Care Home: 5 Wellington Street

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What the care home does well The service is well run and people are provided with a clean, comfortable and safe environment in which to live. Bedrooms are decorated and furnished to their personal taste and their right to privacy is respected. Care is provided by a competent and trained staff team who meet people`s needs in accordance with their individual plans. There are suitable arrangements in place to support people to live the lifestyle they choose, maintain relationships with family and friends and access community-based services. People are encouraged to express their views and there are systems in place to protect them from harm or abuse. What has improved since the last inspection? The service has carried out a re-decoration and refurbishment programme to ensure people continue to be provided with a homely, comfortable and safe environment to live in. Additional electric sockets have been fitted in people`s bedrooms so they no longer need to use extension leads that were potential trip hazards. The service has reviewed its process for assessing people`s needs and is planning to produce easy to read formats for them. The shortfalls in the storage, handling and training of staff in respect of medication identified in the last report have been addressed to ensure people`s health and well being is fully protected. Risk assessments have been carried out and are regularly reviewed to ensure people are appropriately supported when bathing. The quality of recordings kept by staff of people`s dietary intake and weight has been improved. This enables more effective monitoring to take place and for any issues to be addressed promptly. Systems have been implemented for foodstuffs to be labelled with the date opened and use by date to ensure good rotation of stock and food past its best is disposed of. Improvements have been made to the service`s safeguarding systems to ensure people are fully protected from harm. Training has been received by staff in safeguarding issues. Procedures for staff recruitment are being followed more closely. Accurate records are being kept of all hours worked by managers and staff. Monies being looked after on behalf of people by the service is being monitored more closely to ensure any mistakes are quickly identified and addressed. What the care home could do better: Arrangements should be made for the garden to be maintained on a regular basis. The store used for cleaning products should be replaced for a more secure facility to prevent the risk of accidents. Fire risk assessments for the premises should be reviewed at least once a year to ensure people in the home are kept safe. There is a comprehensive quality assurance system, however for this to be effective in the monitoring and development of the service it needs to be completed in line with the procedures.The monthly reports produced by representatives of the company of their visits to the home should be kept accessible in the home for reference and inspection purposes. Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Wellington Street 5 Wellington Street West Bromwich West Midlands B71 1DR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Elsaleh     Date: 1 1 0 8 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 28 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 28 Information about the care home Name of care home: Address: 5 Wellington Street 5 Wellington Street West Bromwich West Midlands B71 1DR 01215323558 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Pioneer Care Limited care home 3 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 5 Wellington Street is a semi-detached property which is rented from the Local Authority by Pioneer Care Limited and is located in West Bromwich. The centre of town is within a two-mile radius and there are local shops nearby. Public transport is good. The home provides care for three people with learning disabilities all are fully mobile. The accommodation includes: a lounge/dining room and kitchen and toilet. There are four bedrooms one on the ground floor, three on the first floor, one of which is used as an office/sleeping in room for staff. There is a domestic type bath and toilet. There is a quiet/activities room located on the first floor. There is a patio and large lawned garden to the rear of the property. This garden is well established and secluded. People are supported in the community and to participate in a range of activities and holidays. A Statement of Purpose and Service User Guide is available to inform peopke of their entitlements and what the service has to offer. The service should be contacted for up to date fees. There are additional charges for toiletries and hairdressing. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 3 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We looked at information we have received about the service since our last visit and sent surveys to people who live in the home, their relatives and health and social care professionals asking them to tell us what they think about the home. We received responses from 65 per cent of the people we surveyed. Comments were positive about the service and have been included in this report. The service is required to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information about what has happened in the home during the last 12 months. This was returned to us by the date requested and contained the information we asked for. This unannounced inspection was carried out by one inspector on 11th August 2009. We spoke to the acting manager, staff and the people who live here. We looked at the care files for two people and two staff files in detail as well as other records and Care Homes for Adults (18-65 years) Page 5 of 28 documents kept by the service. This was to help us to assess the quality of life for people who live in the home and the services performance against the national minimum standards. The atmosphere in the home was relaxed and friendly. A tour of the building found it to be suitably furnished, clean and tidy. People we met appeared healthy and well looked after. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Arrangements should be made for the garden to be maintained on a regular basis. The store used for cleaning products should be replaced for a more secure facility to prevent the risk of accidents. Fire risk assessments for the premises should be reviewed at least once a year to ensure people in the home are kept safe. There is a comprehensive quality assurance system, however for this to be effective in the monitoring and development of the service it needs to be completed in line with the procedures. Care Homes for Adults (18-65 years) Page 7 of 28 The monthly reports produced by representatives of the company of their visits to the home should be kept accessible in the home for reference and inspection purposes. 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 28 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 28 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. People are provided with the information they need to make an informed choice about where to live. There are good systems in place to assess peoples needs and aspirations and identify with them how these can be met. Evidence: Information about the service is provided on request in the Statement of Purpose and Service User Guide. These are reviewed periodically to ensure people are provided with information that is up to date and produced in suitable formats for them to understand. The home has no vacancies and has remained fully occupied since 2003. This is confirmed by the acting manager in the information the service provided to us about the home. Although there have been no new admissions the information tells us assessment systems have been reviewed as part of the services monitoring processes and it plans to produce easier to read formats for the people who use the service. We looked at the records for one person living in the home. It showed us the original Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: assessment carried out by the service was detailed and included the persons physical, emotional and social needs and how these could be met before s/he came to live in the home. We spoke to the people living in the home and they told us they were settled and happy. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their assessed needs and goals are reflected in their individual care plans. They are actively encouraged to participate in the planning and delivery of their care and are able to exercise control over their lives. Evidence: We looked at the care plans for two people living in the home. These contain detailed information about their individual needs, how these are to met, and their likes and dislikes. These have are not yet been produced in easy read formats, such as pictures, for individuals to understand. The acting manager told us work is being carried out to do this. The care plan is discussed with the individual each month with a key worker to ensure it continues to meet the persons needs and preferences. The same member of staff showed us showed good knowledge of peoples plans and how they are to be supported. She told us all the people living in the home require different levels of support with their personal and social care needs, for example one person needs more help with bathing another with dressing. They have their own interests which include going for walks, helping in the home or watching television. She showed us the daily Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: records kept of how people have spent their time and the support they have been provided with. These are monitored by the managers to ensure their needs are being met in accordance with their plans and personal preferences. Six monthly reviews are arranged with the individual, relatives/representatives and significant agencies to discuss her/his care plans and make any changes,where necessary, to the individuals care plan. People living in the home are supported to make informed decisions on a daily basis about how they wish to live. For example how they want to spend their money and any activities they wish to participate in. They meet weekly with staff to discuss their forthcoming appointments, visits and what they would like to do. We looked at the rotas and these show suitable arrangements are made to support people to do things they want to do. The manager told us that none of the people living in the home are using the services of an independent advocate. However, information is available and support will be provided for people to access this service. People and staff meet periodically as a group to discuss issues about the day-to-day running of the home. For example, to agree what colours should be used when re-decorating and discuss visits made by people applying to work at the home. People we spoke to tell us they like to go on activities and holidays together. The meeting in June this year shows the main issue for discussion was the forthcoming holiday. We saw the minutes of this meeting had been produced in written and pictorial formats. The responses we received to our surveys from people living in the home tells us they are able to make their own decisions. The service, wherever possible, supports people to live as independent lifestyle as possible. This is evidenced through the care planning process which considers the risks to people doing specific tasks unsupported and the need to keep them safe. The care files we looked at contained individual assessments and strategies to minimise risks. One person likes to go for a walk to the shops after her/his evening meal. However, they do not recognise the dangers when crossing roads and do not understand monetary values. The risk assessment shows s/he is to be accompanied by staff and supported when making purchases to ensure s/he receives the correct change. All people living in the home require support with bathing. Their individual risk assessments show the assistance each person needs to minimise the risk of falls. It also identifies what tasks the individual is able complete for themselves as part of maintaining their independence. One persons records shows there has been a history of challenging behaviour. A risk assessment was carried out and strategies put in place for responding to this and training has been provided for staff. The manager and staff reported that since changes were made to her/his care plan there has only been one incident in the last twelve months. Care Homes for Adults (18-65 years) Page 13 of 28 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 provided with a range of learning and development opportunities. They are supported to take part in meaningful activities and maintain relationships with family and friends. The meals provided meet their dietary needs and personal preferences and these are served in a pleasant environment. Evidence: Information provided to us by the service tells us it continues to provide the three people living in the home with opportunities for self development. When we arrived two people were out, one at a local day centre and the other had gone out for lunch and then the cinema with a member of staff. The person at home told us s/he likes doing jobs around the house with staff and was seen making drinks and preparing lunch. The people who returned home told us they had enjoyed their day. There is a computer in the home for people to use and staff told us one person was getting quite good. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Individual activity planners are produced each week and daily diaries are kept by staff to report on their activities. These show people are provided with opportunities to do the things they like and are supported with their independent and social living skills. For example going shopping and travelling on public transport. People told us they enjoy doing art and craft, going to the pub and visiting friends. Staff told us people are confident in communicating to them what they want to do. The records show planners are not always followed. The acting manager said this is because people sometimes change their mind and the service is flexible to accommodate this. During our visit we saw people doing different things, one person was listening to music in their bedroom, another was watching television in the lounge and the third went for a walk to the shop with a member of staff. Staff told us people are supported to keep in touch with family and friends. Relatives who responded to our survey told us staff are friendly and keep them informed about what is happening in their family members life. One relative who does not live locally told us my sister telephones every week for a chat. People are also supported to visit friends especially those living in another home belonging to the company. They told us they like going on holiday with their friends. We were shown photographs of their recent holiday to Minehead. One person said We all had a smashing time. The daily routines in the home were seen to be flexible with people choosing to go to their bedrooms when they wanted to and one person spent time in the garden watering the plants. There is unrestricted access to communal areas and the garden. However, people are supervised and/or supported in high risk areas, such as the kitchen, in accordance with their individual risk assessments. Throughout the visit people were making drinks when they wanted. Relatives told us they feel people are supported to live the life they choose. Meals are generally prepared by the care staff and they have been trained in basic food hygiene. Staff told us there is no planned menu because peoples dietary needs and preferences can be catered for on an individual basis. We saw one person being supported to make their own lunch consisting of a sandwich, yoghurt and a drink. People regularly accompany staff to do the weekly shopping. This allows them to select the items they want. Records are kept of meals taken by individuals and monitored to ensure people are receiving a healthy diet. Staff told us there are no concerns about peoples dietary needs. The kitchen was clean, tidy and well equipped. Foodstuffs were clearly labelled with date of opening and use by dates. The fridge and freezer temperatures are recorded to ensure food is stored at the correct temperatures. Care Homes for Adults (18-65 years) Page 15 of 28 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 support from staff in the way they prefer and require to meet their physical and emotional health needs. There are suitable procedures and systems in place for the safe handling and administering of peoples medication. Evidence: Information provided to us by the service tells us all the people living in the home need support with some aspect of their personal care. The two care plans we looked at show how these are to be met. Staff said support is always done in the privacy of their bedrooms or bathroom. One persons plan shows s/he needs support getting in and out of the bath. Staff told us this persons mobility is being closely monitored. The person said they usually choose to have a shower now and staff help me so I dont fall. All the people living in commented on the surveys we sent them that they are always treated with respect. Relatives told us the service meets all their family members needs. People at the home looked well and were dressed according to their age and weather conditions. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: The files we looked at show people have access to the dentist, optician and other healthcare services which includes annual healthcare checks. There are good details about peoples health and health action plans have been completed. Since our last visit more care is being taken to ensure weight charts are being completed on a regular basis. Staff encourage people to try and maintain a healthy weight through diet and exercise. One person told us they enjoy going for walks and another said they enjoy dancing. The service manages medication on behalf of all people living at the home. Training in the safe handling and administering of medication is provided to staff and regular competency checks on their practice is carried out by the manager. Suitable arrangements are in place for ordering, storing and returning medication to the pharmacy and a formal handover of responsibility for the medication is carried out at the change of each shift. We looked at the medication records for two people and found these had been completed. A protocol for administering as required medication was seen on one persons file with instructions for medical advice to be sought if taken over more than three days. The manager told us there has been a significant reduction in the times this medication has been taken following the changes made in how her/his care is being provide. A member of staff said she is familiar with these procedures and told us what they would do to if an error occurred. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to make a complaint and the service has procedures to ensure their views are listened to and acted upon. There are sufficient systems in place to protect people from abuse. Evidence: The service has a complaint procedure which is made available to people living at the home and their relatives/representatives. People we spoke to told us they knew who they would speak to if they were unhappy or had any concerns. One person told us then staff sort it out. The service provides people with a range of opportunities to express their views for example at house meetings, meetings with their individual key workers or by completing the services questionnaire. The records show there have been no complaints made to the service since our last visit and none have been reported to us, CQC (Care Quality Commission). Relatives told us they know how to make a complaint but have not needed to do so. One relative told us the home always responds appropriately any queries or concerns they may have. The service has a book for anyone to record their comments. The last entry made in May this year is from a social worker. She wrote to thank all staff for their co-operation in recent and numerous meetings - everyone was very helpful. Policies and procedures for safeguarding vulnerable adults are kept available in the office. Two staff files we looked at show adult protection training has been attended by them. The service reported a safeguarding concern for investigation by the local Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: authority earlier in the year. A record of the action taken is available in the home and the matter was reported to us at the time by the service. The investigation found no evidence to support the allegation made. No other safeguarding matters have been reported and none were raised during this visit. The service does not act as appointee for people living in the home. However, it does manage small amounts of personal allowance and records are kept of all transactions. At our last visit we found a person had been inadvertently charged for a meal in the community which should have been covered by their fees. The person was reimbursed and the acting manager states greater care is taken when monitoring these records. The organisation also carries out periodic financial audits and confirmed the person had been reimbursed. Care Homes for Adults (18-65 years) Page 19 of 28 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 comfortable and attractive home. The premises are clean and hygienic. Evidence: The home is situated in a residential area and does not have off-road parking. The service has completed a re-decoration and refurbishment programme since we last visited and the issues identified in the previous report have been addressed. For example people have been provided with additional electrical sockets in their bedrooms and wardrobes have been secured to walls to minimise the risk of accidents. We discussed the fitting of more suitable locks to bedroom doors and providing people with their own key. The acting manager told us people have declined offer of their own bedroom door key. He agreed to regularly consult with individuals about this and, if requested, would make suitable arrangements to meet the persons request. The manager is advised to include the fitting of more suitable locks on bedroom doors when the home is next refurbished. Peoples bedrooms are pleasantly furnished to meet their individual tastes. Personal items, such as family photographs, ornaments and posters, are on display. There is a comfortable and pleasantly furnished lounge/dining area for people to spend time together and enjoy mealtimes if they wish. There is a small garden at the front of the premises and a larger garden at the rear Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: with a patio area. Both gardens are in need of attention. One person joined us in the garden and pointed out the different patches of weeds. The acting manager told us one person used to like to do some gardening with staff but has not shown any interest recently. Suitable arrangements need to be made to ensure these areas are well kept. Liquid soap and paper towels are available in the kitchen, toilet and bathroom. A member of staff showed us were protective clothing, such as disposal aprons and gloves, is stored. She confirmed these are kept in ample supply. Staff told us people understand what different cleaning products are and the dangers, but close supervision is still provided when these are being used. There is good information available in the kitchen for the control of substances hazardous to health (COSHH). These products are kept stored away from the kitchen but we found the lock to be faulty. A more substantial lockable storage facility needs to be provided. The acting manager told us this would be addressed the following day. People living in the home commented that it is always clean and tidy and relatives tell us the home has a friendly atmosphere and residents are comfortable and happy. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a skilled and competent staff team who know them well and understand their needs. The services recruitment procedures ensure they are safeguarded from harm or abuse. Evidence: People receive support from a staff team who have different life experiences. The majority of staff hold Level 2 and Level 3 National Vocational Qualifications (NVQ) and arrangements are made for newly appointed staff to commence this training when they have finished their induction. A new member of staff told us they are looking forward to this training. Information provided to us by the service shows no shifts have been covered by temporary or agency staff. Staff told us they volunteer to cover any absences so people are cared for by staff they know and who know their needs. The rotas are planned in advance and on display in the kitchen for everyone to look at. This shows us a minimum of two staff are on duty during busy times. Any changes to shifts are recorded on the rota. This means accurate records of the hours staff have worked are being kept at all times. Two people we spoke to told us a member of staff is always there for them. Relatives commented that they feel their family members are cared for by staff with the right skills and experience. One relative told us it is the best place X has lived in. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: We looked at the file of the most newly appointed member of staff. The information showed us good recruitment procedures are followed. The information seen included a completed application form with full employment history, photograph, written references and satisfactory Criminal Record Bureau (CRB) disclosures. There was also a pictorial interview record completed by a person receiving a service from the company. The member of staff told us they thought the recruitment process was thorough and they had received a starter pack that included the companys staff handbook. The service has produced a training matrix which shows what training has been undertaken and when. Individual training records are also held on staff files. However, we noted a training course attended by two staff recorded on their personal files had not been included on the matrix. The manager is advised to keep the matrix up to date as this will make it easier to monitor and plan for the staff teams training needs. An induction programme has been provided for new staff. This is monitored through individual supervision sessions. The records show discussions are held about different aspects of the staff members performance and the induction booklet is signed off as each section is completed. The records for two newly appointed staff show they have attended training in health & safety issues, protecting vulnerable adults and equal opportunities. Training records for two other staff we looked at includes disability awareness and caring for people with epilepsy. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is well run and meets their needs so they can be confident their views are listened to and act on. Good arrangements are made to ensure safe working practices are followed. However, People would have greater assurance that they are being fully protected if fire risk assessments are reviewed at least once every year. Evidence: The registered manager is responsible for a number of services owned by the provider and is well qualified and experienced in running this service. We were informed of the plan for the acting manager to replace the current registered manager at our last visit. This has not yet taken place and Ms Horsley, the registered manager, still has legal responsibility for the home. She continues to be actively involved in the management of the home. She was on leave at the time of this visit. The acting manager told us he is in the process of completing the NVQ Level 4 qualification. He feels supported by his manager and senior managers within the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: company. Staff told us they feel supported by their managers and comments received included improvements are always being made and training has been good. Relatives also expressed their satisfaction with comments such as a very high standard of care and attention and could not be better cared for. The service has systems in place to monitor its own performance. The individual records kept of this are carried out throughout each month. The acting manager told us the information is collated and transferred to the monthly quality monitoring folder. We looked at the folder and found up until recently it had been well completed and included the responses received from questionnaires periodically sent to people in the home, relatives, health and social care professions and the staff team. The analysis and feedback reports for 20007/2008 shows the service responded to the comments it received. For example, meals are discussed with individuals on a daily basis and training has been provided in managing challenging behaviour. The acting manager also told us arrangements have been made for fax, e-mail and web site facilities be made available to assist with communication and researching current good practice and guidance. The company has its own systems for monitoring the services performance. The acting manager told us they are visited monthly by a company representative and are provided with a copy of the report produced on her/his findings. Only one report, June 2009, was available for us to see and included comments on the services recording systems, staff supervision and the premises. The manager is advised these should be kept accessible in the home for reference and inspection purposes. We looked at a random selection of information held in respect of appliances and equipment, such as the portable electrical appliances, gas appliances and fire detection and equipment. We found appropriate systems are in place to ensure these are checked and serviced regularly. Periodic fire drills take place and training in fire safety is provided for staff. The fire safety risk assessment for the premises is dated 2006. There is no evidence of when this was last reviewed. The manager is advised the West Midlands Fire Service require this to be carried out at least once every twelve months. There have been no visits made to the premises by the Environmental Health Agency or the West Midlands Fire Service during the last twelve months. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 2 3 6 24 30 Care plans should be produced in easy read formats that people who live in the home can understand. There should be suitable arrangements made for the regular maintenance of the garden. A more substantial lockable storage facility should be provided for cleaning products to minimise the risk of accidents. Monthly reports of visit made to the service by a representative of the company should be kept accessible in the home for reference and inspection purposes. The monthly records for monitoring performance put in place by the service should be completely in a timely manner. This will enable effective analysis to take place and issues to be addressed promptly. Fire risk assessments for the premises should be reviewed at least once every twelve months to ensure the safety of people in the home is fully protected. 4 39 5 39 6 42 Care Homes for Adults (18-65 years) Page 27 of 28 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). 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