Care Home: 35 & 37 Britannia Road

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What the care home does well Information is available to people about the services and facilities that are provided at the home, this is in the form of a Statement of Purpose and a service users guide. Care plans are well written and ensure that the person living at the home is `central` to the assessment and decision making processes, plans are kept up to date and are well reviewed. Individuals are supported to access healthcare services as required, medication is well managed at the home. There has been a consistent staff and management team at Britannia Road, these staff members know the people who live at the home well and have a sound understanding of their needs and wishes. Staff have developed effective methods of communication and ensure that individuals are consulted with choices and decisions about their life. Individuals who live at the home are supported to participate in activities of their choice, risks are managed affectively. What has improved since the last inspection? During our last visit to the service we reported that in order to demonstrate that the organisation is committed in providing a well-maintained environment there were a number of areas that required attention such as the tidying and clearing of the back garden area and the cleaning of an extractor fan in the bathroom, there had been improvement noted by us at this visit in these areas. In order that all staff are clear on how to support individuals it is important that all staff read individuals behavioural guidelines and furthermore sign to say they have done so, we found at this visit that staff were signing records to state that they had read these guidelines and staff we spoke with demonstrated an understanding of the complex needs of people who live at the home and how they would be supported. In order to fully demonstrate that the weekly fire safety checks are being undertaken at the home it was required at our last key visit that these records be better maintained, a review of the fire logbook at this visit showed significant improvement in this area. The requirement had been met. In order to ensure that all individuals access to the homes transport is not limited it was recommended by us during our last visit that the home consider the current use of the house vehicle. At this visit we found that full consideration had been given to this area, a new car was now being used and this was being used fully by all individuals to access social, leisure and education services. What the care home could do better: Whilst reviewing staff training records it was found that staff were not completing refresher training on an annual basis in respect of manual handling, in order that staffare kept up to date with current good practice it is recommended that this training is updated on an annual basis. It is required by us that the home must comply with the recommendations reported within the fire officers report, including ensuring staff receive sufficient fire instruction. it is further recommended by us that the home forward to Avon Fire and Rescue a copy of the homes updated fire risk assessment and also that the home act upon their own internal assessment to rectify areas of shortfall and take action required as identified. It is also required that the home forward to us a copy of the redecoration refurbishment plan to demonstrate to us a commitment in providing a well maintained environment for those who live at Britannia Road, this should include the replacement of the two damaged lounge chairs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 35 & 37 Britannia Road 35 & 37 Britannia Road Kingswood South Glos BS15 8BG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 35 & 37 Britannia Road 35 & 37 Britannia Road Kingswood South Glos BS15 8BG 01179618661 01179608686 helen.swash@sense.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sense, The National Deafblind and Rubella Association care home 5 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability physical disability sensory impairment Additional conditions: 5 5 5 May accommodate up to 5 persons aged 19 - 64 years Date of last inspection Brief description of the care home Britannia Road is a five-bedroom home in Kingswood, South Gloucestershire, and was established as a care home for adults in 1999. It has been converted from two semidetached houses, with a connecting corridor to facilitate staff support. The home is based approximately one mile from Kingswood High Street where there is a good selection of local shops. Other Community facilities available in the Kingswood area include Dial-a-Ride bus services, Leisure Centre, Community Centre and Adult Learning classes. Access to Bristol city centre is easy where there is the full range of facilities you would expect in a large city. The home provides placement for individuals with single, or dual sensory impairment, plus additional learning disability. Adaptations include flashing lights, minicom telephones, and tactile surfaces amongst other things. Accommodation is provided for five adults aged between 19 and 64 years. The home is Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home not able to provide nursing care for individuals and is unable to accept admissions on an unplanned or emergency basis. There are currently four individuals living at the home. Care Homes for Adults (18-65 years) Page 5 of 31 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: This unannounced key standard site visit, it was carried out in two days over a 8 hour period by one inspector for the Commission. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. Prior to visit an Annual Quality Assurance Assessment had been completed which allows the service to describe what the home does well, what has improved over the past 12 months and the areas for improvement that have been identified. This assessment was comprehensively completed and provided clear information about the Care Homes for Adults (18-65 years) Page 6 of 31 home and the future development plans and areas raised within this document were verified during the visit. During this visit we reviewed records at the home, these included care and associated documents for all of the individuals who live at the home, we reviewed staffing records including recruitment, selection and training records, we also reviewed fire safety records. During this visit a tour of the communal areas was also undertaken. What the care home does well: What has improved since the last inspection? What they could do better: Whilst reviewing staff training records it was found that staff were not completing refresher training on an annual basis in respect of manual handling, in order that staff Care Homes for Adults (18-65 years) Page 8 of 31 are kept up to date with current good practice it is recommended that this training is updated on an annual basis. It is required by us that the home must comply with the recommendations reported within the fire officers report, including ensuring staff receive sufficient fire instruction. it is further recommended by us that the home forward to Avon Fire and Rescue a copy of the homes updated fire risk assessment and also that the home act upon their own internal assessment to rectify areas of shortfall and take action required as identified. It is also required that the home forward to us a copy of the redecoration refurbishment plan to demonstrate to us a commitment in providing a well maintained environment for those who live at Britannia Road, this should include the replacement of the two damaged lounge chairs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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. Clear Information is available about the services and facilities that are available to individuals who live at Britannia Road. Clear contracts are in place, these outline the terms and conditions of the placements and what individuals can expect from the service Evidence: At this visit we reviewed the homes Statement of Purpose and service users guide. Within the Statement of Purpose we saw that information within this document included information about the vision, values of the organisation Sense. Information is included about the homes registration with The Care Quality Commission and information about the Registered Persons, their qualifications, skills and experience and their contact details. Information within the statement of purpose also includes information about the service to be provided by the home, the criteria for admission, fees to be paid and the terms and conditions of the placement and what people who live at the home can expect in terms of the care planning and reviewing processes at the home. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The service users guide at the home provides information about the range of needs that can be supported at the home, the facilities provided and information about staff. we noted that the information about staff within the service users guide was not up to date and also that the information about the address and contact details of the Care Quality Commission were not correct in this document and the Statement of Purpose, the manager agreed to update this guide in order that both these documents contain accurate information. The home has a clear admissions policy, however, we did not fully review the process for admission into the home as there have not been any people admitted into the home for a number of years, there is one vacancy at the home and their are not any immediate plans to fill this vacancy at this current time. We saw in individuals care files that full care management assessments had been completed prior to any individuals being admitted into the home and that the home had used this information in order to provide a basiss for their own assessment, full and detailed assessments were completed by the home in order to ensure that people were able to be fully supported at the home, in line with their identified, assessed needs. We saw that each person had within their file a placement agreement. The agreements in place were for 2009/20010, within the agreements was information about the fees to be paid, information is provided on how individuals would be supported at the home and what services and facilities are provided as part of the terms and conditions of the placement. Care Homes for Adults (18-65 years) Page 12 of 31 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. Detailed information is recorded within individuals plan of care, staff assist people with their personal goals and involve individuals in the decision making process. Individuals are supported to take risks within a safe context in order to have independence and control over their lives. Evidence: At this visit we reviewed the information folders for all of the four people who live at the home. Within each persons folder we saw that each file was divided into four sections. These were about me , the individuals care plan, minutes of care meetings and minutes of reviews and historical information. Within the about me area within individuals files we saw that this section contained information about health and medical support, there was also a pen picture this is an overview about the individual and records information about the individuals likes and dislikes. Within this section these was also information about individuals spiritual and cultural requirements. We Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: saw that, where possible, individuals were consulted and involved with the information contained within their folders and had been supported to make decisions which affect their life. Records had been written with the individual concerned being central to the process with the focus being about them, their wishes, support requirements with clear information about how they would be supported. At our last key visit to the home in June 2007 we reported that in order that all staff are clear on how to support individuals it is important that all staff read individuals behavioral guidelines and furthermore sign to say they have done so, we reviewed this at this visit and found that staff were reading