Care Home: 264b Vicarage Road

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What the care home does well The house is well designed and allows privacy with single bedrooms and a number of communal areas. It is also well positioned for access to transport links and local shops and facilities. People`s bedrooms reflect their individuality. The home has a stable and experienced manager and deputy that know people living at the home well. The staff promote the independence of people living at the home through day to day domestic, occupational and social opportunities. The manager seeks the views of the people living at the home through regular group and individual meetings. Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in people`s health care needs well and seek helpfrom others where necessary (such as community nurses, doctors and such like). Staff are knowledgeable as to what individual`s preferences are, this meaning the support they receive is as they want or in a way that promotes their well being. People`s medication is safely managed by the staff. The dietary needs of people living at the home are identified and catered for by staff, so people can eat what they want in a way that does not put them at risk. What has improved since the last inspection? 1StThis is the first main inspection of the home since a change of ownership late last year.We did see that there are improvements taking place in respect of people`s records, so as to improve their clarity, this work on going.Some redecoration of the house to has taken place, this with the involvement of people living at the home in choosing the decor. What the care home could do better: The management need to ensure that equipment for lifting people is serviced frequently enough to ensure its safety as stated by the law. This is so staff can be sure the equipment is safe and that there is no risk to people living at the home or themselves from hoists.The home`s safeguarding procedure should make it explicit that the reporting of safeguarding alerts is to happen as soon as possible.Further development of pictorial summaries of care plans could further promote peoples involvement and understanding of these. Examples include very detailed communication plans, that would be easier to understand if summarised. Development of a check list to measure how well staff manage infection control would help identify how the staff can protect themselves and people living at the home from infection. This should be linked in to areas of the house that would benefit from decorative attention. There could be more clarity in respect of some areas where their maybe limitations for people living at the home through risk checks, such as where people have medication in soft foods (as agreed with such as social and health care staff), this to ensure choice is always promoted. Key inspection report Care homes for adults (18-65 years) Name: Address: 264b Vicarage Road 264B Vicarage Road Kings Heath Birmingham W Midlands B14 7NH The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jonathan Potts Date: 1 1 0 6 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: 264b Vicarage Road 264B Vicarage Road Kings Heath Birmingham W Midlands B14 7NH 0121 444 8123 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): samantha.mcmillan@reachthepeoplecharity.org.uk www.reachthecharity.org.uk Trident Sphere Name of registered manager (if applicable) Miss Samantha Mcmillan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: 1.The registered person may provide the following categories of service only Care Home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories Learning Disability Code LD maximum number of places 6. 2. The maximum number of service users to be accommodated is 6. Date of last inspection A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 36 246b Vicarage Road is registered with the Care Quality Commission to provide accommodation and personal care for a maximum of six adults with a learning disability. CHANGE STAFF ALL DAY & ALL NIGHT. The home has recently changed ownership. The new registered provider is a not for profit charity called Trident Sphere that provides a range of social services in a number of locations. The homes manager Miss Samantha McMillan has worked at Vicarage Road for a number of years. The staff team also worked at the home before the change of ownership. There are a number of senior and support staff that are available to support people living at the home 24 hours a day. The house was designed and built as a care home. It is a large bungalow that is set in private grounds. The house offers six single Care Homes for Adults (18-65 years) Page 5 of 36 bedrooms, large bath/shower rooms, a dining area, conservatory and lounge. There is also a separate laundry. The house offers facilities that would accommodate people with physical disabilities. The house is sited near shops and a main bus route with parking available close to the front entrance of the house. The information book about the home is currently nearing completion, this however meaning fees for residency were not available at the time we visited. The home should be contacted for more information. Care Homes for Adults (18-65 years) Page 6 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: CQC This is what the inspector did when they were at the care home Our surprise visit to 246b Vicarage Road was carried out on the 11th June. We arrived at 9.15am, leaving at 5.15pm Our visit followed us looking at all the information we have received about the service since its recent change of ownership. This included information sent to us by the care provider and information from different organizations. We have checked the homes performance against key standards and looked at outcomes for people living