Care Home: 262 Tunnel Lane

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What the care home does well Information about what the service provides is readily available. People`s needs are assessed, to provide a proper basis for planning their care and support. Detailed care plans are kept under regular review, so that residents can get supported in ways that suit them best. Good risk assessments help to ensure that people have opportunities to learn and develop, while being supported to stay safe. Staff have a good rapport with the people in their care. They recognise their rights and treat them with respect. People are supported in a warm and friendly manner. Staff try and encourage people to do what they can for themselves, so as to promote their independence. They are able to take part in the life of their local community and to do things that they value. They are supported to keep in touch with their friends and families where possible. They have a varied diet and can choose what they have to eat each day. People can be confident that their concerns are listened to, taken seriously and acted upon. Action is taken to make sure that people are protected from abuse. Important checks are carried out on staff before they start work, to make sure they are fit for their jobs. Residents are supported to attend medical appointments, to help them stay healthy and well. Staff work hard to keep the house clean, tidy and hygienic, so that residents can enjoy living in a comfortable, homely environment. Staff are well supervised and supported and the home is generally well run. What has improved since the last inspection? Clear efforts have been made to improve the service and meet requirements and recommendations made, since the last inspection. Work has gone on to develop care plans and keep them up to date, so that people get the support they need in the ways they like. Activity planners have also been developed, to help people do the things that they want. Particular efforts have been made to improve the arrangements for residents to keep in touch with the people who are important to them. Support for staff has improved, as arrangements for formal supervision are now up to standard. Staff training is now better organised, so that people get the opportunities they need to learn and develop. Arrangements for the induction of new staff are better, and good work has been done to organise staff records. Action has been taken to fill vacant posts, so that residents can benefit from being cared for by people they know well. Residents have helped to choose the new furniture bought for the dining room. They also now help to do the regular health and safety checks around the house. These things show that staff are serious about helping them make choices and decisions, and promoting their independence. What the care home could do better: Care plans could be improved through better use of person-centred approaches and helping people to set some goals with outcomes that can be measured. This would help to make it clear where progress is made, what is working, or what might need changing. Doing this well ensures that people get the support they need to achieve the things that are important to them. Linking people`s activity opportunities to their agreed goals would also help to make sure they get to do the things they want. It would be better if two people signed the record each time medicine is given. This would help to ensure that mistakes are not made. The home`s maintenance and renewal plan should be reviewed so that work can be planned to redecorate and refurbish the house. Early attention should be paid to the upstairs bathroom and ground floor shower room. Action should be taken to improve the numbers of staff qualified to NVQ level 2 or above. This will help to ensure that staff have all the knowledge and skills they need to do their jobs well. Regular equipment checks should be carried out consistently and effectively. This is so that the health and safety of people living and working in the home can be fully protected. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tunnel Lane, 262 Tunnel Lane, 262 Kings Heath Birmingham West Midlands B14 6JX     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: Gerard Hammond     Date: 2 1 0 1 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 30 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Tunnel Lane, 262 Tunnel Lane, 262 Kings Heath Birmingham West Midlands B14 6JX 01214434131 01214434131 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Friendship Care and Housing Association Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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 5 262 Tunnel lane is registered to provide accommodation, care and support for five people with learning disabilities. The current group of residents are all male and have lived together for a number of years. They have complex and high-level support needs: there are currently no vacancies. The house is a domestic scale property situated in the Kings Heath district of Birmingham. The area is generally well served by public transport. Residents each have a single bedroom: one of these is on the ground floor. Also on this level is the main lounge / dining room, which leads onto the kitchen. There is a separate laundry room. There are bathing, shower and toilet facilities on both floors. The office is on the first floor. This room doubles as the staff sleep-in room. Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home The house is set back from the road; there is a large enclosed garden to the rear and side of the property. Cars have to be parked on the road outside. The service should be contacted directly for current information about fees. Care Homes for Adults (18-65 years) Page 5 of 30 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: This is the homes key inspection for the current year 2008-9. We gathered information from a number of places to inform the judgements made in this report. The Manager completed an Annual Quality Assurance Assessment (AQAA) and sent it back to us.This is a self assessment that focuses on the outcomes for people who use the service and provides us with some numerical information about it. We visited the home and met with residents, the Manager and other members of the staff team. Records including previous inspection reports, policies and procedures, personal files of people using the service, care plans, staff files and other documents were also looked at. Direct observation of care and support, provided further evidence for judgements made. Thanks are due to the residents, the Manager and staff for their co-operation and support throughout the inspection process. Care Homes for Adults (18-65 years) Page 6 of 30 Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 30 Care plans could be improved through better use of person-centred approaches and helping people to set some goals with outcomes that can be measured. This would help to make it clear where progress is made, what is working, or what might need changing. Doing this well ensures that people get the support they need to achieve the things that are important to them. Linking peoples activity opportunities to their agreed goals would also help to make sure they get to do the things they want. It would be better if two people signed the record each time medicine is given. This would help to ensure that mistakes are not made. The homes maintenance and renewal plan should be reviewed so that work can be planned to redecorate and refurbish the house. Early attention should be paid to the upstairs bathroom and ground floor shower room. Action should be taken to improve the numbers of staff qualified to NVQ level 2 or above. This will help to ensure that staff have all the knowledge and skills they need to do their jobs well. Regular equipment checks should be carried out consistently and effectively. This is so that the health and safety of people living and working in the home can be fully protected. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 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. Information about the home is readily available, so that people are clear about what the service provides. Residents needs have been assessed, to provide a sound basis on which to plan their care and support. Evidence: There have been no new admissions to the home since the time of the last inspection. The five men living there have been together as a group now for several years. Sampling of peoples personal files showed that detailed assessments of their care and support needs had been carried out, as required. There was also clear evidence that assessments have been kept under review and updated as necessary. The Annual Quality Assurance Assessment (AQAA) shows that the homes Statement of Purpose and Service Users Guide have been reviewed and updated in the last twelve months. Copies of these documents were seen in the files that we looked at. Care Homes for Adults (18-65 years) Page 11 of 30 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. Staff know how to support residents in ways that suit them because their care plans give clear guidance. They help residents to make choices and decisions, and support them to be as independent as they are able. Evidence: As previously reported, the people living in this house have high-level complex support needs. The personal files of two of the residents were sampled. Both files contained detailed tenant profiles. These documents provide staff with clear guidance about how to provide personal care and support, according to their assessed needs. Care plans are arranged in a consistent way so that important information is generally easy to find. Risk assessments have been carried out appropriately, and the information gained from this process included in the plan. Care plans and risk assessments are indexed and cross-referenced, so that it is possible to see how judgements have been made. As shown in the last inspection report, assessments show that the service continues to have a positive attitude to the management of risk. This is seen as Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: providing opportunities for people to learn and develop, rather than creating obstacles to doing things. Direct observations of staff interacting with residents, and sampling of care plans, provided evidence of the support people get to make choices and decisions, and to be as independent as they can. It is clear that staff understand the significance of individuals routines. Care plans include behaviour management guidelines. One person has an autistic spectrum disorder: staff are advised to avoid crowded or noisy environments when they go out with him, as he becomes anxious. The importance of appropriate communication is underlined: one individuals understanding of time is limited, so it is important that if staff raise an expectation that something is going to happen (e.g. going out for an activity) then this needs to take place fairly quickly. Failure to do this may lead to frustration and episodes of difficult behaviour. Direct observations showed that staff understand this well and manage situations accordingly. People are encouraged to be as independent as their individual abilities permit. Examples of this include getting involved in domestic chores, putting laundry in the washing machine, cleaning the house, doing the shopping and putting it away, making hot drinks and so on. People were directly observed being offered choices about doing