behavioural guidelines and furthermore staff were able to explain to us why information had been recorded and of what benefit this had been for the individuals concerned, we found this recommendation to have been met. We also saw that individuals who live at Britannia Road are offered the opportunity to participate in core team meetings in order to discuss their goals, and aspirations and how they would be supported to achieve these. Core team members are members of staff who have been identified as those who support individuals with day to day support and to assist with the day to day and longer term plans for people who live at the home. Action plans and individuals wishes were well recorded with evidence to show that individuals had been consulted and their views considered and acted upon. Within individuals records we saw that a deprivation of liberties form had been completed for all of the people who live at the home, these assessment forms had been completed in order to review whether the person who is supported by a Sense service is, or may in the future be deprived of their liberty. The assessment covered potential restrictions and factors which could, in combination amount to a degree of restriction. Assessments had been completed by the manager of the home, and the area manager for Sense and had also been signed by the service user. Staff employed at the home have all completed training about the legislative requirements of the Mental Capacity Act. Within each individuals folder risk assessments are in place, these are prams these are person centered risk analysis system. We saw assessments that demonstrated that individuals are supported to take risks, within a framework of support without limiting individuals opportunities. Assessments had been well written and covered areas such as swimming, control of individuals finances. Risk assessments had been recently reviewed and cross referenced into other significant documents which impacted on individuals lives and support, such as peoples communication and behavioural guidelines. We saw within these assessments that peoples right to refuse to participate had been respected and recorded in line with individuals wishes. Britannia Road have clear policies in respect of confidentiality and data protection, we noted that these areas are discussed periodically with individuals during their one to Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: one supervision sessions and also in discussed as part of the organisations induction programme and part of their training session which introduces new staff members to the organisation. Care Homes for Adults (18-65 years) Page 15 of 31 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 well supported to take part in appropriate activities and are supported to be part of the local community in accordance with individuals assessed needs and wishes. Evidence: Through a review of individuals care files, minutes of review and core meetings as well as discussions and our observations during our visit to the home it was evident that people who live at Britannia Road are well supported to take part in age, peer and culturally appropriate activities. People are asked what they would like to do and the home look to faciltities this, either themselves or through other agencies. We saw that their are people living at the home who attend college, one person is completing a course on music/drama, another persons doing a computer workshop. We also saw that involvement opportunities are discussed with people and the individuals themselves make the decision on what they wish to do, or not. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: On the day of our visit we saw that people were supported to attend day activities of their choice. We also saw that people are supported to access community and leisure services such as swimming, cinema, visits to funfairs, skittles, festivals, visits to the pub and restaurants and clubs. There are people who use the services of Woodside a local community Centre and appear to make great use of this resource. During our last key visit to the service we reviewed the homes transport arrangements, this was in oder to ensure that this vehicle was suitable and able to be used by all, a recommendation was made that that in the home consider the current use of the house vehicle. At this visit we spoke to the manager and staff about transport arrangements, we were informed that a new, more suited vehicle had been purchased and full use of this was being made of this. We also saw in individuals files that people had their own bus passes and were able to use these for free public transport. We saw within individuals care plans and minutes of core review meetings that peoples rights to refuse to participate had been also been recorded, and respected. Within individuals care records we saw that the home had obtained and recorded the likes/dislikes and special dietary requirements for people who live at the home, within daily record sheets completed by staff we saw that each person had recorded the meals that had been offered and had. These recorded corresponded with the information we had seen within care plans.During our visit staff were overheard offering individuals a choice of meal and individuals were given assistance to prepare their lunch in a supportive manner enabling people to maintain independence skills. Care Homes for Adults (18-65 years) Page 17 of 31 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 living at the home are supported to receive personal care in the way they prefer and require, peoples health and emotional needs are met at the home and by other supportive agencies. Medication is well managed at the home. Evidence: We saw in daily notes and within individuals care plans that people are asked how they wish to be supported in aspects of their life, including personal care. We saw that people were supported with their personal support in private. People are able to get up and retire when they wish, meals and activities are flexible and staffing is provided to ensure that people are guided and supported in line with