Care Home: 3 & 3a Earlswood Road

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What the care home does well Staff were observed to give support with warmth, friendliness and patience and treat people respectfully. The people living there were asked what they wanted to do and where they wanted to go. Staff offered them choice throughout the day and supported them to do the things they wanted to do. People are offered a healthy diet that they enjoy. People were well dressed in good quality clothes that were appropriate to their age, the weather and the activities they were doing. The medication is well managed so that people get their prescribed medication helping them to stay healthy. Everyone who lives at the home has their own bedroom. There are enough staff on duty so that the people living there can be well supported. Most staff have worked at the home for several years so that they know the people living there well and people are supported by staff they are familiar with. More than 50% of care staff have a National Vocational Qualification (NVQ) in care, this contributes towards ensuring that staff have the knowledge and skills to work with the people living in the home. What has improved since the last inspection? Staff have had more training in managing people`s behaviours so that they can manage behaviour in a consistent and safe manner. New seating has been provided in the lounge area of house 3a and this makes the lounge look a nicer place for people to spend time in. New shower facilities have been installed on the ground floor of the home so that the home has a good choice of bathing and showering facilities for people to choose from. The fire alarms are now tested regularly to make sure they are in working order and would alert people to a fire , helping to keep people safe from harm. What the care home could do better: The service users guide should include the fees charged so that people know how much it costs to live at the home. Copies of people`s terms and conditions need to be available to people who live at the home so they have information on what to expect from the home and the fees payableon their behalf. Care plans need further development to ensure they are fully reflective of people`s needs and personal preferences so that staff know how to support people appropriately. Some redecoration of the home and replacement of carpets needs to be done to ensure the home is comfortable for the people living there. Safeguarding arrangements need to be improved to make sure that people are protected from the risk of abuse or self - harm. Staff recruitment records should ensure that `suitable` people are employed to work with the people living there. Staff training records need improvement so that this information is clear and staff have the training they need to support the people living there. There should be at least six staff meetings a year and staff should have regular supervision so that they are kept up to date with the changing needs of the people who live there, any changes within the organisation and are supported in their role. A permanent manager needs to be recruited for the home so that the home is well run for the benefit of the people living there. Quality assurance systems require further development so people`s views, their relatives and other care professionals views are sought about the day to day running of the Home. Staff need to have regular fire training so that they know what to do to keep people safe if a fire occurs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 3 & 3a Earlswood Road 3 & 3a Earlswood Road Kings Norton Birmingham B30 3QZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 3 & 3a Earlswood Road 3 & 3a Earlswood Road Kings Norton Birmingham B30 3QZ 01212557000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) South Birmingham Primary Care Trust Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The home is registered to provide accommodation, nursing care and support for up to eight adults with learning disabilities who may have challenging behaviours, all the people who live at the home are men. People have lived at the home since 2002 but the home has only been registered since February 2007. The home is managed by South Birmingham PCT and the property is owned by Focus Futures. The home is made up of two separate houses next door to each other, each accommodating up to four people in single bedrooms. Bedrooms do not currently have en suite bathrooms but an undertaking was given at the time of registration to install en suites to 50 of rooms within two years. Each home has its own laundry, bathroom and shower room, kitchen, dining room, living room, sun room and office. There is a sensory room that is shared. The home also has a lift so that people with mobility problems can access the first floor of the home. There is good off road parking at the front of the house, and a private garden to the rear of the property. There is a wide range of community facilities in the Care Homes for Adults (18-65 years) Page 4 of 32 8 Over 65 0 Brief description of the care home area, including shops, pubs, restaurants and places of worship. Public transport links are good, with bus stops close by.Information on the current fee levels for the home was not included in the Service User Guide. Copies of CSCI inspection reports are available in the home for people who wish to read them. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 visit was carried out over one day, the home did not know we were coming. This was the homes first key inspection for the inspection year 2008 to 2009 but we also visited the home in May 2008 to carry out a thematic inspection about safeguarding. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include Care Homes for Adults (18-65 years) Page 6 of 32 notifications and reports received from the home and a questionnaire about the home (AQAA). People who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at all parts of the home, spoke with staff and the acting manager and sampled records about peoples care, staffing and health and safety. All people were spoken with but due to their communication needs most people who live at the home were not able to tell us their views of the home. What the care home does well: What has improved since the last inspection? What they could do better: The service users guide should include the fees charged so that people know how much it costs to live at the home. Copies of peoples terms and conditions need to be available to people who live at the home so they have information on what to expect from the home and the fees payable Care Homes for Adults (18-65 years) Page 8 of 32 on their behalf. Care plans need further development to ensure they are fully reflective of peoples needs and personal preferences so that staff know how to support people appropriately. Some redecoration of the home and replacement of carpets needs to be done to ensure the home is comfortable for the people living there. Safeguarding arrangements need to be improved to make sure that people are protected from the risk of abuse or self - harm. Staff recruitment records should ensure that suitable people are employed to work with the people living there. Staff training records need improvement so that this information is clear and staff have the training they need to support the people living there. There should be at least six staff meetings a year and staff should have regular supervision so that they are kept up to date with the changing needs of the people who live there, any changes within the organisation and are supported in their role. A permanent manager needs to be recruited for the home so that the home is well run for the benefit of the people living there. Quality assurance systems require further development so peoples views, their relatives and other care professionals views are sought about the day to day running of the Home. Staff need to have regular fire training so that they know what to do to keep people safe if a fire occurs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. Evidence: The service user guide for the home was readily available. The acting manager said this had been produced with assistance from a Speech and Language Therapist so that the format is suitable for people who live at the home. This gives the information about what the home provides to people who are looking to see if the home can meet their needs and whether or not they want to live there. It did not state the fees charged and this information should be included. This was recommended at the last key inspection, the acting manager said it had not yet been done as the home was awaiting information on the fees. Unfortunately since our last key inspection one person who lived at the home has passed away. This means that the home now has a vacancy. The acting manager said that the home has not yet had any referrals for the vacancy. The home has an Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: admission policy in place, this indicates that an initial assessment would be done followed by multi disciplinary meetings, informal visits, an overnight stay and an admission meeting prior to any new person moving in. The acting manager said people do not yet have copies of contracts / terms and conditions as recommended from previous inspections. Copies of the terms and conditions need to be available to people who live at the home so they have information on what to expect from the home and the fees payable on their behalf. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not always have all the information they need to be able to support individuals to meet their needs and reduce the risks to their safety, which could impact on their well being. People are able to make choices and decisions about their lives. Evidence: The records of two of the people living there were looked at. These included an individual care plan that stated how staff are to support the person with their needs to include communication, personal hygiene, health, behaviour, activities, nutrition and night time support. Plans sampled had all been regularly reviewed to make sure the information was up to date and reflected peoples current needs. People did not have plans in place for all areas of need. For example where it was identified that people could be incontinent there was no plan to show when this might occur and what support the person needed to promote continence. There was also a lack of information in plans about the support people needed to maintain contact with family and friends Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Plans did have some information about peoples likes and dislikes but plans would be more person centered if further detail was included about peoples personal preferences. For example, if people prefer a bath or shower and when they prefer to have it and if people prefer an electric or wet shave. Where needed people have an individual Safe Handling Pack that details how staff are to support the person through different stages of their behaviour. This includes what the triggers for each of their behaviours may be and what to do to distract the person from behaving in this way. It was noticed that one of these plans had yet to be signed or dated, the acting manager said he would ensure this was done. There is evidence that people who live in the home are supported to make choices about their daily life. Staff were observed offering people choices about what they wanted to eat or drink and whether or not to take part in activities. Regular meetings are held with people who live in house 3a, minutes of meetings show that people are consulted about meals, activities and general home issues. Formal group meetings are not held with people in house 3, the acting manager said this was due to peoples level of understanding and communication needs. To gain their views a new system has been introduced where their keyworker writes a short report about how the person has been, based on their observations of the person. Staff