Care Home: 26 Green Road

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What the care home does well The staff at the home knew the people living there well and ensured they received support in the way they wanted. There was a good understanding of the communication needs of the people living in the home and staff used this well, to support service users in making decisions about their life. The people living in the home took part in a variety of activities both in the home and in the community ensuring they led fulfilling lives. People were seen to be encouraged to do tasks around the home to make them more independent. Where possible people were asked what they would like on the menus and staff used pictures and flash cards to prompt a better range of choices. This ensured the menus were made up of foods liked by the people living in the home. The two people able to express their views said the food was `nice`. People were enabled and facilitated by the staff to remain in touch with their families. Visitors spoken with stated the home offered a good service to the people living there and that they were always made welcome. Staff undertook a good range of training ensuring they could care for people safely and efficiently. Staff recruitment procedures were good and ensured the people living in the home were safeguarded. The manager of the home was very experienced and ensured the home was run in the best interests of the people living there and that they received a good service. What has improved since the last inspection? Staff had received further training ensuring they had all the up to date knowledge and skills they needed to care for people safely. The issues raised at the last inspection in relation to medication had been addressed ensuring the people living in the home were fully safeguarded. The vast majority of the repairs needed to the environment had been addressed ensuring the home was kept to an acceptable standard for the people living there. The organisation had received the employee of the year award from a local college for the support they give to students on placement at the home and the overall support given to employees. What the care home could do better: Contracts detailing the terms and conditions of residence should include the fees being charged so people know exactly what they are paying.Staff needed to record all the activities people took part in to show they were leading fulfilling lives. Staff needed to ensure that food records showed people received a varied and nutritious diet. Care plans needed to include details of how staff could recognise if people were unhappy as some were not able to express this verbally. To ensure the service is continually improved for the benefit of the people living there the home should have a development plan in place. It was recommended that the organisation provided an additional communal area for the people living in the home who because of their specialist needs, may find group living difficult at times, and would appreciate additional space. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 26 Green Road 26 Green Road Hall Green Birmingham West Midlands B28 8DD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 26 Green Road 26 Green Road Hall Green Birmingham West Midlands B28 8DD 01217772896 F/P01217772896 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Optimum Care Services care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Residents must be aged under 65 years Date of last inspection Brief description of the care home 5 26 Green Road is a detached chalet style bungalow located in a quiet residential area in the South of Birmingham. The home is within walking distance of a range of amenities and is close to both bus and rail routes to the city. Accommodation comprises of four single bedrooms on the ground floor and one en-suite bedroom on the first floor. The bedrooms vary in size, all are personalised to individual tastes and preferences. There is a large wooden panelled lounge with television and music centre. This room also has a dining area. The home has a large fitted kitchen with an additional small dining area, a very small office/sleep in room and an outbuilding used as a laundry. There are two bathrooms, one of which has facilities to suit the needs of people who require assistance this includes a hoist chair, raised toilet seat, and a level walk in shower. There is a large garden to the rear of the premises with lawned areas, flowerbeds and a barbecue area. There is limited off road parking to the front of the home with additional parking available on the road. The service user guide for the home was on display in the entrance and detailed the fees at the home as starting at Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home five hundred and sixty six pounds. Additional charges include hairdressing, arts and craft sessions, progressive mobility sessions, and activities. Care Homes for Adults (18-65 years) Page 5 of 34 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: The last key inspection at the home was carried out on January 29th 2007. Following this an Annual Service Review was was done on March 7th 2008. From the information we had received we decided the home had continued to provide a good service to the people living there and that we did not need to bring forward the next inspection. This inspection was carried out over one day. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we had received, or Care Homes for Adults (18-65 years) Page 6 of 34 asked for, since the annual service review. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. Due to the communication needs of some of the people living in the home it was not possible to ask them for their views on the home, so time was spent observing care practices and staff interaction. The people living in the home were not able to complete our Have your Say surveys but we did send surveys to five staff. All of these were returned and the comments and views are included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Contracts detailing the terms and conditions of residence should include the fees being charged so people know exactly what they are paying. Care Homes for Adults (18-65 years) Page 8 of 34 Staff needed to record all the activities people took part in to show they were leading fulfilling lives. Staff needed to ensure that food records showed people received a varied and nutritious diet. Care plans needed to include details of how staff could recognise if people were unhappy as some were not able to express this verbally. To ensure the service is continually improved for the benefit of the people living there the home should have a development plan in place. It was recommended that the organisation provided an additional communal area for the people living in the home who because of their specialist needs, may find group living difficult at times, and would appreciate additional space. 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 9 of 34 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 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home have information in a format suited to their needs, which helps them to make an informed decision about moving into the home. Evidence: There was a service user guide and statement of purpose for the home on display in the entrance hall of the home. The people living in the home had their own personalised copies of the service user guide. The document included pictures and photographs to make it easier for them to understand. Their capacity to understand the document varied but it was pleasing to note there was evidence that efforts had been made to go through the document with them and also their representatives. This ensured people knew what service they could expect from the home, how to raise concerns and so on. It was noted that the service user guide on display in the home did include the range of fees charged at the home but the personalised copies did not include this information. It was recommended that this be included so people had all the Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: information they may need. Two care files were sampled and included copies of the contracts/statement of terms and conditions of living at the home. Again the fees being charged were not included in this document. There had been two new people admitted to the home since the last inspection. These were the first admissions for a number of years. The manager spoke to us about how careful they had been to ensure the introductions to the home had been done gradually both for the benefit of the people moving in and for those who were living in the home. There was information on the files that social workers had undertaken thorough assessments before people had moved into the home. The manager spoke about meeting the individuals and their families before they moved in to ensure they had as much information as possible about the individuals needs and that the staff at the home would be able to meet them. We met both of the people who had been recently admitted one told us, I likes it and I go to college. The other person was not able to give us his views but his family visited the day of the inspection and they told us he has settled well, staff are getting to know him very well. The surveys returned to us by staff indicated that staff felt they always had enough information about people to be able to meet their needs one stated: We are given up to date information about the needs of the people we support and the information is recorded in the care plan and staff are always informed of any changes in an individuals service. Care Homes for Adults (18-65 years) Page 12 of 34 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. The care planning system was good ensuring peoples needs, wishes and preferences were known and could be met by staff. Risk assessments were in place to ensure people were supported in taking some risks as part of an independent lifestyle. People were enabled and encouraged to make meaningful decisions about their lifestyles. Evidence: The care for two people living at the home was tracked this involved looking at their care plans and risk assessments. Both the files sampled included care plans. These detailed very clearly the needs of the individuals, their abilities, likes, dislikes, preferences and how they wanted their care delivered. There was also evidence that consideration had been given to such things as gender sensitive care. There were some very good details included in the care plans about peoples preferred daily routines and these were seen to be followed. For example, we were told and it was documented in the care plan that one person did not Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: like mornings much and liked breakfast before any personal care. This was seen to happen meaning he received his care in the way he preferred. The people living at Green Road had complex communication needs and the care plans gave staff details of how they should communicate with people to ensure they understood as much as possible. For example, one stated the person would be able to communicate verbally but staff would need to make eye contact and ask the individual to slow down so they could understand him. Staff were seen to follow these guidelines. The people living in the home had a range of complex needs and could be vulnerable to risks. The files sampled included numerous risk assessments with management plans for staff to follow to ensure the risks were minimised for the individuals. Risk assessments covered areas such as ongoing health concerns, medication and what to do if people refused, use of transport, use of kitchen equipment and walking when out. Where people could be physically challenging there were clear management guidelines in place for this. The risk assessments ensured the risks people were exposed to were kept to a minimum but did not place any undue restrictions on them. It was also evident that when risks changed these were updated. For example, one person had been very anxious when moving into the home as he had settled more this had been reviewed and his medication to help with this had been reduced. The observations made throughout the day clearly showed staff knew the needs of the people living in the home and that they consulted with them on an ongoing basis. For example, people were asked what they