their wishes and also ensuring that individuals best interests are fully considered. The people living at the home are young and individuals have been supported to purchase their own clothes, hairstyle and individuals appearance reflects their personality and choice. All of the people living at the home are registered with a local general practitioner and Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: are assisted to visit this service when required. we were informed by staff and the manager that people are generally well within their health and are supported when individual needs are identified. The manager informed us that people are well supported by the local authority community learning difficulties team and gave a number of examples of specialist healthcare support for people living at the home, such as a speech and language therapist and also an occupational therapist who is currently in the process of assessing an individuals needs in respect of possible aids to assist with their bathing and maintaining their independence. Within health monitoring records maintained at the home we saw that people are accessing primary healthcare services such as optician and dentist on a regular, as needed basis. At this visit we reviewed the practices for supporting people at the home with their medication. A member of staff talked us through the process for medication administration, storage and recording. We looked at medication held at the home and reviewed medication records. We saw that medication was being given in line with prescribed guidance, records were clear with no errors or omissions. The staff member we spoke with told us about their medication competency training and was able to give a number of clear examples of their role and responsibility, demonstrating a sound understanding. We saw good records are held for medication that is no longer required and for medication which is held in stock. We saw that the pharmacist who supplies and dispenses medication to the home had visited and inspected the arrangements in place at Britannia Road, this visit was undertaken in October 2008, no areas of concern were recorded. Care Homes for Adults (18-65 years) Page 19 of 31 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 home has clear policies and procedures in place in order to protect people who live at Britannia Road, training is given to staff within the area of adult protection. Evidence: At Britannia Road, there are well established policies and procedures in order to respond to and deal with complaints and issues of concern that are raised about the service. Clear information, in line within individuals communication requirements is provided at the home. During this visit we reviewed the homes concerns, complaints and compliments folder and saw that the last complaint recorded was in July 2007. We asked the manager if there had been any other concerns or more recent complaints and were were informed there were not. We saw that within individuals folders they had been provided with a copy of the complaints procedure in the format which was most appropriate to them based on their level of communication requirements. We saw that people are reminded of the process in which they would be supported to raise a concern or make a complaint at their individual one to one core meeting and also within house meetings. No one raised any concerns to us during our visit to the service, no concerns or complaints were raised to The Commission prior to our visit to the service. We asked the manager Helen Swash if there were any safeguarding concerns for Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: people who live at the home, we were informed no there were not. When we reviewed recruitment and selection documents for staff we saw that all the required safety checks to protect vulnerable people had been completed. A review of staff training records evidenced to us that staff have received training in protection of vulnerable adults. A staff member told us about the training they had completed and informed us that the information provided would underpin their knowledge and understanding of their responsibility in this area. The home also has an adult protection trainer working at Britannia Road. This person is able to provide staff with knowledge and support during induction, record keeping, and advice if required. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suited to the needs of the current group of people who live at the home, with faciltities provided as required. Evidence: Britannia House is located within the residential area of Kingswood and is in keeping with the local community. The premises are accessible for the current people who live in the home. It has local facilities nearby which include shops, banks, churches, general practitioner, pubs and restaurants. During our last visit to the service we reported that in order to demonstrate that the organisation is committed in providing a well-maintained environment there were a number of areas that required attention these included that the rear garden must be cleared of clutter in order that it is safe and accessible for individuals use, we saw at this visit that this area had been cleared and it was obvious that people had been making good use of this area during the warm weather. We also required that the bathroom ceiling fan be cleaned as it was thick with dust, we were told that this had been done at the time, however this still is not to the standard of hygiene that is required and attention should be given to improve this. At out last Key visit we saw that the unit in the dining area was damaged and recommended that it be replaced, Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: we saw that this had been replaced. We also recommended that tiles which were missing in the bathroom, by the office should be replaced, this had not been done, attention should be given to this and other areas detailed within this environmental section of the report. The home has sufficient toileting and bathing/showering areas for individuals use. These areas are close to peoples rooms. The