Care Home: 34 Pedmore Walk

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What the care home does well The service continues to review its systems for assessing people`s needs to ensure detailed care plans are produced. It has maintained good working relationships with health care agencies to ensure people`s physical and emotional needs are met. People are supported with their personal care needs in the way they prefer and provided with opportunities to take part in activities and maintain their relationships with family and friends. There well being and safety is protected by the service`s policies, procedures and practice. The service continues to be run by a competent and experienced manager and good arrangements are made to for people to be supported by a trained and competent staff team. What has improved since the last inspection? The service has continued to develop its care planning formats and review risk assessments to ensure people receive the care and support they require safely and, wherever possible, maintain their independence. The medication procedures have been reviewed and improved systems for monitoring and auditing different aspects of people`s medication have been introduced to ensure it is being managed appropriately. What the care home could do better: The service has continued with its programme of re-decoration and refurbishment. However, the building does not fully meet all the needs of the people who live here and would benefit form a more suitable building being identified. The records to show instructions for applying creams/ointments have been followed should be completed on each occasion. This will ensure people are confident the service is fully meeting all their health care needs. Staff records should include all training they have undertaken so people can be fully confident their individual needs are being met by a well-informed and competent staff team. Staffing levels should be monitored and revised where applicable to ensure people`s needs and preferences can be met at all times. The service regular monitors its own performance and provides opportunities for people to express their views. However, it needs to address the shortfalls in its quality assurance system to be able to fully demonstrate people`s views are listened to and acted on. Key inspection report Care homes for adults (18-65 years) Name: Address: 34 Pedmore Walk 34 Pedmore Walk Oldbury West Midlands B69 1BJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Elsaleh     Date: 0 4 0 6 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 32 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 32 Information about the care home Name of care home: Address: 34 Pedmore Walk 34 Pedmore Walk Oldbury West Midlands B69 1BJ 01215523645 01215523645 pedmore@sandwellcct.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sandwell Community Caring Trust care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 8 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) 8 Physical disability (PD) 8 Sensory impairment (SI) 8 Date of last inspection Brief description of the care home Pedmore Walk is a care home provision for 8 adults with severe learning disabilities who also have physical and sensory disabilities. The home was originally a purpose built two storey childrens home situated in a residential area in Oldbury. There is space for two vehicles in the secluded garden area at the rear of the property. A small block of shops is within easy walking distance and there is a good public transport system. The design and location of the home blends in well with the local community. There are eight single bedrooms none of which are ensuite, located on the first floor. A Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 0 8 8 8 Brief description of the care home shaft lift is used by people living in the home to access this floor. The home provides a range of activities and has the use of its own mini bus. The home should be contacted for the up to date fees charged for this service. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We looked at information we have received about the service since our last visit and sent surveys to people who live in the home, their relatives and health and social care professionals asking them to tell us what they think about the homes performance. We received responses from 75 per cent of the people we surveyed. Their comments were mainly positive and some have been included in this report. We asked the manager of the service to complete an Annual Quality Assurance Assessment (AQAA). It tells us about the different aspects of the service it provides for people and includes facts and figures to bring us up to date with what has happened at the home during the last 12 months. This was returned to us by the date requested and contained the information we asked for. Care Homes for Adults (18-65 years) Page 6 of 32 This unannounced inspection was carried out by one inspector on 4th June 2009. We spoke to the manager, staff and met three people who live in the home and one visitor. We looked at two peoples care files and two staff files along with other records and documents kept by the service. This was to help us to assess the quality of life for people who live in the home and the services performance against the national minimum standards. The atmosphere in the home was relaxed and friendly. A tour of the building found it to be suitably furnished, clean and tidy. People we met appeared healthy and well looked after. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 32 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 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 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. Good systems are in place to assess peoples needs and aspirations. Evidence: Information about the service is on display in the reception area. A copy of the Statement of Purpose was made available to us. We asked people who use the service and their relatives if they felt they received enough information from the service to make informed decisions. The two surveys we received from people who live at the home did not answer this question. However, their relatives told us they felt they always get enough information from the service. Information provided to us by the service show its referral, assessment and admission procedures were last reviewed in January this year. The manager told us as part of its referral process a care management assessment is always obtained from the referring authority and the service also carries out its own comprehensive assessment of a persons needs. People living in the home have done so for over 3 years. One persons file we looked at in detail held a copy of the original assessment. The service has also Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: carried out a more recent assessment which includes looking at the persons mental capacity to make their own decisions. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and personal goals are reflected in their care plan. They would benefit from more regular reviews to ensure changing needs are being fully met. They are supported to make their own decisions and take risks as part of an independent lifestyle. Evidence: We looked at the care plans for two people who live at the home. A recent reassessment of one persons needs has been carried out and a revised care plan produced. The care plans contain detailed information about personal, health and social needs and what the person is able to do on their own. Each person has an identified senior member of staff and support worker. They are responsible for ensuring the persons care needs are being met. Two staff we spoke to commented positively on the new care plan formats that had been introduced. They showed a good understanding of peoples needs, preferred routines, likes and dislikes. The manager and staff spoken to told us the people living in the home do not display Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: challenging behaviour and none were identified in the records we looked at. Information kept on the care files show formal reviews, involving the persons relative/representative and health and social care agencies are being held annually. Review dates for one person are recorded as March 2008 and, more recently, February 2009. The file did not contain information about the care needs discussed or outcomes. The manager is advised to arrange for reviews to be held at least once every six months and a copy of the minutes of the meeting kept available on the persons file. This will ensure accurate information is available for updating the individuals care plan and ensure her/his needs continue to be fully met. The manager informed us assessments are being carried out on each persons capacity to make their own decisions. One of the two files we looked at has a completed mental capacity assessment. Peoples daily records show they are supported to make their own decisions. We saw some people choosing how they spent their time, for example, the activities they wanted to do and their choice of meals. The records we looked at show the manager, deputy and a member of staff have attended training on the Mental Capacity Act and Deprivation of Liberties Safeguarding. One member of staff told us she had completed introductory training on the computer and further training was being arranged by the organisation. Each staff member is provided with a copy of the organisations Residential Units Guide to Good Working Practices and Risk Assessments. Detailed risk assessments are available on peoples files. These show how people are to be supported for example to reduce the risks of falls and to enable them to safely participate in various activities. 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 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 learning and development opportunities within the community. They are supported to take part in meaningful activities and maintain relationships with family and friends. The meals provided meet peoples dietary needs and personal preferences and are served in a pleasant environment. Evidence: The majority of people who use the service attend a day care centre during weekdays. The details are included in their care plans. The records show people choose when they attend. One person has recently chosen to return to her/his day centre for only two days a week following a period of ill health. Each person has a communication book which is completed by staff from the home and the day centre. It enables information to be shared about how the person has spent their time and how they have related to others. Staff told us they felt they had a good relationship with day centres and it provided people with opportunities to socialise and new experiences. For Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: example, one person has recently taken part in canoeing and boating trips. Each person has an activity programme which has been produced with them and their key worker. This ensures people are able to spend some quality time with their key worker doing things they enjoy. Activities include going for pub lunches and leisure walks, reflexology and spending time in the sensory room. Reflexology sessions and pub lunches are particularly favourites with one person whose care we followed. S/he also enjoys painting and some of their work is displayed around the house. The service has arranged for external entertainers to visit the home and the records show most people enjoyed this. The manager told us the range of activities out in the community has been reduced due to a shortage of drivers. This is an area being addressed through its recruitment and selection process for staff. Holiday arrangements for this year include some people being supported to spend time in Blackpool. Information provided by the service tells us all people living in the home have regular contact with relatives. The staff we spoke to said family members are actively involved in their relatives lives. They attend meetings about the persons care and social events organised by the home. Visitors are welcome at Pedmore Walk at any time and people are able to