Care Home: 231 Stafford Road

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What the care home does well All the feedback we received from the people who use the service about the standard of care they received at 231 Stafford Road was in the main very positive. Typical comments included - `I like living here`, `ive got everything I need in my bedroom and I was able to choose how it was decorated`, `staff are nice...they look after me here and take me swimming.` The service has developed some excellent quality assurance systems, which provides the people who use live there with various opportunities to express their views and affect the day-to-day running of their home and its future development. For example, we commend the providers for facilitating `listen to me` group meetings, which a number of people who currently reside at 231 Stafford Road regularly attend. It was also positively noted that all the people who use the service are encouraged to join in monthly residents meetings where they can help staff plan next weeks menu, their social activity programme, and choose holiday destinations. The people who use the service continue to have lots of opportunities to participate in a wide variety of `age` appropriate and stimulating social, leisure, and recreational activities, both at home and within the wider community. It was positively noted that where possible the physical environment of the home has been suitably adapted to enable the people who live there to do as much for themselves as they are willing and capable of doing. For example, a number of the worktops in the kitchen and coat rail in the hallway have all been lowered to enable wheelchair uses to access them. All the managers and staff we met during the course of this inspection were observed interacting with the people who use the service in a very kind, respectful, and professional manner. Furthermore, all the written and verbal feedback we received from staff was very positive about the on going training they received and the support they got from their line managers. The atmosphere within the service remained extremely relaxed and congenial throughout the course of the visit, which included the period over lunch. What has improved since the last inspection? The area manager confirmed that as stated in the AQAA the provider was piloting a new care plan format which those service users actively involved with the organisations `listen to me group` had helped develop. A draft copy of the new care plan format was very personalised and easy to read. Progress made by the providers to introduce the new care plan format will be assessed at the services next inspection. The service has significantly improved its medication recording, dispensing, and monitoring practises in recent months having experienced an unusually high and `unacceptable` number of serious medication handling errors in the past year and a half. The providers managed to turn this major on going failing around by introducing:a new monitored dosage system; insisting two staff always witnessed and counter signed for all medicines administered within the service; retraining and continually assessing staffs competency to handle medication safely; and, more frequent and thorough medication spot checks and audits to be carried out by the services management.The services recent recruitment drive has ensured that sufficient numbers of suitably trained and competent staff are on duty throughout the day to meet all the personal and social care needs and wishes of the people who use the service, as well as keep them safe. Staff morale has also improved in the past quarter following the departure of several members of staff involved in two separate safeguarding incidents. The services management told us they were committed to continue the process of improving staff working relations and as part of this process have arranged for everyone to attend a team building away day. What the care home could do better: All the positive comments made above notwithstanding the services management acknowledge there remains considerable room to continue improving the quality of care they provide at 231 Stafford Road. We have made seven good practise recommendations for the service to implement: The provider should analyses the frequency and nature of falls people who use the service have and where appropriate review moving and handling risk assessments with all the relevant health care professionals. This will ensure the risk of individuals falling is minimised. The provider should consider seeking some practical advice and input from Nationally recognised sensory impairment agencies, such as the RNIB and RAD, and explore with them new ways of meeting the needs of people they support who are deaf and/or blind. The provider should up date its medication policies and procedures to reflect all the recent changes they have made to improve its staffs medication handling and recording practises. The provider should ensure all the damaged tiles in the wet/shower room are replaced. This will minimise the risk of infection spreading and make the facility more pleasant to use. The deadlock fitted to the top of the wet/shoer room door, which services no function, should also be removed. This will ensure the risk of people being denied access to this facilities is minimised. The provider should review all its policies and procedures and amend them accordingly to reflect the true nature of the service being provided at 231 Stafford Road (i.e. nursing home needs to be replaced with residential care service). Finally, the providers should review the buildings fire risk assessment and up date it accordingly to reflect any changes that may have occurred since it was last amended. This will ensure the services fire safety arrangements are up to date and all the people who live, work and visit 231 Stafford Road are kept safe. Key inspection report Care homes for adults (18-65 years) Name: Address: 231 Stafford Road 231 Stafford Road Wallington Surrey SM6 9BX     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: Lee Willis     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 32 Information about the care home Name of care home: Address: 231 Stafford Road 231 Stafford Road Wallington Surrey SM6 9BX 02086471271 02086471271 manager.staffordroad@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Solutions Limited Name of registered manager (if applicable) Mrs Tina Edwards Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (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) Physical disability (PD). Date of last inspection Brief description of the care home 231, Stafford Road is a registered care home for people with learning disabilities who may also have physical disabilities. Five people are currently living there. The home is owned, managed and staffed by the organisation Care U.K. under the name Care Solutions Ltd. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 6 6 Brief description of the care home Accommodation is provided over two floors. All bedrooms are single. Communal space consists of an open plan living room, dining room and kitchen. There is a separate laundry room. A small garden to the rear of the home as well as a patio area to the front. The office is situated on the first floor. Stafford Road is a busy road, close to shops, parks and public transport with easy access to Sutton and Croydon. A mini-bus, which is accessible for wheelchair users is available. The fees vary depending on people assessed needs, details are available from the home. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We still quality rate this service as a two star performing residential care home. This means the people who live there continue to experience good quality outcomes. From all the evidence we were able to gather as part of the inspection process it was clear this service still has significantly more strengths than areas of weakness. We spent four and a half hours at the home on a midweek day between 10.30am and 3pm. This report includes reference to documents we examined during the course of the site visit, which included:- needs and risk assessments; care plans; activity records; weekly menus; health care action plans; medication administration sheets; the homes accident book; complaints log; staffs personal files; duty rosters; fire records; and various health and safety certificates. The report also draws upon conversations we had with the services area, registered, and deputy managers; a newly recruited support worker, and the maintenance man. The remainder of the visit was spent touring the premises and its grounds. Care Homes for Adults (18-65 years) Page 6 of 32 Six of our have your say comment cards were returned to us by three people who work at 231 Stafford Road and three social and/or health care professionals who represent a number of people who live there. As part of this inspection process the services manager is required to complete and return our Annual Quality Assurance Assessment (AQAA), which she did when we asked for it. This self-assessment tool helps us determine what the service is doing well, has improved in the past year, and what it plans to do better in the future. We would like to thank all the people who contributed to the inspection process for their time and input. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? The area manager confirmed that as stated in the AQAA the provider was piloting a new care plan format which those service users actively involved with the organisations listen to me group had helped develop. A draft copy of the new care plan format was very personalised and easy to read. Progress made by the providers to introduce the new care plan format will be assessed at the services next inspection. The service has significantly improved its medication recording, dispensing, and monitoring practises in recent months having experienced an unusually high and unacceptable number of serious medication handling errors in the past year and a half. The providers managed to turn this major on going failing around by introducing:a new monitored dosage system; insisting two staff always witnessed and counter signed for all medicines administered within the service; retraining and continually assessing staffs competency to handle medication safely; and, more frequent and thorough medication spot checks and audits to be carried out by the services management. Care Homes for Adults (18-65 years) Page 8 of 32 The services recent recruitment drive has ensured that sufficient numbers of suitably trained and competent staff are on duty throughout the day to meet all the personal and social care needs and wishes of the people who use the service, as well as keep them safe. Staff morale has also improved in the past quarter following the departure of several members of staff involved in two separate safeguarding incidents. The services management told us they were committed to continue the process of improving staff working relations and as part of this process have arranged for everyone to attend a team building away day. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 9 of 32 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 10 of 32 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 11 of 32 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. All prospective new service users have their needs assessed as part of a thorough admissions process and they and their representatives are always offered the chance to meet all the people who live and work at Stafford Road through planned visits. This ensures prospective new service users, their representatives, and the home have all the information they need to decide whether or not the placement is right for all concerned. Evidence: The area manager told us the service was in the process of supporting an individual who currently lived in another Care UK home to move into 231 Stafford Road. The area manager confirmed that in accordance with good practise the prospective new service user had been invited to visit Stafford Road on several occasions before any decision about moving in were taken. A number of people who use the service told us they knew this individual was moving in soon and that staff had asked them what they thought about it. Care Homes for Adults (18-65 years) Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users assessed and changing needs, preferences, and personal goals are reflected in their individualised care plans which staff can then use to ensure the choices of the people they support are respected. The service has developed some excellent arrangements to ensure the people who use it have lots of opportunities to be consulted on, participate in, and make informed choices about every aspect of their life. The people who use the service are actively encouraged and supported by staff to take reasonable risks to enable people to maintain and develop their independent living skills, where possible. Evidence: The two care