temperature in the home at the time of our visit was warm and comfortable. Generally the home was found to be clean and tidy. During this visit we did not go into individuals private rooms, we were informed by the manager that some of these rooms had been redecorated since our last visit and the individuals had been consulted and their wishes taken into account when these areas were re painted. During our visit we viewed the lounge area and saw that this had been divided into two spaces in order to accommodate the wishes for people living at the home, in this lounge we saw that two arm chairs had been patched up on the arms of the furniture, both in a contrasting colour and looked shabby these chairs should be replaced. The dining room had appropriate furniture and appeared to be well used by residents. Within the hallways, stairs and landings and the bathrooms we saw that paintwork was worn, chipped and these areas looked poorly maintained and tired. The manager assured us that quotes had been obtained for redecoration of communal areas including the lounge and dining areas and proposal were in place for this work to be undertaken in July 2009. It is recommended that the home submit to us the proposal for the maintenance of interior decor work, to include timescales. Care Homes for Adults (18-65 years) Page 23 of 31 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. Those living at the home are supported by staff who are clear about their roles and responsibility, staff are well motivated and strive to provide a consistent service for those living at Britannia Road. Evidence: There have been very few changes in the staffing team since our last visit to the service, thereby providing continuity for those who live at the home as they are supported by staff who know them well and who have the required specialist skills to support people who have complex communication needs. There are two deaf staff who use BSL as their 1st language, and contribute to having a total communication environment. The individuals at Britannia Road are also happy to have Deaf staff working with them. All staff have received training in Deaf Awareness. We saw that staff members are issued with job descriptions and contracts of employment, these clearly outline individuals roles and the expectations which the organisation place upon them and how they would be supported within their posts. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective communicators and were interested and motivated in Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: meeting the needs of those living at the home. On duty on the day of the visit were three support staff, staff confirmed that at night there are two members of staff, one person is on call and the other is awake, in order to support people during the night. During our visit we spoke with a member of staff who has been recently employed at the home, this staff member spoke with enthusiasm and warmth about their role. They told us of their induction process and also informed us of training they have undertaken such as protection of vulnerable adults, health and safety awareness and first aid. This member of staff told us, and we also saw in their records, that they were also booked to undertake training in effective communication, working for sense and understanding the values of the organisation and also will be completing training in dealing with behavior that may challenge. This person told us that they feel well supported by the manager and other members of the staff team at the home and also that they felt that the training completed so far had provided them with essential skills in order to work effectively with the people living at Britannia Road. Although we did not view the induction documents completed by new members of staff the manager informed us that the induction completed by the staff at Britannia Road is in line with the required standards as set out by skills for care. At this visit we viewed the staff welcome pack. We saw that within this pack staff had been provided with information such as specific information to support individuals who have a sensory impairment and a learning difficulty, information is given about the aims and objectives of the organisation and details how individuals will be supported within their role through training and individual supervision and probation. During this visit we reviewed the training matrix in place at the home, this showed us that people complete core and specialist training as required, refresher training is required within areas of fire safety and manual handling and information about this can be found within the management section of this report. The training matrix, along with discussions with the manger and staff as well as training certificates seen, demonstrated that staff have completed training in: first aid, care of medicines, noncrisis intervention, effective communication including British Sign Language, working with deaf/blind people, protection of vulnerable adults, infection control and health and safety. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a person with the relevant knowledge, skills and experience in order to support both those who live and work at the home. Suitable arrangements are in place to ensure the health and safety for those who live and work at the home, however, the home must ensure that staff undertake required refresher training in fire safety and manual handling. Evidence: The registered manager of the home is Helen Swash, Ms Swash has completed NVQ 4 in Health And Social Care and her Registered Managers Award. Other management training has included Disciplinary and Capability, Risk Assessments Supervision and Appraisals, Mental Capacity Act training, Equality and Diversity, Finance training and Conflict training and DoLS. (deprivation of liberties). We can confirm that The registered care manager also has a job description and understands that her role includes implementing policies and procedures, managing a budget, ensuring contracts are in place and fulfilled for each person in the home, to comply with care