would like to do and suggestions made if they were unable to convey their thoughts and what they would like to eat. People were encouraged to tell us about their lives. For example, one person had been involved in some interviews for new staff, he had forgotten this but when reminded was able to tell us about asking people questions. Records such as meeting minutes and review records showed that people were supported to make decisions about their lives, this included activities they took part in, where they chose to go on holiday, day trips, how they celebrated festive events and choosing the colours and furnishings for their bedrooms. It was pleasing to note that where people were unable to make major decisions, for example, about the need for health care there had been a multi disciplinary meeting where all the issues had been looked at very closely before a decision to go ahead had been made. This ensured the decision was made in the best interest of the person concerned. Care Homes for Adults (18-65 years) Page 14 of 34 Care Homes for Adults (18-65 years) Page 15 of 34 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 living in the home take part in appropriate activities of their choosing enabling them to enjoy a meaningful lifestyle. They are supported to maintain contact with their family and friends. The people living in the home are offered a balanced diet and they enjoy their food. Evidence: Peoples preferences in relation to how they like to spend their time were detailed in their care files. This information included such things as preferred music, television programmes, books and if they had any religious needs. An activity programme for each person was on display in the kitchen area of the home this included pictures to help people understand it and also showed which staff were on duty. During the day people were seen to undertake the activities detailed such as Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: going to college, going to the doctors, spending time listening to their music and looking at their books. This showed people took part in a variety of activities both inside and outside of the home. Also one of the people living in the home was asked did they want to go shopping as a staff member was going out and they did choose to go. Other documented activities both inside and outside of the home included day trips to such places as Drayton Manor park, annual holidays, visiting art therapist, karaoke, and board games. Staff at the home had mixed views about the activities people were engaged in. Comments received included; Our individuals go into the community which is good for them socially e.g. cinemas, holidays, relaxaway and they attend colleges. I feel they could do more activities in the community as service users can then acheive a sense of belonging within the community and also a sense of acheivement. Staff meeting minutes showed that activities were discussed. Staff should be encouraged to make more suggestions as to where else people could go in the local community. The people living in the home also took part in one off activities. One person had been asked if he would like to have his picture on the calendar belonging to a training organisation that the home used. He was very happy to do this and showed us the calendar in his bedroom. Two of the people living in the home spoke to us about being involved in interviews for new staff the day before the inspection. They told us they had asked the people questions about food. The manager said they wanted to be sure the new staff could cook the food they liked. People were seen to be encouraged to do tasks around the home to make them more independent. The tasks people were involved in included laying tables, clearing away after lunch, vacuuming, tidying their rooms and making drinks. The two people that were able to give us their views told us they were happy at the home and did what they wanted. Staff were very attentive throughout the course of the inspection and clearly knew what people liked to do and what they needed encouragement with to ensure they maintained as much independence as possible. One to one time was given to people as Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: required. One person could become very vocal which could upset others. Staff knew how to manage this and discreetly spoke to the person, took them to their bedroom where there was some very relaxing sensory equipment and spent time with them reassuring and calming them. Staff needed to ensure they recorded all the activities people were taking part in to show people were leading fulfilling lives as not all of the people living in the home were able to tell us how they spent their time. The records in the home and discussions we had showed that the people living in the home were supported and enabled to keep in touch with their families and friends. The records for one person detailed when his family had contacted the home to see how he was or speak with him and also when staff had helped him phone his family. The same person went to see his family every weekend and plans were being made to enable him to stay with his family. One of the people living in the home spoke to us about a family member visiting him and having lunch with him. He also told us he was going to visit the family member that week and have lunch and that staff would take him. During the inspection there were some visitors in the home. Staff had got to know them and they were made very welcome. They made some very positive comments about the service offered to their relative and stated they were always made very welcome. Menu planning in the home was done on a weekly basis. One member of staff was delegated to do this. This person spoke to us about involving the people living in the home in this task. Peoples likes dislikes and preferences were taken into account when planning the menus. Where possible people were asked what they would like on the menus and staff used pictures and flash cards to prompt a better range of choices. This ensured the menus were made up of foods liked by the people living in the home. The two people able to express their views said the food was nice. The records of the foods being served to the people living in the home needed to be further developed as staff were not always recording what vegetables were served and if people were being offered any fruit, snacks or desserts. We joined the people living in the home for lunch. They all ate well and assistance was given by staff where necessary. People were seen to have aids such as plate guards and spoons so they were able to eat independently. The manager spoke to us about having two small tables in the dining area rather than one large. This would enable two of the more able people to have more independence at meal times and being able to help themselves to condiments and such like without putting other people at risk. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: One of the people living in the home was having a special diet due to a medical issue. To ensure the diet was administered safely staff had received training in how to administer the correct food and very detailed guidelines were in place for them to follow. These were seen to be followed. Care Homes for Adults (18-65 years) Page 19 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have personal support in the way they prefer and require. There are good arrangements to ensure the healthcare needs of individuals are met in a caring and safe manner. The systems in place for managing medication were good and ensured people received their medication as prescribed. Evidence: Peoples preferred daily routines were clearly detailed in their care plans. The details were very specific and informed staff of what people were able to do for themselves and what they needed support with. This was particularly important where people cannot easily communicate their needs or preferences. Staff were seen to follow peoples routines ensuring they received their care as they wanted. For example, one person liked to have his breakfast before his personal care, this was seen to happen. One person told us he likes to get up early have his breakfast then has a shower and staff help him. Staff offered assistance with personal care discreetly throughout the day ensuring peoples dignity. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The ongoing health care needs of the people living in the home were detailed in their care plans. These included such things as epilepsy and specific guidance about diet. The management plans in place for health concerns were very detailed and ensured staff would be able to ensure peoples health was monitored and any issues were managed safely. Files showed people had contact with a variety of health care professionals such as G.Ps, dieticians, speech and language therapists, psychologists, dentists, opticians and chiropodists. It was also clear that where there were specific concerns referrals were made to the appropriate professionals. For example one person had an issue with balance and an appointment had been made for this to be assessed. The systems in place in the home ensured people were supported to remain as healthy as possible. At the time of the last inspection a requirement was made that staff have training in Alzheimers as one of the people living in the home had a diagnosis of this. We were told senior staff had received this training and they were to cascade this to staff to ensure they could meet the needs of the individual should the condition deteriorate. Staff had already looked at some of the other areas where they could improve the environment for this person, this had included redecorating his room and providing a sensory and relaxing area, where he could choose to retreat to in comfort. The systems in place for managing medication were good and ensured people received their medication as prescribed. All medication was acknowledged as received into the home and two staff signed for medication when it was administered. Copies of the most recent prescriptions were available for staff to refer to if needed. There was documented evidence that the medication in the home was audited on a regular basis. There were written protocols in place for the administration of PRN (as and when necessary) medication. All the requirements made following the last inspection in relation to medication had been met. These were PRN medication being entered on the MAR (medication administration record) charts, staff receiving training in the safe handling of medicines and food supplements being signed for on MAR charts. Care Homes for Adults (18-65 years) Page 21 of 34 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 people living in the home were listened to and their views acted on. There were good arrangements in place to ensure people were safeguarded from harm. Evidence: There had been one complaint lodged with us since the last inspection. This was sent back to the organisation to investigate. The complaint was fully investigated by the organisation and a copy of the outcome was sent to us. The complaint was not upheld. The home had not received any further complaints. The home has a complaints procedure that is in a format that makes it easier for the people living in the home to understand. The manager did acknowledge that it would be difficult for some of the people living in the home to raise any concerns due to their communication difficulties. He was able to tell us how he would know if people were unhappy by their gestures and behaviour. It would be useful if this information was recorded in care plans so that staff had access to this at all times. The home also had a documents entitled Are You Happy and Listen to Me that were completed with the people living in the home on a regular a basis. When people were first admitted to the home it was requested that this was facilitated by someone other than staff. One was seen that a community nurse had helped the individual complete. This asks if people are happy and tries to establish what they like and do not like Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: about the service. The documents are in a format that makes them easier for people to understand. There were very good relationships between the people living in the home and the staff and they were very comfortable in the presence of staff which would give them the confidence to