activities, going out, and what to eat and drink. Designated key workers are responsible for keeping care plans under regular review. This is done through the completion of a monthly report including social, health and medical updates and the key workers summary. It was suggested at the time of the last inspection that care management could be improved through the development of clear goals. This continues to be the case. This was discussed with the Manager. It was suggested that better use could be made of the monthly reporting system. However, it should be acknowledged that current practice makes a sound contribution to ensuring that care plans are kept up to date. Setting goals with measurable outcomes, and evaluating them regularly, could provide valuable benchmarks to show what is working and what is not. This could be achieved through better use of the monthly report. It is suggested that the summary should include what people have done and where they have been, in more detail (see next section Lifestyle also). It should include some goals for the month ahead, and review the goals set previously. In this way, it should be possible to see if people are achieving things that their care plans show are important to them. It was also suggested that the development of personcentred approaches would help to support this process. These recommendations are made as a matter of good practice. Care Homes for Adults (18-65 years) Page 13 of 30 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. People are able to do things they value, go to places they like and keep in touch with people who are important to them. They choose the things they like to eat, have a varied and balanced diet and enjoy their food. Evidence: We looked at peoples records to see the kinds of opportunities they have to do things they like. The homes Annual Quality Assurance Assessment (AQAA) shows that everyone has been away for a holiday. Sampled files showed that people went out to local shops, to the pub, out for meals, bowling, playing pool, to the cinema, the park, out for walks, bus and taxi rides. At home they did activities including listening to music, jobs around the house and baking. Each person has an activity planner. This is a good tool. It shows how often people Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: should be doing their activities, and whether they have been offered an activity but declined it. What is less clear is how activities have actually been decided on. We did see people being offered activities during the fieldwork visit to the home. As reported above, they were asked about going out, and what they wanted to do. The care team includes staff with specific responsibilities for supporting peoples activities during the day. It has to be acknowledged that residents high-level and complex needs mean that structured activity planning is far from simple. For example, residents who have a restricted understanding of time and a limited attention span present particular challenges in this regard. It was suggested that activity planning could be improved, while recognising the very real challenges that staff face in doing this. Firstly, activities should be purposeful. It was noted that the activity planner made reference to The Five Accomplishments. These are well-established principles relating to the quality of life that people with learning disabilities should enjoy (community presence, or having a part in the life of the community in which you live; choice, competency / involvement or developing / maintaining learning and skills; dignity and respect;and being to have meaningful relationships). It is suggested that activities planned should seek to embody these principles, so that they are real not just theoretical. Secondly,there should be clear links between peoples activities, and their assessed needs and agreed goals. The things people get to do should be one of the main methods of helping them achieve their goals. Thirdly, it is important that peoples goals, and the activities they do, are regularly analysed and evaluated. The monthly report provides an ideal opportunity to do this. The activity planner already shows the desired frequency of particular activities. Each month the key worker summary could show whether or not people did their activities as often as planned. This should then help make informed judgements about whether targets set were realistic, or whether something else might be more appropriate. This is also why it is important to show where activities have been offered but declined. Records of activities should also be a bit more detailed. For example, instead of went out for a ride in the car the record might say where they went, why they went there, what they got out of it, what they did, who they were with, and so on. Residents are also supported to maintain contact with friends and family, where this is possible. Sampling of records showed the particular efforts that staff had made to reestablish contact with one persons relative after many years of not being in touch. Another persons file showed that he goes to stay with family members on a regular basis. There were also particular issues about family members visiting him at Tunnel Lane. A good deal of work was done on this by the Manager and staff so that an agreement could be reached about how best to deal with these issues. A plan has now been put in place so that such visits can go ahead, to everyones satisfaction. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Menu plans and records of meals eaten were examined. These provided evidence of variety and choice. Food stocks were examined: these were ample and included fresh fruit and vegetables. Residents are actively involved in food shopping and choosing what is bought. As previously reported, the small size of the home means that individual choices can always be accommodated. Staff are scheduled to attend In Proportion training, provided by the local Dietician, to develop awareness and skills in promoting healthy eating. Care Homes for Adults (18-65 years) Page 16 of 30 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. People are well cared for and supported in ways that suit them. They get the support they need to help them stay healthy and well. Evidence: We saw that residents were well dressed in good quality clothing, and that they had clearly been supported with their personal care and hygiene. They have a good rapport with the people who look after them. As reported above, residents have complex needs: care plans give staff good guidance about how people should be supported. Conversations with staff showed that they are knowledgeable about individuals particular ways, habits and regular routines. In particular, they showed that they understand the significance of these and the importance of being sensitive to them. They treat people with respect and support them in a warm and friendly way. People have Health Action Plans, so that their healthcare needs can be planned and managed effectively. These have been kept under review. Sampled files had records of referrals to and appointments with healthcare professionals. These included Consultant Psychiatrist, GP, Community Nurse, Epilepsy Liaison Nurse,Dentist, Optician, Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Chiropodist, Podiatrist, Dietician and Massage Therapist. Healthcare records also included regular weight monitoring, healthy eating guidelines,epilepsy management plans,and regular medication reviews. Two of the residents have epilepsy, requiring the prescription of rescue medication (Buccal Midazolam). This is managed as a controlled drug, with separate storage and recording arrangements, management guidelines and clear protocols. Written protocols are also in place for other PRN as required medication. None of the residents manages his medication independently. The home uses the Boots Monitored Dosage System (MDS). The Medication Administration Record was examined: as a matter of good practice, it was recommended that two staff should sign each time medication is administered, to help prevent errors. This is because of the variations and quantities of medication prescribed to this particular group of residents. Monthly audits are carried out on stocks, and each persons medication blister packs has his photograph attached. Creams were labelled with the date of opening, in keeping with good practice. It has been recommended that external and internal medication be stored separately. Medication stores were generally clean, tidy and secure. Care Homes for Adults (18-65 years) Page 18 of 30 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. People can be confident that their concerns are listened to, taken seriously and acted upon. They are protected from abuse, neglect and self-harm. Evidence: Appropriate policies and procedures are in place covering complaints and safeguarding (adult protection). As previously reported, formal procedures have little relevance to the people who live in this house, due to their complex needs and learning disabilities. They are dependent on the sensitivity and vigilance of their carers to notice any changes in normal patterns of behaviour etc. as indicators of concern. It should be acknowledged that the organisation is very proactive in promoting peoples rights to complain, and they have a good record of listening to what people tell them and taking it seriously. We have not received any complaints in respect of this service. The homes complaints record was examined. This showed one issue raised by a member of staff. The matter has been referred appropriately to the organisations Human Resources department. The Annual Quality Assurance Assessment (AQAA) shows that Staff have completed adult protection training. Staff interviewed were able to describe the forms that abuse can take, identify potential indicators, and say what action they would take in the event of witnessing or suspecting abuse had taken place. The Managers response to two separate incidents has shown that she takes decisive action and follows Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: procedures appropriately, to safeguard the residents in her care. The organisation has recently produced an easy read booklet to help residents understand more about abuse and how this might affect them. Everyone has received a copy. This is a good initiative, even if its value to some of the residents in this house may be limited, due to their levels of learning disability. Peoples financial records were sampled. Each person has a written record of income and expenditure, supported with receipts. Cash held balanced with the accounts as appropriate. Sampling of staff records shows that required checks are carried out with the Criminal Records Bureau (CRB) before people start working at the home. This helps to ensure that people are fit for the job. Information on staff training also shows that staff are to attend courses on the Mental Capacity Act and Deprivation of Liberty Safeguards, to improve their knowledge of protecting residents rights. Care Homes for Adults (18-65 years) Page 20 of 30 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. Residents enjoy the benefit of living in a house that is comfortable clean and homely. Some maintenance and redecoration is required to make sure that this continues to be the case. Evidence: We went around the house with the Manager. It is an ordinary domestic scale building, blending in well with all the other properties in the neighbourhood, so that it doesnt stand out as a care