Care Home: 34 Porthill Bank

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What the care home does well This group of young people have lived together previously in children’s homes settings provided by CareTech and continue to be supported by several staff from the former setting. This provides important continuity and a valuable experience in dealing with the challenges they present to the service as young adults. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 The young people have been and continue to be involved in decisions affecting their daily lives and have opportunities to express their ideas in specific weekly 1:1 discussions with key workers and in the monthly meetings in the home. Additionally each person has a named carer on each shift who will take the lead on their support needs. Most people have 1:1 care with staff throughout the day. A wide range of educational, social and recreational needs are tailored to meet individual needs. All have attended college courses and achieved goals that give confidence and satisfaction to the young person as part of their educational and social progress. Work placements are integrated with college achievements and possibilities of paid gainful employment being pursued. The high standard environment provides a comfortable, homely place to live with people encouraged to take ownership and enjoy the facilities. There is evidence of good staff recruitment and involving people using the service. Complaint and protection issues are identified early and appropriate actions taken to protect people. What has improved since the last inspection? Requests from people using the service has resulted in an extension of the activities in the home with regular social events including parties, themed evenings, cultural food events and Disco/DJ evenings, all planned and lead by the young people. They invite friends who also clearly enjoy these events. Requests have also resulted in people obtaining passports, flying for the first time to Disneyland, attending summer camp and going for weekend breaks. Staff support is available for these events and inspire confidence, enjoyment and social development and inclusion for people. They continue to access facilities in the local community – the home is well located for this purpose. A young person was involved in a recent staff recruitment programme. This was successful and there are plans to extend this to all people using the service. There were serious concerns about the medication systems at the time of the last inspection. A requirement was made for an urgent review of medication. This has been successfully addressed – inspection of the system during this inspection showed vast improvements and what is now a good and safe system of medication that ensures people have the necessary prescribed medication to sustain good health. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 At the time of the last inspection there had been friction and difficulties between the home and the GP practice serving the home. The GP practice have informed us that the previous concerns surrounding medication and relationships between the practice and the home have been improved. There are now good professional relationships, which are of benefit to the people using the service. A recommendation to provide training for all staff in Safeguarding Adults has been addressed. Apart from recently employed staff, all have now had this important training. Records of Regulation 26 visits by the provider’s representative were not previously completed/left in the home. On this visit we saw regular monthly visits and reports available in the home. What the care home could do better: The use of the training kitchen should be reviewed as a means of promoting independent living skills for people using the service. Seals to a walk-in shower in an en-suite area should be replaced and action taken to ensure the bath in the main communal bathroom is always available. Progress has been made in many areas and there are plans to further extend what is essentially a fairly new service. There have been 4 Registered or Acting Managers in the past 16 months but we are told that an application for the current Acting Manager to become the Registered Manager, is currently in process with the Commission. We are satisfied with the interim management arrangements for the home. Key inspection report CARE HOME ADULTS 18-65 34 Porthill Bank 34 Porthill Bank Newcastle Staffordshire ST5 0AA Lead Inspector Peter Dawson Key Unannounced Inspection 6th November 2009 09:00 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. 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 home adults 18-65 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. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 2 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 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 34 Porthill Bank Address 34 Porthill Bank Newcastle Staffordshire ST5 0AA 01782 612223 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caretech-uk.com CareTech Community Services Ltd Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Learning Disabilities (LD) 6 The maximum number of service users to be accommodated is 6 Date of last inspection 5th November 2008 Brief Description of the Service: The home provides support and accommodation for up to 6 young adults who have a form of learning disability and complex needs that may include challenging behaviours and/or mental health needs. The service was established for young people 18 years leaving care from children’s homes but requiring ongoing residential support to meet their needs. 34 Porthill Bank provides a good standard environment for 6 young people. There are 4 single bedrooms and 2 flats all with en-suite shower facilities. The building has been extensively renovated at considerable cost, is spacious, comfortable and furnished to a high standard. Accommodation is on 3 floors with shaft lift access to the first floor. The home is located on the edge of a residential area giving easy access by road and public transport to Newcastle under Lyme and Stoke on Trent. Many staff have had considerable experience in providing a specialist service to young people and there is a high staffing ratio to ensure the complex needs of the young people are met adequately and safely. The weekly fees for people at Porthill Bank are £1954 - £2795 per week. