Care Home: 225-227 Coleshill Road

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What the care home does well There is good information to help people decide if the home would be suitable for them.People get to go out and do activities they enjoy.Staff helped the people living in the home to keep in touch with families and friends.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.Equipment is provided so that people can be safely moved from one place to another.Staff have training so they know how to help the people living there.Systems are in place to help run the home in the best interests of the people who live there. What has improved since the last inspection? Staff write down what each person has eaten. This helps make sure they are getting the food they need to be well.Complaints records show that issues have been investigated thoroughly and resolved.Staff have had more training to help keep people safe from abuse.There are enough staff so people can do the activities they want.Dangerous substances are locked away and the keys to cupboards kept safe. What the care home could do better: Improve the care plans so that people can be confident their needs will be met safely in the way they prefer.Make sure that people`s privacy and dignity is respected when they receive treatment from visiting health professionals.Improvement is needed to the medication system to make sure staff always follow good practice.Staff should have an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards Legislation so they know what this means for the people living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 225-227 Coleshill Road Coleshill Road, 225-227 Hodge Hill Birmingham West Midlands B36 8AE 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: 2 7 0 4 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 37 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: 225-227 Coleshill Road Coleshill Road, 225-227 Hodge Hill Birmingham West Midlands B36 8AE 01217475300 01217766843 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.efitzroy.org.uk Elizabeth FitzRoy Support Name of registered manager (if applicable) Mrs Anne Piri Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 13 13 0 0 care home 13 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 13 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) 13, Physical disability (PD) 13 Date of last inspection 0 9 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home 225 - 227 Coleshill Road are purpose built and owned by Elizabeth Fitzroy Support. The home is on a main road and has parking for cars at the rear. The home is situated close to local shops and bus routes. The home can have thirteen people living in it but is made up of several flats so people live in smaller groups. Care Homes for Adults (18-65 years) Page 5 of 37 Everyone has their own bedroom. There is a pleasant wellmaintained garden area and a sensory room. The inspection report is available in the home for visitors to read if they wish to. Information is available about the home. Care Homes for Adults (18-65 years) Page 6 of 37 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 7 of 37 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. An Expert by Experience visited with us. This is someone who has personal experience of learning disabilities. The manager sent us information about the home before our visit. Care Homes for Adults (18-65 years) Page 8 of 37 We met with people who live at the home. Some people were not able to tell us what they thought of the home due to their communication difficulties. 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. We looked at some areas of the home including some peoples bedrooms. We sent surveys to the home to give to peoples relatives and staff. Care Homes for Adults (18-65 years) Page 9 of 37 What the care home does well There is good information to help people decide if the home would be suitable for them. People get to go out and do activities they enjoy. Staff helped the people living in the home to keep in touch with families and friends. Care Homes for Adults (18-65 years) Page 10 of 37 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. Care Homes for Adults (18-65 years) Page 11 of 37 Equipment is provided so that people can be safely moved from one place to another. Staff have training so they know how to help the people living there. Systems are in place to help run the home in the best interests of the people who live there. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 12 of 37 Staff write down what each person has eaten. This helps make sure they are getting the food they need to be well. Complaints records show that issues have been investigated thoroughly and resolved. Staff have had more training to help keep people safe from abuse. There are enough staff so people can do the activities they want. Care Homes for Adults (18-65 years) Page 13 of 37 Dangerous substances are locked away and the keys to cupboards kept safe. What the care home could do better Improve the care plans so that people can be confident their needs will be met safely in the way they prefer. Make sure that peoples privacy and dignity is respected when they receive treatment from visiting health professionals. Care Homes for Adults (18-65 years) Page 14 of 37 Improvement is needed to the medication system to make sure staff always follow good practice. Staff should have an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards Legislation so they know what this means for the people living at the home. 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 CQC West Midlands Region Care Homes for Adults (18-65 years) Page 15 of 37 Citygate Gallowgate Newcastle upon Tyne NE1 4WH Tel 0300 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 16 of 37 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 17 of 37 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. Arrangements are in place so that people have the information they need and they can be confident that their needs will be met on admission. Evidence: The service user guide was available in the home. This provided people who may be thinking of moving into the home with appropriate information to help them decide if the home could meet their needs. The guide was available in an easy read format making it easier to understand for people who may be considering moving into the home. There was no information in the guide about the fees charged. This is important so that people know how much it costs to live at the home. We brought this to the attention of the manager who updated the guide with this information during our visit. One new person had moved into the home recently. We saw that the manager had completed an assessment of the person’s needs. They had involved staff from where they previously lived in the assessment process. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: We were told that there had been a phased approach to the admission for the person, this had been taking place over the last three months. This has included invitations to visit the home, introductions to people, visits with family, family meals, overnight stays, weekend stays and week long stays. The manager told us it was important for any new admission to the home to be done very gradually so that people are helped to settle in and so that other people living in the home were not upset. We spoke with the person who was new to the home. They told us they had visited the home before moving in and had been involved in meetings about moving there. They also said I like living here. Care Homes for Adults (18-65 years) Page 19 of 37 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. Care plans and risk assessments do not always give staff the information they need to support people to meet all their needs and achieve their goals. People who live in the home are supported to make decisions about their lives to enhance their independence. Evidence: The care for two people living at the home was tracked. The abilities of the two people varied considerably. One of the individuals was totally dependent on staff for support in meeting their needs. The other person had some degree of independence. The care files for the people living in the home included care plans which gave a considerable amount of information about the individuals, what they liked and what they needed support with. Some of the information included in the care plans was very well detailed. They showed how people wanted to be supported and were very clear about how staff were to deliver their care. In this respect care plans were quite person centred. There were some areas that needed improvement. For example, one person was on medication to prevent constipation but there was no care plan in place to help prevent them becoming constipated. There was also some information in plans that was not Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: signed or dated. It was therefore difficult to establish who had been involved in the information and if it was up to date. There was some good information on the care files in respect of how people communicated. Staff were seen to communicate effectively with people and in line with what was written in their guidance. Staff were directly observed engaging with people and encouraging them to make decisions wherever possible. For example asking them what they wanted to do and did they want to go out, what they wanted to eat and drink. The Expert said Staff said that as staff have worked with people for a long time they know them well and know their facial expressions and what they are trying to communicate. Each flat has its own regular meeting so that issues can be discussed if appropriate. Some people also attend external forum meetings that the organisation facilitates to allow people from all their local services to come together and discuss matters of mutual interest. There were numerous risk assessments on the files of the people being case tracked. These included assessments and management plans for such things as manual handling, use of vehicles, use of kitchen equipment, going swimming and use of bed rails. However we saw information in one persons care file that they may be at risk of leaving the home without staff support. The only assessment in place for this referred to the persons previous home and not where they lived now. The manager said she had only recently been made aware that this was a risk and would be completing a risk assessment for this. We saw that one person spends most of their time in their wheelchair and has a pressure relieving mattress on their bed. Staff and the manager told us that this person had never had a pressure sore and was not at risk of developing one. However there was no written risk assessment in place to evidence a full assessment had been completed. Care Homes for Adults (18-65 years) Page 21 of 37 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 so that people living at the home experience a meaningful lifestyle that includes doing activities they enjoy. Evidence: Care plans gave some information about what people enjoyed doing and of their daily and weekly routines. The homes Annual Quality Assurance Assessment told us We have increased opportunities and activities for people by focusing on what peoples weekly timetables look like and how we plan with people, this has allowed us to be more person centred. When we visited most people went out to various planned activities. The Expert said One person had been out for the day with her Key Worker to music therapy and then into town and another person was at the day centre. I was pleased that people were out in the community instead of being at home all day. They also said One person had been to the cinema earlier that week, they told us this hadnt been planned it was just spur of the moment. I was really pleased to hear this as not everything has to be planned, it is important that people can be flexible about what they do. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: Daily records gave some detail of the activities people were taking part in both in the home and the community. For example, attending day centres, swimming, out for meals, to the cinema, shopping, potting plants, DVD nights and going to the internet cafe. Records also showed that holidays had been discussed and plans were ongoing for these. The home has a snoozelen type room, situated in a purpose built log cabin in the garden. The manager told us that several people enjoy using this facility. Records provided evidence of support to maintain contact with families and friends, including visits at the home and contact by telephone. People are also supported to buy cards and gifts at appropriate times, for example for Mothers Day. Relatives told us that the home help people to stay in touch. One relative told us whenever I visit I feel very welcome another said we are delighted with the care he is getting and the consideration shown to us. We spent time with people in one of the flats while they had their lunch. As it is was a nice sunny day people enjoyed having their meal in the garden. People had sandwiches for lunch and were seen to be given a choice of dessert, this included fresh fruit. Staff were seen to give people the support they needed throughout the meal. Some people at the home need to have a special diet, for example because they may be at risk of choking. Discussions with staff show they are aware of peoples dietary needs. One relative told us special diet needs are catered for. At the last inspection we identified that improvement was needed to food records so that staff can monitor more effectively if people are having a healthy diet. We saw that the standard of recording had improved but on some limited occasions staff had recorded veg without detailing the actual type of vegetables people had. One person told us food is nice, I choose what I want. We saw that the menus did not have any alternative choices recorded. The Expert said I noticed there was only one choice for the evening meal, when I asked about it I was told that every flat has a different meal but there is only one choice. I was told that people decide what goes on the menu in their weekly flat meetings, which is good but they should still have a choice every day as they may have changed their minds. Also it would be better if there was a picture menu for people to choose from as this may be easier to understand than the written one. The homes Annual Quality Assurance Assessment told us We are looking at menu planning becoming more individualised. Care Homes for Adults (18-65 years) Page 23 of 37 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. Staff support people well so that their health and personal care needs are met so ensuring their well being. Evidence: The personal care needs of the people living in the home were well detailed in their care plans. Direct observations of the grooming and dress of people using the service provided evidence that the standard of basic personal care they received was very good. One relative told us X is always well groomed. One person who lives at the home told us they like having a bath and they are able to have one when they want. Interactions between the people living in the home and staff showed that both were comfortable in each others company, and support was given in a friendly manner. We did however observe that when the chiropodist arrived to undertake nail care for people this was done in the lounge of one of the flats. We did not see staff consult people about where they would like this to take place. It would have been more respectful if this had been undertaken in the privacy of peoples own bedrooms. The manager assured us this would happen in future unless people made an alternative choice. Staff complete an assessment of peoples health needs. This is called the Ok health assessment. This helps staff to know what help a person needs to be healthy and to stay Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: healthy. Staff said and records showed that a range of other health professionals are involved in the care of individuals. One health professional told us its a wonderful place, I have been coming here for a number of years and have not seen anything of concern. Staff are good. Records sampled showed that staff support people to attend health appointments where needed to ensure they get the health care they need. Some people at the home have communication difficulties, it is good practice therefore that care plans contain information about how staff would know a person is unwell. Care files included some very good information about the manual handling needs of the people living in the home which included which hoists were to be used and sling sizes. There were also some very good management plans in place for such things as epilepsy. These management plans ensured people were cared for safely. Staff who administer medication have received training and are assessed to make sure they are safe to administer medication. With the exception of one person, peoples medication was stored in locked cabinets in their bedrooms. This means that people can have their medication administered in the privacy of their own room. One persons medication was in a locked cabinet in the laundry. We were told a maintenance request had been made for the cabinet to be re-located to their bedroom. We found that the laundry was very warm and so may have been an unsuitable location for the storage of medication. We brought this to the attention of the manager who made arrangements for the cabinet to be re-located during our visit. Systems are in place to check people receive their medication safely, this includes checking medication at staff handovers. An audit of the homes medication system had also been completed by a senior manager during one of their visits to the home. Some minor improvements to the system are needed. The administration directions for one person had been completed on their medication administration record (MAR) by staff. These had not been signed. It is considered good practice for handwritten directions added by the home to be checked and signed by two staff. This reduces the risk of any errors occurring. We saw that for one person their topical cream had been opened. Staff need to make sure they date creams on opening so that it can be discarded after twenty eight days. This helps make sure creams are in good order and effective. The home did not have a copy of the Royal Pharmaceutical Societys guidance about good practice on administering medication in social care settings. Staff should have access to this to make sure they are all aware of good practice. Care Homes for Adults (18-65 years) Page 25 of 37 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 ensure that the views of the people living there are listened to and they are protected from harm. Evidence: There was