receive their visitors in the privacy of their own bedroom. During this visit we saw people following their own routines for example spending time in different parts of the building. Risk assessments are carried out for high risk areas, such as bathrooms, to ensure people are kept safe. Staff we spoke told us about different peoples routines and preferences as detailed in their care plans. The dining room is used as an additional activity room when meals are not being served. We saw two people spending time here, one listening to music and the other playing games. A social care professional also commented that s/he feels The service interacts well with the people who use the service. People living in the home appeared relaxed with staff and were being addressed by their preferred name. Peoples privacy is respected, for example they do not open a persons mail without permission. Written consent to open mail on a persons behalf was seen on the care files we looked at. The service works closely with relevant health care agencies, for example dieticians. This is to ensure peoples dietary needs are appropriately met. Nutritional screening is undertaken and records kept of meal options and quantity consumed for monitoring purposes. The support to be provided to individuals at mealtimes is included in their care plans. One persons plan shows this varies depending on her/his health and how they are feeling at the time. Staff told us they are provided with in-house training on how individuals need/like to be supported at mealtimes. This training has not been Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: included on their training records. Menus are produced in consultation with people living at the home and include their dietary needs and likes and dislikes as detailed in their care plans. Staff told us people living in the home are provided with a minimum of two options. Some people living in the home are able to express their preferred choice of meal. Others with more limited communication skills are shown the options. Alternative choices are provided on request or where a person indicates they would like a different meal. We discussed pictorial menus with the manager and two staff. They told us some people in the home are able to read and express their preferred choice. While others with more complex needs are better able to indicate a preference by being shown the options and making a choice based on texture and aroma of the meals being offered. Mealtimes are regarded as social occasions with staff and people sitting down together. We observed staff providing support, where required, in a sensitive manner. One person chose to go to their room and dine later because s/he was feeling tired and wanted sometime on their own. The service employs a cook to prepare the main meal of the day. This is served in the late afternoon/early evening. The service provided information telling us all staff members have attended basic food hygiene training. We looked at the training records for two staff which confirmed both had attended training during the last year. We observed staff following good hygiene practices, for example wearing protective clothing when preparing food and regularly washing their hands. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in the way they prefer and require to meet their physical and emotional health needs. The service has procedures for managing medication. However, recording procedures should be followed at all times when creams/ointments are applied for people to be fully confident their skincare needs are being fully met. Evidence: The two care plans we looked at show how their personal care needs are to be met. For example, one person expresses her/his wish to bathe by leading a member of staff to either the walk-in shower or bathroom. Staff we spoke to told us about how they support people with their personal care. This care is provided in the privacy of a persons bedroom or bathroom. The visiting hairdresser is popular with most people living in the home. However, the service also makes suitable arrangements for people to visit the salon of their choice. We were told that three people like to get up early. The rota shows the staffing complement is sufficient to support them with their personal care. However, Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: discussions with staff tell us people have to remain upstairs until other staff members arrive for duty. This means people could have to wait hour or more before they are able to go downstairs or have breakfast. This was discussed with the manager who stated she would assess this and revise the rota, where necessary, to ensure sufficient staff are available. The service works closely with health care professionals. One persons file holds a letter from her/his doctor. This states it is in the persons best interest to take a sedative prior to visits to the dentist. This ensures suitable arrangements are made to reduce anxiety. The manager told us arrangements are made for community nurses from the local GP surgery to visit weekly. This provides opportunities for any new health care concerns to be raised and planned follow-up appointments made, where necessary. A physiotherapist was providing treatment to a person with a re-occurring problem during our visit. Two health care professionals commented the service always follow instructions and keeps detailed monitoring records of the patients symptoms. Specialist equipment, for night-time use, has recently been provided for one person and assessments are being carried out by health care specialists on the benefits similar equipment may have for other individuals. The manager told us to use this equipment will require night-time staffing levels to be increased on a permanent basis and is discussing this with the organisation. The manager and staff members we spoke to told us about the in-house training provided by community nurses and physiotherapists. These are not recorded on the staff training files. The service last reviewed its medication procedures in 2008. It manages medication on behalf of all