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection of this service was on 5th November 2008. The quality rating for this service is 3 Stars. This means the people who use this service experience excellent quality outcomes. The unannounced key inspection was carried out by one inspector on one day from 8.30 am – 5.00 pm. The National minimum standards for Younger Adults were used as the basis of the assessment of the service. An Annual Quality Assurance Assessment (AQAA) was completed and returned to us by the Acting Manager prior to the inspection and provided us with comprehensive information about the service. The AQAA is a legally required self-assessment document containing information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. Some information from the AQAA is included in this report. We were able to see and speak to all 4 people using the service. We also spoke with all staff on duty throughout the day. We were able to observe interactions between them and observed positive and close professional relationships. There were 2 vacancies in the home at the time of this inspection. We looked at a sample of care plans, risk assessments, daily activity records, health and medication records and other documents relevant to the inspection of the service. We inspected the environment including communal and bedroom areas of the home. The Acting Manager was present during the inspection and also the Service Development Manager, both provided helpful information and clarification on matters during the inspection. We were able to feedback a summary at the end of the inspection. We were also able to speak with the new Quality & Performance Manager routinely visiting the home, who provided us with helpful information about quality reviews of the home. What the service does well: This group of young people have lived together previously in children’s homes settings provided by CareTech and continue to be supported by several staff from the former setting. This provides important continuity and a valuable experience in dealing with the challenges they present to the service as young adults. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 6 The young people have been and continue to be involved in decisions affecting their daily lives and have opportunities to express their ideas in specific weekly 1:1 discussions with key workers and in the monthly meetings in the home. Additionally each person has a named carer on each shift who will take the lead on their support needs. Most people have 1:1 care with staff throughout the day. A wide range of educational, social and recreational needs are tailored to meet individual needs. All have attended college courses and achieved goals that give confidence and satisfaction to the young person as part of their educational and social progress. Work placements are integrated with college achievements and possibilities of paid gainful employment being pursued. The high standard environment provides a comfortable, homely place to live with people encouraged to take ownership and enjoy the facilities. There is evidence of good staff recruitment and involving people using the service. Complaint and protection issues are identified early and appropriate actions taken to protect people. What has improved since the last inspection? Requests from people using the service has resulted in an extension of the activities in the home with regular social events including parties, themed evenings, cultural food events and Disco/DJ evenings, all planned and lead by the young people. They invite friends who also clearly enjoy these events. Requests have also resulted in people obtaining passports, flying for the first time to Disneyland, attending summer camp and going for weekend breaks. Staff support is available for these events and inspire confidence, enjoyment and social development and inclusion for people. They continue to access facilities in the local community – the home is well located for this purpose. A young person was involved in a recent staff recruitment programme. This was successful and there are plans to extend this to all people using the service. There were serious concerns about the medication systems at the time of the last inspection. A requirement was made for an urgent review of medication. This has been successfully addressed – inspection of the system during this inspection showed vast improvements and what is now a good and safe system of medication that ensures people have the necessary prescribed medication to sustain good health. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 7 At the time of the last inspection there had been friction and difficulties between the home and the GP practice serving the home. The GP practice have informed us that the previous concerns surrounding medication and relationships between the practice and the home have been improved. There are now good professional relationships, which are of benefit to the people using the service. A recommendation to provide training for all staff in Safeguarding Adults has been addressed. Apart from recently employed staff, all have now had this important training. Records of Regulation 26 visits by the provider’s representative were not previously completed/left in the home. On this visit we saw regular monthly visits and reports available in the home. 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. 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. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive information and assessments ensure people’s needs can be met and that placements are successful. EVIDENCE: This service was registered in July 2008 to provide accommodation for young people leaving care at 18 years, who were from CareTech children’s homes settings in the neighbourhood. They had all lived together previously and were actively involved in planning and establishing the home. The transitional arrangements were excellent. This is the second key inspection since the home’s registration. There were originally 6 young adults and this reduced to 4 in January 2009. There have been enquiries and two people proposed for admission. The service is keen to take the time to make the correct judgment about the suitability of new people and ensure they are compatible with the needs of the current group. Comprehensive information and assessments are obtained prior to making a decision. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 10 There is a Statement of Purpose and Service Users Guide. These have been revised into an easy-read format for each person including a pictorial input and the price of care for each person. A more user friendly complaints procedure is also included. The address and telephone number for the Commission needs to be updated. The AQAA states that in the next year the service intends to, “Develop a DVD Statement of Purpose. One resident has volunteered to take part in this and is excited at the project. She is currently undertaking performing arts at college” 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good individual plans, reviewed regularly with the young people ensure they are supported to make decisions about their lives with appropriate support. EVIDENCE: We looked at a sample of care plans, risk assessments and activity plans. Personal plans clearly involved the individual person in compiling and reviewing them with assistance from the key worker, records we saw had been signed by the young person involved. Information was detailed and comprehensive and we were assured that as far as possible people understood most of the information in the care plans. The process is person centred and based upon detailed assessments, incorporated into the information and there was evidence of regular reviews of care plans and risk assessments. Risk assessments about daily living are detailed; we were able to see risk 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 12 assessments for ‘hotel’ and ‘flight’ for a person flying for the first time for a Disneyland holiday. Young people in this service have the propensity to present behaviours that challenge and interventions are needed to respond to those challenges. We saw well documented support and behavioural plans to deal appropriately with situations that present challenge and sometimes physical, aggression towards other people using the service or staff. Activity programmes are developed individually – we saw four separate activity plans and discussed some with the young people involved. They clearly contribute to activity planning and speak with enthusiasm about their programmes. Health information is provided in Health Action Plans, outlining health care needs and recording actions taken to ensure good health and wellbeing. A record of interventions by Healthcare professionals is evidenced. Monthly meetings are held with people using the service and each key worker ensures that specific “1:1 talk time” is set aside each week to comment upon any aspect of support. This is fed into the service and into activity plans to provide an evolving process of monitoring and reviewing the needs and wishes of all people in the home. People are encouraged to participate in aspects of life in the home, some have been involved in staff selection and some have advice and support from Independent Advocates as well as family support. The service is aware of current policy and good practice issues and tries wherever possible to transfer this into daily life in the home. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to educational, leisure and community facilities ensure social inclusion for and maximise quality of life of the people using the service. EVIDENCE: The four people using the service have all been involved in college courses, mainly full time. One has recently completed a course and awaiting placement on an alternative appropriate college course – meanwhile she has a varied programme of activities, both internally and externally throughout the week and is fully and constructively occupied. This person usually needs 2:1 support whilst attending college. She told us that she enjoys her programme of activities and talked about a recent short break in Blackpool, supported by two 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 14 members of staff. There are plans to support one young man to seek employment when his current college course finishes. The AQAA states, “Workers facilitate the young adults to access and undertake varied educational and leisure pursuits including day trips, holidays, sport and church attendance. They engage in meaningful daily occupation that includes attendance at college and some undertake voluntary work. They have a range of achievements including college certificates and qualifications, medals for sport, cups for pool and snooker etc” - This was evidenced in discussions, recording of activities and from observations. We saw that the activity records give a clear and detailed account of how people spend their day including activity, food, mood and significant events. Transport is readily available including the home’s people carrier, bus passes, train and taxis. All have to be supported by staff outside the home, although one does make monitored journeys by taxi. People are involved in domestic routines in the home that include taking responsibility for maintaining their bedrooms. We were told that they gather and sort laundry. The main kitchen is locked to ensure safety although some do access that area with staff supervision. There is a “training kitchen” that people do access, although there was no food or drinks available. Reasons given were food obsessions and safety. The Acting Manager disagreed, but we felt that basic facilities for preparing drinks and simple snacks could be made available as part of the home’s stated philosophy of maximising independence and the development of practical and social skills. Greater, more spontaneous access to this area would benefit people using the service. The building provides places for 6 people - with 4 bedrooms and 2 flats – the flats have separate sitting/lounge areas with the object of preparing people for progression to greater independence. All have en-suite facilities with a walk-in shower facility. One person showed us her new flat with enthusiasm and pride. She had recorded in the comments book, “I am very happy that I moved into the flat”. We saw menus that reflected a varied menu and included healthy eating options compiled with input from people using the service. Themed nights have included different cultural foods that people clearly enjoy. Many social events at nights and weekends are initiated by the young people, who arrange parties, invite their friends and enjoy disco music hosted by one of them as DJ. The home is well located and allows swift and easy access to local community facilities. Where possible people handle their own monies, two have bank accounts and cash cards and all have support to budget. Finances kept on behalf of people were briefly seen where monies received and taken are recorded. We did not audit the system on this visit. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 15 Staff have had training in equality and diversity. There are no barriers to any activities or facilities. People invite friends as guests to the home and there are no restrictions or judgments. Additional male care staff have been recruited to give full and regular access to male and female staff on each shift. In this area it states in the AQAA that this could be further improved with, “training in supporting adults with learning disabilities in the areas of sexual relationships and sexual health”. Families and friends are an integral part of the care and support given. All young people have contact with their family, this varies from telephone contact to regular weekly visits and overnight stays. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed health action plans and a vastly improved medication system ensure people’s healthcare needs are safely met. EVIDENCE: Support in personal care is not required to meet the physical needs of people. Only oversight, prompting and monitoring surrounding personal hygiene is needed. This is given sensitively and privately by a chosen carer identified on each shift, which allows choice of gender. Each young person is supported to complete a, ‘My Health Action Plan’ giving details of diagnosed healthcare needs including physical and emotional healthcare needs. Action plans include the interventions necessary to promote current and future healthcare needs. All are registered with a General Practitioner and receive a range of specialist services provided by the local learning disability service including: Consultant Psychiatrist, Psychological 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 17 services, Speech and Language, Occupational Therapists, Social Workers and Community Nursing Services. Sexual health training for staff is being planned to give people more support in that important area. All people have a diagnosis of autism and behaviours that challenge the service. Additionally some have mental health needs and some need epilepsy care. Specialist external support is available to meet the complex needs of the group. Behavioural specialists are available to support and advise on detailed behavioural plans where there are significant identified needs. Individual needs in these areas are defined in Personal Care Plans, 24 hour plans of care, behaviour support and activity plans. At the time of the last inspection the GP expressed concerns about the medication system in the home. Relationships between the home and GP practice were tense and unsatisfactory. We found that the medication system in the home was unsafe and made an immediate requirement to urgently review the medication systems with the GP and Pharmacy to ensure the safe handling of medicines in the home. On this visit we found that the medication system had been changed. A monitored dose system is now in place. Checks showed the safe recording, handling, safekeeping and administration of medicines. We were able to audit the system and ensure that the correct medication had been administered to people as prescribed. Records were good with written protocols for PRN (as required) medication, there was a diminishing count of medication held in the home and all medication listed with purpose and potential side effects. The medication stocks are now checked and signed daily by staff. - It was not previously possible to audit the system. All staff have had training in administering medicines and also tests to ensure competency (not seen). There is a vastly improved medication system in the home that is now safe. We spoke to the GP practice about these issues. They confirmed that they had no further concerns about the medication system in the home and that relationships had also improved over the past year between the home and surgery. There are now no areas of dispute concerning other aspects of health care. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures ensure people have opportunities for expressing concerns about the service. They are safeguarded from harm by staff training and robust procedures. EVIDENCE: The organisation’s complaints procedure is available with the visitors book in the reception area of the home for visitors. There is also a good pictorial complaints procedure and each young adult has a copy in their service user guide. This is reinforced in discussions and meetings with people. Our address and telephone number details need to be updated in both. People are provided with opportunities for raising concerns in weekly “1:1 Talk Time” and monthly meetings together. The home have received 3 complaints since the last inspection, these have been dealt with swiftly and appropriately under the home’s complaints procedure. We have not received any complaints about the home since the last inspection. At the time of the last inspection there were shortfalls in staff training in Safeguarding Adults. This has been addressed. Apart from recently employed staff all have now had training in this important area. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 19 The home has made 3 referrals under safeguarding procedures since the last inspection. These were appropriate and necessary referrals and related to disputes between people using the service resulting in minor injury. The disagreements were as a result of the ongoing controlling behaviour of two young people. Strategy meetings were held and advice sought from learning disability specialists. As a result some changes were made to the behavioural strategy plans. The home had followed all procedures and actioned strategy meeting requirements to provide good outcomes for the people using the service. Safeguarding procedures are clearly displayed in the office area of the home and staff aware that procedures must be followed after hours and when managers may not be on duty. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in a smart and well maintained home that is both comfortable and safe. EVIDENCE: This home was established to provide accommodation for a group of young adults moving from children’s settings at the age of 18 years. They were involved in the planning, changes and extensive renovation of the building and as a result are able to take some ownership of the facilities and presentation of the home. There are 2 lounges on the ground floor, a reception area and separate dining area. There is also an office, laundry, kitchen and training kitchen referred to previously in this report. The first floor provides a smaller lounge, 2 single bedrooms. The 2 flats also have lounge areas; used as a means of promoting 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 21 independence for people who may ultimately be supported in the community. There is another area being refitted to provide a gym and hairdressing/beauty treatment room. On the second floor there are 2 single bedrooms. All bedrooms and flats have en-suite facilities with a walk-in shower. All bedrooms/flats in use were seen, were well furnished with equipment and soft furnishings chosen by the young people in individually personalised rooms. We noticed that in one en-suite area the floor seals to the shower area were not in place exposing the floor adhesive. This should be re-secured. As all rooms have shower facilities there is a need for only one bathroom. We found that there was no plug for the bath and it could not be used. We noticed in records seen that days earlier, a person had been unable to have a bath upon returning home and this had contributed to some distress for the person. The plug should be replaced. The home is very well presented throughout. Furniture, fittings and equipment are to a high standard, providing a comfortable homely setting. Standards of hygiene are high. There are regular Health and Safety and fire risk assessments ensuring the continued safety of the building. We were told that CareTech’s maintenance responses are swift and positive. The Estates Manager attends local management meetings. The AQAA states, ‘Service users have been supported to enjoy their home and throw it open to family and friends by planning and executing a number of parties, club nights and themed dining nights’. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate numbers of well trained and supported staff ensure that the needs of this group of young people are adequately met. EVIDENCE: Staff roles are clearly defined. Some staff have previous knowledge and experience of the people they support, having cared for them in the previous children’s setting, this has been a positive factor in a smooth transition into this home for younger adults. The AQAA states, ‘Staff at Porthill are a mix of female and male. They are varying ages and have different ethnic backgrounds, cultures and religions. This ensures service users are supported by a diverse team rich in individual experiences, skills and qualities’. We saw evidence to support this statement. We spoke to all staff on duty during the day. They were positive and clearly committed to the needs of the 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 23 young people with whom they had good engagement and had established positive relationships. Staff we spoke with confirmed that they were well supported by managers and that their training needs were met by the organisation. Following induction, placement on LDQ training courses are arranged and specialist and statutory training courses available to staff. A number of staff have already completed NVQ awards and more enrolled for imminent courses. Staff confirmed monthly staff meetings take place (minutes were seen) and also that there is regular supervision. There is now a training matrix giving a clear summary of training undertaken or needed. The shortfall in training in Safeguarding identified in the last report has been provided. The training matrix is now included in the details with the Statement of Purpose. There are good staffing levels. People are generally allocated 1:1 staffing as part of their assessment and contractual arrangements with sponsoring authorities. There are 2 waking night staff and we were told that this equates with the night time demands of the service. We inspected some staff files to assess recruitment procedures. We found that all required checks had been carried out prior to employment and all other documentation required under regulation was present. We were told that people using the service had been involved in some staff recruitment and that this had been successful. The service would like to extend this further in the future to become a regular feature of recruitment procedure. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 Leadership and management in the home ensure people’s health, safety and welfare. EVIDENCE: The home has had one Registered Manager and 3 Acting Managers since registration 16 months ago. The present Acting Manager has been in post since July 2009. Her application to be approved by us as the Registered Manager is presently in process. She has extensive experience with this client group and also supported this particular group in their former children’s setting. Her appointment as Acting Manager seems to have brought the necessary positive lead and stability to the 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 25 home. A new Deputy Manager has been recently appointed and also several new staff in recent months. There have been many positive changes since the last key inspection. The organisation supports the service from a regional office in West Bromwich but has recently opened a local office. There is an experienced Service Development Manager (present during the inspection) who also carries out monitoring visits under Regulation 26 of the Care Home Regulations. We saw regular monthly visits, review of service and reports supporting the visits and actions taken. A relatively new Quality & Performance Manager (also spoken with during the inspection) oversees quality reviews and feedback from people using the service. Quality review reports were available in the home. There are regular weekly management meetings including the people mentioned above. Additionally there is a monthly meeting of 4 Adult Services Managers, 4 Children’s Services Managers, Maintenance, Finance and others as needed. We are satisfied with the interim management arrangements for the home pending the approval of a Registered Manager. The Organisation supports the service well and we are pleased with the progress and changes being made to further develop a positive service for this group of young adults. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 3 3 3 3 3 3 Version 5.3 Page 27 34 Porthill Bank DS0000071639.V378306.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA11 YA27 Good Practice Recommendations The service should review the use of the training kitchen with a view to people learning and using practical life skills Floor seals should be re-fitted in the en-suite shower identified and a bath plug provided to ensure there is a bath facility for people. 34 Porthill Bank DS0000071639.V378306.R01.S.doc Version 5.3 Page 28 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.westmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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