at the home. This was carried out by us talking to people using the service, asking staff about these peoples needs, and observing how staff provide support. We also looked at care plans, medical records and daily notes for these 2 people. This is called case tracking. We also looked around the building, looked at a number of management records and talked to management and staff. Page 8 of 36 CQC Care Homes for Adults (18-65 years) What the care home does well The house is well designed and allows privacy with single bedrooms and a number of communal areas. It is also well positioned for access to transport links and local shops and facilities. Peoples bedrooms reflect their individuality. The home has a stable and experienced manager and deputy that know people living at the home well. The staff promote the independence of people living at the home through day to day domestic, occupational and social opportunities. The manager seeks the views of the people living at the home through regular group and individual meetings. Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in peoples health care needs well and seek help Care Homes for Adults (18-65 years) Page 9 of 36 from others where necessary (such as community nurses, doctors and such like). Staff are knowledgeable as to what individuals preferences are, this meaning the support they receive is as they want or in a way that promotes their well being. Peoples medication is safely managed by the staff. The dietary needs of people living at the home are identified and catered for by staff, so people can eat what they want in a way that does not put them at risk. What has got better from the last inspection 1St This is the first main inspection of the home since a change of ownership late last year. Care Homes for Adults (18-65 years) Page 10 of 36 We did see that there are improvements taking place in respect of peoples records, so as to improve their clarity, this work on going. Some redecoration of the house to has taken place, this with the involvement of people living at the home in choosing the decor. What the care home could do better The management need to ensure that equipment for lifting people is serviced frequently enough to ensure its safety as stated by the law. This is so staff can be sure the equipment is safe and that there is no risk to people living at the home or themselves from hoists. Care Homes for Adults (18-65 years) Page 11 of 36 The homes safeguarding procedure should make it explicit that the reporting of safeguarding alerts is to happen as soon as possible. Further development of pictorial summaries of care plans could further promote peoples involvement and understanding of these. Examples include very detailed communication plans, that would be easier to understand if summarised. Development of a check list to measure how well staff manage infection control would help identify how the staff can protect themselves and people living at the home from infection. This should be linked in to areas of the house that would benefit from decorative attention. There could be more clarity in respect of some areas where their maybe limitations for people living at the home through risk checks, such as where people have medication in soft foods (as agreed with such as social and health care staff), this to ensure choice is always promoted. Care Homes for Adults (18-65 years) Page 12 of 36 If you want to read the full report of our inspection please ask Miss Samantha McMillan the person in charge of the care home If you want to speak to the inspector please contact Jon Potts 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT Jon - CQC 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service, and their representatives will soon have access to updated and current information. The home checks that it is aware of the current needs of people living there. Evidence: At the time we visited the home we saw a copy of the homes information book (statement of purpose) this dated April 2010. The manager did tell us that this book is to be updated following the recent change of the homes ownership. We saw that the company has a generic information book about the services they provide. The development of an information book specific to the home in an easy read format would enhance the information available to people. In addition the information within this book should include information about what it would cost to live at the home and any additional charges that may apply. The people living at the home have resided there for a number of years, this meaning that there have been no recent admissions to the home. We did discuss the admission process with the manager of the home and she confirmed that an admission would be planned and gradual. The home we saw to have a procedure in place underlining the Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: need for a robust checking process for any one looking to move into the home. There is no procedure to show the phased nature of any admission process that the manager told us would be carried out, procedures only detailing what staff need to do on the day of the admission, and the expectations in respect of checks (assessments) that are to be carried out. We looked at the case files for two people living at the home and saw that they have had involvement in a review with social services and significant others in the last 12 months. These have clearly updated information on the progress of the individuals to whom they relate and provide the home with a summary of what is important for the individual, this is respect of their current needs and aspirations. We saw that the staff are currently updating records in case files, this including the completion of review forms of individual needs. We saw a number of completed copies