plans we looked at in depth set out in detail the individual needs, strengths, preferences, and the support each person required. The area manager confirmed that as stated in the AQAA the provider was piloting a new care plan format Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: which those service users actively involved with the organisations listen to me group had helped develop. A draft copy of the new care plan format we looked at was very personalised and easy to read. Progress made by the providers to introduce the new care plan format will be assessed at the services next inspection. All the care plans we looked at had been reviewed in the past month and up dated to reflect any changes in peoples need and/or circumstances. One hundred percent of the care staff who returned our surveys told us they were always given up to date information about the needs of the people they supported in their care plans. Furthermore, most of the health and social care professionals who returned our surveys told us the services assessment arrangements usually ensure that accurate information is gathered and that the right service is planned for people. A social care professional wrote in one survey - care plans are very person centred. Staff we met told us all the people who use the service have a designated keyworker whom they regularly meet on a one-to-one basis. In addition to this, people who use the service have the chance to express their views at residents meetings held approximately once every two months. We commend the service for producing the minutes of these meetings in easy to read pictorial formats that enable all the people who use the service to read them and see how their involvement can have a positive influence on the running of their home. As previously mentioned in this report the providers also arrange regional listen to me meetings, which a number of people who reside at 231 Stafford Road regularly attend. All the care plans we looked at in depth contained a comprehensive set of assessments that identified all the potential risks and hazards these particular individuals could face on a daily basis and the action staff should take to minimise the likelihood of them occurring. It was also evident from the comments we received from the area manager and the other staff we met that the service is committed to encouraging and supporting the people who live at 231 Stafford Road to take responsible risks and do as much for themselves as they are willing and capable of doing. For example, a number of the worktops in the kitchen and coat rail in the hallway have been lowered to enable people who use wheelchairs to access them. Staff told us they actively encourage and support the people who use the service to help them with their laundry and cooking. One hundred percent of the health and social care professionals who returned our surveys told us the staff always support people to live the life they choose wherever this is possible. Care Homes for Adults (18-65 years) Page 14 of 32 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. The people who use the service have the opportunity to participate in a variety of meaningful, age appropriate, and interesting social and leisure activities - both within their home and the wider community. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally well-balanced and presented meals that reflect people unique food tastes and specific dietary requirements. Evidence: On arrival we noted that most of the people who use the service were out attending pre-planned community based activities at a local college. It was evident from information staff recorded in daily diary sheets that the people who use the service participated in a wide range of meaningful recreational activities each day that reflected everyones age and social interests. People who use the service and staff all Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: told us activities that were most popular included going shopping, cooking, swimming, listening to music, art and crafts, woodwork, and aromatherapy. During a tour of the premises one individual showed us all the things that had made in pottery classes, which was something they clearly enjoyed attending. After lunch we observed staff offering people the chance to go swimming, which a number took up. The manager told us spiritual needs are recorded in care plans and those individuals who have expressed a wish to practice their faith are supported by staff to do so at local places of worship. The manager told us it was customary to invite service users next of kin to their annual care plan reviews. It was evident from the feedback we received from the people who use the service and staff that the service operates an open visitors policy. We met two people who use the service during lunch who both told us they liked the food staff made at 231 Stafford Road. Another told us they liked fish, which was advertised at least once on all the weekly menus we sampled at random. The atmosphere around the dinning table remained very relaxed and congenial during lunch and it was positively noted that three different types of meals were served up by staff at the bequest of everyone sat around the dinning table. Staff were also able to show us the pictorial prompt cards they use to enable all the people who use the service to communicate their meal and drink choices more easily. Peoples food preferences and dietary needs can also be identified from their care plan. Care Homes for Adults (18-65 years) Page 16 of 32 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that there existing and changing physical and emotional health care needs are always recognised and met. Overall, the way the service records, administers and monitors its medication handling practises has significantly improved in the last quarter and are now adequate to minimise the risk of people who use the service being given the wrong type and/or dosage of medication. This comment notwithstanding there remains scope for further improvements to be made to the way the provider reviews its medication policies and staff administer medication. Evidence: All the people who use the service were suitably dressed in well maintained clothes that were both age and seasonally appropriate. The area manager told us the services local GPs surgery has a specialist learning disability nurse who carries out annual health care checks on everyone who resides at Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: 231 Stafford