home. Each of the residents has his own single bedroom. One of these is on the ground floor, the rest are upstairs on the first floor. Peoples rooms are individual in style, reflecting the interests and personalities of the occupants. They have their own personal possessions, furniture, photographs, pictures, ornaments, and things of interest to them as individuals. Shared spaces include the kitchen, which had a complete refit just over twelve months ago. New furniture has been bought for the lounge / dining room (a new dining table and cabinet) and the Manager said that the residents had helped to choose these. There is limited space in the house to receive visitors, and the Annual Quality Assurance Assessment (AQAA) shows that options to improve that are being explored. There are ample toilets and bathing facilities to meet peoples needs, situated on both Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: floors of the house. However, it was noted that the upstairs bathroom is in need of attention. There are what appear to be damp spots on the ceiling, and the plaster is flaking quite badly. This needs investigating to ensure that there is not a more serious problem (e.g. with the roof or guttering). It was also noted that the plaster in the downstairs shower room is badly cracked. Records show that maintenance issues are reported and generally dealt with very promptly. While the house is decorated and maintained to a generally satisfactory standard, it was noted that the decor is now beginning to look a bit tired, particularly in some of the residents bedrooms and high traffic areas of the home. It has to be acknowledged that the complex care needs of this group of residents, and in particular some of their behaviour patterns, place an excessive amount of wear and tear on the fabric and condition of the building. It is recommended that the maintenance and renewal plan for the home be reviewed so that work to address these issues can be scheduled at the earliest possible date. This is so that the residents can continue to enjoy living in a house that is comfortable and homely. It should also be acknowledged that the staff team continues to work hard to keep the house like this. The house was generally clean and tidy, with good standards of hygiene maintained throughout. There is a large enclosed garden to the side and rear of the house. As previously reported, residents enjoy this regularly, when the weather permits. One of the residents has his own shed, which he values highly. It was noted that the garden gatepost at the front of the house was in need of repair or replacement. Care Homes for Adults (18-65 years) Page 22 of 30 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. Residents are supported by competent staff, who are given a good induction to the job and regular training. However,numbers of staff with formal qualifications needs to improve, to make sure that they have all the knowledge and skills they need to do their jobs well. Important checks are carried out before people start work at the home, to make sure they are fit for their jobs. Staff are supervised regularly, so that they get the support they need to do their jobs properly. Evidence: We talked to staff on duty and directly observed them supporting residents, during the fieldwork visit to the home. Members of the care team were able to show that they have knowledge and a good understanding of residents support needs. As reported above, they understand the significance of peoples routines and behaviours, and generally deal with these consistently and sensitively. The high-level and complex care needs of the men living in this home mean that continuity of approach and handling are very important. Information provided in the Annual Quality Assurance Assessment about staff holding qualifications at NVQ level 2 or above was considered. This shows that the number of staff in the current care team qualified to that level falls short of the target minimum Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: of 50 . A recommendation was made at the time of the last inspection that the training and development plan for the team be developed. Training within the organisation is managed centrally: the Manager has produced a matrix that provided evidence that staff training is now well structured and regularly delivered. It should also be acknowledged that some long-term sickness and absences have impacted negatively during the past twelve months. Gaps have been covered by the existing team and regular bank / agency staff, to promote continuity of care. The Manager said that action had been taken to fill vacant posts. One day opportunities worker has already started, and another should begin shortly, subject to appropriate clearance. Another support worker is also due to commence soon, again subject to clearance. We looked at staff records and saw that good work has been done to improve organisation, as recommended at the last inspection. Sampled files contained completed applications and employment histories, two written references and evidence of checks with the Criminal Records Bureau (CRB). Records also included job descriptions, statements of physical fitness and receipts for copies of professional codes of conduct. This shows that the service takes the action it should to make sure that people are fit for the job, before they start work at the home. Staff files also contained certificates for training completed, and evidence of appropriate induction. The Manager also told us that a new system has now been put in place to manage staff performance and personal development. In addition to regular supervision, staff now also take part in a six-monthly review. This covers their individual training and development needs, and performance during the