spoken with said that methods of communication for people were being improved and that staff training was arranged to look at the introduction of objects of reference with people. This is a method where people use everyday objects to communicate, for example using a cup to show that they would like a drink. Each persons records included individual risk assessments that had been regularly reviewed. These stated how staff are to support the person to reduce the risks from things such as aggression, swimming, accessing the community and accessing the kitchen. The home needs to make sure that risk assessments are reflective of all the control measures in place. One person was seen to have an assessment regarding the risk of choking. This did not cross reference to an assessment completed by the speech and language therapist regarding choking where it had been advised that staff needed to cut the persons food into small pieces. Staff reading only the homes assessment may not be aware that foods needs cutting up and the person could be put at risk of choking. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are generally sufficient to ensure that people living in the home experience a meaningful lifestyle. The people living there are offered a healthy diet to ensure their health and well being. Evidence: Most people at the home have an individual weekly activity timetable. Records and discussion with staff show that activities on offer include walks, shopping, puzzles, drinks out, foot spa and massage therapy. About once a month some people are supported by staff to go shopping. We spoke to one person who lives at the home about the activities on offer they told us there are things to do. There is a snoozelen room in the home. All the equipment in the room was working so that people could spend time relaxing in there with the music and lights on, however Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: the acting manager said that most people chose not to use it. Records showed that a large proportion of activities were drives out. Records detailed that drives out were to places such Selly Oak or Alvechurch but did not actually record what people did there, for example if it was shopping, a walk or just staying in the vehicle. As identified at the last inspection people have a leisure assessment that details what type of activities they enjoy but this was not observed to always link into their care plan. Some assessments would benefit from being reviewed. Often where staff record that activities have been undertaken they usually do not record if the person enjoyed the activity to assist in future activity planning. Discussion with staff shows that some people at the home have a lot of contact with their relatives whilst others have very little. Some people spent time visiting their relatives at Christmas. Discussions with the acting manager indicate that some people have lost contact with relatives over time. As stated earlier in this report care plans need to be developed further to ensure people get the support they need from staff to maintain contact with family and friends. For example plans could detail how relatives prefer contact to be made, how often and if people need to be supported to send cards to relatives on special occasions such as Christmas or birthdays. Food records sampled showed that a variety of food is offered that includes fruit and vegetables to ensure that people are having a healthy diet to ensure their well-being. Lunchtime practice was observed and people were given a choice of what they wanted to eat and drink. Staff ate with people whilst also giving them appropriate support. Staff spoken with said that people have the opportunity to plan the menu for the coming week with staff and also to participate in the food shopping. One person we spoke with was able to tell us their views of the food, they said it was good. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the health needs of individuals are met, which could impact on their well being. Evidence: The people living in the home were well dressed in clothes that were appropriate to their age, gender, culture, the weather and the activities they were doing. Sampling of records show that people have the opportunity to go and have regular hair cuts and to go shopping for their personal toiletries. It was observed that people had been supported to pay attention to their personal care and hygiene so ensuring their self esteem. As recorded earlier in this report one person at the home has recently sadly pased away. Discussions with staff and sampling of records indicate that both staff and people at the home had been offered appropriate bereavement support. Records sampled showed that health professionals such as the speech and language therapist, psychiatrist and nutrition are involved in individuals care where appropriate. People had been supported to attend regular health checks such as the dentist so ensuring their health and well being. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Each person has an individual Health Action Plan. This is a personal plan about what help a person needs to be healthy and to stay healthy. Records indicated that some people at the home are at risk of constipation, however care plans had not been completed about this. These need to be done so that staff know the support and monitoring that is needed to make sure the person is healthy and not in discomfort. Plans had some good information about peoples dietary needs that showed the support people needed to reach their ideal weights. For one person who is overweight their weight record shows they are slowly losing weight. Records showed that the person needed to be weighed every two weeks but they had not been weighed for a month. Medication is stored in a locked cabinet. Medication is administered by qualified nurses. Medication Administration Records (MAR) sampled had been signed when staff had given the person their medication indicating that people had their medication as prescribed. It was good that guidelines were available telling staff how people like to take their medication. There was also a photograph of the person so if unfamiliar staff were giving it this would ensure it was given to the right person. Protocols were in place for people who were prescribed PRN (as required) medication. These stated when the medication should be given and had been reviewed since the last inspection so that staff have up to date guidance about when to give the medication. Copies of each persons prescriptions are kept so that staff can ensure that what is provided by the pharmacist is what has been prescribed by the doctor. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaint procedure if followed would ensure that people or their representatives would be listened to and concerns acted upon. Safeguarding arrangements need improving to ensure that the people living there are protected from abuse, neglect and self-harm. Evidence: We have not received any complaints about this home in the last twelve months and the acting manager said that the home had not received any complaints directly. The complaints procedure of South Birmingham Primary Care Trust was available in the hallway of the home for visitors to read. An easy read procedure was also available, this included large simple print and pictures to make it easier for people to understand. There are also guidelines in place for staff to help people complain who have communication difficulties, this directs staff to consider their body language, facial expressions and behaviour. Two staff who we spoke with said they would feel confident in raising any concerns if they had any with the acting manager of the home. Some people who live at the home have behaviours that may result in injuries to themselves or hitting other people. At the last key inspection we found that more staff needed to have training in managing behaviour to ensure they have the right skills to support people when they are displaying behaviours that may result in injuries to themselves or other people. Records and discussions with staff show that most staff Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: have now had this training and further training is booked for those staff who still need to attend. At our thematic inspection to the home in May we spoke with staff about their understanding of safeguarding (protecting people from abuse) and found that generally staff have good knowledge in this area. Discussions with staff indicate that most staff have had training in protecting people from abuse as part of a national vocational qualification in care or via an in house training pack. The provider does offer more in depth training on safeguarding but the home appears to have struggled to obtain places on this for staff. Sampling of staff training records did not show that many staff had received any training and these will need to be updated so that it is clear which staff still need to receive training. Records and notifications sent to us by the home show that one person sometimes displays behaviour where they hit their head against hard surfaces such as their bedroom wall. Since the last key inspection the home has referred the person to the occupational therapist and obtained a helmet for them to wear to try and protect their head from injury. From looking at the persons care plans and discussion with a member of staff it was not clear that staff have information when the helmet needs to be worn. Clear information is needed so that staff practice is consistent and the person is protected from harm where possible. One person at the home suffered a fractured finger. As staff did not know how this had occurred they notified social services to see if this needed to be investigated under safeguarding procedures. The acting manager said that social workers had not viewed this as a safeguarding matter. Unfortunately the acting manager was unable to locate any written documentation regarding the outcome of this during our visit. The personal monies of the people living in the home are held securely. Staff check these monies at the handover of each shift to ensure that the money is still there and any money taken out for people to spend had been calculated properly. Personal monies are also regularly audited by the Trusts Locality Manager as part of their monthly visit to the home to ensure peoples money is being looked after properly. At the last key inspection we found that people had a record of what personal possessions they had but these were not up to date. We sampled two records at this visit and found that they had been updated so that it is clear what belongs to them and can be identified if anything should go missing. Care Homes for Adults (18-65 years) Page 20 of 32 Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, tidy well personalised home that generally meets their needs and reflects their taste and interests. Some maintenance issues need attention to ensure that the home is well maintained for people and looks nice. Evidence: We looked at all of the communal areas in the home and all bedrooms. The home was a warm temperature despite it being a very cold day. Discussions with staff and the maintenance records did show that recently some night staff had complained that communal areas of the home were cold late at night. Records show that engineers have been to the home to reset the night time heating controls but it was not clear if this had improved things. Discussions indicate that this is an issue that has affected staff rather than people who live at the home whose bedrooms appear to be unaffected. One person we spoke with told us that his bedroom was warm at night. We advised the acting manager to monitor the temperature of the home to make sure it was not too cold for people. Since our key inspection to the home new seating has been provided in the lounge area of house 3a and this makes the lounge look a nicer place for people to spend time in. As identified at previous inspections some areas of decor are