Road. All the care plans we looked at contained health care action plans that set out in detail all these individuals health care needs and the outcome of appointments they had attended with various health care professionals. One hundred percent of the health and social care professionals who returned our surveys told us peoples health care needs are always properly monitored, reviewed, and met by the service; and that staff always respect the privacy and dignity of the people who use the service. These professionals also said staff always seek advice from health care professionals as and when required, and act upon it. One health care professional wrote in our survey people who use the service have been kept mobile against all the odds because of the commitment of the manager and her staff team. It was evident from all the incident records we saw and had been notified about in the past year that the majority of accidents that have occurred within the home in the past year usually pertained to falls involving one service user in particular. The area manager confirmed this was the case and said she was not aware of any formal analyses regarding the frequency and nature of these falls being undertaken by the service. We recommend this is undertaken and professional advice sought from the relevant health care professionals before this individuals moving and handling risk assessment is updated. Furthermore, we recommend the service gets in contact with the Royal National Institute for the Blind (RNIB) and the Royal Association of the Deaf (RAD) to seek their advice and input about how they could improve the service they offer to people with sensory impairments. The services management acknowledge there had been an unusually high number of serious medication handling and recording errors occur at 231 Stafford Road since its last key inspection. The providers sent us an improvement plan setting out how they intended to make medication handling practises within the service safe again. The services management told us they both believed the recording, administering, and monitoring of staffs medication handling practises had significantly improved since the aforementioned action plan was introduced at the end of last year. As a consequence of the plan:- a professionally recognised monitored dosage system has been introduced; all staff authorised to handle medication on behalf of the people who use the service have received medication refresher training and undergone one-to-one medication handling competency assessments; and, all medicines administered are now witnessed and counter signed for by two members of staff. No recording errors were noted on any of the medication administration sheets we sampled at random from the past three months. During lunch we observed two members of staff administer medication safely and in accordance with the providers Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: new medication procedures. All the care staff who returned our surveys told us they had been given enough knowledge about handling medication safely. The manager also told us she spot checks the staffs medication handling and recording practises at least once a week and the providers routinely audit medicines held by the home as part of there quality assurance system. The providers medication policies and procedures have not been reviewed lately and suitably amended to include all the recent changes they have made to the way they expect staff to handle medication on behalf of the people who use the service. Care Homes for Adults (18-65 years) Page 19 of 32 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. The services arrangements for dealing with complaints are sufficiently robust to ensure the representatives of the people who live at the home feel their views and any concerns they have will be taken seriously and acted upon. People who use the service are kept safe because staff understand what constitutes abuse and know what to do if they witness or suspect it. Evidence: One hundred percent of the health and social care professionals who returned our surveys told us the service always responds appropriately to any concerns that are raised about how the home is operating. Similarly, all the care staff who returned our surveys also told us they knew what to do if someone had a concern about the home. The area manager told us all the people using the service who regularly attend the providers listen to me meetings and were recently reminded what they needed to do if they were unhappy about anything at their home. During a tour of the premises we noted easy to read pictorial complaints procedures in peoples bedrooms which made it clear who they should speak to if they were not satisfied with the service they received at 231 Stafford Road. One person who uses the service told us they would speak to their keyworker if they did not like something. The area manager and all the other staff we spoke with during this site visit Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: demonstrated a good understanding of what constituted abuse and/or neglect, and what their reporting responsibilities were if they suspected and/or witnessed its occurrence. Both the support workers we met confirmed they had received safeguarding training within the past year and the area manager was able to provide us with documentary evidence of this on request. The service has experienced two safeguarding issues within the past twelve months. Both incidents were taken seriously by the provider and all the relevant external agencies, including the local authoroties safeguarding vulnerable adults team and us, were all notified without delay in line with best safeguarding practice. It was also positively noted the providers immediately suspended the two members of staff accused of perpetrating the abuse to protect all concerned. The first allegation made has been substantiated following a full investigation and appropriate disciplinary action taken. The second is still being looked into. Both these aforementioned safeguarding matters were dealt with by the provider in a very prompt, professional, and transparent manner. Care Homes for Adults (18-65 years) Page 21 of 32 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. The interior layout and design of this home, including its domestic looking furniture, fixtures and fittings, and soft furnishings, ensures the people who use the service live in an environment which is safe, comfortable, and non-institutional. The