standards Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: and other relevant legislation as well as being open and approachable to staff, adopting a multi agency approach to care planning , keeping records that are clear, accurate relevant and appropriate to its purpose. Within the homes Annual Quality Assurance Assessment completed by the home in March 2009 they had recorded that: We ensure that all aspects of Health and Safety within the workplace are adhered to and monitored. Each staff member has a delegated responsibility in relation to health and safety, this includes gas checks, electrical checks, first aid supplies, vehicle maintenance etc. A senior member of staff completes a generic health and safety audit on a monthly basis which monitors that all health and safety checks have been completed, that window restraints work, risk assessments are in date and relevant, posters, licenses and certificates are valid and on display if required, etc. We also have an annual health and safety audit from a senior manager and aspects of health and safety are also checked by the General Manager during regulation 26 monthly visits. Accidents are recorded and remain confidential with Data Protection Act and the information is put into a data programme on a monthly basis and sent to the Health and Safety manager for the region. Any patterns or high level of accidents are investigated and this has recently been carried out at Britannia Road. Formal notifications known as Regulation 37s are use to report incidents that affect the wellbeing of individuals and a number of these have been reported in the last 12 months. Whilst we were at the home we reviewed the homes Sense quality assurance self assessment. This had been undertaken at the home in August 2008. As part of the auditing process the home had sent questionnaires to those who use the service, relatives of those who live at Britannia Road, those who commission from the service. Staff and the manager employed at the home were also involved in the auditing process. The summery of the findings included information to be incorporated within the homes own action plan in order to provide a structure for the service to respond to the areas identified within the assessment process. At our last key visit to the home, which was undertaken in June 2007 we reported that in order to fully demonstrate that the weekly fire safety checks are being undertaken at the home it is required that these records must be better maintained. At this visit we reviewed the recording of fire safety checks and are satisfied that this requirement has been met. We saw that the home have been recording both weekly and monthly fire safety checks in respect of equipment and emergency lighting at the home, we saw records of contractors visits which evidenced that systems and fire safety equipment within the home is well maintained. When we reviewed fire training records we found that not all staff are receiving the required safety instruction, this was also noted by the fire officer who visited the home in March 2009. Within the fire officers Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: report we saw that recommendations had been made by them, one of these included that the homes fire risk assessment was not suitable and sufficient, we spoke to the manager about this and saw that the home had reviewed their risk assessment and had developed a remedial action plan also in March 2009 as a response to the fire officers visit. It is required by us that the home must comply with the recommendations reported within the fire officers report, including ensuring staff receive sufficient fire instruction. it is further recommended by us that the home forward to Avon fire and rescue a copy of the homes updated fire risk assessment and also that the home act upon their assessment to rectify areas of shortfall and take action required as identified. Whilst reviewing staff training records it was found that staff were not completing refresher training on an annual basis i respect of manual handling, in order that staff are kept up to date with current good proactive it is recommended that this training is updated on an annual basis. Whilst at the home we reviewed how the home records and respond to risk. We saw that all of the risk assessments within the homes generic risk assessment folder had been reviewed in April 2009. Risks evaluated had included activities in which individuals who live and work at the home participate in such as food hygiene and use of electrical items. We saw assessments in respect of dangerous objects within the home and control of substances which may be hazardous to health (COSHH). Whilst at the home we reviewed records of accidents that had occurred at the home, we saw that incidents had been well recorded with information provided to demonstrate that people had been supported appropriately in this area with information available on how to reduce the likelihood of incidents reoccurring, where this is possible. There are clear policies and procedures at the home, these have been kept under review and inform and guide staff practice, we saw that these policies and procedures are discussed within the induction programme for new staff and also within supervision sessions. Care Homes for Adults (18-65 years) Page 28 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 41 23 The registered person shall after consultation with the fire authority comply with the recommendations and findings of the recent fire officers report. In order to demonstrate a commitment in providing a safe environment for those who live and work at the home. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 42 The home should act upon the findings of their fire risk assessment to ensure that these who live and work at the home are safe. The home should forward to Avon Fire Brigade a copy of their updated fire risk assessment, this is in order to demonstrate compliance in this area and to ensure that the assessment in place is robust and meets the required standard. 2 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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