of these that clearly highlight where there are changes in peoples needs and wishes, and what could and should be changed to encompass these. It was documented on the front of the review sheets that individuals are involved and when we asked staff about the monthly reviews they all told us that people are involved in these. Care Homes for Adults (18-65 years) Page 16 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported to have involvement in planning the care and support they wish to receive. Some limitations that maybe present due to risk factors could be more transparent. Evidence: We found the two individuals plans we looked at to be written in the first person, this conveying ownership of the information to the individual whose support they relate to. From observation of interaction between the people living at the home and staff, and the ways in which they supported people we saw that the plans are accurate, reflecting what is important for individuals. We looked at the last multi agency review records, where the support these people needed was discussed with them and significant others. The information within these supported what we saw written in the plans, as did records we saw that staff record daily. Communication plans that we saw reflected the way we saw individuals communicated during the time of our visit, and reflected some detailed communication checks completed by health professionals with individuals and their key workers. We discussed the plans Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: with the individuals key workers and they showed a good understanding of the plans, what peoples needs, wishes and aspirations are, as well as how people prefer to be supported. We saw that the use of communication aids is fully explored, with these available to the individual as needed. The plans we saw are supplemented with some pictorial and easy read information although there is some scope for development so as to make them easier to understand for people with communication difficulties. We saw that care plans are very comprehensive, although the amount of information documented in some cases could act as a barrier to understanding for people living at the home, where as an easy read, pictorial summary could supplement the main plan and assist decision making and involvement. One issue raised by the manager was the fact that the home does not have a colour printer, and whilst the manager was able to access the one at the providers head office, access to one on site would allow the preparation of colour photo based plans on site, that are clearer and more interesting for people to look at. We saw that the home has introduced new monthly review formats, these clearly highlighting any changes or issues for peoples individual support. It was evident that support plans do reflect peoples preferences from our observation and time with people on the day of our visit. Key workers explained how people communicate and how they are involved in their reviews (as was recorded). We saw this reflected what we observed when meeting people living at the home. We saw that there was information available in files that summarized most potential risks that maybe presented to the individuals based on their lifestyle. There could however be more clarity in respect of where their maybe limitations, such as not holding bedroom and front door keys due to risk. Care Homes for Adults (18-65 years) Page 18 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are involved in making choices about their life style and are supported to be independent. Access to a fulfilling and active lifestyle for people living at the home is promoted by staff. Evidence: We saw that people living at the home all have individual activity plans and these show that they are encouraged to have involvement in a range of opportunities that include leisure, stimulation and occupation. We saw that the activities people are involved with reflect their likes and dislikes as established through staff following communication pathways. We saw that peoples individual plans are supported by descriptions of the routines that staff need to follow to support them throughout the day and night. We saw that these reflected where there is opportunity for people to be independent, making it clear what people are able to do themselves and where they need support. The home is positioned so as to allow easy access to a range of shops, these within Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: walking distance. On arrival we saw staff supporting people from the home on a walk. Shortly after we arrived a number of people went out to sea life, those remained then involved with musical activity (facilitated by a visiting music man). From observation of this session we saw that people enjoyed themselves, with exercise and self expression as part of the session. Based on the activity plans we saw people have access to the community, going to the pub, bowling, church, cinema and college. When stopping in people have access to in house activities that reflect their individual needs, with some having a lot of sensory equipment that provides stimulation and assists with communication. There is also easy access to bus stops. The home did previously have a minibus that staff used to facilitate peoples access to the community, and the manager told us that a new people carrier is to be delivered in the very near future, this to facilitate peoples transport arrangements. The home still promotes use of public transport for those that are able though. We saw that peoples links to family and friends are detailed within their individual plans, as is the ways they choose to maintain contact with them. We saw clear information as to how staff support people, this highlighting issues such as