home is kept very clean and the arrangements it has in place for controlling infection are robust. Evidence: During a tour of the premises we noted it was decorated to a good standard and fitted out with all manner of comfortable looking furniture and soft furnishings. This made all the communal areas look very homely and domestic in character. The maintenance person told us since the services last inspection the lounge and a number of bedrooms have been repainted, and new skirting boards fitted in the hallways. It was positively noted that the bedroom to be occupied by the new service user had recently been redecorated in the colours of their favourite football team, which they had requested. During a tour of the premises we viewed a number of bedrooms that were already in use with the permission of the present occupant. Bedrooms have all been decorated in a style that reflects the individual tastes of the people who occupy them. The layout of the home and the width of door-frames ensures all the people who are wheelchair users can access all the areas they need too without the need for staff assistance, Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: which includes their bedrooms and toilet facilities. As previously mentioned in this report worktops and coat rails have all been lowered to ensure everyone can reach them, and sufficient numbers of grabs rails installed in toilets and bathrooms. The service also has a Parker bath, a wheelchair accessible wet room shower facility, and a mobile hoist. Some of the tiles in this shower room are damaged and need to be replaced. The deadlock fitted at the top of this shower room door, which staff assured us is never used, should also be removed. The L shaped garden at the rear of the property is well maintained and there is plenty of furniture out there for all the people who use the service to sit on and enjoy their garden. The laundry room is suitably positioned away from any areas where food is prepared, stored, or eaten, and its washing machine is capable of cleaning clothes at appropriate temperatures in line with infection control standards. The home looked spotlessly clean, and smelt fresh. One staff who completed our survey told us Stafford Road was - very homely, had a nice feel about it, and is always kept clean and tidy. Care Homes for Adults (18-65 years) Page 23 of 32 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 services recent recruitment drive now ensures that sufficient numbers of suitably trained and competent staff are on duty at all times during the day to meet the needs and wishes of the people who use the service, as well as keep them safe. The home has sufficiently robust arrangements in place to ensure its staff team receive all the support they need to do their jobs and care for the people who use the service. Evidence: All the staff we met were observed interacting with the people who use the service in a very kind, respectful and professorial manner throughout the course of this site visit. We also observed staff politely asking people what they would like to choose for their lunch meal on the day of this inspection and whether or not they would like to go swimming that afternoon. Most of the staff who returned our surveys expressed concerns that there was not always enough staff on duty to meet the individual needs of all the people who used the service. Typical written comments we received included, - staffing hours is something home could do better, staffing hours are a problem here, and we could do with some more staff. The area and services managers both acknowledged that staffing levels had been a problem in the past year following the recent suspension of Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: two members of staff, but was beginning to ease with the recruitment of several new members of staff. The services management confirmed the home was now only two permanent members of staff short of its full compliment and the process of recruiting more staff was on going. On arrival we noted enough staff on duty in the home to meet the personal and social care needs and wishes of all the people who currently used the service. The services management told us they would increase the number of staff on each shift during the day when the new service user moves in. We will assess this at the services next inspection. The services management also acknowledged that staff morale had been adversely affected by the recent safeguarding incidents, but believed it had improved with the recruitment of several new members of staff. The two support workers we met, who were both relatively new to the home, both told us they felt staff morale was very good at 231 Stafford Road and that they worked well together as a team. The services management also told us a team building away day was planned for next month to continue the process of improving working relations between the homes care staff. Progress made by the service to achieve this aim will be closely monitored by us. All the care staff who returned our surveys also told us their employer had carried out Criminal Records Bureau and reference checks on them before they started working at 231 Stafford Road. Furthermore, one hundred percent of the care staff who returned our surveys told us their induction covered everything they needed to know about their job as support workers before they started working at the home. The area manager was able to produce documentary evidence on request that showed us the service had carried out satisfactory recruitment checks on all its new staff before being employed and ensured they each received a thorough induction before being allowed to work unsupervised with the people who use the service. It was evident from comments made by staff and documentary evidence provided by the services management that the on going training received by staff that work at the home is relevant to their role. Records indicate sufficient numbers have achieved a National Vocational Qualification in care, level 2 or above; fire safety, first aid; food hygiene; moving and handling; safeguarding adults; handling medication; and infection control. Most of the health and social care professionals who returned our surveys also told us the services manager and staff always have the right skills and experience to meet the social and health care needs of the people who live at the home. All the staff who completed our surveys told us the training they received was relevant to their role as support workers, helped them understand and meet the individual needs of the people they supported, and kept them up to date with new ways of working. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Two support workers we met told us they regularly receive a formal one-to-one supervision with the homes manager and a team meeting with their fellow peers at least once every two months. The area manager was able to provide us with the minutes of these one to one and group meetings on request. Most of the staff who returned our survey told us their manager gave them enough support and regularly met with them to discuss how they were working. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a competent management team in place to ensure its is effectively run in the best interests of the people who live there on a day-to-day basis. The service has developed some excellent quality assurance systems which enable it to ascertain the views of people who represent the service users and to take them into account when looking at new ways of improving the standard of care they offer. Not all the providers policies and procedures reflect the type of service offered to the pople who reside at 231 Stafford Road, and should be amended accordingly. In the main the services fire and other health and safety systems are robust enough to minimise the risk of anyone living or working at the home being harmed. Evidence: The area manager for the service told us the day-to-day manager of 231 Stafford Road was suitably qualified to run a residential care of this size and nature and had over five years experience working in this type of setting as a senior capacity. The area manager also told us the homes manager had improved her practice in the past Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: year and had learnt from past mistakes she had made. We received a lot of positive feedback from a number of the health and social care professionals who returned our surveys. Typical comments included, the manager is very committed, this home is very well run and organised, the manager seems to run the home very well and us always helpful when requested to provide us with information. it was also evident from the comments we received from the area manager that she works very closely with the homes manager. The area manager was able to produce copies of the findings made by senior managers representing the provider who carry out unannounced monthly spot checks on the home. These reports were very comprehensive and included the views of the people who use the service and those that work there. As previously mentioned in this report we commend the provider for introducing listen to me meetings as a way of increasing the influence pople who use the service have within the organisation. According to the services AQAA the providers policies and procedures are reviewed at regular intervals and up dated accordingly to reflect any changes in best practice. This comment not withstanding we noted that a number of policy documents we sampled at random, which had clearly been developed centrally by Care Solutions, frequently included the term nursing home when referring to the type of service provided at 231 Stafford Road. This anomaly needs to be amended. The service has a fire risk assessment for the building in place, although it has not been reviewed for many years. The services other fire safety records revealed its fire alarm system continues to be tested on a weekly basis and all staff, including those that work mainly nights, have been involved in a fire drill or received from fire safety instruction in the past three months. Two fire resistant doors we tested at random both closed flush into their frames when we released them. During a tour of the premises we noted that all products hazardous to health were being kept securely locked away and that all the food taken out of its original packaging were correctly labelled, dated, and stored in accordance with basic food hygiene standards. We noted that the temperature of hot water emanating from the first floor bath was found to be a safe 42 degrees Celsius when we tested it after lunch. The area manager told us all the homes baths had been fitted with failsafe thermostatic mixer valves that minimised the risk hot water temperatures exceeding 43 degrees Celsius. Up to date Certificate of worthiness were made available on request that showed us the homes gas installations, fire extinguishers, portable electrical appliances, water heating, and mobile hoist - had all been tested by suitably qualified engineers in the past year in accordance with the manufactures guidelines. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 The provider should considering seeking practical advice and input from Nationally recognised sensory impairment agencies and explore with them new ways of meeting the needs of people they support who are deaf and/or blind. The provider should analyses the frequency and nature of falls people who use the service have and where appropriate review moving and handling risk assessments with all the relevant health care professionals. This will ensure the risk of individuals falling is minimised. The provider should up date its medication policies and procedures to reflect all the recent changes they have made to improve its staffs medication handling and recording practises. The deadlock fitted to the top of the wet/shoer room door, which services no function, should be removed. This will ensure the risk of pople being denied access to this facilities is minimised. The provider should ensure all the damaged tiles in the wet/shower room are replaced. This will minimise the risk of infection spreading and make the facility more Page 30 of 32 2 19 3 20 4 27 5 27 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 aesthetically pleasing. 6 40 The provider should review all its policies and procedures and amend them accordingly to reflect the true nature of the service being provided at 231 Stafford Road (i.e. nursing home needs to be replaced with residential care service). The providers should review the buildings fire risk assessment and up date it accordingly to reflect any changes that may have occurred since it was last amended. This will ensure the services fire safety arrangements are up to date and all the people who live, work and visit 231 Stafford Road are kept safe. 7 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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