Care Home: 44 Castle Road

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What the care home does well A book that tells people about how the service works has pictures so people can see what it is like to live at Castle Road.Staff looks after people well and care plans of the people who live in the home have lots of details to help the staff to give good support.Staff help people to write down what help everyone needs to do the things they want to.People are supported in their medical appointments and the acting manager has developed good health plans into one book to help people stay healthy and well.People who live at Castle Road are supported to keep in touch with their families and friends.People are able to freely move around all areas of their home as they choose.Staff training and development is encouraged by the manager to make sure that people who live at the home receive the best possible service.The acting manager makes sure that suitable staff are employed and that all checks are made to keep people safe.The acting manager has the skills and experience to make sure the home is well run. What has improved since the last inspection? Books that tell people who the service is for and how the service works are where people can see and get them.The acting manager now makes sure people who come to live at the home are able to get on with other people who live at Castle Road.Staff have read and follow the plans that tell them how to keep people safe so that they are not in any danger.The arrangements procedures for managing and administering people`s medicines have got better. This will help to keep people safe.People living at the home are now able to use the lounge, kitchen and hall ways without any fear.Plans are now written down that show what training staff have had and what they need to make sure they can give the care and support people need.The acting manager is making sure the lounge and hallways are painted so that people live in a nice home. What the care home could do better: Efforts must be continued to provide people with menus that they are able to understand so that people are able to fully see and choose their choices of meals. Staff must be careful of the words they use to describe people and their behaviours to keep people`s dignity and show respect.Staff must make sure that information about people living in the home is kept confidential.Staff must always make sure people’s agreements are got before going in people`s rooms keep people`s privacy.To continue to make sure all staff receive infection control training and refreshers are done in a timely fashion. This will help people to stay well.Medication needs to continue to be better looked after. Staff do this because people living at the home cannot do this themselves. Key inspection report Care homes for adults (18-65 years) Name: Address: 44 Castle Road 44 Castle Road Cookley Nr Kidderminster Worcestershire DY10 3TF 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: Sally Seel Date: 1 1 0 5 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 51 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 51 Information about the care home Name of care home: Address: 44 Castle Road 44 Castle Road Cookley Nr Kidderminster Worcestershire DY10 3TF 01562852405 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.dimensions-uk.org Dimensions (UK) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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 catgeories: Learning disability (LD) 4 Date of last inspection 0 7 0 7 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 51 A bit about the care home This is a small sized home for up to four people with a learning disability. The home is on a road near to some other houses, shops and buses. Care Homes for Adults (18-65 years) Page 5 of 51 Everybody who lives at the home has his or her own bedroom but you may choose to share a room with other people. There is a kitchen with a dining table where people are able to sit with others to eat, enjoy a drink or just chat. There are toilets, bathroom and shower room for people to choose. There are aids to help you take a bath or shower safely. Care Homes for Adults (18-65 years) Page 6 of 51 The home has a car, and the staff support the people that live there to go out in the car. You can have a pet if the people you share with do not mind and there is a cat living at the home which people like. There is a garden at the back of the house and this is going to be planted with plants that look and smell nice with some being vegetables for people to grow. Care Homes for Adults (18-65 years) Page 7 of 51 Information about the home is provided in the statement of purpose and service user guide. The monthly fees are in the service user guide and the manager of Castle Road will help you to work out how much it will cost you to live at the home. Care Homes for Adults (18-65 years) Page 8 of 51 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 Care Homes for Adults (18-65 years) Page 9 of 51 How we did our inspection: This is what the inspector did when they were at the care home An inspector carried out an inspection over the period of one day without telling anyone she was coming. An expert by experience and their supporter spent part of the day at the home. They know about living in a care home so they looked around the home speaking with people who live at the home. Care Homes for Adults (18-65 years) Page 10 of 51 The acting manager and other staff helped the inspector on the day of the visit to the home. We were shown around some of the home and said hello to some people who live there. We looked at some care support plans and plans to help make sure someone keeps healthy. Care Homes for Adults (18-65 years) Page 11 of 51 We looked at some of the medicines and records which tell us how staff help people who live in the home with their medicines. Papers in the office were shown to the inspector to tell them how the home is run. 1 survey was returned from a person who lives in the home. 7 surveys were returned from people who work in the home. Care Homes for Adults (18-65 years) Page 12 of 51 The acting manager filled in a form called an Annual Quality Assurance assessment (AQAA). This shows how the needs of people who live in the home are met and what is planned for the future. What the care home does well A book that tells people about how the service works has pictures so people can see what it is like to live at Castle Road. Care Homes for Adults (18-65 years) Page 13 of 51 Staff looks after people well and care plans of the people who