raise issues where they were able. Meeting minutes and discussions with staff showed that the people living in the home were listened to and their views acted on. The staff surveys that were returned to us indicated that staff knew what to do should anyone lodge a complaint at the home. There had been no adult protection issues raised with us or directly with the home. There were appropriate policies and procedures on site for staff to follow should any issues arise. The managers in the home had been trained as trainers in adult protection and had cascaded training down to all but four staff. These staff were to have this training in March. The arrangements in place should ensure that the people living in the home are safeguarded. There were robust systems in place for managing money on behalf of the people living in the home, where necessary, to ensure they were safeguarded. The manager of the home oversaw the bank accounts for three of the people living in the home and was able to draw money for them. The records for the system in place were sampled and found to be appropriate. All income and expenditure was recorded and receipts were available for expenditure made on behalf of individuals. The system was regularly audited by a senior manager to ensure it was managed appropriately. The manager was satisfied that all the people living in the home had access to money when they needed it. The recruitment procedures for new staff were robust and ensured only people that were suitable to work safely with the people in the home were employed. Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff seek to maintain a comfortable home environment, but the building has limitations that impact on the people living there and the staff. It is a clean tidy and safe environment and good hygiene standards are maintained. Evidence: The home was well maintained and very comfortable for the people living there. Several maintenance issues were raised at the last inspection however these had been addressed. These included new flooring had been fitted in the bathrooms and kitchen, tiles had been regrouted in the bathrooms, the kitchen had been refurbished, the majority of the cracked windows had been replaced, blinds had been replaced in the bathroom and four of the bedrooms had been refurbished. There were some relatively minor issues raised during this inspection that needed to be addressed to ensure the home was kept to an acceptable standard for the people living there. The glass in the front door was cracked and needed replacing (this had been followed up by the manager), the seal around one of the baths needed to be replaced, there were one or two small cracked window panes and the bathroom ceiling had some water damage. This had been repaired since the last inspection but was ongoing due to problems with the roof leaking. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Previous inspections have indicated the premises has some design shortfalls in relation to meeting the needs of the people there. These remain. Primarily the difficulties relate to the combined lounge and dining room. It has previously been recommended that the organisation provide an additional communal area for people, who because of their specialist needs, may find group living at difficult at times, and would appreciate additional space. Staff accommodation is not adequate as it is a small room that doubles as an office and a sleep in area. There are no separate facilities for people to meet in private, in fact this was well demonstrated at the time of this fieldwork visit when the inspector had to utilise the lounge in order to carry out the fieldwork, this is far from adequate and infringes on the peoples needs and rights. We were told that a review of the premises had taken place since the last inspection but the manager did not have a copy of the report. A copy should be forwarded to us so that we can be assured plans are underway to ensure the home will meet the long term needs of the people living there. The laundry area is situated outside of the building in a converted garage/side building, this is not ideal as service users and staff, have to go outside to access this facility. The toilet and bathing facilities in the home were appropriate for the needs of the people living there. One bathroom provided sufficient space for people to be supported, and a hoist was available to access the bath. There was also a floor level walk in shower making this easy for people to access. One bedroom on the first floor has its own en-suite which met the needs of the occupant and provided additional privacy. All the bedrooms were of single occupancy and nicely furnished and decorated. Two of the people living in the home told us how they had chosen the colours and some of the furnishings for their rooms. The bedrooms varied in size, were all very different and personalised. Hygiene and infection control measures were in place. Standards of cleanliness were good and there were no unpleasant odours ensuring a pleasant environment for the people living in the home. The environmental health officer had recently visited the home and inspected the kitchen. The report from this visit was very positive stating very good practices in place. Care Homes for Adults (18-65 years) Page 25 of 34 Care Homes for Adults (18-65 years) Page 26 of 34 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. Staff are trained and supported to meet the specific needs of the people living in the home. There are robust recruitment practices that provide safeguards for vulnerable people. Evidence: Staff turnover at the home is quite low and many of the staff had worked there for a considerable amount of time which was very good for the continuity of care of the people living in the home. Staffing levels were appropriate for the needs of the people living in the home. The rotas showed that there were always a minimum of two staff on duty throughout the waking day, one waking night support worker and one person sleeping in. The managers hours were supernumery to the support rota. When people were going to college and other venues extra staff were made available as escorts. This meant there were always adequate numbers of staff available to ensure peoples needs could be met. The home also took students on placements from a local college which had proved very successful and meant the people living in the home had contact with new people from time to time. The home had recently been awarded the employer of the year award by the college. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Staff were seen to engage with the people living in the home throughout the day. Staff were able to tell us about the needs of the people living in the home. There was good use of communication skills and skills for managing complex behaviours. The people living in the home were seen to receive support with personal care, activities and so on in the ways detailed in their care plans. This ensured people received their care in the way they preferred. The recruitment files for three staff were sampled. These showed that all the required checks were undertaken for new employees before they started working at the home ensuring they were safe to work with the people living there. Staff had undertaken a good range of training to enable them to care safely for the people living in the home. Training undertaken since the last inspection included first aid, infection control, adult protection, medication, LDAF (Learning Disability Award Framework) and epilepsy awareness. The surveys staff returned to us indicated they were generally satisfied with the training they received. One person commented they would benefit from some dementia care training. As stated earlier in this report the manager had been trained as a trainer in this topic and was to cascade training to staff. All the other comments received were positive and included: I have been given training which helps me keep up to date with new ways of working. Our management makes sure that all our training is in date. We have gone back to do training on all outdated certificates. The induction covered all I needed to know it went in stages, step by step. The company has helped me to do my job and to support individual needs. Training opportunities are very good. The AQAA stated that nine of the eleven permanent staff had NVQ level 2 or above giving the home more than the required fifty percent. Care Homes for Adults (18-65 years) Page 28 of 34 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 people living in the home benefited from a well run home with a motivated staff team. Good arrangements for health and safety practices had ensured the safety of the people living in the home and the staff. Evidence: The manager has been in post at the home for a number of years and is very experienced in the care of people with a learning disability and the running of a residential home. Throughout the course of the inspection he demonstrated his knowledge of the needs of the people living in the home. His interactions with them and the staff at the home were very good. The people living in the home were very comfortable in his presence and did not hesitate to approach him to speak to him. Visiting relatives were also very comfortable speaking to the manager which would give them the confidence to raise any issues. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The home had a quality monitoring system in place that included in house audits in relation to a variety of things such as health and safety, medication and care plans. A senior manager from the organisation undertook monthly visits to the home and compiled reports on the conduct of the care home. Satisfaction surveys were regularly issued to families, visiting professionals and staff. The people living in the home were assisted by staff to complete Are You Happy surveys. There were regular staff meetings. There needed to be a system in place for collating all the information gathered from the quality monitoring tools and producing a development plan for the home. This would ensure that the service was continually improved for the benefit of the people living in the home. It would also be a way of the manager feeding back the outcome to interested parties. The health and safety of the people living in the home and the staff were well managed. Staff had received training in safe working practices. Risk management was good, risk assessments were in place to ensure appropriate support and control measures were offered to the people living in the home. Staff knew what action to take in order to keep individuals safe from harm. The AQAA indicated that the equipment in home was regularly serviced. The inhouse checks on the fire system were sampled and found to be up to date. Fire drills were taking place regularly and records were being kept of these. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 5 Contracts/statements of terms and conditions should include the fees being charged to live at the home. This will ensure people know exactly what the charges are. Staff should record all the activities people take part in to show they lead fulfilling lives. The records of food served need to show that a varied, well balanced diet is offered to the people living in the home. Care plans should include details of how staff can recognise if people are unhappy. This will ensure staff can address any issues. A copy of the report following the review of the premises should be forwarded to us so that we can be assured plans are underway to ensure the home will meet the long term needs of the people living there. Any cracked window panes must be replaced to ensure the home is entirely safe. The rook leaks should be addressed to avoid further damage to the ceiling in the home. This will ensure the home is kept to an acceptable standard for the people living there. 2 3 4 12 17 22 5 24 6 7 24 24 Care Homes for Adults (18-65 years) Page 32 of 34 8 9 27 28 The seal around the bath should be replaced to ensure good infection control is maintained. Additional communal space should be provided to ensure the people living in the home have enough space to meet their needs. To ensure the service is continually improved for the benefit of the people living there the home should have a development plan in place. 10 39 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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