning to help people to stay healthy. Care Homes for Adults (18-65 years) Page 15 of 38 Improve the policy and procedure for washing dirty laundry in the kitchen to reduce the risk of infection. Records of training undertaken by the staff team should be improved to fully show all the training that they have done. The fire risk assessment should be more detailed to show how the home keeps people safe from fire. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 16 of 38 If you want to speak to the inspector please contact Kerry Coulter CQC Citygate Gallowgate Newcastle upon Tyne NE1 4PA TEL 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 17 of 38 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 18 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need and their needs are assessed so they can be sure that the home is right for them. Evidence: People told us they had received enough information about the home. The home has a service user guide in place that tells people about the home. It has been updated since our last inspection to include how much it costs to live there and our new contact details. The guide is in a written format but we were told by the owners that it had been explained to people so they could understand it. Making the guide available in alternative formats, for example to include pictures may make it easier for people to understand. One new person has moved into the home since our last inspection. The home completed an assessment of the persons needs and obtained a copy of their care plan before they moved into the home. We found that there was some information about the person that was not included in their assessment. However discussion with the owners indicate they were confident the home could meet the persons needs as the person had lived there before so they knew him well. The new person told us that he had the opportunity to visit the home before he moved in. He told us I like it here, glad I moved in. Care Homes for Adults (18-65 years) Page 19 of 38 Care Homes for Adults (18-65 years) Page 20 of 38 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. Staff may not have all the information they need to be able to support individuals to meet their needs and reduce the risks to their safety, which could impact on their well being. People are able to make choices and decisions about their lives so that they can do the things they want to do. Evidence: We looked at the care files for two people who live at the home. Each person had an assessment of their needs that indicated where and how they needed staff support. Each person had a care plan that had been reviewed in the last six months so that it contained up to date information.. The records of the review indicated that the person had been consulted about their care. As identified at the last inspection the care plans in place do not always detail how people need to be supported although the home has made efforts to try and improve on the plans in place. Peoples care plans did not always record their health needs. For one person their plan did not record all of their health needs. Discussion with the owners indicate that there is a good deal of knowledge about peoples care needs within the care Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: team, but this knowledge should be transferred into peoples care plans. Surveys received from relatives told us that the home meets peoples needs. Throughout our visit people were encouraged to make their own choices, for example what to eat and drink, what to watch on television or where to spend their time. People told us they can choose what to do to include where they go on holiday. At the last inspection we were concerned that the stairs in the home were quite steep and that peoples safety on the stairs had not been assessed. This assessment has now been completed. Other risk assessments that were seen to be in place included peoples needs regarding their mental health. Sometimes people make their own tea and toast. Discussion with the owners indicate this is usually done under the supervision of staff to help reduce the risk of people having an accident, such as burning themselves. It is recommended that the measure in place to help keep people safe are included in a written risk assessment. Care Homes for Adults (18-65 years) Page 22 of 38 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. Arrangements help people to experience a meaningful lifestyle that ensures their selfesteem and well being is promoted. People are offered a healthy diet and enjoy their meals. Evidence: People have the opportunity to participate in activities that they enjoy and lead the lifestyle they choose. One person told us Theres lots to do here, can choose, I like to listen to music and another said Its a nice home. Records showed that people undertake activities that they prefer and enjoy, this includes attending the day centre, personal shopping, visits to parks and the library, going to the pub and having lunch out. Records show that people are supported to go out most days. Where people want to they are supported to attend religious services. People are also encouraged to participate in keeping their bedrooms clean and tidy and to participate in domestic activities such as making toast and drinks. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: People have the opportunity to have an annual holiday. They told us that this year they had been to Somerset. One person told us he had chosen to go their as he had been there before and enjoyed it. People are supported to maintain links with friends and family and to celebrate festivals that are important to them. One person told us that he had been out with staff to a market to buy a Christmas present for a relative. Relatives told us that the home helps people to keep in touch with them. Records showed that people have the opportunity to go food shopping with staff to help choose what food they would like. One person told us I go food shopping with staff. The home has a planned menu that is repeated every week. Amendments to the menu do show that people sometimes choose to have something different. However thought should be given to having a rotating menu to help increase the variety of meals on offer. People told us Food is nice, Food is alright and I can choose, I have chapatis. Meals on offer meet peoples cultural and religious needs. There were sufficient food stocks in the home to include fresh fruit and vegetables. People were seen to have an afternoon snack of fruit whilst we were there. The owners told us they try and encourage people to have a healthy diet. Care Homes for Adults (18-65 years) Page 24 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health needs of individuals are met so helping to ensuring their well being. Evidence: We saw that people were well dressed in a style that was appropriate to their age, the weather and their cultural background. It was observed that they had been supported to pay attention to their personal care and hygiene so ensuring their self esteem. Records showed that people are supported by staff to go shopping to choose their own clothing. One person told us Staff help me to wash