live in the home have lots of details to help the staff to give good support. Staff help people to write down what help everyone needs to do the things they want to. People are supported in their medical appointments and the acting manager has developed good health plans into one book to help people stay healthy and well. Care Homes for Adults (18-65 years) Page 14 of 51 People who live at Castle Road are supported to keep in touch with their families and friends. People are able to freely move around all areas of their home as they choose. Staff training and development is encouraged by the manager to make sure that people who live at the home receive the best possible service. Care Homes for Adults (18-65 years) Page 15 of 51 The acting manager makes sure that suitable staff are employed and that all checks are made to keep people safe. The acting manager has the skills and experience to make sure the home is well run. Care Homes for Adults (18-65 years) Page 16 of 51 What has got better from the last inspection Books that tell people who the service is for and how the service works are where people can see and get them. Care Homes for Adults (18-65 years) Page 17 of 51 The acting manager now makes sure people who come to live at the home are able to get on with other people who live at Castle Road. Staff have read and follow the plans that tell them how to keep people safe so that they are not in any danger. Care Homes for Adults (18-65 years) Page 18 of 51 The arrangements procedures for managing and administering peoples medicines have got better. This will help to keep people safe. People living at the home are now able to use the lounge, kitchen and hall ways without any fear. Care Homes for Adults (18-65 years) Page 19 of 51 Plans are now written down that show what training staff have had and what they need to make sure they can give the care and support people need. The acting manager is making sure the lounge and hallways are painted so that people live in a nice home. Care Homes for Adults (18-65 years) Page 20 of 51 What the care home could do better Efforts must be continued to provide people with menus that they are able to understand so that people are able to fully see and choose their choices of meals. Staff must be careful of the words they use to describe people and their behaviours to keep peoples dignity and show respect. Staff must make sure that information about people living in the home is kept confidential. Care Homes for Adults (18-65 years) Page 21 of 51 Staff must always make sure people’s agreements are got before going in peoples rooms keep peoples privacy. To continue to make sure all staff receive infection control training and refreshers are done in a timely fashion. This will help people to stay well. Medication needs to continue to be better looked after. Staff do this because people living at the home cannot do this themselves. Care Homes for Adults (18-65 years) Page 22 of 51 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sally Seel 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 23 of 51 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 24 of 51 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given enough information about the home using pictures to aid individuals understanding and have their needs assessed before moving in to Castle Road. Full consideration is now given to make sure people moving into the home will fit in with other people who already live there to ensure that the home is the right one for them and the move is a positive one. Evidence: The statement of purpose and service user guide have now been updated following our last key inspection. This means people who are considering living at this home are able to clearly see what it would be like to live at there. We saw that the service user guide has some good information so that people can see how there needs could be met. The fees charged for living at Castle Road are noted with what benefits people are able to claim with staff help. This gives people some control over their finances and they are able to consider the costs of living at Castle Road before they move to live there. All of this helpful information is in an easy read layout as we saw that pictures are used to illustrate the written word. Where the written word is used it is done positively, such as, short sentences are used and words that people may have some understanding of their meaning. This is good practice as people who will be considering living at Castle Road Care Homes for Adults (18-65 years) Page 25 of 51 Evidence: have learning disabilities so require information that is easy to read. This helps people to make their own informed choices about where they would like to live and how their needs are met. The acting manager may want to consider reviewing the statement of purpose and placing pictures in this as well so that all information guides are easy to read and understand. We received one survey from a person who lives at the home which was completed by their family member. This told us that this person was asked if they wanted to move into this home and did receive enough information about the home moved they moved in. We looked at the admission details of a person who had recently moved into the home. We saw that this person had moved from one of the providers other homes and information about this persons needs and abilities had been shared. This is positive as it shows that staff would have information about the support this person would need to ensure that their full range of needs and choices would be able to be met at Castle Road. The AQAA tells us, The last person moving into Castle Road, visited the home on a regular basis, they and their family were kept informed about what they would be able to do. Prior to their admission they also spent an overnight stay. From the day that the person moved in they were supported during the day by both Castle Road staff and staff from the home that they had moved from, this extra cover has been provided over the first month. We were told that this persons family have been complimentary about the home. Also family members of people who already live at the home are pleased about the compatibility of how the new person gets on with others who live in the home. This is good to know as at the previous key inspection family members, advocates and staff had expressed their concerns about another person who at the time had moved into the home and how they fitted in with others. This person moved to another home to live. With this in mind the acting manager has already