the gender of carer people prefer and their chosen sleeping arrangements. The home facilitates peoples contact with their family and friends . We saw that there is space within the house to allow visitors to see people in private if needed. People are also supported to attend church and follow their chosen religion. We saw that the home has a menu board on display in the hall that tells people what is available on the day (this supplemented by pictures) . There is also a more detailed menu we saw to be available in the kitchen. We were told this can be subject to change dependent on peoples choices on the day, as can be the times of the meals dependent on the activities people maybe involved with. We saw that there are monthly meetings with people living at the home where menu planning is discussed. We saw from case files that we looked at that staff have explored what individuals food preferences are, and we saw that daily records of the meals people have reflected the choices that they have expressed. We sat with people during lunch and observed the support that staff gave to people whilst eating. We saw that this reflected what was detailed in individuals plans and staff took cues from peoples body language to pace the support they gave in accordance with the individuals preferences. We saw some people encouraged to feed themselves, and where there is a preference people are able to eat where they are comfortable, such as in their bedroom. We saw that there is clear guidance to inform staff where people have special dietary needs. We spoke to staff who clearly understood the individual dietary guidelines we Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: asked them about and the implications it had for the support of the individual, this so as to promote their nutrition and safety. Care Homes for Adults (18-65 years) Page 21 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals health care needs are promoted and there is prompt follow up on any areas which compromise a persons well being. Personal support is provided in a way that promotes independence. Evidence: We saw that the way people wish to receive their personal care and support was clearly detailed in the two individual care plans that we looked at. We spoke to staff about how they support people and they told us how they do this so as to ensure people can make choices, no matter how they communicated. The ways we saw people supported during our visit also matched information agreed in peoples plans. The manager told us how it is not always apparent how people wish to be supported due to their specific communication needs. She showed an awareness of the need to explore peoples behaviour to establish what they are trying to say. She told us that the company has a psychologist they employ for advice and assistance in this area. We saw that the individual plans are supplemented by easy to understand, yet detailed health action plans. These outline the health care needs for the people they relate to with access to health professionals promoted based on these needs. We saw that issues that are flagged up in these action plans are followed up, with access to such opticians, Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: dentists, psychology and dieticians. The plans also summarise outcomes from health professionals visits so that individual plans reflect the support people need to promote their well being. There was no evidence of annual health checks by the individual G.Ps however, this an issue that the manager said she was fully aware of and pursuing. We saw from sight of staff training certificates and the homes training plan that some staff have received training that reflects the health care needs of people living at the home, examples of this including dysphasia, epilepsy and autism. Whilst the home does not currently carry out nutritional screening the manager told us of plans to introduce the same in the near future. Whilst there are some difficulties weighing people the manager us ways in which the staff would pick up on any undue weight loss. The home has a suitable medication policy and procedure that the manager stated is updated as needed. We looked at medication records and found these to be well recorded with no gaps found in records of administration. The manager showed us the systems that she has in place for checking and auditing the medication, these including stock audits and drug cupboard temperature checks. We also saw records of checks the manager carries out on staff competency when handling medication. We saw from the homes training records, with further confirmation through sight of training certificates, that the staff that handle medications are appropriately trained. We did discuss the fact that the home gives some medication to people in food, this established to have been agreed as an appropriate response by a multidisciplinary team. The safety of this practice is also agreed and documented by the medical professionals. It was clarified that this was to assist with digestion rather than give covertly, although we suggested that a risk assessment should clarify that whenever medication is given to a person in this way staff must make the individual aware that medication is in the food. Whilst we judged the homes medication to be well managed there was no evidence of recent audits by external pharmacists, this to be sourced from the contracted pharmacist or the local Primary Care Trust. We advised the manager to access an external check as an additional evidence of appropriate medication management. Care Homes for Adults (18-65 years) Page 23 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safety of people living at the home is promoted by staff, although the homes safeguarding procedure has the potential to delay reporting