my hair and all people confirmed they go to the barbers when they need a haircut. Records sampled showed that health professionals are involved in peoples care when needed to ensure their well being. For example one person has regular input from their psychiatrist. The home keeps clear records of all health appointments attended by people, this showed that people attend regular health checks such as the dentist and optician. One person told us If Im poorly I tell the staff and they take me to the doctors. At the last inspection we found that people did not have a health action plan. This is an individual plan about what the person needs to be well and what health care services Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: they need to access. This is something the Government said all people with a learning disability should have. The home has now introduced health action plans but these would benefit from further development. For example we looked at the plans for two people and found these were very similar and did not reflect that they had different needs. Where it was recorded the person needed regular blood tests it did not say what these were for and how often they were needed. However, as stated earlier in this report the owners and staff have good knowledge of peoples needs and this includes their health care needs. People who live at the home are not able to administer their own medication and so this is done by staff. Certificates were available to show that staff have received training to do this. Medication is usually stored in the homes medication cabinet. However when we visited the lock on the cabinet was broken. Appropriate action had been taken and medication was locked away elsewhere. Evidence was available to show that a new medication cabinet was on order. Records showed that people have their medication regularly reviewed by their GP or psychiatrist to ensure that it is still effective in meeting their health needs. Medication Administration Records (MAR) sampled had been signed when staff had given the person their medication and indicated that people always had their medication as prescribed. Written guidance is available for the administration of paracetamol medication so that staff know when it should be given. As recommended at the last inspection the home keeps copies of the prescriptions. This helps staff to check that what is provided by the pharmacist is what has been prescribed by the doctor. Care Homes for Adults (18-65 years) Page 26 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements help to ensure that the views of the people living there are listened to and acted on and they are safeguarded from abuse. Evidence: The homes annual quality assurance assessment stated that there has been no complaints received by the home in the last 12 months and we have not received any complaints about this service. The home has a complaints procedure available and this is readily available to people in a folder in the lounge. The procedure has been updated since we last visited the home to include some pictures to help make it easier for people to understand. Surveys from people who live at the home told us that they know how to make a complaint and who to speak to if they are unhappy. Relatives told us that they know how to make a complaint and that the home responds appropriately to any concerns. Records and discussions with the owners indicate that they and the two staff they employ have undertaken training in safeguarding adults from abuse. The home has a policy on safeguarding people from abuse and on whistle blowing, as well as a copy of the Birmingham multi agency safeguarding procedures. These help staff to know what to do if they suspect that abuse has occurred. Discussion with the owners indicates they have both attended workshops about the Mental Capacity Act. The Mental Capacity Act came into force in April 2007 and requires an assessment of the persons capacity if there is any doubt they may not have the capacity to make a decision about their welfare. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: Neither of the people who live at the home is able to manage money independently, due to their degree of learning disability, therefore the home assists them to look after their money. We sampled the records for one of the people at the home. They have their own bank account into which their benefits are paid. Individual expenditure is subsidised throughout the month by the manager, with records and receipts retained appropriately. Each account is then settled at the end of the month. It is good that the person is encouraged to sign for the expenditures. Receipts indicate that the person was not paying for items that the home should be responsible for purchasing. Care Homes for Adults (18-65 years) Page 28 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable and clean environment that meets their individual needs. Evidence: The home is a small terraced house that blends in with the other homes in the road and is not distinguishable as a care home from the outside. The premises are very homely in style and were clean and warm when we visited. Surveys from people at the home told us that the home is usually clean.Since the last inspection one of the lounges has been redecorated. The kitchen and bathroom have also been tiled and repainted. The home does not have a separate laundry and so the washing machine is located in the kitchen. It is positioned at the kitchen entrance so that staff do not have to carry soiled laundry right through the kitchen. Care records show that people at the home do not have incontinence and so generally there would not be any heavily soiled items. We looked at the homes policys and procedures and saw that there was one in place for infection control. However it is recommended that this is further expanded with regard to the infection control procedures for soiled laundry to reduce the risk of infection. The home has a bathroom located on the ground floor of the home, this is accessed via the kitchen. There are no toilet or bathing facilities situated on the first floor of the home where peoples bedrooms are located. Two people told us that they did not mind having to go downstairs to use the bathroom. However one person told us sometimes I Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: hold it in because I dont want to come downstairs. Ideally toilets and bathing facilities should be located close to peoples bedrooms. However as the home is a small terraced house there does not appear to be much potential to provide bathing facilities on the first floor. Each person has their own bedroom that is located on the first floor. This is accessed via the stairs that are quite steep. This means that anyone living at the home needs to have good mobility. Bedrooms were personalised according to individual needs, tastes and interests. Bedrooms included photographs of people important to the person and if appropriate to the individual religious pictures so ensuring their religious and cultural needs are considered. One person told us my bedroom is nice. Care Homes for Adults (18-65 years) Page 30 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development