given some thought to improvements for the next twelve months in the form of a resettlement checklist which would act as a reminder to all staff which the AQAA is confirmed in the AQAA ....producing a check list of things that need arranging i.e. registering with doctors, dentist, informing benefits agencies etc. This should make sure all staff have the relevant information about a person moving into the home to fully meet their needs from day one. The Expert reported:- 3 men live at home, two had lived in the house for about 17 years, and one had moved to the home about 2 months ago. The new resident had moved from another care home recently, because there was some difficulty in his placement and he was quite unsettled, and needed a more quite and relaxed home. The male member of staff said that the male resident was much happier, and his family had seen a real change in him, and felt much happier with his new home. This shows that practices now in place and further improvements should mean that in the future all people who move into Castle Road and people who live there are able to live together. Survey responses from staff told us:- A very homely, happy house for the Care Homes for Adults (18-65 years) Page 26 of 51 Evidence: people we support to live. Castle Road is now a lovely, friendly warm homely environment for the people who live here. Care Homes for Adults (18-65 years) Page 27 of 51 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. Efforts are made to promote person centred support and care based on individuals needs and capabilities. Risks are fully assessed to support people to stay safe and promote peoples independence without being restrictive. There is room for improvement in how staff speak about people and how individuals confidential information is shared. Evidence: The care and support provided to two people who live in the home was focused upon to ensure that individuals are supported and encouraged with meeting their individual goals in relation to their specific needs. We saw that the acting manager has worked hard to develop support plans for each person to meet their needs which had been identified from the assessment processes. These plans were clear and held sufficient information with a picture to illustrate the written words to enable people to participate in their care planning and to give guidance to staff in meeting peoples needs in ways best to suit the individual. Areas included routines, personal care, communication, family contact, making choices, meals, behaviour, health, activities and cultural needs. We saw that each persons plan shows clearly how goals are to be achieved together with what staff actions are required in order to assist the person in their daily lives. For example in one persons Care Homes for Adults (18-65 years) Page 28 of 51 Evidence: support plan said that they would be able to brush their teeth if staff helped to place the toothpaste on their tooth brush and in another it confirmed that the person is able to eat independently with the right aids. We saw communication plans which are important as they provide staff with information about how people prefer to communicate and what aids are used. For example, in one persons we saw that staff need to communicate by pointing to objects of reference, using their tone of voice, facial expression and gestures to what is being said. By using these plans staff are able to assist people in making their own decisions within their daily lives. We were told that communication passports are going to be developed and in the AQAA it tells us, To try to access communication training for staff who have not received it to enable them to be more proactive in communication skills. This will certain make a difference together with more pictures and symbols within peoples support plans to truly aid individuals participation in communicatiing how they would like staff support. It is important that this is now done in a timely fashion as the Expert reports:The male staff member said that a lot of planning goes into the activities for people, and that they do a variety of local activities such as going on the severn valley railway, meals out, and into Birmingham. If people want to do activities that need more planning then they make sure that they have enough staff on. I was a little bit worried that one male resident may not be able to choose his own activities, as he had no method to communicate. Activities should always be the persons choice, not staffs, and I think it is real important for his staff and key worker to use an accessible communication system so he can achieve this. The two male staff and the manager I spoke to were really friendly and really put the needs of the residents first. They understood that people need to have better ways of being able to communicate and were really trying to make sure this happens. People living at the home were also going to have their own communication passports to ensure that everyone is able to communicate with the residents and make sure all the residents can have a voice. Although it was just being started it showed that things would be changing. Each person is allocated a key worker who has responsibility for ensuring aspects of care and support are in place. Records indicate key worker meetings take place regularly so that any changes in peoples needs are monitored and met in a timely fashion. For example, we looked at the personal path maps which we saw give a good insight into individuals aims and goals. These told a story and were an excellent way of involving people with the help of staff in completing to give meaning to a persons life which individuals can understand with the help of their key workers. These are reviewed to make sure that goals aimed for are being achieved and to reflect any changes required helping a person to reach their goals. Staff that we spoke to had good knowledge of peoples specific needs and how these are Care Homes for Adults (18-65 years) Page 29 of 51 Evidence: met. One survey response that we received from a person who lives in the home, their relative told us that the person usually make decisions about what they do each day. The AQAA says, All risk assesments now have signing sheets for staff to sign to say they have been read. Risk assessments are being reviewed and additional assesments are in the process of being written. We certainly found this to be the case in the care records we saw and we examined risk assessments that covered all areas of a persons life. Such as, getting sunburnt, getting up, choking and improving