a complaints procedure for the home and this was available in a pictorial format to try and make it more understandable for the people living in the home. One person told us he would speak to the staff if he had any complaints. However for the majority of people at the home they are dependant on the vigilance of staff to interpret changes in mood, behaviour or body language as indicators that something may be causing concern. It is therefore good that in care files sampled there was information about how staff would know if the person was unhappy. Relatives told us they were aware of the homes complaint procedures. The Expert said As I was walking around I noticed that there were accessible complaints leaflets in all of the flats. I asked how people could complain if they are not happy and was told that they would tell the Manager or they would raise it in their resident meetings. This is really good but I hope that the people who do not verbally communicate get the chance to complain also. We have not received any complaints about the service since the last inspection and there have been no safeguarding alerts made. The homes complaint log recorded they had received one complaint directly. Records showed the complaint had been investigated by the home. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: Staff spoken with confirmed they had received training in safeguarding people from abuse. We spoke with one staff about what they would do if an allegation of abuse was reported to them. The staff member was confident in her answer and was able to describe the procedure that would be followed to keep people safe. Training records sampled showed that staff have not yet completed training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguarding (DOLS) legislation. Staff spoken with were unfamiliar with this legislation. Staff need to be aware of this legislation and the implications it has for people living in a care home. The manager told us that she had completed MCA training and she thought that the organisation would be arranging training for staff in the future. There were systems in place for managing money on behalf of the people living in the home. The records for one person were sampled. Receipts were kept for all expenditure and there were also two staff signatures. The system is audited by a senior manager in the organisation to make sure peoples money is being well managed. Care Homes for Adults (18-65 years) Page 27 of 37 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, safe and clean environment that meets their individual needs. Evidence: The home is split into several small flats. We looked at some of the flats to include some peoples bedrooms. Each flat has its own lounge, dining room, kitchen, laundry and bathroom. All were well maintained and provided people with very comfortable accommodation. Communal areas were well furnished and decorated. One relative told us that the home was a bright, clean, friendly, warm and safe place. The Expert said All of the flats were really nicely decorated. The bedrooms that I looked at were very personal and the people had chosen their own decor. I noticed that everyones bedroom doors were open even when the people were not at home. I would expect doors to be locked when the people are not there unless they have asked for them to be left open. The home was clean and tidy throughout and a good standard of hygiene had been maintained. Satisfactory hand washing facilities were in place and paper towels had replaced the cotton towels evident in communal areas at the previous inspection. The home had safe outside areas that could be used by the people living there. People were seen to make good use of the gardens during our visit as it was a pleasant sunny Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: day. One garden included a wooden outbuilding housing a snoozelan facility that could be used by all the people living in the home. There were several aids and adaptations around the home to enable the needs of the people living there to be met. A passenger lift is available so that people who have mobility difficulties do not have to use the stairs. Each bathroom offers adapted bathing facilities and showers, for the benefit of people with mobility difficulties. Some bathrooms had a ceiling track fitted so that hoists could be used more effectively. Staff have worked hard to support people to have their rooms as they like. These are very personal to the occupant and reflect personal tastes, age and gender. One person told us I like my bedroom. They told us they had chosen the decor of their bedroom and we saw that it was designed to match the colours of their favourite football team. Records show that people are supported by staff to go out and choose items for their bedrooms. Care Homes for Adults (18-65 years) Page 29 of 37 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 help to ensure that the needs of the people living there are met. Evidence: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. Over 50 of the staff have a National Vocational Qualification in care and this means that the people who live there are supported by a well qualified staff team. One person told us staff are nice. Relatives told us they care so much, I have no worries, they are all so kind to everyone that is there and all the staff deserve recognition and praise and lots of it. The Annual Quality Assurance Assessment told us that the home has only one male staff despite most of the people living at the home being male. One relative told us male staff would be a great help. The manager told us that they had tried to recruit more male staff but that it had proven difficult. She was however hopeful that in the recent staff recruitment that had taken place some male staff had been recruited. The Expert said I observed all of the staff talking to people with respect and encouraging them where possible to be independent. All of the staff seemed to know the people well. Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: There were enough staff on duty to meet peoples needs when we visited, we did not see anyone having to wait for staff support. Staff told us there were always or usually enough staff on duty, however one staff in their survey told us there were sometimes enough staff. We looked at the recruitment procedures followed for two new members of staff. These had improved since our last visit. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. This helps to ensure that suitable people are employed to work with the people living there. Work is currently underway with people to develop a Wish list about who they would like to be supported by, to be used in future staff recruitment. Training opportunities are offered to staff on a rolling programme scheduled centrally within the organisation. New staff confirmed they had undertaken a full induction training programme when they started working at the home. Staff were positive about the training on offer. They told us training is brilliant, training is very good here and we get good training, if ask for something they provide it. Records showed that some staff were overdue their annual refresher training for manual handling however evidence was available to show that this was being arranged. Staff meetings are held regularly and there are systems in place to ensure regular staff supervision takes place. This helps keep staff updated with how to meet the needs of the people living there, changes within the organisation and with best practice. Care Homes for Adults (18-65 years) Page 31 of 37 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: The home has an experienced manager who is registered with us. The manager is appropriately qualified to NVQ level 4, and also holds the Registered Managers Award. When we last inspected the home the manager had not been at work for some time and the home was being managed by two assistant managers. The manager is now back at work and is supported by the two assistant managers, who share responsibility for the two houses. The manager and the assistant managers were present throughout the inspection and were very helpful. They showed a good understanding of the needs of the people living in the home. The manager completed and returned the Annual Quality Assurance Assessment when we asked for it. We found that the information given in the AQAA was accurate so we can be confident that the manager has the best interests of the people living there as a priority in managing the home. Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: Staff told us that the manager is the best manager the home has had, we all work well together, you can talk to her and the manager is very good, she listens, she comes around the flats to see people, checks things are okay. One relative told us Home is run wonderfully well, always seems a happy place to be in. Each month the representative of the organisation visits the home to make sure it is being well run, reports of these visits were available in the home. The organisation has adopted the REACH standards as a tool for measuring the quality of all the services it provides. These standards are designed specifically to relate to the supported living model of care provision, rather than to a registered care home. The manager stated it can be difficult to measure the service against the standards when the people who live in the home have such complex and diverse needs as some of them are not able to communicate their views. However the manager stated she audited one standard every month and looked for evidence to support the statements. We looked at a sample of the homes health and safety records, these showed health and safety is generally well managed. Water temperatures are checked regularly, these were observed to be within safe levels so that people are not at risk of scalding. The fire risk assessment is reviewed regularly and updated where needed. This ensures that action can be taken to minimise the risks of there being a fire. There are regular fire drills so that staff and the people living there would know what to do if there was a fire. There were some gaps on the records of testing the fire alarms, the manager told us this had been when the maintenance person had been away from work. We were told that the care staff had tested the alarms but forgotten to record this. We saw that in recent months the records showed the tests had taken place, we were told this coincided with the maintenance person returning to work. An engineer regularly services the fire equipment to ensure it is well maintained so would work if there was a fire. Certificates were available to show that the gas appliances, passenger lift, manual handling equipment and electrical installations in the home are safe. The home had recently been inspected by an Environmental Health Officer regarding their arrangements for food safety. The report of the visit said that the home had high standards. At the last inspection a requirement was made for COSHH substances (for example cleaning products) to be stored securely in the home. We saw that the homes regular health and safety audits included checking this was being done. When we visited COSHH products were seen to be stored in locked cupboards. Care Homes for Adults (18-65 years) Page 33 of 37 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 34 of 37 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 6 Information in peoples care files should be signed and dated so that it is clear who has written it and that the information is up to date. Improve the care planning system to make sure care plans are in place for all areas of need. So that people can be confident their needs will be met in the way they prefer. There should be risk management plans in place for all identified risks. This will ensure people are not exposed to any unnecessary risks. Improve arrangements so that treatment from visiting health care professionals is undertaken in a manner that respects peoples choice, privacy and dignity. The home should obtain a copy of the Royal Pharmaceutical Society good practice guidelines for administration of medication in social care to help ensure good medication practice. Page 35 of 37 2 6 3 9 4 18 5 20 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 23 Staff should have an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards Legislation so they know the implications for the people living at the home. Care Homes for Adults (18-65 years) Page 36 of 37 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. 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