Care Home: 210 Little Sutton Lane

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What the care home does well There are systems so that people`s needs would be assessed before they moved into the home, so that they know the home could meet their needs.People get to go out and doactivities they enjoy.People have a healthy diet with lots of fruit and vegetables to help them stay healthy.People who live at the home all have their own bedrooms that contain their personal things.People have regular health checks to help them to stay healthy.Staff have training to help keep people safe from abuse.Most staff have a qualification in care so they should have the skills and knowledge they need to meet the needs of the people living there.Quality assurance systems are in place to help run the home in the best interests of the people who live there.The home has a fire risk assessment to help make sure the risk of a fire happening is reduced. What has improved since the last inspection? This is the home`s first inspection since they have been re-registered with us. What the care home could do better: People need to be provided with an up to date copy of the service user guide so that they have the right information about the home. People`s care plans and risk assessments need further development to make sure people get the care they need in the way they prefer. The home need to support people to monitor their weight to make sure people are a healthy weight. Improvement is needed to the medication system to make sure people are not given medication they might be allergic to.The new complaint procedures need to be made available to people so that they know how to make a complaint if they are unhappy about something. Make sure staff get the training they need to help them to meet peoples needs. Systems to ensure health and safety need to improve to help make sure the home is safe for people. Key inspection report Care homes for adults (18-65 years) Name: Address: 210 Little Sutton Lane 210 Little Sutton Lane Sutton Coldfield W Midlands B75 6PH The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter Date: 0 9 0 3 2 0 1 0 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 36 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 © (2010) 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 36 Information about the care home Name of care home: Address: 210 Little Sutton Lane 210 Little Sutton Lane Sutton Coldfield W Midlands B75 6PH Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Molinder Kaur Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 0 1 0 0 care home 4 Real Life Options learning disability physical disability sensory impairment Additional conditions: 1.The registered person may provide the following categories of service only Care Home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories Learning Disability Code LD maximum number of places 4 2. The maximum number of service users to be accommodated is 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home 210 Little Sutton Lane is a bungalow in Sutton Coldfield. It is near to local shops and bus routes. The home has been open for several years but has been re-registered with us as the care is now provided by Real Life Options. Up to four people live at the home and each person has their own bedroom. There is a bathroom with adapted bathing facilities and shower room with walk in shower so that people with mobility difficulties can use them. Care Homes for Adults (18-65 years) Page 5 of 36 There is a large kitchen and dining and lounge space, which is large enough for the number of people that live in the home. There is some space at the front of the home for car parking. The home has a large garden at the rear of the home. People should ask the home about how much it costs to live there as when we visited the service user guide was being reviewed. Care Homes for Adults (18-65 years) Page 6 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 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 over one day. The home did not know we were going to visit. The manager sent us information about the home before our visit, this is called an AQAA. We met with people who live at the home but due to their communication difficulties they were not able to tell us what they thought of the home. We therefore asked staff about their needs. We looked at the care plans, health records and daily notes for two people. This is called case tracking. We also looked at staff and health and safety records. Care Homes for Adults (18-65 years) Page 8 of 36 We looked at some areas of the home including some peoples bedrooms. We sent surveys to the home to distribute to peoples relatives and staff but we did not receive any completed surveys. What the care home does well There are systems so that peoples needs would be assessed before they moved into the home, so that they know the home could meet their needs. People get to go out and do Care Homes for Adults (18-65 years) Page 9 of 36 activities they enjoy. People have a healthy diet with lots of fruit and vegetables to help them stay healthy. People who live at the home all have their own bedrooms that contain their personal things. People have regular health checks to help them to stay healthy. Staff have training to help keep people safe from abuse. Most staff have a qualification in care so they should have the skills and knowledge they need to meet the needs of the people living there. Quality assurance systems are in place to help run the home in the best interests of the people who live there. Care Homes for Adults (18-65 years) Page 10 of 36 The home has a fire risk assessment to help make sure the risk of a fire happening is reduced. What has got better from the last inspection What the care home could do better People need to be provided with an up to date copy of the service user guide so that they have the right information about the home. Peoples care plans and risk assessments need further development to make sure people get the care they need in the way they prefer. The home need to support people to monitor their weight to make sure people are a healthy weight. Improvement is needed to the medication system to make sure people are not given medication they might be allergic to. Care Homes for Adults (18-65 years) Page 11 of 36 The new complaint procedures need to be made available to people so that they know how to make a complaint if they are unhappy about something. Make sure staff get the training they need to help them to meet peoples needs. Systems to ensure health and safety need to improve to help make sure the home is safe for people. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kerry Coulter 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 Care Homes for Adults (18-65 years) Page 12 of 36 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 13 of 36 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 14 of 36 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 about the home. Evidence: The home has had a change of provider and re-registered with us in December 2009. A new Statement of Purpose has been completed to reflect the new arrangements at the home. This was seen to be a comprehensive document. The Annual Quality Assurance Assessment (AQAA) told us that the Service User Guide had been updated in the last twelve months. We found that people still had copies that related to the previous provider and so were now not relevant. The manager provided evidence that she was working on a new guide that was in an easy read format. The new Guide needs to be completed and copies made available to people so that they have information about the home that is up to date. People who live at the home have done so for a number of years and the home did not have any vacancies when we visited. The AQAA did not tell us about the homes admission and assessment procedures. Policies available in the home showed that procedures are in place for staff to follow. These indicate that people would have the opportunity to visit the home and that a full assessment of their needs would be Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: completed prior to them moving there. Care Homes for Adults (18-65 years) Page 16 of 36 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. Systems in place do not always ensure that staff have all the information they need to support people in the way they need and prefer. Evidence: We case tracked the care provided to two people. Each person had a care plan. Care plans are records that are used to show what sort of help each person needs and how staff will provide that care. Not all of the information in peoples care plans was up to date, for example one person had a plan regarding pressure care. There was no evidence that this had been reviewed since May 2008. This means that staff do not have up to date information about the persons pressure care needs. Not all of the information about peoples needs was readily available. The manager told us that some information had been taken out of the files in preparation for moving over to a new care plan format. The new provider had completed an audit of care plans as part of their quality audit in December 2009. They had already identified that improvements Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: were needed. The manager showed us a new format that was going to be introduced for care plans and their review. People who live at the home have limited verbal communication. Most communicate their needs by gestures, body language and their behaviour. Care plans had information about peoples communication needs but were not very clear about how people made choices about things they want to do. We asked a member of staff how people were supported to make choices. They told us We know what people like and dont like. The homes quality audit completed in December 2009 identified that systems on choice making for people could be improved. The manager showed us that the home was working on a library of photographs of food and activities which were intended to be used as communication aids with people. The home has risk assessment records to guide staff in how to support people with activities that may involve an element of risk. For example, using transport, using the kitchen and safety in the community. These include clear guidelines about how the risks can be minimised and had been reviewed monthly. Some people at the home have rails fitted to their beds to help prevent falls. Assessments on the use of the rails had been completed but were not very detailed. They did not record if bed rails covers were needed or assess the impact of the use of pressure relieving mattresses with the rails. Care Homes for Adults (18-65 years) Page 18 of 36 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 are in place to ensure that the people living there usually experience a meaningful lifestyle. People are offered a healthy diet so ensuring their health and well being. Evidence: People do not attend day centres and so the majority of their activities are based in the community supported by staff. During our visit one person went out to the local library with staff and other people went out food shopping. Discussion with staff and sampling of records show that people have regular opportunities to go out and participate in activities they enjoy. This includes shopping, bowling, cinema and going to the pub. People have also been on holiday, one destination included St Lucia. Photographs of the person on holiday show they had a good time. Whilst there are good activities on offer to people when they go out some improvement is needed to peoples leisure time in the home. At some times of the day there was little interaction from staff and peoples activity consisted on having music or the television on. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: In the morning both the radio and the television were on in the open plan lounge making it difficult for people to concentrate on either. The manager told us that there were some improvements being made to in-house activities. We were told that recently a Music Man had been to the home and that people had really enjoyed the music activity. The manager said it was intended to arrange this as a regular activity for people. The home has an open visitors policy. Records and discussion with staff shows that people are supported to maintain contact with friends and family. People using the service had been assessed by a speech therapist due to eating and swallowing difficulties. Staff were aware of foods that were suitable to be cooked and all foods needed to be pureed or mashed. Food records sampled showed that a variety of food is offered. This includes fruit and vegetables to ensure that people are having a healthy diet to ensure their well being. People who need support from staff to eat their meals were supported with sensitivity and at the persons own pace. Care Homes for Adults (18-65 years) Page 20 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements in place may not always ensure that the health and personal care needs of the people living there are met and so does not ensure their well being. Evidence: All of the people who live here need some support with personal care to varying degrees. Staff were seen to give support to people when needed. The people living in the home were well dressed in clothes that were appropriate to their age, gender, culture and the weather. When people had drinks staff put aprons on people to help protect their clothes from any spillages. However the aprons were then left on people for most of the morning. This does not treat people with dignity or as adults. It is disappointing that this was still part of the care practice in the home given that it was an issue raised in the homes quality audit completed a few months previously. Each person has an individual Health Action Plan. This is a personal plan about what help a person needs to be healthy and to stay healthy. The Annual Quality Assurance Assessment told us that new health action plans are to be implemented that are in line with Real Life Options policies. People had been supported to attend regular health checks such as with the dentist and opticians so helping to ensure their health and well being. One person was supported by Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: staff during our visit to go to the dentist for a check up. One person at the home has a pressure sore. Discussions with staff indicate they are aware of the pressure care the person needs. During the afternoon the person was supported by staff to have bed rest, in line with their care plan. We spoke with a health professional who was visiting the home. They told us they have no concerns about the pressure care provided by staff and that staff do what is asked of them. There was no evidence that people at the home had their weight monitored in recent months. The manager told us that people used to go to a weight clinic but did not go anymore as it was always too busy and people were kept waiting in the cold. It is disappointing that no alternative arrangements have been made regarding weight monitoring. These need to be put in place as losing or gaining a significant amount of weight can be an indicator of an underlying health need. Staff who administer medication have been trained to do so. The homes Annual Quality Assurance Assessment told us that is was planned to update this training this year. The home operates the Monitored Dosage System (MDS). Inspection of the medication system demonstrated that the home completes a regular audit of all medicines and an accurate record of all medicines administered is recorded on Medication Administration Records (MAR). Two staff administer all medicines to help ensure accuracy. There was a photograph of the person with the MAR so if unfamiliar staff were giving it this would ensure it was given to the right person. Protocols were in place for people who were prescribed PRN (as required) medication, these stated when the medication should be given. They were due for review and the manager told us that plans were in place to do this. Copies of each persons prescriptions are kept so that staff can ensure that what is provided by the pharmacist is what has been prescribed by the doctor. One persons Good Life plan recorded they were allergic to a type of antibiotic. This was not recorded in their main care plan or on their MAR. We spoke with one member of staff who was unaware of any medication allergy. The manager told us it had not been fully recorded as it had never been clarified if the person was actually allergic. We did not see any evidence to show that this had been pursued with health professionals. The manager assured us that this would now be done. Some handwritten ammendments had been made to MARs and these had not been checked and signed by two staff to make sure they were accurate. It is good practice to do this. Discussion with the manager indicated they were unawhere of the Royal Pharmaceutical Society good practice guidelines for the administration of medication in care homes. The home is advised to obtain a copy of these so that good medication practice can be promoted. Page 22 of 36 Care Homes for Adults (18-65 years) Evidence: Care Homes for Adults (18-65 years) Page 23 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements may not always ensure that the views of the people living there are listened to and they are safeguarded from abuse. Evidence: We have not received any complaints about this home and the home has not received any directly. As stated earlier in this report this is an existing care home that has recently had a change of provider. We found at this inspection that there were a variety of complaint procedures in the home, some for the new provider and some were still available from the old provider. This meant that complaints information could be confusing to people. In the hallway of the home there was a poster giving our details regarding complaints. However it referred to our predecessor organisation and did not give our new contact details. The homes Annual Quality Assurance Audit told us each service user has a user friendly policy that explains clearly how to complain. We saw that each person did have a user friendly policy but these