indigestion, eating and drinking skills, tripping and falling, travelling in the car, event of fire evacuation plan, get up during the night, risk of burning and scalding and drowning. These processes should ensure that measures are put into place to minimise potential risks and maintain a persons safety and independence without being restrictive. We observed on the day we visited that people were well dressed in clothing that reflected each persons personality and choices. We also saw that people travelled around the home as they chose and sat at the kitchen table to enjoy their drinks and be with staff even when meals were not being served. This demonstrates an improvement to the previous key inspection when there was a not such a relaxed atmosphere and peoples movement and choices were being restricted by staff needing to support a persons behaviour difficulty. The Expert reported:I was just a little upset to hear two female members of staff talking about a male residents behaviour as having a paddy. I dont think staff should be talking about other residents in front of other residents and using words like that. Information should be kept confidential and I dont think the kitchen is the place to discuss peoples behaviours. This is an area that must be improved to make certain that appropriate terminology is used by staff to describe peoples behaviour within the home and also to consider how confidentiality is maintained to uphold the rights of people who live in the home. Care Homes for Adults (18-65 years) Page 30 of 51 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. Improvements are now taking place and are ongoing to make certain people are supported and encouraged to lead full and active lives based on their individual needs and capabilities. Meals provided are balanced and healthy and improvements are taking place to make sure individuals are able to shop for their meals and choose these. Evidence: Positively activity planning within the home is improving and the acting manager is making sure that this is ongoing and being followed through in practice for people who live at Castle Road. Processes that are used for this purpose are support plans showing persons interests, weekly meetings with people and the personal path maps. The AQAA tells us, ...activities include Skittles, going to car racing events, musical events, attending church, foot massage, visiting places of intrest i.e safari park, boat trips, shopping, sailing, visits to Museums, cafes, music, crafts, Cookery sessions, watching TV, attending parties, fun days, making and visiting friends. We saw various pieces of information that confirmed what the AQAA told us, such as, the activity board that is displayed in the office area of the home where we saw details of activities which included, Care Homes for Adults (18-65 years) Page 31 of 51 Evidence: disco, Wyre Forest walk, cinema club, baking, Forest Glades for massage. We were also told about individual holidays that are being planned with people by their key workers. One survey response from a person who lives in the home tells us what the home does well, Plans regular activities and what the home could do better, Needs appropriate staff when certain activities or outings take place e.g. similar interests. The rota does not always reflect this. Staff surveys told us what the home does well:The people we support do go away on holiday and they do activities if there is enough staff on shift. Activity plans, holidays, day trips. Good at planning activities, day trips, holidays and in house jobs for the people we support to help with. and What the home could do better:The home could ensure there was enough staff on so some people could go out for the day. Less paperwork so more time can be spent supporting the people we support to do more activities. It is suggested that the acting manager takes a look at some of the responses we have received where people who live in the home, their relatives and staff. These appear to feel that at times there is not always sufficient staff on duty so that individuals are able to take part in planned actiities as they choose together with spontaneous activities. The Expert reported:- During my visit 2 male residents had spent most of the time in the house. One man went out for a bit to the bank to pay in a cheque into his own bank account, this was great to see, but other than that had just been in the lounge watching TV or playing with his abacus. I think people should have more exciting and fun activities to do during the day, watching TV is ok, but not all day. I asked about peoples holidays. Everyone has their own holiday each year. Some people have been abroad before and this year staff were supporting people to go on holiday. One male resident was having a holiday away, and staff were supporting him to have an over night stay in a bed and breakfast with his mum. This was great to hear that people are having individual holidays and that people can have a holiday with their family. I am pleased that the home sees this as being really important. One activity a member of staff told us about was that he had arranged for a male resident for his birthday to be a passenger in fast red sports car, this is because the Care Homes for Adults (18-65 years) Page 32 of 51 Evidence: resident loves red and fast cars. I thought this was brilliant and showed that staff really think about the needs of the person, and think creatively about how to do it. The resident really loved it. It is great to hear people are having exciting activities. We are confident that the acting manager will continue to develop activity opportunities for people who live at Castle Road so that people are receiving the support and encouragement they need to lead lifestyles that hold meaning to them. We looked at how people are supported to be involved in their abilities to do tasks around their home. In activity planners were saw that people are being assisted to clean and tidy their rooms and put dirty cups and dishes in the kitchen sink. This is positive as this practice assists people to retain their own levels of independance within their capabilities. The AQAA confirms, Survey responses show that families visit their relatives at the home on a regular basis. Individual files include information on their Relationship Circle. This is used to illustrate the circle of support that is important to each person and how the staff at Castle Road can help people maintain their relationships. We also saw that on the personal path maps that staff support people to maintain relationships that are