quite worn in Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: appearance and several carpets are quite stained. The acting manager said that redecoration and the provision of new carpets was not yet scheduled due to disagreements between the Trust and the housing association who own the home about who should pay for this. This has been ongoing for some time and now needs to be resolved to make sure that people who live at Earlswood Road have a home that is well maintained. As identified at the last key inspection the net curtains to the first floor corridor in house 3a are very badly stained. The acting manager did not know if any new curtains had been ordered. New curtains or blinds need to be installed at the current appearance of the hallway is spoilt by the stained curtains. Bedrooms seen were generally satisfactorily decorated according to individuals tastes, interests, age and gender. Most bedrooms were very personalised with peoples possessions. At the last inspection in House 3 the ceiling in one bedroom was observed to need repainting as it was stained where drinks had been thrown at the ceiling, his has now been done. Some bedrooms needed some redecoration where heat from radiators had caused discoloration to the walls, as identified at previous inspections. People do not have en suite bathrooms and so have to share the two bathrooms and two shower rooms in House 3 and 3A. An undertaking was given when the home was registered in February 2007 that 50 of bedrooms would have an en suite bathroom within two years. The acting manager said that architects had so far not been able to come up with plans to achieve this and so recently two additional showers had been installed on the ground floor of the home. Satisfactory hand washing facilities were observed in the bathrooms, laundry and kitchen areas. The home was clean and generally free from offensive odours. It is good that the home completes a daily audit of infection control procedures, this helps to ensure the home is clean and procedures are in place to reduce the risk of infection. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for staffing, their support and development does not always ensure that the people living there are always supported by an effective staff team who are supported, supervised and have the knowledge to meet individuals needs. Evidence: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. Evidence from previous inspections and the annual quality assurance assessment from the home indicate that more than 50 of care staff have a National Vocational Qualification (NVQ) in care, this contributes towards ensuring that staff have the knowledge and skills to work with the people living in the home. Rotas showed and staff said that there are usually six staff to eight staff including one or two qualified nurses on each shift during the day. In addition, there is a member of staff who works a twilight shift in the evening, five days a week. From discussion with staff and observation during the inspection staffing levels appear to meet peoples needs. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The acting manager told us that no new staff had been employed since our last key inspection so we looked at the recruitment information for some of the existing staff. An audit had been completed by the home of staff files, this showed that all staff had criminal record bureau (CRB) checks. We found that where some staff had offences recorded on their CRB checks there was a lack of information in their file to show that this had been satisfactorily assessed. For one person there was no information about the type of offence committed and the acting manager did not know what it had been. Robust risk assessments need to be completed and available to ensure that suitable staff are employed. A previous inspection identified a lack of staff training records making it difficult to fully establish if staff had received all the training they needed to meet peoples needs. At the last key inspection we found that the manager had introduced a training matrix that showed the training staff had received. Unfortunately this matrix has not been kept up to date so it was again difficult to establish that the staff team receive the training they need. Monthly records did show that staff have received training in challenging behaviour, autism and food hygiene. Several staff are also booked to attend first aid training in February and March. Records did not show that staff all had received refresher training in manual handling or training in safeguarding people. We asked to see the induction record for one member of staff but this was not available. The acting manager told us that all staff complete the Trust induction on commencement of employment. We spoke with two members of staff, they were both generally satisfied with the training they received. The staff supervision records showed that some staff had not received regular, recorded supervision meetings at least every other month. Regular supervision is needed so that staff receive the support they need to carry out the job or receive feedback on their performance. Staff meetings have occurred infrequently in house 3. This means that staff do not always get a formal opportunity to be updated about the changing needs of people, changes within the organisations philosophy or an opportunity to influence how care for people will be delivered in the future. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not always ensure that the home is run in the best interests of the people living there to ensure their safety and well being. Evidence: Since our last key inspection the registered manager has left the home. The home has an acting manager who was formerly the deputy manager of the home. He told us that the Trust is currently advertising the vacant manager position. A new manager needs to be recruited and an application made to us to register them so that the home is run in a way that benefits them supports the people living there. The acting manager is a qualified nurse. Staff spoken with said that he was approachable. We received the homes annual quality assurance assessment when we asked for it. It was basic in content and not that detailed about the quality of the service provided to people and where the home needed to make improvements. A representative of the Trust is required to visit the home monthly to make sure it is Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: being well run. This is normally undertaken by the locality manager. Reports available in the home did not show this was being done every month. The acting manager said there had been some gaps in visits during a period when there was a change in locality manager but that recent visits had taken place and they were awaiting the reports for these. When we completed the homes last key inspection we found that the Trust had completed a full quality assurance audit of the service provided, dated 2006. At this inspection the acting manager told us that there had been no other quality assurance audits completed. The homes annual quality assurance assessment records that it is intended in the next twelve months to change the registered provider for the home. Discussion with the acting manager indicates that this may be in April. Before any change of provider a regisration application will need to be made. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to make sure it is well maintained so it works well. It was not evident that all staff had received regular fire training. All staff need regular fire training to ensure they know what to do to keep people safe should a fire occur. The acting manager said this would be arranged for February and March. The passenger lift and assisted bath are regularly serviced to ensure they are safe and work well. Certificates were available to show that the gas appliances and electrical installations in the home were safe. Records showed that staff tested the water temperatures regularly to make sure they are not too hot, which could put people at risk of being scalded. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 9 Where a person has been diagnosed with a health condition there should be a care plan in place. To help ensure the person receives the support they need to stay healthy. 27/02/2009 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 2 1 5 The service users guide should include the fees charged so that people know how much it costs to live at the home. Copies of peoples terms and conditions need to be available to people who live at the home so they have information on what to expect from the home and the fees payable on their behalf. Care plans need further development to ensure they are fully reflective of peoples needs and personal preferences so that staff know how to support people appropriately. An audit of peoples risk assessments should be undertaken to ensure they are reflective of the current control measures in place to make sure people are protected from the risk of harm. 3 6 4 9 Care Homes for Adults (18-65 years) Page 29 of 32 5 12 Review the information recorded when activities are undertaken to indicate what people have actually done and if they enjoyed it. Review the activities on offer to make sure they are varied and meet peoples personal preferences. Look at the arrangements in place to support people to maintain contact with family and friends to ensure support is appropriate to meet peoples needs and preferences. People should be weighed in line with the frequency recorded in their care plan to help establish if the person is at a healthy weight. Detail on the use of a helmet need to be added to one persons care plan so that staff practice is consistent and the person is protected from harm where possible. Audit staff training files to establish which staff still need to receive training in safeguarding people from abuse and arrange training for those staff who still require it. This will help to ensure that all staff have the knowledge they need to protect people from abuse. Where incidents are reported to the local authorities (social services) the home should ensure that documentation is available in the home on the outcome of the referral to show that the correct procedures to safeguard people have been followed. The temperature of the home should be monitored at night to establish if it is comfortable for the people who live at the home. The communal lounges in both houses and stained areas above radiators throughout the home need redecoration. Net curtains in the corridor need replacement so that the environment is homely and well maintained for people. Where carpets remain stained following cleaning these should be replaced so that the environment is homely and well maintained for people. Where criminal record bureau checks for staff record that staff have committed a criminal offence there should be a risk assessment available to show that full consideration to the suitability of the staff working with vulnerable people so that they are fully protected from the risk of abuse. Update staff training records so that they are reflective of all the training staff have received and where there are gaps in training make arrangements for staff to receive the training they need. 6 15 7 19 8 23 9 23 10 23 11 24 12 24 13 24 14 34 15 35 Care Homes for Adults (18-65 years) Page 30 of 32 16 36 Staff should receive the supervision and support they need to carry out their jobs and meet the needs of the people living there. A permanent manager needs to be recruited for the home so that the home is well run for the benefit of the people living there. Quality assurance systems require further development so peoples views, their relatives and other care professionals views are sought about the day to day running of the Home. Ensure that all staff have had regular fire training so that they know what to do to keep people safe if a fire occurs. 17 37 18 39 19 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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