Care Home: 290 Newton Road

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What the care home does well Information about the service, including its complaint procedure, is provided to people in pictorial formats. This information is also made available to their relatives/representatives. Care and support is provided by a staff team that knows people`s individual needs, routines and preferences. People are able to choose which staff member they wish to support them with their personal and health care needs. Medication is managed by staff trained to do so and is stored safely. The service encourages people to live independent lifestyles. They play an active part in the day-to-day running of the home; such as menu planning and the preparation of meals. They are supported to participate in a range of community-based activities and to maintain contact with family and friends. What has improved since the last inspection? People being supported more to take an active role in planning for their care and developing their care plans. Weekly activity plans are produced with them and made easier for them to understand. Staff recruitment procedures are being followed more closely by the service. Appropriate employment checks are carried out before a person starts working in the home. This ensures the well being and safety of people living here is protected. The bathrooms have been refurbished and people have been consulted on the redecoration. The service has improved its arrangements for the safe and secure storage of medication. Fire safety procedures, equipment and practices have been fully reviewed to ensure all people in the home are fully safe. What the care home could do better: The service needs to review its arrangements for storing people`s information to ensure confidentiality can be maintained at all times. The television in the lounge should be re-sited to a level that enable people are able to view programmes in comfort. Temperature recordings for food stored in the fridge and freezer should be monitored regularly. Staff need to be made aware of the most suitable times to take readings and what to do if the temperature falls below or above the acceptable level. People are regularly consulted about meals. However, this is not fully reflected in the menus produced and records of meals taken. Detailed recordings would enable more effective monitoring to take place. Where concerns are raised about a person`s dietary intake these records would assist health care professionals, such as a dietician, in their assessment. It is advisable for information about healthy eating be provided to staff. This will ensure they are able to provide people with good advice and be confident in implementing any recommendations made be a dietician. Staff need to be aware of protocols put in place for people who are prescribed "as and when required" medication. This will ensure a consistent approach is taken when it is administered. Procedures for recording the administering of this medication should be followed at all times. This will enable its affects to be better monitored and assist the auditing process. Risk management processes need to be reviewed and include a positive approach to risk taking that supports people, wherever possible, to take risks as part of an independent lifestyle. Consideration should also be given to the affect individual risk strategies may have on other people living in the home. Any restrictions/limitations should be agreed with the individual and their relatives/representatives. The home provides a service for people who have a learning disability. All staff should be supported to achieve the Learning Disability Qualification (LDQ). Records for newly appointed staff should be fully completed in order to demonstrate they have received a comprehensive induction to the service. Plans for their training should be produced and priority given to courses such as protecting vulnerable adults and client-centred issues relevant to the needs of the individuals who live here. A comprehensive quality assurance system should be fully implemented to enable the service to assess its own performance. In order for people to be fully confident their views underpin the service`s self-monitoring and review its findings and annual development plan should be produced and made available to all interested parties. Key inspection report Care homes for adults (18-65 years) Name: Address: 290 Newton Road 290 Newton Road 290 Newton Road Great Barr Birmingham B43 6QU     The quality rating for this care home is:   one star adequate 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: Linda Elsaleh     Date: 2 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 290 Newton Road 290 Newton Road 290 Newton Road Great Barr Birmingham B43 6QU 01213577517 01213578417 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Name of registered manager (if applicable) Mrs Joanna Price Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 7 Date of last inspection Brief description of the care home 290 Newton Road is a large detached residential property. The service caters for up to seven people with a Learning Disability. It offers personal care and support to a group of individuals with a range of complex needs. Staffing levels reflect the level of support required for the individuals accommodated. The home is situated on a very busy dual carriageway near to local shops, post office, and pubs etc. There is a pedestrian subway crossing. The home is accessible by public transport and offers limited off road Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 7 0 6 0 3 2 0 0 9 Brief description of the care home parking which is shared with the adjacent supported living project. The premises offer a small yard and recreational space at the rear of the property. There are