people living at the home. On the day of our visit some staff was receiving training in the safe handling and administration of medication and arrangements had been made for other staff members to attend the following week. For the majority of staff this was an opportunity to update previous training. The training records for two staff we looked at showed us they had last attended this training in 2007. There are suitable arrangements for the safe storage of medication and internal systems and recording processes for auditing the medication kept in the home. The service has good arrangements for medication required to be taken outside the home. The local pharmacist carried out an audit in January and no concerns were identified. The manager carries out periodic in-house competency checks to ensure procedures Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: are being followed by staff. We looked at the medication administration record (MAR) sheets for two people. These show tablets and syrups had been administered as prescribed and, where applicable, the correct codes used. However, we found a few omissions in recordings for applying prescribed creams. The manager had identified this shortfall when monitoring these records. Procedures for recording should be followed to ensure peoples skincare needs are being fully met. Care Homes for Adults (18-65 years) Page 20 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 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 suitable systems to ensure any concerns raised by people who live in the home and other interested parties are listened to and acted upon. There are procedures in place to promote peoples well being and safeguard them from abuse. Evidence: A copy of the services complaint procedure is available and reviewed by the service in January. The records show one complaint has been received by the service since our last visit and has been appropriately addressed. Surveys returned to us by people who use the service, relatives and health and social care professionals tell us they all know who they would approach if they were unhappy or concerned about anything. Policies and procedures for the safeguarding of vulnerable adults are kept available in the office. Information provided by the service show no safeguarding concerns has been identified or reported them. No concerns have been reported to us (Care Quality Commission) and no concerns were raised during this visit. We looked at the records for two staff which shows us it has been three years since they attended training. The manager is advised to ensure periodic refresher training is included in training programmes to ensure staff are kept up to date with safeguarding procedures and practice. The service does not act as appointee for people living in the home who are unable to manage their own finances. However, it does manage small amounts of personal Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: allowance. There are suitable procedures in place and the records we looked at were found to be in good order. Regular audits are carried out by the manager for which records are kept. Periodic audits are also carried out by a representative of the organisation during her/his visits to the home. Care Homes for Adults (18-65 years) Page 22 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. The service has made further improvements towards the standard of decor and furnishing to provide people with pleasant surroundings in which to live. It remains clean, free from odours and hygienic. The building does not meet all the needs of the people who use this service. It places limitations on some aspects of their independence and can compromise their dignity. Evidence: There is off-road parking available for two vehicles and a small garden with lawn and paved areas. The hanging baskets and pot plants were chosen by the people living in the home during trips out to garden centres. Garden furniture is available but needs to be cleaned ready for people to use. We looked around the home and it was clean, tidy and well furnished. The atmosphere is homely and friendly with photographs and art work on display throughout the building. The service has been carrying out a programme of re-decoration and refurbishment. The lounge has been re-decorated, doors and paintwork have been repaired and re-painted and lighting throughout the home has been replaced. People are unable to use the conservatory at the present because of the re-decoration programme and the limited storage space. The manager told us this room will shortly Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: be bought back into use. Seven of the eight people who live here are wheelchair users. The width of the ground floor corridor and toilet means there is little space for manoeuvring easily. This was evident when we watched a member of staff supporting a person down the corridor. A social care professional commented the dining area and lounge are very small especially for wheelchair users. Each person has their own bedroom and those we looked at were individually decorated and furnished. Items on display include family photographs, various ornaments, entertainment and sensory equipment. Three staff told us people are restricted in how they can have their furniture arranged due the size of their rooms and the aids and equipment needed. One member of staff who responded to our survey commented When we are hoisting there isnt much room to manoeuvre and there are no en-suite bathrooms which isnt very dignified for the clients. The laundry and sluice areas are well organised and the staff team has been trained in the prevention and control of infection. Personal protection clothing, such as aprons and gloves, are readily available. Everyone who responded to our survey stated the home is always fresh and clean. We met with the provider in 2005 and were informed new premises were being sought. The manager tells us a suitable building has not yet been identified, but is confident the organisation is continuing to pursue this. Care Homes for Adults (18-65 years) Page 24 