of safeguarding issues. Evidence: We saw that the home has a clear complaints procedure. There is a pictorial version of this available in the foyer of the home, this accessible to people living there or visitors. These are supplemented by complaints forms which people can help themselves too. We saw that records of complaints and concerns are fully documented in the homes complaints record. It was stated that there are plans to fit a comments/complaints and compliments box in the home so that people can make comments anonymously. Regular meetings with staff and people living at the home are used as forums to raise any issues about the service. We saw that there are photographs of all the staff available in the reception area of the home, this with their names. This is a useful tool that does allow people to identify staff should they not know their names, in the event they wish to offer compliment or complaint. We saw that the home has a copy of the local multi - agency safeguarding procedures available to staff, this to support the homes own procedures. The homes procedures state that where there is a safeguarding issue this is to be reported to designated safeguarding officers within Trident (the provider). Birminghams safeguarding policy makes reference Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: to any allegations or complaints about abuse being brought promptly to their attention, this clarified as at least on the same day. The homes procedure therefore has the potential to delay reporting of allegations, although the manager told us that if there are safeguarding issues she would raise them with the local authority directly, this to ensure there was no delay. This was also the understanding of other senior staff in the home, showing that the manager had reinforced the importance of raising safeguarding issues promptly (safeguarding is discussed in team meetings for example). Review and change of the homes safeguarding policy to expedite reporting times is expected. Discussion with the manager and staff showed us that they have a very good understanding of what should be done if allegations are raised. Staff we spoke to confirmed they had received safeguarding training and are aware of the homes whistle blowing policy. We looked at records relating to the safekeeping of peoples monies and found these to be accurate and well maintained. We observed staff booking money out in accordance with good practice. All monies are checked on the changeover of staff, these checks documented. There are also weekly checks by the manager and checks by senior managers when they carry out their statutory visits. We also saw that inventories of peoples personal possessions are in place. Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall physical design and layout of the home is suitable in meeting the needs of the individuals that live there and meets with their expectations. Risk to people living at the home could be improved through timely checks of lifting equipment and better infection control. Evidence: 246b Vicarage Road is sited on a side road off a main A road. As such this affords good access to local amenities yet allows a degree of privacy. The building was designed as a care home, with easy access, various adapted facilities and all single bedrooms. The size of the home also lends itself to the creation of a homely environment that is spacious and well maintained. From sight of the premises we saw that it is generally well maintained although there are some areas that would benefit from redecoration such as the hallway and lounge, this as paintwork is scuffed and chipped in places. Peoples bedrooms we saw to be individually decorated, these reflecting personality and choice although two would benefit from new floor covering, due to wear. Some updating of the house has taken place recently though, this including renovation and replacement of some furniture, painting of the kitchen, and new floor covering in some rooms. There are three communal sitting areas which allows space for privacy. There is also a pleasant private garden area. We saw that people living at the home are able to move Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: around freely without any restriction. We sampled the records relating to ensuring equipment and fixtures are checked for safety and found that all these are up to date with the exception of checks on hoists which we saw to be overdue at the time we visited. There are a number of adaptations available including hoists, grab rails, wider corridors and such like that benefit people that live at the home. We noted that wardrobes in bedrooms are not currently secured, and whilst these when checked are heavy stable items there is a need to document checks to verify their safety. The home has not had any recent visits from the Fire Prevention Officer, but the manager has reviewed fire safety arrangements through a fire check. There are also clear plans for peoples evacuation in the event of a fire. The home last received a visit from Environmental Health in May this year, the manager having dealt with the two issues identified. The manager stated that the home has a four star rating for food hygiene. We saw that overall the home was fairly clean although we noted that the area between the skirting and flooring in the lounge presents as a dirt trap. We also saw that some of the grab rails in toilets have small areas of rust present as did the mobile hoist which was also scuffed and scratched. We also noted that there was a rough area of repair on the bath and the boxing at the top was not in good order. These issues would mean that there are traps for bacteria that would compromise the homes infection control. In addition when we looked in the shower room there was drain like odour present