seven single bedrooms, all of which offer en-suite toilet and handbasin. Communal space on the ground floor include a lounge and dining area. Kitchen facilities are domestic in size and there is a separate laundry, which offers commercial equipment. Social and recreational pursuits are provided for the people who live here and the home also has its own people carrier vehicle, which is used to transport people to appointments and for outings etc. The service should be contacted for information about fees. Care Homes for Adults (18-65 years) Page 5 of 33 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The service is required to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information about what has happened in the home during the last 12 months. This was returned to us when requested and contained the information we asked for. We looked at information we have received about the service since our last visit and sought comments from relatives, friends and care professionals involved with people living in the home. Comments about the service were positive and have been included in this report. This unannounced visit was carried out by one inspector on 26th November 2009. We spoke to the area manager, relief manager, staff and people at the home. We looked at the care files for two people and files for two staff in detail; as well as other records and documents kept by the service. This was to help us to assess the quality of life for Care Homes for Adults (18-65 years) Page 6 of 33 people who live in the here and the services performance against the national minimum standards. The atmosphere in the home was relaxed and friendly. The premises were found it to be suitably furnished, clean and tidy. People we met appeared healthy and care for. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The service needs to review its arrangements for storing peoples information to ensure confidentiality can be maintained at all times. The television in the lounge should be re-sited to a level that enable people are able to view programmes in comfort. Temperature recordings for food stored in the fridge and freezer should be monitored regularly. Staff need to be made aware of the most suitable times to take readings and what to do if the temperature falls below or above the acceptable level. People are regularly consulted about meals. However, this is not fully reflected in the menus produced and records of meals taken. Detailed recordings would enable more effective monitoring to take place. Where concerns are raised about a persons dietary intake these records would assist health care professionals, such as a dietician, in their assessment. It is advisable for information about healthy eating be provided to staff. This will ensure they are able to provide people with good advice and be confident in implementing any recommendations made be a dietician. Care Homes for Adults (18-65 years) Page 8 of 33 Staff need to be aware of protocols put in place for people who are prescribed as and when required medication. This will ensure a consistent approach is taken when it is administered. Procedures for recording the administering of this medication should be followed at all times. This will enable its affects to be better monitored and assist the auditing process. Risk management processes need to be reviewed and include a positive approach to risk taking that supports people, wherever possible, to take risks as part of an independent lifestyle. Consideration should also be given to the affect individual risk strategies may have on other people living in the home. Any restrictions/limitations should be agreed with the individual and their relatives/representatives. The home provides a service for people who have a learning disability. All staff should be supported to achieve the Learning Disability Qualification (LDQ). Records for newly appointed staff should be fully completed in order to demonstrate they have received a comprehensive induction to the service. Plans for their training should be produced and priority given to courses such as protecting vulnerable adults and client-centred issues relevant to the needs of the individuals who live here. A comprehensive quality assurance system should be fully implemented to enable the service to assess its own performance. In order for people to be fully confident their views underpin the services self-monitoring and review its findings and annual development plan should be produced and made available to all interested parties. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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 are provided with the information they need to make an informed choice about where to live. It is available in pictorial formats and explained to them by staff. The service has procedures in place for assessing the needs of people who may wish to come to live at the home. These should be periodically reviewed in order for people to be confident the service can meet their needs and aspirations. Evidence: Information about the service is provided in its Statement of Purpose and Service User Guide. Peoples files we looked at contained a copy of these documents in pictorial formats. Staff told us people living at the home have shown more interest in discussing the contents because the pictures made it easier for them to understand. During this visit we saw staff explaining pictorial information when requested to do so by two people. We looked at the written documentation for the services referral and assessment process. These include initial referral, pre-assessment checks, needs assessment and Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: home compatibility assessment. The date of the last review of these is 2006. Information provided by the service tells us there have been no new admissions since 2006. The service is advised to review this process periodically to ensure the process to be followed is up to date. Comments received from relatives/representatives of people who live at the home told us they were provided with information about the service and are kept up to date with what is happening in the home. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in the planning of their own care and are supported to make their own decisions. The services risk assessment process does not support people, where possible, to take risks in order to follow an independent lifestyle. Consideration is not given to how individual risk strategies may affect the quality of life for other people living in the home. Information about people who use this service is not securely stored and more suitable arrangements need to be made to ensure confidentiality is maintained at all times. Evidence: Information about people living in the home is contained in individually colour coded files. The files are organised and each person knows what colour their files are. There are details of peoples life history and contact information about people who are Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: important to them. Staff told us they found this information useful in getting to know the people they support. The individual persons personal, health and social needs and how these are to be met are included in their support plans. The content and formats are being reviewed and staff told us the relief manager, and a registered homes manager from within the organisation, are providing them with guidance and support to do this. It was evident from discussions held and the records kept that people are aware of their care plans and these have been explained to them. During the last year discussions and formal reviews of care plans have taken place on a regular basis with the funding authorities. One relative told us they support their family member by attending their reviews with them. One to one staff support is provided to each person and this is reflected in the staffing rotas. Staff told us people are able to choose who they wish to provide them with support and this was confirmed by two people we spoke to. Throughout our visit we saw people making decisions about how to spend their time. For example; if they wanted to spend time in their bedroom on their own, in the lounge chatting or helping staff prepare the evening meal. Coded locks are fitted to doors considered to be high risk areas such as the kitchen, bathrooms and external doors. This means people are unable to access these rooms or the courtyard without staff support. There are individual risk assessments on peoples files with strategies for keeping them safe with dates showing when these have been reviewed. The managers and staff gave examples of the risks posed to peoples safety if they were able to freely access these areas. The files we looked at, and the discussions held, show the risks identified are historical. There are no details to show how the risk review process has been carried. The service needs to implement a more comprehensive and pro-active approach to risk management. People should be supported to take some risks in order to develop their independent living skills and due consideration should be given to the impact any strategy put in place for one person may have on the lives of other people living in the home. A relative commented their family member can safely carry out tasks in the kitchen, but said they were aware access to the kitchen was restricted to them because of the behaviour of others. Where restrictions/limitations are considered to be necessary these should be agreed with the person and their relative/representative and accurately recorded. The office is located on the ground floor and information about people living in the home is stored on open shelves. Staff files and other documents are stored in lockable Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: filing cabinets. This was commented on during our previous inspection. A coded lock is now fitted to the office door. However, there were several occasions when the office was not being used by staff and the door was left open meaning confidentiality could not be assured. The service needs to make better arrangements for ensuring information about people living in the home is securely stored at all times. Care Homes for Adults (18-65 years) Page 15 of 33 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 living in the home lead individual lifestyles. They are supported to participate in a range of activities, maintain contact with family and friends and have opportunities to develop new friendships. Meals are offered that meet peoples individual needs, likes and dislikes. They are provided with pleasant surroundings in which to enjoy mealtimes. Evidence: Two of the three people living in the home attend arts/craft and cooking courses at local colleges. They attend on different days of the week, supported by a member of staff. This enables them to develop individual friendships. The third person is older and prefers to spend most of their time at home, sometimes helping with light household tasks, or going out on trips with a member of staff. People are encouraged to use different modes of transport: for example the home has its own car, each Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: person has a bus pass and during this visit one person took a taxi to college because they were running late. Each person has a weekly activity plan available on their files that includes a range of community-based activities. Staff told us these plans are draw up with individuals and provides them with weekly guides. There are times when people change their minds and choose an alternative activity. The