Care Home: 484 Halifax Road

What the care home does well We saw good interactions by the staff with people using the service. Staff were polite and discreet in their work. People staying at the home looked happy and cared for, and the comments they made about the service were positive. People`s right to make decisions and choices about daily life, and regarding the support and care you receive is respected, and their needs and requirements recorded in a plan of care that is followed by the staff team. People are supported to make choices and decisions about day-to-day aspects of their life and about how they spend their time. People receive a balanced diet. People receive personal support from staff in the way they prefer and want, and people`s physical and healthcare needs are met by the staff team, who support people to use local healthcare facilities. The storage of the medication was not satisfactory as it was seen to be unsafe; however, this risk was dealt with on the day of the visit. People are provided with good levels of information about how to complain about the service, and people are aware of the process. People live in a clean, comfortable and safe environment. People are supported by a good staff team that is approachable. Despite the registered manager being absent from the service, the management position is satisfactory, and there are good lines of accountability. What has improved since the last inspection? At the last inspection a requirement was made that the provider must make sure that all the necessary criminal record bureau and protection of vulnerable adult checks must be made and appropriate references obtained before staff start work. Action has been taken to meet this requirement. At the last inspection, a requirement was made that a record of any serious incident that take place in the home must be kept and all incidents which involve a safeguarding issue must be referred to the Bradford Safeguarding Team. This has been actioned the staff at the home. Good records are now in place for all incidents, and referrals are made to Bradford Safeguarding Team when necessary. What the care home could do better: People would now benefit from a full re-assessment of their needs, in order to determine what type of service would suit their current needs and requirements. The use of recognized person centered planning methods for the people who use the service, may in some circumstances, be of benefit to the individuals at the home, and the staff that support them. Improvements in the recording of food temperatures need to take place so that appropriate checks can be made if a person is ill following a meal. Investment in staff training would potentially ensure that individual staff members develop greater expertise and use best practice when working with individuals. The laundry floor and walls need some attention so as to reduce the potential spread of mould. The high use of agency staff and a lack of staff that can drive could potentially have the effect of undermining the good work of the staff team. The role of the nursing staff needs to be reviewed so as to ensure that people`s skills, abilities and knowledge are fully utilized. Greater attention needs to be paid to the auditing and monitoring systems operated within the home so as to promote people`s health and welfare. Key inspection report Care homes for adults (18-65 years) Name: Address: 484 Halifax Road 484 Halifax Road Bradford West Yorkshire BD6 2LH     The quality rating for this care home is:   one star adequate 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: Tony Brindle-Wills     Date: 1 4 1 0 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: 484 Halifax Road 484 Halifax Road Bradford West Yorkshire BD6 2LH 01274676466 F/P01274676466 susanramsden@bdct.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Brunel & Family Housing Association Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Halifax Road is a Yorkshire Housing Association home situated on the outskirts of Bradford. The home is registered to provide long-term personal and nursing care for up to six adults with learning disabilities. Staff are employed by Bradford District Care Trust. The building is a large three storey terraced house. Accommodation is provided on two floors, with six single bedrooms, three bath/shower rooms and a domestic style kitchen, living and dining room. Halifax Road has a garden at the front of the house and a car parking area to the rear of the building. Local shops and bus routes are within easy access. 0 1 0 6 2 0 0 9 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: one star adequate 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 visited the service and looked at the following records; care assessments and care plan files, care reviews, personnel and training records, staff meeting minutes, health and safety records. We talked to three members of staff who work at the home along with a manager who oversees the operation of Halifax Road. We sent surveys to people who use the service, their relatives, and professionals with an interest in the people living at Halifax Road. The comments we received were positive, with relatives stating that they believed the care and support being given by the home was very good. Below is a summary of the comments we received: I am satisfied with what the staff at Halifax Road are doing. I am very happy with the service that my relative is receiving. I am quite happy with the staff. Halifax Road is fine, no problems as far as I can see. Care Homes for Adults (18-65 years) Page 5 of 31 We made a request for an Annual Quality Assurance Assessment (AQAA) prior to our visit, which the manager completed and sent back to us in time for our visit. We used this document to to cross reference a variety in information and evidence we had gathered while visiting the agency. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: People would now benefit from a full re-assessment of their needs, in order to determine what type of service would suit their current needs and requirements. The use of recognized person centered planning methods for the people who use the service, may in some circumstances, be of benefit to the individuals at the home, and the staff that support them. Improvements in the recording of food temperatures need to take place so that Care Homes for Adults (18-65 years) Page 7 of 31 appropriate checks can be made if a person is ill following a meal. Investment in staff training would potentially ensure that individual staff members develop greater expertise and use best practice when working with individuals. The laundry floor and walls need some attention so as to reduce the potential spread of mould. The high use of agency staff and a lack of staff that can drive could potentially have the effect of undermining the good work of the staff team. The role of the nursing staff needs to be reviewed so as to ensure that peoples skills, abilities and knowledge are fully utilized. Greater attention needs to be paid to the auditing and monitoring systems operated within the home so as to promote peoples health and welfare. 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 8 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move into the home. People have a contract but the information is not in an accessible format, and would benefit from being reviewed against the recent guidance on contracts from the Office of Fair Trading. Evidence: There have been no new admissions to the home for over five years. The care files we saw showed that people living at the home had moved in following the closure of a local long stay hospital and had been assessed as needing nursing care. However, our discussions with staff and the manager, and the information we saw in the care files, suggests that people may not now require nursing care. It is recommended that peoples needs are reassessed to determine what care and support they require and how those needs can best be met for each individual. Staff at the home explained that if anyone was interested in moving into the home, information would be made available to them about the services provided. They added that they would visit the person at their home in order to complete an assessment of their needs, in order to to make sure Halifax Road would be suitable for them, and in Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: a position to meet their care and support needs. As part of this process staff would also gather information from any other agencies such as the council and their assessment of the persons needs. Where possible the person would then be encouraged to visit the home, for tea, or even an overnight stay so that they can see what the home is like, and meet the people who live and work there. At a previous inspection we noted that some work needed to be undertaken on the contract that people were given, specially that information relating to transport costs should be included and that the contracts should be in an accessible format. The transport costs have been included, but work still needs to be completed to ensure that contracts are provided in an accessible format. It is recommended that whilst undertaking to put the contracts in an accessible format, the contracts should be should be reviewed in the light of recent guidance on contracts from the Office of Fair Trading. It was explained that this guidance gives details of what should be in a contract, and how it should be presented. Care Homes for Adults (18-65 years) Page 11 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. Peoples right make decisions and choices about daily life, and regarding the support and care you receive is respected, and their needs and requirements recorded in a plan of care that is followed by the staff team. Evidence: Staff at the home explained how the care plans are put together in relation to the care and support people receive. This involves consideration of the full assessment and risk assessment carried out before people start to use the service. Staff at the home explained that in the case of the majority of the people living at Halifax, they have been living there for a number of years, and the staff them very well. Despite this, the staff said that they actively engage with people in discussion about their social, personal and healthcare needs; and identification of peoples short and long term goals. All this is recorded within peoples personal care plans, and was found to detailed, accurate and update, giving details of how choices and decisions are made. We found that reviews of the care plans take place periodically, with the Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: involvement of the person, their relatives (if appropriate) and health and social care professionals involved in a persons life. Feedback supplied by people who completed our survey showed that they were satisfied with the way peoples health and person care needs were met. One relative said, The staff are very good at helping my relative with their personal care, and always make sure they do the right thing for them. The three care plan files that we looked at were found to be very detailed and up to date. We found that the staff have a very good written record of the care and support needs of the people they are working with. The information was written in a person centered manner; individualized and from the persons perspective. We found information about how the staff promote choice and independence in relation to the activities people are involved in such as dressing, bathing, eating, socialising etc. We found up to date and detailed risk assessments that related to various tasks and activities that people take part in. Information about risks is given to people so that informed choices can be made. When a person is unable to fully understand the information or risks presented to them, then the records show that appropriate considerations are made and discussions take place with the relevant third parties, regarding any support plans that are devised, or restrictions that are placed upon. One of the nurses at the home explained that the format of the care plans is currently being updated. An example of this was seen and found to be in good order. We discussed the use of recognized person centered planning methods for the people who use the service, and staff at the service agreed that in some circumstances, the use of these techniques would be of benefit to the person and the staff. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make choices and decisions about day-to-day aspects of their life and about how they spend their time. People receive a balanced diet. Evidence: Information contained with the records of three people showed that they are given the opportunity and support they may need to practice their beliefs, including keeping in touch with their faith community. The social events, entertainment and activities provided by the care home are organized so that people can join in if they want to. The meals on offer to people are varied and nutritious. They reflect peoples food preferences and any special dietary needs. They were seen to be well prepared and cooked, and attractively presented. People at the home confirmed that they are encouraged to get involved in meal preparation, and that they are free to eat their meals wherever you like, for example, in their own room or in the dining room. People Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: said that they can also take them in their own time. Some gaps in the recording of food temperatures were found, however, the nurse on duty said that temperatures are taken at every meal. Information in peoples files shows that they are given opportunities for education and socialising at local day centres. Staff at the home said that they have been involved in trying to access college courses, community education and other learning, however the take up has been limited. Some people have one-to-one support to help them to be included in activities outside of the home. People at the home said that they are supported and encouraged to use local services such ashairdressers, shops and banks. Staff said that information about local events, facilities and activities are given to people, and this was confirmed by people living at the home. Information contained with people files showed that the staff explain, justify and record any limits on peoples independence and these limits are reviewed regularly. Care Homes for Adults (18-65 years) Page 15 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 receive personal support from staff in the way they prefer and want. Peoples physical and healthcare needs are met by the staff team, who support people to use local healthcare facilities. The arrangements for the safe storage of medication are now much improved. Evidence: The individual care plans held at the home describe the way people will receive the individual support and care that they need. Staff at the home explained that part of the care planning process is to discuss peoples needs with them so that they know that the plans are accurate. Evidence of this was found. We found evidence to show that peoples personal plans change and are adapted as their needs for support change. We found evidence to show that the staff develop with people a personal plan that details their needs and preferences and sets out how they will be met in a way that people find acceptable. Their personal plan reflects their changing hopes, choices, needs and responsibilities. The staff then use the plan to help them to meet peoples needs. The personal plans includes information and decisions about: what people like Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: to be called; what people like to eat and drink; how people spend their time and what people like doing; any equipment and adaptations people may need; who should be involved in reviews of their care; any communication needs people may have; what communication arrangements people need if their first language is not English. We found evidence to show that peoples personal plans are evaluated every month, and reviewed every six months, or sooner if people want. We observed that people are treated with respect and keep their dignity in all activities, including personal care, healthcare and social activities. The nurse on duty explained that keeping healthy or regaining health is important to peoples wellbeing and quality of life at Halifax Road. The nurse added that staff at the home acknowledge that people have a right to have their health needs met and the records show that the staff support individuals in using a full range of external healthcare services. The records show that if people require community healthcare services (for example, physiotherapy, speech and language therapy, occupational therapy) then they are helped to do this by the staff team. We found evidence to show that if people have been receiving hospital healthcare services, for example a review of their epilepsy and its treatment, or on going support with mental health issues, then again the staff support and help people to do this. We found evidence to show that the staff complete good records regarding any visits people make to external healthcare services. The evidence within peoples files, and feedback from staff working at the service indicates that the people living at Halifax Road do not have any significant complex healthcare needs that can not be met by the social care staff who work in the home, in partnership with local healthcare services, and professionals such as the community learning disability or mental health team. One staff said that ensuring that people keep healthy also includes making sure that if people require medication, then it is arranged efficiently and safely if they are unable to do this for themselves. We checked the medication and found no discrepancies in the records. However, the storage arrangements were found to be inadequate. The medication was being stored inside what would be described as a tool box, inside a cupboard in the dining room that was next to a radiator. After consultation with the Commissions Pharmacy inspector it was agreed by the nurse on duty that the medication needed to be stored elsewhere in order to ensure that it was safe, and also that it was not subject to major temperature fluctuations as this can have an effect on medication. The nurse and manager overseeing the service agreed that the medication would be moved into a secure cupboard in the homes office on the second floor. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: People living at the home said that they received care and support in the way that they require. One person said that the staff are very helpful in supporting them to use local health facilities. Another person indicated that they had been involved in putting together aspects of their person care plan. The feedback we received from people who responded to our survey was positive with people saying that the staff always listen and act on what people say in relation to the care they people need. One person said that they would like a different doctor, and this should be pursued by the staff at the home with the individual concerned. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with good levels of information about how to complain about the service, and people are aware of the process. The lack of staff training in the area of managing violence and aggression, potentially puts people at risk of harm and abuse, as individual staff members may have no expertise in this area, and may use poor practice when working with individuals. Evidence: The nurse on duty and manager overseeing the home said that through training and supervision the staff are informed that they must always respect and actively promote peoples rights. The nurse added that one way in which this is done is by taking peoples comments, concerns and complaints about the quality of the service and their experience of it seriously. We found information in the records held at the home, that regular meetings are held for people to enable them to contribute to and influence how the home is run and how service are to be delivered. One person said that they have the right to speak for themselves, and that they do this at meetings or when things are not going their way. One staff member said that sometimes, people at Halifax Road may need help in making informed choices or in expressing their views, and to support people, advocates are called upon to help do this. We found evidence in peoples records to support this. People at the home said that they can freely discuss any concerns they have with staff members or any member of the care homes management. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: The service has clear procedures in place that can help people to complain about any aspect of the service. Information held at the home shows that the management team deals with concerns and complaints quickly and sympathetically, and provides a full account to relevant parties about what will happen as a result of their complaint, and the outcome of any investigation. People at the home said that they know how to make a complaint or comment about the service. Staff said that people are also told how to contact other organizations who have an interest in the service such as Social services and the Commission. Information relating to this was seen and found to be in a format that was accessible to people. When asked about this information one person said I know where your telephone number is in case I need to complain. People who completed our survey indicated that they felt safe at Halifax Road. One relative said that they were satisfied that their relative was safe but not be overprotected, as they were supported to take part in a range of activities. The home has a written policy and procedure on the conditions under which restraint is used. We looked at one persons behaviour management plan, which was seen to be positive, person centered and well written. It stated that staff trained in the use of restraint should support this person when all other methods had failed. Information in the staff training records showed that staff have not had refresher training in this area of care and support, and some staff have not had any training at all. Information with the records shows that this is despite the fact that there has recently been a safeguarding investigation at the home concerning the use of restraint. The manager overseeing the service explained that training in the area of managing aggression and violence was due to take place in the next few months. It was explained that this was positive, but questions need to be asked about why this training has not been arranged sooner, taking into account recent events at the home, and the needs of the people living there. The nurse on duty explained that if it is necessary to restrain people on certain occasions this will be written into their personal plan and records kept of any incidents involving their restraint. Evidence of this was found. At the last inspection, a requirement was made that a record of any serious incident that take place in the home must be kept and all incidents which involve a safeguarding issue must be referred to the Bradford Safeguarding Team. This has been actioned the staff at the home. Good records are now in place for all incidents, and referrals are made to Bradford Safeguarding Team when necessary. Care Homes for Adults (18-65 years) Page 20 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 live in a clean, comfortable