Care Home: 41 Regent Road,

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What the care home does well The service provides information for people using the service, in formats they can more easily understand. This is vital if they can be confident that they are involved in decisions affecting their lives. People using the service said in their surveys, "I like living here, I can make my own decisions about what I want to do," and were generally positive about the service they receive. We saw that people have been supported to improve their involvement in a wide range of activities in and out of the home, including employment opportunities. Health and personal care needs are known and action taken to ensure that they are met and montiored. A health professional said, "The service people receive is excellent, I would be happy to recommend this home." The service has provided evidence that staff received regular training and supervision sessions, sufficient staff are available to meet the needs of people using the service. Staff said, "I have immense job satisfaction and believe we offer a good service to people living here. I feel that new staff coming to work in the home have a wonderful induction prior to coming into the home, which is extremely beneficial, this is then continued with a mentor who supports them, this is valuable time for staff and service users which helps them all to settle easily and the little things in the service users life are communicated to make sure new staff are familiar with them." Another said, "I would just like to say that I consider myself lucky to work in this service I enjoy the job I have." The manager has demonstrated that she manages the serice well and knows the areas it should improve. A social worker said, "I have been satisfied with the service provided to the people I support." What has improved since the last inspection? The expert by experience said, "I saw that improvements have been made to the information people have available to them and pleased to see that people knew where the information I asked for was." The service has told us that it is improving the the way in which it involves people using the service with setting their goals and plans and that through care planning and risk assessing one person is now accessing Church and weekly Church events independently. People are being supported in accessing a wider range of activities and social events and outings. Medication procedures have been reviewed and staff have received medication updates. Health action plans have been developed. A full redecoration of the home has taken place and the garden area has been improved and is now accessible for people who are wheelchair dependent. What the care home could do better: The service should continue with is plan for improvements to the service and where possible ensure that people in the ground floor flat have as a many opportunities as those in the first floor flat. Some people said in the surveys, "I don`t know how to make a complaint." Where people have a visual impairment, the service should be sure that information is available to them in a format they can understand. Some elements of medication management could be improved, the homely remedies procedure should be more robust and medication received should be recorded accurately. The service must ensure that staff recruitement procedures are robust, so that people using the service can be confident that they are being protected. The expert by experience said, "People said that they meet to talk about what they want to do but not very often, I think they should be able to meet more often if they want to." Key inspection report Care homes for adults (18-65 years) Name: Address: 41 Regent Road, 41 Regent Road, Hanley Stoke-on-Trent Staffordshire ST1 3BT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Jones     Date: 1 7 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 41 Regent Road, 41 Regent Road, Hanley Stoke-on-Trent Staffordshire ST1 3BT 01782263720 01782263720 accounts@richmondcaregroup.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shelton Care Limited care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 16 Physical disability (PD) 3 Date of last inspection Brief description of the care home The accommodation has been designed to provide single bedrooms in two units of eight beds, each with its own facilities. The interior of the home is decorated and maintained to provide a domestic atmosphere, whereas the exterior of the home retains its industrial heritage, it was previously a factory site. We have been told previously that plans are in place to develop the outward appearance of the building to improve the general look and impression. These plans have been in place for some considerable time. The service provides residential care for adults with learning Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 16 3 Brief description of the care home disabilities including three who may have a physical disability. There is a day service owned by the proprietors on the same site, adjacent to the residential services. The people living at Regent Road are able to access in-house and local community daytime provision. The accommodation is situated close to community facilities and services. The fees for the service are included in each individuals copy of the Service User Guide, prospective users of the service and their supporters should contact the provider for the fee range for the service. Additional charges are made for hairdressing and toiletries. 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: We undertook an unannounced key visit of this service on 17 June 2009. The visit was carried out by one inspector who was accompanied by an expert by experience and his mentor. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Before the visit we asked the service to provide us with information in the form of an Annual Quality Assurance Assessment (AQAA). An (AQAA) is a self assessment that is filled in once a year by all providers whatever their quality rating, it tells us about the service and what it is doing, to try to improve the lives of people who use it. And how it has improved since the last key visit, which took place 26 June 2007. Since the last key visit we have carried out an Annual Service Review which is a summary of our knowledge of a service that has not had a key inspection in the last Care Homes for Adults (18-65 years) Page 6 of 31 year. It is also how we decide if a service is still as good as we thought it was at the last key inspection or annual service review. We send out surveys to people using the service, relatives, staff, advocates, health and social care professionals before a key visit or an ASR. We have had a good response to these, 7 people using the service have returned surveys, 1 social worker, 1 health professional and 4 staff. We have included their comments in this report. During this visit we talked to people using the service and staff, and discussed any areas of concern they had. We discussed any concerns we had noted in the AQAA or surveys with the manager. We looked at information in the home to help us decide if people using the service have a good quality life. We looked at care, staff, medication, health, complaints and other records to help with this. Based upon the information we have been provided with, and what we have seen and heard. Our judgement is that the Quality Rating for this service is 2 star. This means that people using the service receive good quality outcomes. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The expert by experience said, I saw that improvements have been made to the information people have available to them and pleased to see that people knew where the information I asked for was. The service has told us that it is improving the the way in which it involves people using the service with setting their goals and plans and that through care planning and risk assessing one person is now accessing Church and weekly Church events independently. People are being supported in accessing a wider range of activities and social events and outings. Medication procedures have been reviewed and staff have received medication Care Homes for Adults (18-65 years) Page 8 of 31 updates. Health action plans have been developed. A full redecoration of the home has taken place and the garden area has been improved and is now accessible for people who are wheelchair dependent. 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. 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. Prospective users of the service can be confident that they will be provided with information about the service, and have their needs assessed so that they can be sure that the home is suitable. Evidence: The service told us in the AQAA that. We provide comprehensive care packages and risk assessments we complete an in-depth transition plan where possible. Prospective users of the service are provided with a Service User Guide and staff will spend some time with them to explain it. All prospective users will have a six week review and will have their own copy of the guide. We have also been told in the AQAA that the Statement of Purpose and the Guide have been updated and produced in a user friendly format. The expert by experience said, I asked to see the Service User Guide. One of the men who lived in the up stairs flat went and got a copy off the wall for me. I was pleased that he knew where it was and what it was. However, the guide that he gave me had recently been updated so we were shown the new one. They had obviously improved the old one a lot and had Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: made it more accessible with lots of pictures and easy words. The writing was quite small in some parts so this could be changed to match the rest of the guide. The guide was very good as it had the photos of the owners and the Manager and how to contact them. There was a lot of information about how the people who live there pay for living there, paying for things that they break and paying for outings etc. I asked some of the people who lived there about this to see if they understood. Most people understood that their money comes from Social Security but that they contribute some money themselves. They told me that they all pay towards the minibus and that they all get to use it. They didnt know how much they pay towards transport but knew that they paid for the petrol and if they use the minibus a lot then they pay more. I was really pleased that they knew so much about what their money paid for. A person using the service said, I made the decision about moving in to the home with my parents. Other surveys indicated that the majority of people had been involved in the decision to move into the home and had received information about before deciding to. A relative said, We are more than happy with service and care our duaghter has receives. The expert by experience said, When I arrived at Regent Road the first thing that I noticed is that the building stood out from the others on the road, it looked different to the other houses on the street and I instantly knew that it was the residential home. We were shown to the upstairs of the house by the Manager. She explained that there were 7 people living upstairs and 7 people living downstairs. I was told that the people who live upstairs need less support than the people downstairs and they are all able to verbally communicate. At first I thought that this was a large number of people living in one house. The house was split into 2 houses so upstairs there were 2 living rooms, a dining room, kitchen, bathrooms and all of the bedrooms. 