actual activities individuals have participated in are recorded on their daily notes. This is to enable their key worker to monitor the things people like to do and ensure the plans continue to meet the needs and interests of the individual. One member of staff told us she is looking at suitable physical activities, such as swimming, that may interest one person to help them to keep fit and maintain a healthy weight. One person told us they like to spend time on their computer, listening to music and going to discos. Two people showed us the outfits they had bought to wear at the local disco they were going to that evening. The staff meeting minutes we sampled for June 2009 show discussions took place about arranging holidays. One person enjoyed a weeks holiday on the Isle of Wight in August and a photo album of the trip has been compiled with them. Information provided to us by the service show its policy for contact with/visits by family and friends was reviewed in February 2009. Visitors are welcome at anytime, but are advised to contact the home to ensure the person will be in. The files we looked at include details of people who are important to the individual and a list of dates to remember, such as birthdays. One person told us they had bought a Christmas present and gave it to their friend when they visited the previous day. The service keeps a record of calls/visits made to/by individuals for monitoring purposes to ensure people are being supported appropriately to maintain their relationships. One relative told us their family member is very settled and gets on well with the staff. A friend of another said the home has been much calmer of late and (name of person living in the home) appears more relaxed. Representatives for two people commented staff appear more attentive and generally pleased with the lifestyle provided for our clients. However, they also felt restrictions placed on access to some areas within the home needed to be looked at. When we arrived at the home we saw one person enjoying a late breakfast, one had gone to college and another was out shopping with a member of staff. People are encouraged to participate in some of the household tasks. This provides them with Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: opportunities to develop their daily living skills. One person told us they sometimes vacuum the carpet in the lounge and staff helps them to keep their bedroom clean and tidy. They invited us to see their room and opened the door using their own key. They said I like my room and playing on my computer. People are able to spend time in their bedrooms when they choose. However there are times, as previously stated, when people have to ask staff for access to some areas including the courtyard. Staff we spoke to told us people make their own decisions about what they would like to eat for breakfast and lunch on a daily basis. For example, the person having a late breakfast chose toast and coffee. Menus for the evening meals are discussed with the people living in the home on a weekly basis. A shopping list is produced and people, who wish to, participate in the weekly shop. We sampled some of the menus and records of meals taken. These do not include all meal components such as what vegetables are available or were served and fresh fruit is only option identified for dessert. We spoke to two people and they told us their likes and dislikes, including vegetables and desserts. People should be provided with a wider range of options that meets their dietary needs and likes and dislikes. One persons records show a referral has been made to a dietician because of concerns about their general health. The service is advised to keep detailed records of all meals and snacks eaten to assist the dietician in her/his assessment. The relief manager told us pictorial menus and new recording formats are in the process of being produced. The service does not employ a qualified cook. Discussions held and records seen show arrangements have not been made for staff to attend a healthy eating course. This training would enable people to receive advice from staff with up to date knowledge and who are confident in implementing any recommendations the dietician may make. Information provided by the service and the training records sampled show all staff have attended a basic food hygiene course. They state that they understand the importance of storing and serving food at the correct temperature. However, fridge and freezer recordings show several readings taken fall outside the recommended temperatures and no action has been taken to investigate these. The times of the recordings indicate these are being taken when the appliances have been in constant use, ie meal times. Staff should be aware of the best time for recordings to be taken and procedures to be followed if there is any indication food is not being stored at the correct temperatures. This issue was brought to the attention of relief and senior managers at the time of this visit. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Mealtimes are regarded as social occasions for staff and people, who wish to, to share a meal and discuss the days events. On the day of this visit one person was happily preparing chicken curry with staff for their evening meal. Care Homes for Adults (18-65 years) Page 19 of 33 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 receive support in the way they prefer that meets their personal, emotional and health care needs. Suitable arrangements are in place for the safe storage of medication which is managed on peoples behalf by staff trained to do so. However, the services recording procedure for protecting the well being of people prescribed as and when required medication is not always followed. Evidence: People tell us they are able to retire to bed and get up at a time any time. They are encouraged by staff to go to sleep and get up at suitable times when they are going to college or have a morning appointment. Care plans identify the level of support people need in respect of their personal care. This ranges from verbal prompts to more assistance with some tasks. Discussions held with staff confirm they know the support people require and encourage them to maintain and develop their independence in these areas. One persons morning routine was explained to us and how important it was to them to ensure their day got off to a good start. During our last inspection we reported that personal toiletries continued to be held in locked cupboards in a Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: locked communal bathroom. The minutes of the staff meeting held in June 2009 show these have been transferred to the peoples bedrooms. This change in practice was confirmed by the staff and people we spoke to. This tells us a more positive approach is being taken to person centred care and to providing support that is based on the persons right to dignity and autonomy. People told us they choose the clothes they wish to wear. We heard one person discussing the outfit they had decided to wear for their evening out. Individual record sheets are kept of peoples health care appointments, such as GP, dentist and optician. Health care plans are also in place. One persons plan showed it was last reviewed and updated in November 2009. The files also hold copies of reports from peoples consultants. This tells us people are supported to access communitybased health care and specialist services. People living in the home continue to be prescribed small amounts of medication which is, where possible, dispensed in a monitored dosage system. All aspects of medication are managed on peoples behalf by staff trained to do so. Information provided by the service shows its medication procedures were reviewed in February 2009. There are suitable arrangements for the safe storage of medication. This has been re-located from the second to ground floor. The medication folder contains sample signatures and initials, of staff authorised to handle medication, for identification and auditing purposes. Information sheets for each persons prescription with details of possible side affects are also kept in this folder. We sampled some of the medication administration record (MAR) sheets. Entries made for routinely prescribed medication were legible and complete. However, recording systems identified in the services procedures are not always being followed for as and when required medication. The relief manager has produced a protocol for administering this medication to one person following their recent drugs review. However, staff members we spoke to were not aware of this. Both issues were brought to the attention of the relief and senior managers who assured us these would be dealt with. Care Homes for Adults (18-65 years) Page 21 of 33 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 are regularly consulted about their care and the day-to-day running of the service and feel their views are listened to and acted upon. Suitable procedures are available in the home and training is provided for staff to protect people for harm. Evidence: Information provided by the service shows two complaints have been received by the service. The area manager told us this was a recording error and no complaints had been received since our last visit. The relief manager also stated no complaints had been received since she this took up post. The pictorial complaint procedure, provided to people living in the home, was reviewed in October 2009. People are encouraged to express their views about the service and the care they receive on a daily basis and during one-to-one discussions with their key worker. Two people told us who they would speak to if they were unhappy or worried about anything and were confident staff would put it right and make it better. Relatives/representatives of people living in the home said they know how to make a complaint and if they felt the matter was not being dealt with to their satisfaction they would contact the services head office. However, they were confident that the previous manager and the relief manager would address any concerns they had in a Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: professional manner. A copy of the local authoritys Safeguarding Vulnerable Adults procedure is available at the home, together with the organisations adult protection procedure. Records show the majority of staff members have attended adult protection training and arrangements have been made for others to attend in the near future. The relief manager has recently discussed safeguarding issues with staff who have yet to attend this training. Two safeguarding referrals have been received by the local authority. The organisation is co-operating with the investigation being carried out by the safeguarding team. Relatives/representatives we spoke to told us they were satisfied with the care being provided and had no concerns about their family member/clients safety. No concerns were raised by staff or identified by us during this visit. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has improved the standards of the environment to ensure people are provided with a comfortable and safe place to live. There are procedures in place to ensure the premises are kept suitably maintained, clean and hygienic. Evidence: At the time of the last inspection it was reported the service had carried out a redecoration and refurbishment plan. However, some work previously identified had still to be completed, such as replacing carpets and re-fitting the overhead shower to the wall in the small bathroom. This work has now been done. A maintenance book is being completed by staff and work is identified in terms of priority. It is advisable the date work was completed is recorded. This will enable the service to monitor the organisations response. On the ground floor there is a large well equipped kitchen and laundry room. Communal areas include a lounge and dining area. Both were suitably decorated and furnished. However, the television continues to be encased in a box high up on one of the walls and looks unhomely. The positioning could cause discomfort for people watching the television over a period of time and needs to be reviewed. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: People living in the home have good mobility and use the stairs to access the first and second floors. A lift is available and serviced on a regular basis. Two bathrooms, with coded door locks, are situated on the first floor and have been re-furbished. We were informed hot water temperature outlets are thermostatically controlled to protect people from accidents. The large bathroom has been fitted with a walk-in shower. One person told us they chose the decorative transfers for the walls and helped staff to put them up. The over the bath shower has been re-fitted to the wall in the small bathroom. Staff told us this bathroom is seldom used as people prefer to use the walk-in shower. Bedrooms for the three people current living in the home are situated on the first floor and have en-suite facilities consisting of a toilet and wash hand basin. People are encouraged to personalise their rooms with family photos, drawings and any certificates they have achieved. The bedroom we were invited to see by the occupant was furnished with a television, music equipment and computer. We were informed people regularly used the games room on the second floor. This floor was not seen during this visit. The staff bedroom, previously located on this floor, is now on the ground floor and is a more spacious and pleasant environment. There is a courtyard to the rear of the premises and access is restricted by coded door locks. People wishing to use this area ask staff to open the door for them. As previously stated, these restrictions have been discussed with senior managers. The service does not employ domestic staff and the care team is responsible for ensuring household tasks are completed on a regular basis. Information about the prevention and control of infection and the control of substances hazardous to health (COSHH) is available for them. Records seen show they have attended training in these areas. Cleaning products are kept in a locked cupboard in the kitchen. Relatives/representatives of people living in the home commented on the improved environmental standards and cleanliness of the premises. Care Homes for Adults (18-65 years) Page 25 of 33 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. People are supported by staff that know their needs, how these are to be met and have received suitable training. Good recruitment procedures are followed to protect peoples safety and well being. However, the service needs to demonstrate more fully that all newly appointed staff receive a comprehensive induction and a planned programme of training. Evidence: Information provided by the service prior to, and during this visit, tells us five members of staff have left during the last twelve months. At the time of our visit the staff team was identified as eight support staff, one acting team leader and relief manager. The deputy manager is on extended leave and one team leader post is vacant. The team is made up of individuals (male & female) who have different life experiences. Relatives/representatives of people living at the home commented that staff members are helpful, however the constant change in the staff team is unsettling for their family members/clients. The retention of staff is an issue the management is advised to review as part of its quality assurance. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: All people living in the home require one to one support during the waking day. Discussions held with staff show they are familiar with peoples individual needs, routines, preferences and how these are to met. Duty rosters show suitable staffing levels are being maintained to ensure peoples day and night time needs are met. Information provided by the service shows the majority of the staff team holds a National Vocational Qualification (NVQ) Level 2 in Health & Social Care. One of the newer staff told us they had almost completed the course and will soon commence training for the LDQ (Learning Disability Qualification). The training matrix shows other staff members have not yet completed LDQ training, where this is so arrangements need to be made for them to complete this. Policies and procedures for recruiting staff were reviewed in February 2009. We looked at the recruitment files for two members of staff. The information available shows procedures are followed to carry out appropriate checks, such as with the CRB (riminal Record Bureau), before successful applicants commence employment. This ensures the safety and well being of people who receive a service from them is protected. However, a copy of application forms and references are not held on these files. The area manager told us these are viewed at the head office by herself and the manager of the service. It is advisable for the manager to record the date when these were seen by them on the files kept by on the premises, together with any discussions held. Staff we spoke to told us they feel they receive a good induction that includes shadowing a senior/experienced member of staff to enable them to get to know the people living in the home, their preferred routines and how their care needs are to be