important to them, for example, on one persons we saw that their auntie and advocate were noted and on the action points it noted that staff would liaise with auntie regarding visits. The Expert reported:- I asked a male member of staff about how people make choices especially around meal times and planning their activities. I was told that everyone helps plans the menu every Sunday for the following week. 2 of the residents can verbally communicate so they can say what they like to eat, but one resident does not verbally communicate or understand pictures, objects of reference, or signs. I asked how he could choose then? The member of staff said that it was very difficult and could not give me an honest answer. The manager told me that they are getting some support from communication professionals to look at ways to develop a communication system for this male resident. I think it is really important that people have a way of communicating, and I was pleased to see that the home was working hard to find a way for this man to communicate. The menu board was on the wall, but was not at all accessible. The home will be using a new accessible menu with pictures and objects of reference so that everyone can understand. I think an accessible menu board is a good idea so people can see what their meal is. There was only one choice for breakfast, lunch and dinner on the board, so I asked what would happen if people did not like the choice that day? I was told the resident could be offered something else. I think there should always be choices for residents. The manager said they were making an accessible shopping list for people using pictures and objects of reference so people could be involved in the planning of the shopping and Care Homes for Adults (18-65 years) Page 33 of 51 Evidence: buying the food. I think this is a good idea as people should always be included in planning and shopping for meals. As at the previous inspection the food is purchased locally and staff prepare the meals as needed each day. Records showed a balanced and varied diet is being offered with each person having the meals they want on the day. There are no set times for meals and drinks, and snacks are available throughout the day. One survey response to what the home does well told us, Food, menu healthy options. Care Homes for Adults (18-65 years) Page 34 of 51 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. The health and personal care that people receive is based on their individual needs. Medication procedures and practices have improved and must continue to do so to ensure practices within the home safeguard people who live there. Evidence: We found that the personal care needs of people are clearly recorded and that wishes are complied with. For example, one person requires staff assistance, Verbal prompts for dressing but makes attempts to dress myself but needs lots of verbal prompts to help me choose clothes, passing me each item asking me to put them on. Records confirm this preference is upheld and from our observations we saw that people were dressed appropriately for their age, gender and culture. Efforts had been made to ensure items of clothing were co-ordinated, promoting dignity and well being. It is also good practice that we saw people are supported to have their say and individual choices taken into account when considering their likes and dislikes in relation to staff assistance. For example, we saw, Things that I am looking for in someone who will be supporting me. This is a nice touch and helps staff to respond to peoples individual needs together with staff recruitment as this provides people with control over their lives. Staff survey responses told us:- We encourage the people to live the life they wish, we encourage them to be as independent as possible. Care Homes for Adults (18-65 years) Page 35 of 51 Evidence: Providing a well balanced service for the people we support to live the lives they want. In the AQAA it tells us, People have good access to medical support through their GP, orthopaedic consultants, opticians, speech and language therapists, dentists, chiropodist, and the community learning disability team. We found this to be true as we saw that some good health care records are in place that demonstrates peoples needs are met. For example, we saw that the acting manager is developing peoples health action plans and hospital books into one format. These can help to show that individuals special health care needs are recognised and understood and that people are being supported to stay healthy through preventative as well as routine and specialist health care input. Key worker meetings also help in picking up, monitoring and reviewing individual health. In the recordings from one such meeting we saw that one person was experiencing some weight loss and it was identified that an eating and drinking assessment was in progress. It was also positive to see that peoples weights are being taken regularly so that any losses and or gain are identified as this should mean that early detection of any underlying medical conditions can be identified. This means that each persons health is monitored; any problems identified so that their good health is being promoted. The AQAA tells us, Medications are now supplied by Boots using the monitored dosage system which has improved the dispensing and tracking of medications. We certainly found this to be the case when we reviewed the administration and storing of medications with the acting manager. We saw that medication procedures and practices have improved following our last inspection visit to the home. The pharmacist who supplied the medications to the home as completed an audit and no requirements have been made in relation to improving practices. Medication is stored in an appropriate locked cabinet and we were shown one of the medication cabinets that have been placed in one persons room which will hold their medicines. Medications are administered by staff who have received medications training. We were advised that staff also have their competency tested in relation to the giving of medications. We found that Medication Administration Records (MARS) had been signed appropriately and these cross referenced with the amounts of medications left to take indicating that medication had been given as prescribed. We discussed with the acting manager that all of the prescribed medications for a person who had recently come to live at the home need to be placed upon their MAR. We only found one discrepancy with one persons tablets which we counted as what