generally ensure that the needs of the people living there are met. The recruitment practices help to ensure that the people living there are safeguarded from abuse. Evidence: The care team at Waterloo Road comprises three family members (husband and wife owners and their son) and one other worker. All of them have been at the home for some years and this means that people who live there are supported by staff that they know well. The two staff do not have a National Vocational Qualification (NVQ) in care but they both only work part time in the home. Most of the care is provided by the two owners who both have an NVQ. During our visit we observed interactions between people at the home and the owners and staff. The owners and staff treated people with respect and spoke to them in a friendly manner, interactions were positive. Surveys returned by people at the home recorded that staff always treated them well. All three people told us that staff are nice. The staff rota and discussions with the owners indicate that at night there is one waking staff on duty and during the day levels vary from one to two staff depending on peoples activities. This appears sufficient to meet the needs of the two people currently living at the home. The survey received from one of the staff records that there are always Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: enough staff on duty to meet peoples needs. One staff told us its a nice place to work. As staffing arrangements in the home have remain unchanged for several years we only briefly looked at staff recruitment information. We looked at the files for two staff. These included evidence that a satisfactory Criminal Record Bureau (CRB) check had been completed to ensure that suitable people are employed to work with the people living there. Staff had received training in 2006 covering a broad spectrum of social care, protection and related issues and more recently have received refresher training in safeguarding people from abuse. Since our last inspection staff have received training in medication and first aid. We were told by the owners that staff had received training recently in the homes fire procedures and the Mental Capacity Act. This needs to be recorded on staffs training records. Relatives told us that staff have the right skills and experience. Records sampled and surveys received from staff show that they receive supervision every other month so that they are supported in their role. Care Homes for Adults (18-65 years) Page 32 of 38 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 management arrangements help to ensure that the home is run in the best interests of the people living there and their health, safety and welfare is promoted and protected. Evidence: As previously stated in this report both the owners of the home work there on a day to day basis, one of them is the registered manager of the home. Both are qualified to NVQ level 4 and hold the registered managers award. Discussions with the owners indicate they have kept themselves up to date with current care issues such as attending seminars on the new Mental Capacity Act. One member of staff spoken with told us that the owners of the home are very approachable. The Annual Quality Assurance Assessment (AQAA), which tells us how the home thinks they are meeting the regulations and standards, was returned to us when we asked for it. The home uses a quality assurance system called Practical Quality Assurance System for Small Organisations. Whilst this does indicate that there has been some consultation with Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: people at the home it focuses on management systems rather than on peoples views. At the last inspection we recommended that quality assurance systems needed further improvement to include the views of people at the home. At this inspection we found that surveys had been given to people at the home to seek their views. The completed surveys indicated that people were happy with the home. Now that a third person has moved into the home consideration should be given to consulting people to see if they would like to participate in regular residents meetings. Fire records showed that staff test the fire equipment regularly to make sure it is working and that regular fire drills are held so that people know what to do if the fire alarms sound. At the last inspection the home had not completed a fire risk assessment to ensure that the fire precautions in place were satisfactory. This has now been completed but could be a little more detailed regarding the measures in place regarding fire safety. The home was visited by the West Midlands Fire Service in February 2009 who told us they were satisfied with the fire precautions in the home. The home has a cupboard for the storage of COSHH items, these were seen to be securely stored at the time of our visit. Certificates were available to show that the gas and electrical installations in the home had been tested by qualified engineers who stated that these were safe. Previously the home did not have a system for making sure the temperature of the hot water at the bath was safe for people. At this visit we found that staff now regulaly monitor the temperature of the water. Records showed that the temperature did not put people at risk of scalding. Care Homes for Adults (18-65 years) Page 34 of 38 Are there any outstanding requirements from the last inspection? Yes  No  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 35 of 38 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 Description 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 Description 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 1 Making the service user guide available in alternative formats, for example to include pictures may make it easier for people to understand. Care plans should be further developed to make sure that they clearly record all the support that each person needs so that people can be sure their needs will be met. The measures in place to help keep people safe when undertaking tasks such as drink making should be included in a written risk assessment. A rotating menu should be introduced to help increase the variety of meals on offer to people. Health action plans should be further developed for each person to enhance health care planning to help people to stay healthy. Page 36 of 38 2 6 3 9 4 5 17 19 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 6 30 The policy on infection control should be further expanded regarding the procedures for washing soiled laundry in the kitchen to reduce the risk of infection. Staff should undertake the Learning Disability Qualification and / or the National Vocational Qualification in care so that people are always supported by well qualified staff. Records of training undertaken by the staff team should be improved to fully evidence all the training that they have undertaken. The fire risk assessment should be more detailed regarding the measures in place regarding fire safety to help keep people safe. 7 32 8 35 9 42 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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