referred to the previous providers procedures and not Real Life Options. Whist the homes Statement of Purpose does contain a copy of the new complaints procedure due to out of date procedures still being available to people the system in place is disorganised and does not ensure people would see the most up to date procedure. Records show that staff have received training in safeguardng people from abuse, there are also policies and procedures availabe to guide staff. We spoke with one staff about Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: what they would do if they suspected abuse was occurring. They told us they would always report any suspicions to the manager. Records showed that staff had received training on the Mental Capacity Act (MCA) , however it was not clear if this had included Deprivation of Liberty Safeguards (DOLS). These are linked to the Act and ensure that people who live in a care home are not being cared for in a way that deprives them of their liberty. The manager told us that staff had received some training on DOLS. However one staff spoken with seemed unfamilair with the term DOLS and was unsure what it was. All staff that work at the home should have understanding of this so they know the possible implications of this legislation for the people living there. Two personal finances were examined and accurate records were obtained. All personal monies are counted at the beginning of each shift and a record of this handover maintained. Care Homes for Adults (18-65 years) Page 25 of 36 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 safe, homely and comfortable environment that meets their individual needs. Evidence: The driveway to the home was not in good condition with some uneven areas of tarmac. The grass lawned areas had deep tyre tracks. This does not present a first good impression to any visitors. Staff told us that the tyre tracks were caused by the homes vehicle getting stuck on the grass as the drive area is not large enough for the homes vehicle. Staff also told us that the poor condition of the driveway made it hard work to push people across in their wheelchairs. We looked at all of the communal areas in the home and some of the bedrooms. The home was clean and a comfortable temperature, decor was in good order. The home consists of four single bedrooms, a bathroom with adapted bathing facilities and shower room. There is a kitchen and an open plan dining area and lounge, which are suitable for the number of people that live in the home. Communal areas are decorated with pictures, photographs of the people living there and places they have visited. Each person has a large single bedroom, which has been adapted to meet the needs of each person, including hoist tracks, a sensory mat and specialist beds. Bedrooms were Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: personalised and generally in good decorative order. However one persons floor covering was quite stained and needs attention so that it does not spoil the appearance of the bedroom. There is an adapted bathroom with hoist facilities and an assisted bath and a range of sensory equipment. Satisfactory hand washing facilities were observed in the bathroom, laundry and kitchen areas. The home was clean and free from offensive odours. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by sufficient and suitable staff to help meet their needs. Evidence: The majority of care staff have a National Vocational Qualification (NVQ) in care, this contributes towards ensuring that staff have the knowledge and skills to work with the people living in the home. There were three staff on duty when we visited and we did not see people having to wait for staff support. Staff rotas show there are usually a minimum of three on duty and staff spoken with confirmed this. One staff spoken with told us that shifts are now better covered since Real Life Options became the provider and there is less reliance on casual staff. Discussion with the manager indicates that four new staff have recently been employed so that people are now usually supported by permanent staff. The provider has permission from us to store staff recruitment documents at their headquarters. However recruitment information available in the home for four new staff indicates that robust recruitment procedures had been followed. The manager told us that Real Life Options were also arranging for staff who transferred from the previous provider to have new Criminal Record Bureau Checks. Discussions with the manager and sampling of records indicate that new staff undertake Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: an induction to the home. The manager told us that existing staff were overdue some refresher training as the previous provider had not arranged this. The manager said that manual handling and first aid training was arranged for March. The homes recent quality audit had also identified that staff needed training in meeting the specific needs of people who live there to include epilepsy and dysphagia (swallowing difficulties). Discussions with the manager indicate that staff have not received pressure care training and this should be arranged. Training records showed that some staff had not had fire training in the last twelve months, this is needed to make sure staff know what to do to keep people safe should a fire occur. Sampled records indicate that staff have regular meetings and receive supervision. This means that staff have a formal opportunity to keep updated with the changing needs of the people living there and with best practice and be involved in the running of the home. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements have not always ensured that the home is well run for the benefit of people living there. Evidence: The manager of the home has worked there for several years and was the manager of the home with the previous provider. The manager has the right experience and qualifications to manage the home. They told us that they get good support and have received supervision from their line manager. However the manager commented that the amount of time they had to spend on management tasks has been reduced as they had to work two days a week on providing direct care to people. Whilst discussions with the manager show they want to improve the home so that outcomes for people are good there were some things that had not been well managed. For example as recorded earlier in this report weight monitoring had ceased with no alternative arrangements being put in place and a possible allergy to medication had not been followed up. The manager also did not ensure that a notification was sent to us about an allegation made inappropriate staff to staff behaviour. Management arrangements should be improved to make sure the home is well run for the benefit of Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: people who live there. We received the homes annual quality assurance assessment when we asked for it. This told us about some of the improvements the home had made and improvements that were planned. The Provider uses a number of quality monitoring tools to audit the service it provides at this home. These include monthly visits by the divisional manager to the home to check on its operations. A detailed quality audit has also been undertaken and areas identified for improvement. It is an area of good practice that an observational tool is used as part of the audit. This helps identify what the experiences are of people who live at the home who are unable to verbally feedback their views. Certificates were available to show that the gas appliances and people lifting equipment in the home were safe. The home did not have an up to date certificate for electrical appliances and this is needed to show electrical installations in the home are safe. The home had a fire risk assessment available and it was good that individual fire evacuation plans had been completed. This means that staff know what support people would need to evacuate the home in an emergency. Records showed that the emergency lights had been regularly tested. The manager was unable to locate recent records to show that the fire alarms had been tested, these need to be available in the home. Certificates were available to show that the fire alarms had been serviced in January this year. We saw that during our visit a member of staff was wearing a pair of open backed slippers. This did not give a professional impression and it not safe practice given that the staff would be assisting people with manual handling. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 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 1 9 13 Where bed rails are in use a 12/04/2010 comprehensive risk assessment must be in place. This will help to make sure that people are not at risk of harm from the use of unsuitable bed rails. 2 20 13 Where there is information to 31/03/2010 suggest that people may be allergic to medication this must be clarified with health professionals and recorded in peoples care plans and on their MAR. This will make sure that people are not given medication that they could have adverse reactions to. 3 42 13 A current certificate for the electrical installations must be available. 16/04/2010 Care Homes for Adults (18-65 years) Page 33 of 36 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 To show that electrical installations are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The new Service User Guide needs to be completed and made available to people. So that people have up to date information about the home. Complete the process of transferring information into the new care plan format so that each person has a care plan that is up to date and details their needs, preferences and goals. This will help make sure staff have all the information about how to meet peoples needs. Improve the communication systems in place so that the methods used by staff meet peoples different communication needs. This will help people to communicate their needs and wishes to staff more effectively. Review the opportunities provided by the home regarding peoples in house leisure needs to make sure they meet peoples needs and expectations. Staff practice regarding the use of protective aprons should be improved to make sure their use respects peoples dignity. Systems to monitor peoples weight need to be introduced to make sure people are at a healthy weight. The home is advised to obtain a copy of the Royal Pharmaceutical Society good practice guidelines for the administration of medication in care homes so that good medication practice can be promoted. The home should make sure that out of date complaints Page 34 of 36 2 6 3 7 4 14 5 18 6 7 19 20 8 22 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 procedures are archived and that people have access to the up to date procedures. To help make sure people know how to make a complaint if they are unhappy about something. 9 23 All staff that work at the home should have understanding of the Deprivation of Liberty Safeguarding Legislation so they know the possible implications of this legislation for the people living there. Attention is needed to the front drive of the home to make sure it is in good order and is a suitable surface for people who use a wheelchair. Attention is needed to remove the stains from the floor covering in one persons bedroom so that it is clean and comfortable for the person. Make arrangements for staff to have all the training they need to meet peoples needs. Management arrangements should be improved to make sure the home is well run for the benefit of people living there. Records to show the fire alarms are tested weekly should be available in the home so that people can be assured the alarms are in working order. Systems should be in place to make sure that staff wear safe footwear when working in the home. To help reduce the risks of accident and injury to them and to people living at the home. 10 24 11 24 12 13 35 37 14 42 15 42 Care Homes for Adults (18-65 years) Page 35 of 36 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 © (2010) 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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