and safe environment. However, the laundry floor and walls need some attention so as to reduce the potential spread of mould. Evidence: We found that the building has six single bedrooms. The communal kitchen was found to be clean and tidy, with appropriate facilities for people to use. One person said that they like to go into the kitchen and make cups and tea, and sometimes a sandwich. There is a spacious dining room and a communal lounge, both were found to be clean and tidy. The rest of the home was found to be clean and tidy, and well maintained and pleasantly decorated. The laundry facilities are located in the cellar, and the cellar floor and walls were found to be in need of some attention as they are not impermeable and the wall finishes are not easy to clean. Peoples bedrooms were found to be pleasantly decorated, and reflected personal tastes, and furnished to meet individual needs and requirements. People who responded to our surveys told us that the home was always fresh, clean and spotless. People living at the home said that they liked it, and that they thought it was comfortable and homely. Care Homes for Adults (18-65 years) Page 21 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 are supported by a good staff team that are approachable. However, gaps in their training and development, the high use of agency staff and a lack of staff who can drive potentially has the effect of undermining the work that they do. The role of the nursing staff needs to be reviewed so as to ensure that peoples skills, abilities and knowledge are fully utilized. Evidence: We found evidence in the staff personnel files that showed that the staff job descriptions have links with the main aim of the home, that being to support the people living there to achieve their personal goals as detailed within their personal plans. People at the home said that they have a good relationship with the staff and see them as friends and helpers. People living at the home said that the staff team are easy to talk to and good listeners. Information contained within the rotas showed that the numbers of staff on duty are satisfactory to meet the needs of the people living at the home. However, we found that due to sick leave, and staff suspensions, the use of agency staff is high. The manager overseeing the home explained, that when agency staff are used, she tries to Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: get the same staff each time, so as to provide some consistency for the people at the home. A check of the rotas confirmed that for the majority of the time this is the case. We found that on some occasions during the week, the nurse on duty may be only person in the building, and the only person available to drive the homes minibus to peoples day placements. When this is the case, not only those going out fore the day leave the building, but those who would usually stay at the home. Those who would usually stay at home then have to tolerate a 25 mile round trip of Bradford whilst everyone else gets dropped off at their respective day placements. One person living at the home said that didnt always like doing this. We found that over half of the staff team hold a National Vocational Qualification Level 2 in Care, and that those who do not, are undergoing training in order to obtain this qualification. At the last inspection a requirement was made that the provider must make sure that all the necessary criminal record bureau and protection of vulnerable adult checks must be made and appropriate references obtained before staff start work. Action has been taken to meet this requirement. We checked the recruitment files of 4 staff who work at the home. Two recently recruited staff had the correct information in their file relating to pre-employment checks. However, one staff member who had been recruited some time ago, did not have references from the most recent employer. Instead, they had personal references from former colleagues. It was explained to the manager overseeing the service that any staff recruited in the future must have a reference from their most recent employer. We found that the service has a training and development plan for staff. However, some gaps were found in the training of some staff, most noticeably training in the area of safeguarding adults and managing violence and aggression. This is despite a recent adult protection incident at the home involving the management of aggression and challenging behaviour. We found little evidence of any specialized training linked to the needs of the people living at the home being offered to the staff team Information contained within peoples personnel files shows that staff receive support and supervision. One staff member said that they find this useful, and use the time to discuss how best to carry out their jobs. The manager overseeing the home explained that some staff had recently undergone disciplinary procedures regarding their conduct, and we found evidence to support this. The service had undertaken appropriate actions to protect people at the home, and deal with people conduct. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Some of the nursing staff at the home said that they feel that their knowledge and skills are often not fully utilized. They explained that this was due to the fact that the people at the home did not have significant complex healthcare needs. One person said that their skills and expertise in this area of care are often put on the back burner, as their work involves providing leadership to the staff team, the development of care plans, cooking and cleaning, and most noticeably, the undertaking of management responsibilities. Care Homes for Adults (18-65 years) Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite the registered manager being absent from the service, the management position is satisfactory, and there are good lines of accountability. Greater attention needs to be paid to the auditing and monitoring systems operated within the home so as to promote peoples health and welfare. Evidence: The records show that the registered manager is now working elsewhere within the organisation after training and development needs were identified for them following an internal inquiry. The manager overseeing the service explained that the current management position is that she supervises the home from a distance, and that the nursing staff undertake some management responsibilities and report directly to her. She added that she undertakes a monthly management visit in order to review the quality of the service. Records of this were found, and were in good order. She explained that she visits the service on a weekly basis, sometimes more frequently. Staff confirmed this. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: One of the nurses explained that annual surveys are sent out to people at the home and other relevant third parties, in order to obtain their views about the service. They added that the management team then use that information to produce a report about the service, and action any points about the quality of the service that need to be tackled. Records of this were not available at the time of the visit. Evidence held within the homes health and safety records was cross referenced against the Annual Quality Assurance Assessment supplied to us prior to the visit taking place. We found that relevant checks are made on equipment, such as the fire alarms, the gas and electric systems, and other equipment held at the home. As previously mentioned, poor recording of food temperatures means that appropriate checks can not be made if a person is ill following a meal. One staff member explained that audits such as those relating to care plans, medication and money are not completed as often as they should. The reasons given for this were due to the fact that staff are often engaged in direct care work, or other tasks. It was explained that greater attention needs to be paid to ensuring that regular and periodic quality assurance checks are made within the home. Staff explained that this has been difficult due to the sickness within the team, and the absence of the manager. However, the records show that efforts are being made to address this by way of a review of the role and responsibilities of the whole staff team and allocation of specific pieces of work. Staff have not yet had training in the Mental Capacity Act, however, they are aware of how their actions and the actions of others can have an impact on peoples liberty. Good records are kept of any restrictions placed on people due to risks that face them, and the manager overseeing the service explained that when restrictions are placed on peoples movements, then relevant parties are consulted including the person, their relatives, advocates and any professionals in their life. Records were found to support this. Care Homes for Adults (18-65 years) Page 26 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 27 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 23 13 Arrangements must be made, by training the staff or by other measures, to ensure that people are not harmed or suffer abuse, or or not placed at risk of suffering harm or abuse. Staff must have appropriate training in managing violence and aggression. Doing this will ensure that peoples rights are protected, and their welfare promoted. 04/12/2009 2 35 18 Gaps in staff training relating to mandatory training, safeguarding and managing violence and aggression training must be filled, so as to ensure that staff are provided with training appropriate to the work they are asked to perform. The service provider is asked to supply the Commission with an up 06/12/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 to date training plan for the staff team. Doing this will ensure that staff are appropriately trained, and fully aware of best practice in the area of work that they undertake, thus promoting peoples best interests and welfare. 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 3 People living at Halifax Road would now benefit from a full re-assessment of their needs, in order to determine what type of service would suit their current needs, aspirations and requirements. Contracts for people living at the home could be put into an accessible format. The contracts should also be reviewed in the light of recent guidance on contracts from the Office of Fair Trading. The use of recognized person centered planning methods for the people who use the service, may in some circumstances, be of benefit to the person and the staff. The recording of food temperatures should take place so that people can be satisfied that food is served at the correct and safe temperature. The alternative storage arrangements for the medication that were made on the day of the visit, should be continued so as to ensure that medication is stored on behalf of people in a safe manner. The laundry floor should have an impermeable finish, and the laundry walls finishes should be easier to clean. The role of the nursing staff needs to be reviewed so as to 2 5 3 6 4 17 5 20 6 7 30 31 Care Homes for Adults (18-65 years) Page 29 of 31 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 ensure that peoples skills, abilities and knowledge are fully utilized. 8 33 Appropriate numbers of staff with the correct skill mix should work in the home, so as to ensure that work can be undertaken with people on an individual level, and to prevent them from having to undergo needless travel around Bradford and the surrounding area. Greater attention needs to be paid to ensuring that the auditing and monitoring systems operated within the service take place, so that managers and can have a clear picture of the services strengths and weaknesses. 9 42 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!