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. People who use the service usually play an active role in planning their care and goals, but the service needs to consider how all people can be better involved in decision making. Evidence: The service told us in the AQAA that, We encourage people to be involved in their care plans as much as possible. We promote person centered planning, we provide relevant information in pictorial and user friendly formats, to be sure we can involve people as much as possible. We saw that care records are more accessible and the format is more user friendly, we looked at one persons Person Centered Plan. It contains very good information about the persons needs and what sort of support needed, but it was disappointing to see that she has only two goals. One to go on Holiday, the second to remain more active, we feel that this is not supporting the individual to be more independent. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We saw that where people had a specific difficulty for example a visual impairment, the records show this but are not necessarily pro active in relation to how they support the individual. We also have concerns that not all staff have been trained in autism, when a number of people have been assessed on the autism spectrum. A social worker said, The information provided by the service, for reviews are in depth and valid, and the service always seeks advice and acts to improve peoples social and health care needs. A health professional said, They provide excellent support to clients during reviews, PCPs and professional meetings. And present accurate and comprehensive assessments, which I have observed to always be in a user friendly format. Staff say, Regent Road provides up to date care and addresses the clients individual needs. The expert by experience said, I went downstairs to the other house to talk to some of the people there. There were 5 people in the living room. They had all been out during the day which was good. I was told that the people downstairs have limited verbal communication so the staff supported them to speak with me. The staff told me that one person used pictures and sign language. I didnt see any of these being used whilst I was there. A member of staff showed me some of the peoples rooms. I was disappointed that she did not ask the people if we could go in their rooms and that the rooms were not locked. The rooms are locked upstairs so why is it different downstairs? Whilst I was there a member of staff asked one of the people who live there to help set the table for dinner, it was good to see that they are involved in household tasks. Care Homes for Adults (18-65 years) Page 14 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 who use the services are able to make choices about their lifestyle, but they must be confident that they will all receive similar opportunities. Evidence: The service told us in the AQAA that, We fully involve people using the service in monthly reviews of care plans and risk assessment. Encourage involvement in monthly house meetings. Encourage full participation in making choices, expressing needs and making decisions. Support individuals in participating in the running of the home i.e., menu planning, shopping, cooking and domestic tasks. With the consent of people using the service we fully inform and involve family members of outcomes of health appointments, planned events and holidays. We support individuals in their personal choice of activities, holidays etc. A social worker said, The service offers a range of choices in regards to activities and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: holidays. A health professional said, The staff at Regent Road do an excellent job, and are committed to providing a quality service to all people using the service and their families. Staff say, we liaise well with families and professionals, provide independent daily living skills and choices, provides variety of activities which are always discussed with people using the service. Community presence and interaction is good. A person using the service said, decisions are sometimes made for me due to my autism and me not making suitable choices but I am always included in the decision. I like to go out walking and shopping on saturdays and church on sundays with my peers. Another said, I would like to go out more sometimes. The expert by experience said, I asked some of the people in the living room what they had been doing that day? One lady told me that she takes paperwork to the main office and brings it back to the home. She told me that she gets paid £5.00 to do this. A couple of other people told me that they work in cafe life which is a business that makes sandwiches and delivers them to the local community. They get paid between £10 and £15 for doing this. It really pleased me that people were working and that they were getting paid for it. Some of the other people I spoke to had been to the day centre and to college. They told me that they did drama, dance, English and maths and cooking at college. One girl who I spoke to was going to a college course in the evening and she left to go whilst I was still there. It was good to see that she did courses in the evening and didnt just have to stick to daytime courses. I was also told that people go out to the pub over the road and go to the cinema and bowling as long as there are enough staff to go with them. Everyone can go out separately providing there are enough staff. This is important as not all 7 people are going to want to go to the same places all of the time. Quite a few of the people I spoke to also went to church on Sundays and coffee mornings and evening services during the week. It is good to see that people are being supported to practice their religion. Everyone I spoke to seemed to do quite a lot and they all appeared to be doing activities that they had chosen to do and that they enjoyed doing. One of the men told me that he runs at Northwood Stadium. He showed me medals that he has won by taking part in races all over the country. This really pleased me and it was obviously something he took a lot of pride in. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: I asked the people in the upstairs house if they helped with housework and cooking. I was shown a rota on the wall that clearly showed everyone took turns to help to cook the evening meal, clean the house, clean their rooms and do shopping. The rota had pictures on and was easy to understand. People told me that they also do their own laundry but the staff will help them if they need support. People are supported to make their own breakfast and their lunch. I was really pleased to see that people are being supported to do things for themselves and not just having everything done for them. Whilst I was there I saw people making drinks and getting snacks for themselves. I asked if they had a menu they could choose their meals from. I was shown a written menu. I noticed that there was only one meal written down for each evening and was told that they choose what meals they are having at the beginning of the week. I feel it would be better to have more than one choice on the day and decide what you want then as how many people know what they want to eat a week in advance? 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 who use the service can be sure that their health and personal care needs are met and privacy and dignity respected. Evidence: The service told us in the AQAA that, We follow robust systems to ensure correct administration of medicines, recordings, storage and disposal. Each individual has a health file containing all health information, recordings of outcomes of appointments which is reviewed monthly. All service users have a health action plan and health care plan to ensure health needs are met. Referrals are made to outside health care professionals when changing needs are identified. We have liaised with a lead person at our local PCT for advise on individual health needs. All staff receive medication, epilepsy and rectal diazepam training every two years - or sooner if needed. We looked at how the service manages medication and identified a number of things that can be improved, such as the system should be more robust to ensure that an audit trail can be followed. The system for providing medication for outings or when people are not in the home should be more robust, to ensure that the chance of error Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: is reduced. Homely remedy lists should be agreed with the pharmacist or GP for each indiviudal to ensure that peoples health is not at risk. We saw that the storage facilities are suitable for the purpose and recommended that if controlled medication is prescribed a controlled drug cupboard must be provided. Each person has an Health Action Plan, this is a record of their health needs and the action needed to ensure that their needs are met. We saw that people are being supported to attend health appointments regularly and receive preventative health checks. A health professional said, The service provide excellent support to people using the service, present accurate and comprehensive assessments, which I have observed to be in a user friendly format. People are always treated with dignity and respect. We observed staff responding to peoples needs sensitively and people told us in surveys that, Staff always treat me well. A health professional said, Clients are always treated with dignity and respect. 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. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. They are protected from abuse, and have their rights protected. Evidence: The service told us in the AQAA that, We have pictorial complaints procedures are situated throughout the Home. All new staff are issued with a complaints/ whistleblowing policy on induction. All documentation of complaints, concerns and protection are all responded to and recorded to a high standard. There has been one complaint received since our last inspection of which was not upheld. All staff receive POVA training. We have posters displayed throughout the Home, encouraging people to whistleblow and displaying a phone number to report concerns. We saw that a complaints procedure is on display. Most people have told us in the surveys that they know how to make a complaint and who to go to if they are unhappy. But three did not know. One person said, I always speak to my key worker when I am not happy or low in mood, or other members of staff. The expert by experience said, I asked people if they knew how to make a complaint. They didnt know if they had a complaints form but said if they did have one it would be in the office. They all said that they would tell a member of staff if they werent happy about something and said they all had a Key Worker who they could talk too. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: They all said that they were happy that their Key Workers would sort out any problems that they had. One lady said she had an Advocate that was independent of the home and that she would talk to her if she had any problems. It was good that they all knew who they could talk too if they had a problem. I did notice an accessible complaints leaflet on the wall so the home does have one but maybe the people who live there need to be shown it again so that they know it is there. A social worker said, The service always respond appropriately if concerns are raised. The records show that all staff have received training in the Protection of Vulnerable Adults, we spoke to one member of staff, who was able to give a satisfactory account of what action they would take if they suspected abuse. We are aware that there has been one safeguarding referral since the last key visit, we understand that the service co-operated fully with the enquiry. Information in the AQAA indicates that the service is aware of the changes in law and the Mental Capacity Act, we saw that the manager and deputy have received this training and recommend that other staff are provided with training or guidance. We saw that the service has taken action to ensure that their recruitement procedures are more robust, and all pre employment checks are carried out before staff are employed to work in the service. 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. People who use the service can be sure that their home is safe and well-maintained and provides a comfortable and clean environment in which to live. Evidence: The service told us in the AQAA that, We provide and maintain a safe, clean environment, cleaning rotas are in situ, regularly reviewed to ensure maintaining a safe, clean environment. Health & Safety monthly audits. Rolling decoration and carpet cleaning system in place. We also saw in the AQAA, that there are areas that have improved since the last key visit, these include. Full decoration of the home, internal and external, a new bay window fitted on the first floor. New improved garden area, which is now wheelchair accessible, includes veg patches, flower borders, seating and barbecue area. Weekly visits from gardeners or maintenance to ensure outdoor areas remain safe, neat and tidy. The expert by experience said, When I arrived at Regent Road the first thing that I noticed is that the building stood out from the others on the road, it looked different to the other houses on the street and I instantly knew that it was the residential home. We were shown to the upstairs of the house by the Manager. She explained that there Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: were 7 people living upstairs and 7 people living downstairs. I was told that the people who live upstairs need less support than the people downstairs and they are all able to verbally communicate. At first I thought that this was a large number of people living in one house. The house was split into 2 houses so upstairs there were 2 living rooms, a dining room, kitchen, bathrooms and all of the bedrooms. I sat in the one living room where some of the residents were watching TV. The Manager left the room then so that we could talk to the people who lived there in private. It was good that she did not stay. Another staff member came in and introduced herself but she then left which was good. All the surveys confirmed satisfaction with the environment in which they live. We saw people moving freely about the home. The expert by experience said, All of the bedrooms were personalised and the people who live there had chosen the decor themselves. People in the upstairs house have their own keys. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that staff are provided in sufficient numbers to support them, but because some staff have not been properly checked before starting to work they have been placed at risk. Evidence: The service told us in the AQAA that, All staff are given regular personal development plans and supervisions throughout the year to ensure staff continue to be interested, motivated and committed to ensure they continue to have the skills and experience for the job role. There has been an increase in NVQ trained staff and improved training opportunities. We now have our own bank staff which prevents the use of agency staff. We have an over recruitment of two support workers this ensures we have full staffing levels throughout the year during staff annual leave entitlements. We follow robust recruitment procedures. We noted that the service has a full staff team and provides sufficient staff on duty to meet individual needs. The numbers of staff trained to National Vocational Qualification (NVQ) Level 2 and above exceeds the recommended minimum. There is a programme of regular staff supervision, this was confirmed by two members of staff. We looked at a sample of eight recruitment records and noted that the four most Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: recent have all of the records required, such as two written references, police checks, evidence that identity has been checked and a full work history. But in four others we noted some omissions. The new Human Resources manager stated that she has made changes to procedures to ensure that no one starts to work in the home unless all pre employment checks have been received and are satisfactory. All new staff will receive a common induction away from the home, all staff will have a POCA(Protection of Vulnerable Children check) as well as Adult check. We have been informed that people using the service are being asked to be involved in the recruitment of staff. Staff training records show good levels of training generally, but more staff should be trained in Autism, The Mental Health Act, Deprivation of Liberty, Equality and Diversity. Is is noted that the Manager has recognised this as an area for improvement in the AQAA. One staff survey said, They need to extend training further. Another said, I feel that new staff coming to work in the home have a wonderful induction prior to coming into the home, which is extremely beneficial, this is then continued with a mentor who supports them, this is valuable time for staff and service users which helps them all to settle easily and the little things in the service users life are communicated to make sure new staff are familiar with them. A third said, I would just like to say that I consider myself lucky to work in this service I enjoy my job and I have immense job satisfaction. One member of staff said, the communication could be better within the company, the pay does not reflect the hard work we put in. We noted in the AQAA that a salary rise has been given in the last 12 months and the company has an incentive scheme for staff, where good practice is rewarded. A social workers comments included, The staff are welcoming. A health professional said, The staff have a shown that they will go that extra mile to ensure that peoples needs are met. 