met. They are provided with an Induction Handbook and Workbook. We looked at two workbooks. These had not been signed off and the record of meetings not fully completed. Therefore, we are unable to confirm that a suitable induction programme and supervision is being provided for newly appointed staff. Records are kept of training attended by staff such as; first aid, the Mental Capacity Act, caring for people with epilepsy and managing challenging behaviour. The service does not appear to take a planned approach to prioritising training for newly appointed staff. For example, a support worker attended training for managing challenging behaviour in April 2009, but has yet to attend training in protecting vulnerable people from abuse. Care Homes for Adults (18-65 years) Page 27 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements need to be made for the more permanent day-to-day running of the service by a qualified and competent manager. A comprehensive quality assurance system and annual development plan should be produced so people living in the home, their relatives and other interested parties, can be fully confident their views underpin the services own self-monitoring and review. Policies and procedures are in place to promote and protect peoples health and safety. Evidence: Information we have received indicates staff have been unhappy with the previous management style. However, people living in the home and their relatives comment positively about the service provided. A relief manager was appointed in July to undertake the day-to-day running of service in the absence of the registered manager. She is experienced in working with this Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: client group and is known to some of the people who live here. The area manager has spent the last two weeks working with the relief manager, supported by other registered managers within the organisation, to try to understand the teams concerns and to review practice within the home. At present no arrangements have been made to recruit to the managers post. However, the responsible individual and area manager have agreed the service will continue to be run by the relief manager for the foreseeable future. The organisation carries out an annual quality and performance assessment on the service and surveys are sent people living at the home. They are supported to complete these by their key workers. The area manager told us any issues raised about the service are forwarded to her to deal with. The service needs to implement a fully comprehensive system for monitoring its own performance which includes seeking the views of people living in the home and their relatives and representatives. It is advisable for people to be supported to complete surveys by others who are independent from the home. The results of the surveys about the service should be published together with its own findings and plans for future development. This will demonstrate that peoples views underpin the self-monitoring and review carried out by the service on its own performance. Information provided by the service shows health and safety policies and procedures are periodically reviewed. The relief manager has recently undertaken a full review of all fire safety procedures that included providing in-house training for staff and the carrying out of file drills. We sampled some of the records kept for the routine checks and servicing of appliances and equipment. These show suitable arrangements are in place to ensure all people in the home are kept safe. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 9 Comprehensive risk assessments should be carried out including robust reviewing processes. Strategies restricting access to areas in the home should be agreed with the indvididual, relatives and/or representatives. Due consideration should also be given to the impact these may have on the lives of the other people living in the home. 2 10 Information about people living in the home should be securely stored at all times to ensure confidentiality is maintained. Appropriate procedures should be taken to ensure food is stored at the correct temperature at all times. Staff should be provided with information on healthy eating to enable them to provide people with good advice and for them to be confident in implementing any recommendations made be a dietician. Menus and records of meals taken should include the full range of vegetables and desserts. This will assist the monitoring process where concerns about a persons Page 31 of 33 3 4 17 17 5 17 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 dietary intake has been raised. 6 20 Procedures for recording the administering of as and when required medication should be followed at all times. Staff should be aware of the contents of individual protocols procuced for this medication. The television should be re-sited to ensure people are able to view programmes in comfort. The service should support all staff to achieve the Learning Disability Qualification (LDQ). Records should be fully completed in order to demonstrate a comprehensive induction to the service is carried out and a planned approach taken for arranging training for newly appointed staff. Suitable arrangements should be made for a qualified and experience manager to be registered by the Care Quality Commission (CQC). This will provide stability for people living here. The service should implement its own comprehensive quality assurance system and seek the views of the relatives/representatives and other relevant people in order to demonstrate fully that peoples views underpin its own self-monitoring, review and plans for future development. 7 8 9 24 32 35 10 37 11 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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