was left did not tally with the MARS. However, the acting manager assured us that they would recount these tablets and undertake a thorough audit of them. We have confidence that the acting manager will make certain that this person is receiving their medications as prescribed by their clinician. We suggest that all medication for the same person is placed altogether in the one cabinet within the home as we found that there were two storage cabinets for some medications. This means that it potentially makes it harder to audit and there is a higher percentage of oversight occurring when administering medications. The acting manager acknowledged Care Homes for Adults (18-65 years) Page 36 of 51 Evidence: this and told us in the AQQA about improvements they are going to make in the next twelve months:To have the Medication changed over to the Boots blister pack system for the gentleman admitted in February 2010. For all the people supported to have annual health checks. Care Homes for Adults (18-65 years) Page 37 of 51 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. Systems within the home encourage and support people to raise issues and concerns. Staff have a good understanding and receive training so people should be protected from harm. Evidence: We saw that there is a complaints procedure and this is in suitable formats so that people living in the home are able to understand, such as, using pictures to illustrate the written word. It is also important for people who live at Castle Road to have access to advocates where required and key workers help in this process to ensure each person who lives at this home has the support which they need to be able to make their complaints and or concerns known. For example it is important that staff are able to recognise if a person is unhappy and in the survey responses we received from staff we were told that The acting manager informed us there have been no complaints in the last twelve months and CQC (Care Quality Commission) have also not received any complaints. However, if the home should receive a complaint they have a specific book to log these to ensure action is taken together with the required monitoring and reviewing of each complaint received. This should make certain there is a culture of openness within the home and a proactive approach to identifying and addressing concerns. A completed survey from one person said the staff always listen to them and act on what they say stating, always. Also in response to, Is there someone you can speak to if you are unhappy and Do you know how to make a formal complaint; was left blank. Care Homes for Adults (18-65 years) Page 38 of 51 Evidence: The seven surveys we received from staff all indicated that they knew what to do if someone has concerns about the home. The AQAA tells us, Staff recieve training in abuse awareness, and this training is part of induction training for new staff. It is suggested that adult protection training is placed onto the staff training matrix so that it can be seen at a glance. This will then show when staff may require a refresher as if it is only completed at the induction stage then the provider may want to ensure this training is also done periodically so staffs awareness is refreshed. This should ensure staff able to describe and recognise the actions that they would take if they witnessed any form of abuse. There is a safeguarding adults and the prevention of abuse policy in place which should be reviewed periodically. We were told that staff have access to Worcestershies safeguard and protect policy. This is the policy that must be followed if abuse is suspected. There have been no recent safeguarding referrals since we inspected the home last year. All staff that we spoke to demonstrated good knowledge and understanding of their responsibilities with regard to protecting individuals from harm. For example one person explained, Report straight away. Go above manager if manager. We saw information booklets about Deprivation of Liberty Safeguards (DOLS) on display in the office area of the home so that staff are able to use these. The AQAA tells us that an area that staff are going to be updated in is the Mental Capacity Act and DOLS. This was identified at the previous inspection and should now be followed through in a timely way and consideration for this to be placed upon the training matrix. This is important for staff practices as this legislation examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. We did not examine the financial records for monies held on behalf of people who live at the home on this occasion but no concerns were expressed to us and therefore we shall inspect these records when we next inspect the home. We sampled two staff records and found that appropriate recruitment and selection checks have been followed. This means that the systems in place for the recruitment of staff are satisfactory which is discussed further in the staffing standards of this report. Care Homes for Adults (18-65 years) Page 39 of 51 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. Improvements have been made which have resulted in people living in a comfortable, well maintained environment. The home is clean and tidy and generally infection control practices promote good hygiene. Evidence: The Expert reported:- I noticed that the house was in a nice residential area and did not look like a residential care home at all. I had to climb up 2 steep steps to ring the door bell, which will be difficult for people with a physical disability. I rang the door bell and it was answered by a male member of staff who introduced himself. I was asked to sign in. I think that residents should open their own front door. Walking into the home I noticed it was really homely, and warm. It had a nice smell, and seemed quite quiet. I was invited on a tour of the home. I was told that one man was at a day service all day, one gentleman was in the lounge and another was resting in his room. I walked into the lounge, and said hello to the male resident. He was unable to verbally communicate, but did look across at me. The lounge was homely, well furnished, and comfortable. The staff Care Homes for Adults (18-65 years) Page 40 of 51 Evidence: member told me it was great to be able to have peoples belongings in the lounge, as a previous resident would destroy them so they could not leave anything lying about or have things on the wall. I was shown a bedroom, and although the member of staff did ask the male resident, because he was unable to verbally communicate, I did not feel I should