and the extractors we saw to be clogged with debris. There is also difficulties with storage as both bathroom and shower room had open storage of incontinence pads. We saw that the home has liquid soap and paper towels available and there are notices on display in respect of hand washing. We also saw that staff are issued with personal antibacterial hand gels which is positive. We also saw that protective items (such as latex gloves and aprons) are readily available in the house and we saw staff use these appropriately. We asked the manager as to any audit of the homes infection control procedures and we were told one is not currently in place. Completion of such an audit would help highlight what staff do to maintain good infection control. The manager was advise to obtain a copy of the Department of Health publication: The Code of Practice for Health and Adult Social Care on the prevention and control of infections and related guidance, to assist with the implementation of robust infection control checks. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are at present well trained, skilled and available in sufficient numbers to support individuals with their chosen lifestyles. Evidence: We looked at the homes staffing rota and found that this was consistent with the staff on duty. We saw that the staffing levels and hours reflected the staffing required by the social services department. We saw that the required staffing hours are documented by Birmingham council so that the home is clear as to their expectations. The manager told us that there are usually sufficient hours available to meet the needs of people living at the home, although difficulties can be encountered if taking everyone out due the number of wheelchairs in use. The manager did state that she has the flexibility to manage the staffing hours to allow for peaks and troughs in peoples needs and allow for changes based on what people planned to do. We saw that where needed one to one staffing is available to allow for individual support. Based on the levels of dependency of individuals living at the home we judged this to be sufficient to allow staff to meet their needs within the home. We looked at the homes training plan and saw that this was clearly documented, and whilst there are some areas where there is more staff training needed, these are clearly identified and the manager is looking to source the appropriate training opportunities for Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: staff. The training that staff currently hold we saw to be evidenced by certificates within their files. The home utilizes training through Birmingham City Council, but the manager told us that each staff member has an amount of the training budget allocated to them for identified individual training needs, subject to its relevance. Staff we spoke to confirmed that this was accurate. The manager also showed us an in house training pack that she was planning to utilize to assist with in house training in a number of critical areas, such as safeguarding and safe working practices, this through use of tools such as workbooks. We saw that the majority of staff hold a vocational qualification in care to level 2 or above, this meaning that they have a good knowledge of how to support people in a way that caters for their diversity. Discussion with two staff also showed that they had a good knowledge of how to support the diverse needs of people at the home. The home has had some turn over of staff, with a number of new staff employed since transfer of ownership. We looked at the records related to some recently recruited staff. As with most providers that are large organizations we have checked their recruitment processes on a corporate level, this meaning that we would not expect to find first hand evidence of recruitment checks (such as the original copies of enhanced disclosures and references). We would however expect to find completed checklists that a manager has seen and verified all recruitment checks. We saw that the files contained such checklists but these did not indicate whether references and health checks had been undertaken. There was confirmation that other enhanced disclosures are obtained. We also noted that one staff member was recruited prior to receipt of an enhanced disclosure, although after a baring list check. Good practice would involve a risk check covering how that person would be supervised until receipt of the disclosure. Discussion with the manager confirmed that she was well aware of the checks needed for new staff so as to protect people living at the home. She also confirmed that the recruitment checks not documented on the checklists in staff files she knows have been received. Management of the recruitment process is initially undertaken on a centrally managed basis, and there are strategies in place to involve people living at the providers homes in the recruitment of staff. Recently recruited staff also told us that service users were involved in interviewing them as part of their recruitment. The manager showed us that staff support meetings (supervisions) occur on a frequent basis, this well documented from the records we saw in staff files. We also saw evidence of regular staff meetings, these again well documented. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home manager, who is qualified and competent, listens to the views of people living at the home and works to develop the service accordingly. Evidence: We looked the homes certificate of registration which was on clear display in the front hallway of the house. This is the current certificate and reflects the service that the provider delivers. The manager Samantha McMillan has run the home for a number of years and in discussion, and from the information we received prior to the inspection we saw that she is aware of how to run the home to meet the needs of the people living there. She is suitably qualified and has demonstrated that she knows where the home performs well and where and how it can be better so as to improve outcomes for people living there. Staff we spoke to have also said that the manager is approachable and supportive. We saw during the time of our visit that people living at the home appeared comfortable when talking to the manager. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: We are aware that the home has recently transferred ownership and as such there is still a degree of change in respect of the homes policies, procedures and management systems. We saw that new systems are being introduced on a phased basis, evidence of such seen within the case files and management records that we looked at. The manager has told us of a number of systems that are to be introduced that will assist with the smooth running of the home. The manager is aware of the need to promote safeguarding, and she has told us that the homes procedures would not impact on her ability to make decisions on such as safe guarding referrals. The manager has promptly informed us of any incidents at the home. As previously stated the manager is currently reviewing the information about the home to reflect the transfer of ownership. We asked about the homes development plan and this again is still in development, although we saw the Annual quality assurance assessment (information that the home sends us every year about how the home is performing) to be well completed. We heard, and saw evidence of how the manager has gained the views of individuals living at the home, this through group meetings, questionnaires and one to one review meetings as well as speaking to people on a day to day basis. This has enabled the manager to send us information that, based on other evidence we have gathered, is mostly accurate as to the homes performance. The only procedural concern we raised is in respect of the homes safeguarding procedures (see earlier in the report). Use is made of action plans to summarised what work is needed, this drawing from such as meetings with the people living at the home and visits by senior managers. We saw that the home has procedures relating to safe working practices that are acceptable, these supported by records of health and safety checks and senior managers visit records, the later seen to be very thorough. Staff training records also show that most training within the scope of safe working practices is provided to the staff team with any training needs identified and prioritized. The home we saw to have systems in place for logging and reporting any issues related to potential hazards, although as previously stated the servicing of hoists is one area where the target date has lapsed. Risk assessments in respect of most areas of safe working practice are in place. We looked at the homes accident book and this did not indicate an causes for concern, with the occasional minor accident well documented. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 29 23 The registered persons must 23/07/2010 ensure that all lifting equipment is serviced every six months. This is to ensure that the equipment is safe and that there is no risk to people living at the home or staff from defective equipment. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 To complete the review of the homes statement of purpose and service users guide and make this information book available within the home. This information book is to be Page 33 of 36 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations made available in appropriate formats and also contain the range of fees and any additional charges that maybe payable by people living at the home. 2 2 To develop the homes admission procedures to reflect how any person looking to move to the home would be introduced on a gradual basis. 3 4 20 20 To source an external audit from a pharmacist of the homes systems for management of medication. To ensure that the agreed methods for assisting some individuals to take their medication (in such as soft foods) is risk assessed. Staff should make individuals aware at the point medication is given. The homes safeguarding procedure should make it explicit that the reporting of safeguarding alerts is to happen as soon as possible. Redecoration and refurbishment of those areas referenced in the body of this report should be prioritized Risk checks (assessments) should be completed to confirm that there is no risk to people living at the home from unsecured wardrobes. The home manager should develop an audit tool to measure the effectiveness of the homes methods for infection control. This tool should reflect guidance form the department of health document The code of practice for health and adult social care on the prevention and control of infections and related guidance. This audit tool should consider how the home will address issues that have the potential to compromise infection control such as rust on aids/adaptations, dirt traps, lack of storage and rough surfaces that are not easily cleaned. 5 23 6 7 24 24 8 30 Care Homes for Adults (18-65 years) Page 34 of 36 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 9 34 Where staff are employed prior to receipt of an enhanced disclosure a risk assessment should be completed to identify how this person should be supervised so as to protect people living at the home. This will provide on- site evidence of good recruitment practice. The registered persons should document the receipt of employment checks for new staff on the checklists in their files. 10 34 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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