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 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 trained staff that know them well and understand their needs. They are protected by the services recruitment and selection policies, procedures and practice. Evidence: Four people who receive a service were at the home when we arrived. Two were being supported by staff to get ready to attend their day centres. The rota showed us the people who were planned to be duty were on shift. It also identified who was in charge of the shift, responsible for administering medication and for the preparation of meals. Two staff we spoke to told us an additional member of staff is included in the rota to cover catering duties during the cooks absence. The staff team is made up of people of different ages and life experiences who have a clear understanding of their roles and responsibilities. Information provided to us by the service show over 75 per cent of the staff team have achieved the National Vocational Qualification (NVQ) Level 2 or above. Relatives commented that they considered the staff to be suitably trained to meet peoples needs. Information provided by the service tells us that during the last 3 months it has not engaged any temporary or agency staff. The manager told us there is a stable staff Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: team. This means people are provided with care and support by staff they know and are familiar with their needs and personal preferences. We looked at the recruitment files for two staff. These show us the required preemployment checks are undertaken such as references and CRB checks (Criminal Record Bureau) before an applicant takes up post. Each newly appointed person is supported to complete the organisations induction programme and undertake a mandatory training programme during their probationary period. Two staff files we looked at contain training records detailing which courses have been attended. These include health and safety, such as manual handling and client-centred issues, such as caring for people with diabetes and epilepsy. As reported on earlier our discussions with staff highlighted other areas of training they had received such as inhouse training in providing appropriate support to individuals during mealtimes, the use of new equipment by a physiotherapist and caring for a person with Parkinsons disease provided by a community nurse. This shows the services commitment to ensuring people are cared for and supported by staff trained to meet their individual needs. The manager is advised to ensure all training provided to staff is recorded to enable effective monitoring to take place of their performance and personal development needs. Care Homes for Adults (18-65 years) Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home benefit from a well planned and managed service. In order for the service to accurately measure its performance against its aims and objectives it needs to develop and implement some aspects of its quality assurance system. Evidence: The service is run by a well qualified and experienced manager who undertakes regular training to update her own knowledge and skills. She is supported to carry out her duties by a stable team and experienced senior staff team. The manager tells us she feels well supported by the organisation. The copies of reports from a representative of the organisation show regular visits are carried out by them to monitor the services performance. The service also has its own monitoring systems which included issues such as environmental standards, accidents/injuries and risk assessments. There were no comments from relatives and other stakeholders available in the home. The manager stated in the past the response to surveys has been poor. She has agreed to look at Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: other methods of obtaining the views of relatives and other stakeholders. Peoples views should be included in the services quality assurance system and an annual development plan produced and made available to all interested parties. We looked at a random selection of information held in respect of appliances and equipment, such as the portable electrical appliances, gas appliances and fire detection and equipment. These showed us appropriate systems are in place to ensure regular servicing and checks are being carried out to ensure the safety of everyone at the home. Care Homes for Adults (18-65 years) Page 28 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 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The manager is advised to arrange for reviews to be held at least once every six months and a copy of the minutes of the meeting kept available on the persons file. This will ensure accurate information is available for updating the individuals care plan and ensure her/his needs continue to be fully met. Staffing levels should be reviewed against individual care plans to ensure people who rise early are able to go downstairs and have breakfast at a time of their choosing. The medication administration record (MAR) sheets should be completed each time prescribed creams/ointments are applied. This will enable effective monitoring to take place and ensure peoples skincare needs are being fully met. The plans to identify and re-locate to a more suitable building should be pursued to enable the people who use this service to live in an environment that fully meets their needs. Staff records should include all training they have undertaken so people can be fully confident individual needs are being met by a well-informed and competent Page 30 of 32 2 18 3 20 4 24 5 35 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 staff team. 6 39 A more comprehensive quality assurance system needs to be developed to enable the service to fully assess its own performance. This should include obtaining the views of relatives and other stakeholders and producing an annual development plan based on its findings. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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