relevant period. Records also show that staff are now receiving formal supervision on a frequent and regular basis, as required following the last inspection. The staff team also meets together as a group each month, and the minutes of these meetings were seen in evidence of this. Care Homes for Adults (18-65 years) Page 24 of 30 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. Residents benefit from a service that is generally well run. Service quality assurance and monitoring is in need of some development. This is so that it can be clearly seen how residents views underpin future planning. Checks on essential equipment generally get done, so that the health and safety of people living and working in the home is protected. Evidence: The Manager has now been in post for fifteen months; at the time of the last inspection she was newly appointed. There is clear evidence that she has worked hard since then to develop the service for the benefit of the people who use it. She told us that she has now almost completed her work leading to qualification at NVQ level 4. Action has been taken to meet requirements and recommendations made at the last inspection. Her application to become registered as the homes manager is in progress. She completed the Annual Quality Assurance Assessment (AQAA) and sent it back to us in good time before our visit to the home. She has been without the support of her deputy (Assistant Team Leader) for a significant period of time due to ill health. She Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: has supported other members of staff to take on additional responsibilities in the interim, as an opportunity for their development and learning. She has demonstrated that she can take decisive action to ensure that residents are safeguarded. Staff say that she is approachable and that they are confident about raising any matters of concern with her. The Manager says that she continues to enjoy good support from her line manager. Monthly visits and reports on behalf of the Registered Provider (as required under Regulation 26, Care Homes regulations 2001) have been completed as appropriate. Copies of the reports were available for inspection. Quality Assurance and monitoring of the service should be formalised. As reported at the time of the last inspection, there is clear evidence of regular related activity (e.g. key worker meetings, care plan reviews etc.) and the organisation has a good record of taking positive action to find out what people think about the service provides. The challenge, of showing how the views of people with such complex needs are represented, should not be underestimated. However, it is again recommended that developing person-centred approaches, in conjunction with clear goals and measurable outcomes, present good opportunities to take this forward. The information gained should be collated and analysed, with a report produced and circulated to all interested parties. We looked at the records kept in the home showing how peoples health and safety are protected. The Landlords Gas Safety Certificate was in date. There is a certificate for the homes electicity circuit, but it is not clear when this should be renewed. As the certificate is over five years old, it was recommended that this matter be taken up with the landlord. Regular testing of the fire alarm and emergency lighting systems, and fire-fighting equipment has generally been done. However, it was noted that there were some gaps in the records. The lift alarm has been regularly checked, and fire evacuation drills completed. It was good to note that residents are involved in equipment checks, to promote their sense of ownership of the proceedings. There is a fire risk assessment in place, and the fire alarm has been serviced. Portable appliance testing of electrical equipment is due to be carried out shortly. It is recommended that a checklist or similar be set up for tasks involving regular equipment testing. It may be advisable to allocate these tasks to designated individuals, with contingency arrangements in place to cover absences. This will help to ensure that jobs get done consistently and reliably. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 6 Develop care planning with person-centred approaches so as to agree goals with measurable outcomes. This will help make clear judgements about progress made, and what might need to be changed. Develop planning so that there are clear links between peoples activities and their agreed goals. This is to ensure they get the support they need to achieve the things that are important to them. Review medication practice so that two staff can sign each time medication is given, to help prevent medication errors. Store external and internal medication separately, to help minimise any risk of infection. Review the homes maintenance and renewal plan, so that necessary work can be scheduled at an early date. This is so that residents can continue to enjoy living in a homely and comfortable environment. Improve the numbers of staff qualified at NVQ level 2 or above, to ensure that people on the staff team have all the knowledge and skills they have to do their jobs well. Develop the quality assurance and monitoring of the service, and produce a report of the findings. This is to Page 28 of 30 2 12 3 20 4 28 5 32 6 39 Care Homes for Adults (18-65 years) ensure that residents views underpin the review and development of the home. 7 42 Allocate health and safety checks to designated individuals, with contingency arrangements to cover absences. Develop a system to monitor this effectively, to make sure that tasks are done consistently at the required times. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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