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. People who use the service can be confident that the service is managed effectively. Evidence: The service told us in the AQAA that, We Have an effective Quality Assurance System. We promote person centred practice. People using the service are encouraged to contribute towards decision making in the running of the Home. Care plans are comprehensive and up-to-date. Staff are supported in personal development / training. People using the service are safeguarded by the Homes record keeping, policy and procedures. Good working practices and conduct within the Home. The Manager has an open door to everyone living at the home. The service sent us the AQAA when we reminded them to, we saw that it contains very good information about what the service does well and how it intends to continue to develop. We saw that the service has effective Quality Assurance Systems in place, the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: organisation has a dedicated member of staff who carries out the audits, an action plan is then produced, with timescales for the manager to address any outstanding areas. The format for collecting the information has been produced in a user friendly style, it may be useful to share this information at the meetings people have, to ensure that they are involved in the decision making. In addition the service sends out surveys to people using the service, their relatives and supporters. We have been provided with copies of some of the surveys. Relatives comments are very positive about the care and support their relative receives. One survey said, While we have every confidence in care staff and the quality of care, it would be appreciated if we could meet with the a member of the management team occasionally. We have been very satisfied with the high standard of care provided. Another said, They are always looking to improve the service and give people living there a chance to live as independently as possible. We saw in the AQAA that the equipment in the home is serviced regularly and have asked the manager to evidence that the records are up to date. We are concerned about how the service has recruited staff in the past but have been assured and seen evidence that recruitment practise has changed and is becoming more robust. Care Homes for Adults (18-65 years) Page 27 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 28 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 34 18 The provider must ensure that recruitment practice is robust. So that people using the service can be confident that they are not at risk. 17/08/2009 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 1 The text in some parts of the Service User Guide should be made bigger, so the the service can be sure that it can easily be read. The service should consider further formats for the Service User Guide to ensure that all people can easily access and understand the information. The service should ensure that the diverse needs of people are being met. The serice needs to continue to improve the person centered approaches it has introduced, particularly around goal setting for individuals. Rooms downstairs to be treated the same as upstairs and should be locked when people are not in them, if they want Page 29 of 31 2 1 3 4 6 6 5 7 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations them to be. 6 7 8 9 8 17 20 20 House meetings should be more regular so that people can discuss any issues they might be having. The menu should be more accessible and daily choices should be added. The service should ensure that medication received in the home is recorded accurately. The procedures for managing medication to be administered when individuals are away from the home should be more robust to reduce the risk of error. The service should provide a Controlled drugs cupboard if a person in the home is prescribed controlled medication. The service should ensure that there are clear instructions regarding homely or over the counter remedies for each individual. To be confident that peoples health is not compromised. The service should ensure that people using the service know how to make a complaint if they want to. The provide should consider how the exterior of the service can be developed to ensure that the service is more in keeping with other domestic dwellings. The service should ensure that all staff have received training that is relevant to the people using the service for example autism spectrum disorder. The service should provide all staff with training and guidance about Mental Capacity and Deprivation of Liberty. The outcomes and action plans following quality audits should be shared with people using the service so they can be confident they have been included in any decisions to develop the service. 10 11 20 20 12 13 22 24 14 35 15 16 35 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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