go into his bedroom. The staff continued to show us the room, even though the gentleman had not given his permission, as he could not verbally communicate and did not appear to use objects of reference to communicate. Peoples room are private, and people should always give people permission to go in. I looked from the door way, as the door was open, and not locked the room looked really nice, well furnished with lots of personal belongings. Upstairs I was shown into an empty room, which was spacious. The male member of staff said that people could choose all their own colours, and furniture when they move in. I was pleased to hear this, as people should always be able to choose what their room is like. I saw that none of the doors to the kitchen, garden or laundry had locks on them. I was happy to see this. Lots of time kitchen doors are locked to stop residents going in, but in this house people are free to come and go as they please. The staff member said that this is peoples own home, and they can go where they want, there are always enough staff around to offer support if needed. We found the atmosphere within the home to be calm and relaxed with people moving around as they choose some with help from staff. As the Expert reported it was particularly positive to note that the lounge area now had homely touches which were missing at the previous inspection. The AQAA also confirms other improvements that have taken place within the home, There is now a shower above the upstairs bath, the bathroom flooring has been repaired. Communal areas have been redecorated, new gates fitted to the front of the house, Disabled access improved to the side of the house this has now been concreted to give ease of access for wheelchairs, new furniture has been bought for the lounge. We were also told by the acting manager that the garden is to be developed into a sensory garden with summer house. This shows that ongoing improvements to the home are ensuring peoples needs are met within a well maintained homely environment. As at the previous inspection we found the home to be clean and hygienic with no unpleasant odours. There is a cleaning schedule to make sure that the home remains clean and hygienic. There are hand washing facilities in place within the communal areas that we looked at. We also saw that five staff have received infection control training. The acting manager must therefore making sure all staff have completed this training so that infection control is fully promoted and people who live in the home are not placed Care Homes for Adults (18-65 years) Page 41 of 51 Evidence: unnecessarily at risk from infections. Care Homes for Adults (18-65 years) Page 42 of 51 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. Improvements have been made in the arrangements for staff supervision, training and development. This is to ensure that staff have the support, knowledge and skills they need in order to do their jobs well, for the benefit of the people in their care. Evidence: We were shown the staffing rotas and told by staff that individuals needs are met appropriately by the numbers of staff on duty at any given time. We were told that there are eight permanent members of staff. The rotas do not show any staffing levels falling below what the home confirmed with us. However, as mentioned previously in this report there should be some consideration in making sure that staffing levels meet individuals needs to participate in their chosen planned and spontaneous activities. We observed staff interacting with individuals in an unhurried manner. Any tasks were completed which further confirms that staffing levels seem to be appropriate for the three people living in the home at this time. There seems to be a stable staffing group who have knowledge of people they support. This means that people who live in this home have consistency in the support they receive due to building familiar relationships with staff. Staff surveys told us:- The home could ensure there was enough staff on so some people could go out for the day. Care Homes for Adults (18-65 years) Page 43 of 51 Evidence: The home has a good staff team who are willing and capable to support the people who live here. We have a dedicated staff team who do our best to support the people who live here and try to meet their everyday needs. I think we have a very good staff team who all try their hardest to support people who live here, to meet their individual needs. The AQAA shows that five staff are trained to NVQ level 2 or above, and that training provided meets national standards and statutory guidelines. We saw the matrix which has been developed to show training that staff have completed and highlights when refreshers are due. We can see from the matrix that staff have generally been maintaining their mandatory training in health and safety, moving and handling, food hygiene, safe handling of medications, first aid and fire training. It was positive to find that staff have received specialist training in order to meet individuals needs, such as, epilepsy, positive behaviour support, autism, eating and drinking, equality and diversity are a few examples. This ensures that people living at Castle Road can feel confident that the care and support they receive is provided by a skilled and knowledgeable staff group. Two staff records were sampled and we found appropriate recruitment documentation, such as, Criminal Record Bureau (CRB) checks, and completed application forms. Records included two written references for each person and a copy of an application form. This demonstrates that the home has carried out appropriate checks to make sure staff employed by them are suitable to work with vulnerable adults. Care Homes for Adults (18-65 years) Page 44 of 51 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. Management arrangements ensure that the home is run in an open and transparent way that benefits the people living there and promotes their best interests. There have been sustained better outcomes for the people who live at Castle Road due to the skilled leadership of the home and the realisation of improvements that were needed to ensure peoples lives are not restricted by others. Evidence: As at the previous inspection an experienced manager from another part of the service has been drafted in to supervise the home as the permanent manager is away from work. The acting manager, Mr. David Round is appropriately qualified and experienced to run the home and spends three days of their working week at Castle Road. We did not find any information that