Care Home: 5 Fallings Heath Close

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What the care home does well We found that 5 Fallings Heath Close offers a genuine commitment to care with a professional, yet an open and very personable approach, which reflected the homeliness of a confident relationship between carers and people living in the home. Through the process of inspection we considered that the establishment of a professional accountability towards effective assessment, through detailed person centred care and support planning, and the review of people`s needs were meaningful and robust, designed to support individuals to play an active role in the care process. The plans are formed in detailed, pictorial style and supported in plain English. This highly personable attitude and approach to care is appreciated and welcome by people living in the home, and their relatives alike. The staff have an open and positive relationships with people who use the service, and are aware of individual needs, and how to manage complex behaviour. Staff were seen to communicate at a level and pace to suit individuals, by their approach and using appropriate and specific forms of communication. The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of people with learning disability needs. We recognised the maintenance of satisfactory staffing levels, with in depth staff training and supervision established in safeguarding the interests of people. Policies and procedures were found to be reviewed regularly, and we found evidence of a willingness to seek advice from other health professionals in order to maintain a service which encourages best practice. Overall we consider the attitude in meeting caring and organisational demands is commendable, with forward thinking, planning and application contributing to an excellent service. What has improved since the last inspection? Through the inspection process we found that the people who live there are actively involved in the planning of their support and care. We examined and confirmed that care files have been re-organised to provide a more person centred care approach, allowing greater detail to be recorded of people`s wishes around daily living and social life. During the course of our inspection we established that there have been a substantial enhancement of consultation, providing a stable environment whereby people have developed skills that support them to take a more active part in their environment. Staff training has been a feature of significance in the provision of a broad programme of supported care. We acknowledge that those requirements and recommendations made at the last inspection have been satisfactorily addressed. What the care home could do better: The achievements in establishing a high standard of care have been recognised, areas of detail outlined through recommendations will continue to play a part in the ongoing development and maintenance of an excellent service. Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Fallings Heath Close 5 Fallings Heath Close Darlaston Walsall West Midlands WS10 8BT     The quality rating for this care home is:   three star excellent 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: Keith Jones     Date: 1 1 0 5 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 30 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 30 Information about the care home Name of care home: Address: 5 Fallings Heath Close 5 Fallings Heath Close Darlaston Walsall West Midlands WS10 8BT 01215686176 01215688188 tinaco@accordha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Accord Housing Association Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 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 categories: Learning disability (LD) 4 Date of last inspection Brief description of the care home 5 Fallings Heath Close is a residential home located in Darlaston, Walsall, and is part of Accord Housing Association. The home provides a service for four adults with a learning disability. The large modernised two-storey property is situated within a residential area and is in keeping with the local community. The home is accessible via public transport and is in close proximity to local amenities. The home comprises of four single occupancy bedrooms, equipped with en suite facility, one bedroom is located on the ground floor and the remaining three on the first floor. Bathrooms and toilets are situated in close proximity to bedrooms and communal areas. Appropriate aids and adaptations are provided, to meet the needs of Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 4 Brief description of the care home the people who use the service. A passenger lift is in place to enable individuals to access all areas and facilities within the home. Located on the ground floor is a spacious lounge equipped with essential furnishings and items to provide a comfortable area for relaxation and recreational purposes. People who use the service also have access to a dining area; there is also a modern domestic kitchen and a separate laundry area. Staffing is provided on a 24-hour basis to ensure the total supervision and support of people using the service. People who use the service at 5 Fallings Heath Close have access to relevant healthcare professionals if and when required. The full range of fees were not detailed in the service Statement of Purpose, or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Adults (18-65 years) Page 5 of 30 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: three star excellent 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 conducted this unannounced inspection with the Scheme Manager and senior support staff on duty, whose input contributed to this report. Our inspection of the building allowed us free access to all areas and open discussion with people who live there and staff on duty. There were four people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with learning disability care needs. To do this we looked at (case tracked) three peoples files from referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who use the service and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Care Homes for Adults (18-65 years) Page 6 of 30 Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We inspected a sample review of administrative procedures, practices and records, confirming excellent practice and effective management. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The achievements in establishing a high standard of care have been recognised, areas of detail outlined through recommendations will continue to play a part in the ongoing development and maintenance of an excellent service. Care Homes for Adults (18-65 years) Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who may use the service are thoroughly assessed before they are offered a place in the home. In this way they and their relatives can be confident that the home will be able to meet their needs. Evidence: We examined and discussed the revised Statement of Purpose and Service User Guide and we found them to provide an informative description of the homes aims, and the way it operates. We found that there was sufficient information, and it is delivered in such a manner as to help people who may use the service, and their family, to make an informed choice as to the suitability of the home in meeting their needs. We also found that the Service User Guide is represented within the framework of the care records, indicating that people are actively engaged in the full process of residency. We recognised that the previous inspection had evidenced that a thorough assessment of individual needs are undertaken prior to them moving into the home, to ensure that the home could meet the persons individual needs, and of those of people already living in the home. The home demonstrated to us the importance of careful planning Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: an admission, recognising the need to build as full a profile of an individual as possible. Assessments from other professionals such as social workers are kept on each persons file. Our examination of each persons care plans and records clearly demonstrated the extensive efforts to see through the admission procedure and assessment. Each record showed the attention to peoples individuality, and their unique needs. Evidence was seen of that assessment process being applied following admission and into continuing care. The home does not accept emergency admissions. Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in decisions about their lives and play an active role in planning the care and support that they receive. Evidence: On our examination of four peoples care files we found the person centred support plan to identify a persons individual support needs around their health issues, with an excellent record of daily living. We recognized a comprehensive assessment, a person centred plan, and a risk based health and safety assessment. Each were found to identify the needs of the individual, including their input wherever possible, with an individual support plan completed, which covers all areas of the persons life profile, detailing personal information, including abilities, likes and dislikes, how s/he communicates, some described in pictorial accounts. People are actively encouraged to do things for themselves, and support is offered as and when required, to promote independence and positive behaviour. These plans were seen to be highly individualised, risk assessed based, reviewed on a monthly basis and reassessed on an as and when basis. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Individual care plans, clearly identifying the key worker, were designed to maximise attention to the specific areas relevant to the individual. Each record identified any specialist input required by the person, demonstrating involvement and understanding, with easily recognised key values of individuality, competence, rights, choices, continuity, and status recognition. We saw on the day of inspection the day to day activities where people were seen to be relaxed in dealing with routine household activities, or generally engaged in social discourse. Where they did not want to do something at a particular time there was no pressure to conform. We talked with three people who were present, with one other person attending day centre activities. A communication plan was in place for each person, in which staff were guided, by observation, in what to do in certain situations, reading Makaton signs, and behavioural signals, a particular turn of phrase, and what they thought from experience of reactions. Behavioural management strategies are devised in conjunction with a psychology service, which were seen by us to be re assessed on a regular basis to help staff to support a person if their behaviour presents a challenge. Care Homes for Adults (18-65 years) Page 14 of 30 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. The wishes and choices of people are at the heart of service provision, and the home is operated to achieve these goals. Evidence: Throughout the inspection we saw that people living in the home were enjoying a high degree of encouragement to express themselves in positive and meaningful ways. Bedrooms were seen to demonstrate that individuality to match personal outcomes. We looked at activity records for each person, which identified individual events to suit personal needs. On the day of inspection there were no events involving the local community, but reports from the Scheme Manager indicated a sense of belonging within that community, including relationships that at times have been testing. The overall emphasis on the importance of nurturing a solid foundation of trust and respect with the local and wider community is recognised. One person attends a day centre five days a week, all four people, at times, enjoy going out for meals, and local Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: events like a trip to the local pub or theatre. The introduction of a pictorial reference, that the people helped to format themselves, ensured that they know what the planned activities for the day are, and helped them to make an informed decision about participating in the events. Discussion with staff, and inspection of records revealed that individuals have been regularly involved in arts and crafts, shopping, listening to music and singing, having a meal out and going for a walk. The home has an active participation in risk assessed holidays, with people going to Brean Sands in Somerset with two members of staff this year, and planning a Euro Disney vacation. A fully flexible open visiting policy was stated as the policy, although no visitors were present during the inspection, however the policy reflected the importance placed upon family or friends regular contact. Peoples life styles and interests are recorded in their care plans, if possible, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for people to latch on to without dictating events. Personal choice and self-determination are respected in policy and action. We saw that bedrooms inspected with the peoples permission, and some pride in presenting their domain, were well appointed personal areas. Those who wish to bring in personal possessions are encouraged to do so. We found that people are involved in risk assessed domestic type tasks in the home as part of social skill development, this includes ironing, cooking, cleaning bedrooms, washing, etc. Observed practice showed that interaction between staff and people was friendly and appropriate. It was confirmed that staff only enter their bedrooms with prior permission, and always knock before they enter. Choices were available for every aspect of daily living and menus provided a varied and good choice of food available on a flexible, person orientated programme, with people going out on shopping trips to buy food with staff. The dining area was homely and friendly, adjacent to the kitchen area, offering a pleasant, conducive ambiance for a social meal. The kitchen was domestic in style, seen to be clean, organised and with satisfactory equipment. Safety figured highly in the layout and use of kitchens, and appropriate risk assessments had been taken. Two people were seen to assist staff with preparing their lunch, taken in the pleasant dining area and lounge in a relaxed manner. Care Homes for Adults (18-65 years) Page 16 of 30 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. Principles of respect, dignity and privacy are at the forefront of the approach of the service when meeting the personal and healthcare needs of people living in the home. Evidence: We recognize that people have some difficulties communicating effectively; to which the service provides a pen picture and pictorial reference method of communication, and Makaton, a form of sign language used in conjunction with standard British Sign Language procedures. Staff demonstrated to us that they had a very good understanding of peoples personal, emotional and physical support needs, building on a comprehensive assessment. Individual care plans, clearly identifying the key worker, were designed to maximise attention to the specific areas relevant to the individual. Each record identified any specialist input required by the person. The person centred support plan is provided in a clear, unambiguous style, demonstrating involvement and understanding. There are easily recognised key values, individualised to match personality and personal expectations. This has established that the home operates a clear policy of a flexible routine, established to meet and encourage self-determination, tailored to meet Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: peoples needs in a non-patronising manner, and delivered with an observed empathy of close bonding. The recording of social activities are seen to be an integral part of care reporting and planning. Social activities are designed to stimulate motivation and interest in their surroundings, with encouragement and help from care staff. Personal choice and relative self determination are respected in policy and action. The general atmosphere throughout the home was one of family, confidence, warmth and contentment. Staff were observed in addressing people in a respectful and dignified way. Each person has a Health Action Plan that addresses all aspects of their individual health needs, including medical and family history and treatment consent, monitored on a monthly basis. This was seen by us to include a positive behaviour plan which identifies all aspects of health concerns. Specialist support and advice are sought as needed with each person being registered with a local doctor, dentist, optician, and chiropodist, and have access to physical and mental health services, including a psychiatrist. The administration of medicines adhere to procedures to maximise protection to people. The manager and all senior care staff are trained to administer medication. The receipt, administration and return of medicines were documented and accurate. Storage was secure, with accountability recorded throughout the process. No person have been assessed as able to self administer their medication, although all had an assessed capacity to be involved in the process, and be aware of the regime. It was advised that an explanatory section be included in the care plan which would explain what each medicine was for, and how to identify them. The storage arrangements for controlled drugs require a more robust securing of the metal cabinet by Rag bolting to an adjacent wall. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had a meaningful complaints policy. People are given opportunities to freely express any concerns and these are quickly responded to. They are protected from abuse, and their human rights are promoted. Evidence: The complaints policy was seen, and records examined. There were few minor concerns assessed, all dealt with at the source by the Scheme Manager. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. There were no recorded complaints or allegations made to us since the last inspection. Case tracking confirmed the effectiveness of a Provider, Scheme Manager and staff sensitive to peoples needs, and a readiness to test the robustness of their information and report structures. We asked people if they were aware of how to make a complaint; one persons response was: Of course, and I do if I get upset, but M. always sorts it out. We recognise that staff receive training on safeguarding at induction and there is also a planned programme of internal courses across the parent organisation for all staff. Staff working at the home receive training on behavioural management, management of violence, and management of challenging behaviour, consistent with the observed policies. We inspected records of recent aggressive and violent incidents, which Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: evidenced that the appropriate non-violent crisis intervention was taken, and the situations effectively defused. Peoples legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure, which clarified the responsibilities of all staff in their daily contact with people. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, well maintained and comfortable home for the people, with a provision that encourages independence. Evidence: The home is a large, modern, detached property in a residential area, located in an excellent position for reaching local shops and communal facilities. The home has a main front entrance where the visitors book was located. There is a good sized garden to the rear of the property, that is presently undergoing a clean up and redesign after a harsh winter. We saw work ongoing in improving a small herbal patch access, improving sensory areas for people who want to engage with natural materials. It was noted that plans to develop the whole garden are presently in hand, including accommodating a rabbit hutch. The property comprised of four single occupancy bedrooms, equipped with en suite facility, one bedroom is located on the ground floor and the remaining three on the first floor. All bedrooms were tastefully designed and decorated to meet the needs of the individual. The design and layout of the property enabled the individual to live in a safe, well-maintained and comfortable environment, which encouraged independence. There was evidence that there has been some internal redecoration, and furnished to Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: reflect the homely feel, within the confines of the modern styles. We confirmed that each person had contributed their opinions and influenced the outcome of decor, to personalise their rooms, to reflect their interests, and with staff had explored methods of finding suitable equipment and furniture that was modern, but suitable for potential complex behaviour exhibited by individuals. Appropriate aids and adaptations were provided to meet the needs of the people living in the home. A passenger lift was in place to enable individuals to access all areas and facilities within the home. Located on the ground floor is a spacious lounge equipped with essential furnishings and items to provide a comfortable area for relaxation, and for recreational purposes. A computer with a large keypad was frequently used by one person living in the home. People have access to a pleasant dining area; there is also a modern domestic style kitchen and a separate laundry area. All internal services were well maintained and functioning. People living in the home take some responsibility for domestic activities including cleaning, assisting with laundry and cooking. Bathrooms are of a very good standard, well equipped and maintained. To enhance safety the manager was advised to place a bath thermometer in each bathroom. The general decor throughout is of a high standard. Care Homes for Adults (18-65 years) Page 22 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels ensure that sufficient staff are provided to meet the needs of people who use the service. Recruitment processes are consistent and robust, protecting the people who use the service from harm and abuse. Evidence: We recognize that staffing levels had maintained consistency to ensure equilibrium between numbers, skills and qualifications, with a strong foundation of experienced staff. Three weeks of off duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. We acknowledged that there are three members of staff on each day shift from records examined; two in the evening, with one night member of staff. The Scheme Managers hours were essentially supernumerary but that she is on call for out of work hours to offer advice and support as and when necessary. . The Scheme Manager emphasised the homes commitment to training and to achieving targets for National Vocational Qualification (NVQ) level III. There are five staff with NVQ level III, representing 70 achievement, with one staff on training and one application pending. We are informed that all staff, on completion of the induction and probationary period, are submitted for NVQ traing. Overall the evidence shows a Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: comprehensive account of a meaningful and important schedule of training, to meet internal and external demand. Mandatory training is provided for all staff including: fire safety awareness, food hygiene, abuse and movement and handling. Consideration has been given into the implications of the Mental Capacity Act 2007. We confirmed that all staff are given an in house induction. The use of a training matrix gave us an overview of training schedules, and a visual reminder to the manager and staff when training was due, or should be scheduled. Discussions with a three support workers confirmed that mandatory training was up to date, and that special training was offered on a frequent basis. Three staff files were sampled and found to be consistent in the process of appointing staff. It was evidenced that POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks have been made. The management have a procedure for interview, selection and appointment of staff, that has proven effective. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care, to ensure protection of people using the service. Staff were able to verify that they had received a contract. Three on duty members of staff were interviewed, each expressing their working conditions openly and with confidence. Each individual was complementary as to the level of training they receive, and the management arrangements. One stated clearly, and with purpose that: Have worked here for only four weeks, in which have had a very thorough, and on going induction programme. This has helped me enormously as I had no previous care experience. I have found the managers and senior staff very helpful and very professional. Have really enjoyed the senior team leader experience and learnt a great deal, with good support from an experienced and understanding manager. We confirmed that staff supervision was seen to complement an effective induction and training programme. A two monthly system was evidenced, and staff indicated its value and constructive help. Diversity issues with staff were discussed, and confidence in meeting those issues were expressed as being recognised. and accommodated. Care Homes for Adults (18-65 years) Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: We recognised that the Scheme Manager of the home, Katrina Cox, who commenced at 5 Falling Heath in April 2007, has completed her Level 4 and Registered Managers Award. She has been employed by Accord Housing Association for over five years. During this time she has demonstrated evident competence in running a care home, and has established a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. We have acknowledged that since her appointment she has introduced Person Centred Care Planning, and has expanded the community based activities for those people using the service. She has established that people are actively involved in the production of their care plans and that all contribute to the management ethos of the home, and are helped to exercise choices as much as possible. We were impressed by the openness, professional and pleasing Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: confidence in the observed interactions of staff and people who live in the home, with relationships based on mutual trust and respect. Appropriate risk assessments are in place for people, through person centred care planning and recording, staff selection, and the general environment, these are up to date and accurate. The Registered Providers, Accord Housing Association, present a high profile in direction and managerial involvement in the smooth running of the Home, delegating a wide range of management responsibility to the Scheme Manager to good effect, together they have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were generally found to be well maintained in ensuring that peoples rights and best interests are safeguarded. The Manager offered evidence of procedures in place including: Administration of medicines, Abuse awareness (Safeguarding), including Whistle blowing, the Mental Capacity Act, and dealing with challenging behaviour. During the inspection of individual financial records it was identified that straightforward, simple systems were in place to protect people from any financial abuse. Records were clear, and receipts were kept secure, audited six monthly by head office. The health and safety of people and staff are promoted with safe storage of hazardous substances and annual electrical PAT (Personal Appliances Testing). It was advised that PAT should be done on acquisition of new equipment. The accident book was examined and found to be in order for staff working, and people living in the home. Cross-referencing with care records identified that a cause and effect situation to care plans was undertaken following the reporting of incidents and accidents. Following through recent incidents it had been decided whether or not the events had had any significant effect on care planning aims. The Manager was advised to retain copies of accidents/incidents in the individuals care plan. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of people in the home. Care Homes for Adults (18-65 years) Page 26 of 30 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 30 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 That consideration be given to develop an audio and pictorial presentation of the Service User Guide to allow a clearer understanding of the choices the home have to offer people who may use the service. That the available Controlled Drug cabinet be secured to an adjacent wall by means of a Rag Bolt, to ensure a secure storage facility. It would be advantageous for each person receiving medication to have a pictorial description of the purpose of each drug/application, to enhance their involvement and awareness of their health care treatments. To complete the work started on the rear garden to provide a safe and secure area for people to use and enjoy. That a bath thermometer be situated in all communal bathrooms to ensure safe water temperatures are presented. Copies of accident records should be retained in the persons care file, to facilitate an awareness of incidence and maintain a meaningful care record. 2 20 3 20 4 5 24 27 6 42 Care Homes for Adults (18-65 years) Page 28 of 30 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 7 42 Testing of all personal electrical equipment be undertaken on receipt, to ensure a safe environment for people using the service. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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