would support that people are receiving poor outcomes due to the acting manager not being physically in the home all week. However, it would be good if the management arrangements could be more permanent as this brings added stability for people who live at the home and the staff group. Staff spoke to seemed happy with the acting manager and the way the home was run. We observed people who live in the home and staff conversing with the acting manager Care Homes for Adults (18-65 years) Page 45 of 51 Evidence: in a relaxed and comfortable style. Staff survey responses told us that the acting manager has good organisational and people skills and two surveys said, Very good home manager and The home has a fantastic manager, Mr David Round. It was clear from speaking with the acting manager that they have knowledge of the people who are living in this home. This demonstrates that the management team enjoys a hands on approach within their management style of the home. Also a proactive approach is taken to make certain that people who live in this home have new opportunities to increase their independence and ensure improvements are continually sourced. Some of these opportunities and improvements have been reflected throughout this report, such as, the process for new people coming to live in the home appears to be clear in its aims of making sure people are compatible with other already living in the home, environment improvements, staff training is being effectively planned with the help of a matrix and so forth. We looked at ways in which the quality of services for people who live at Castle Road are measured so that good outcomes are achieved in the best interest of people who live there. For example, we saw records of the monthly visits that are undertaken by a representative of the organisation. These informed us that people who live in the home are enabled to share their views together with staff, the homes environment is inspected together with care records, financial management, various policies and procedures, complaints and compliments. We were told that although meetings take place with people who live in the home there are no regular meetings for relatives and this may be an area that the acting manager may want to consider in the future. Although we are aware that relatives and advocates inputs are gained to enable peoples goals to be achieved as we found by looking at care records and personal path maps. The AQAA also tells us, There are good open relationships with relatives of the people living at Castle Road. The AQAA was as previously confirmed completed by the acting manager and returned to us. It was detailed and provided us with some good insights into practices in the home together with real live practice examples of how they plan to achieve goals. This shows that the management team and staff have the best interests of the people who live at Castle Road at the very heart of all that is achieved to shape service delivery in an open and transparent way. We found that health and safety checks were completed with appropriate assessments in place that staff have read. For example, water temperatures and staff know what the required temperatures should be to ensure they are not too hot or cold. This ensures temperatures stay within the recommended safe limits so that people were not at risk of being scalded. The water had been tested for Legionnella. Suitably qualified engineers complete the test of the gas equipment and electrician completed a test of all electrics within the home to ensue these are in a satisfactory working condition. The fire risk assessment detailed what action, if any, needs to be taken to ensure that the risks of there being a fire are minimised as much as possible. Regular fire drills are held so that Care Homes for Adults (18-65 years) Page 46 of 51 Evidence: staff and the people living there know what to do if there is a fire. These records show that people are protected from any risks to their health or care needs within peoples living environment. Care Homes for Adults (18-65 years) Page 47 of 51 Are there any outstanding requirements from the last inspection? Yes  No  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 48 of 51 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 Description 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 Description Timescale for action 1 20 13 To make arrangements for 25/06/2010 all prescribed medications of person who has recently come to live at the home must be accounted for on the MAR with agreement and review with their clinician. This is to ensure that the care service maintains accurate records of medicines they are in receipt of. 2 20 13 To continue to make 25/06/2010 arrangements to ensure that medication administration records are accurately maintained. This is to ensure that all medication is administered as directed by the prescriber to the person it was prescribed, labelled and Care Homes for Adults (18-65 years) Page 49 of 51 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 Description Timescale for action supplied for. 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 7 Consideration should be given to further progressing individual methods of communication aids and communication passports with people who live in the home with help from external professionals. By doing this individuals will be able to fully participate in making their choices and decisions known to staff so that they lead lives that are meaningful. To ensure that staff are fully protecting the information that they know about people. This is to make certain staff uphold individuals rights to confidentiality. Progress in a timely way should be made to make sure that menus are accessible to people who live in the home with pictures and objects of reference. This should mean that all people will be able to see their meal with their choices fully upheld. Staff should always uphold peoples rights to privacy and not enter their rooms unless the person has clearly communicated that they could. To progress all infection control training for staff and to make sure refreshers are completed in a timely manner to ensure people are protected from the risk of infections. Staff training in relation to protecting vulnerable adults should be completed in a timely manner including refresher courses so that people can be confident that they will be protected from harm. 2 10 3 15 4 16 5 32 6 32 Care Homes for Adults (18-65 years) Page 50 of 51 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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