Care Home: 53A Ipstones Avenue

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What the care home does well People are cared for in a respectful manner by staff working at the home and this ensures that their self-esteem and dignity are maintained. Staff are committed to improve outcomes for the people who live at the home and have provided clear examples of trying to bring in activities that are more meaningful to individuals in a creative way that promote indpendence together with a less institutionalised way of living. People have access to a range of health and social care professionals and this ensures that health care needs are met. A key worker system has been developed at this home whereby people can express their individual feelings, wishes, concerns or issues on a one to one basis. The registered manager has strived to ensure that the changes in the provider have been managed and this includes trying to retain and recruit staff throughout the changes. Registered manager told us:`We are currently changing towards more active support ensuring service users are encouraged and promoted to complete key activities of daily living such as cooking, drink making etc`. Staff told us:`Meals are excellant`. `Good quality food, fruit and vegetables`. Quite good team work. Works what is best for clients generally do care. What has improved since the last inspection? The homes environment is continually improving in relation to redecoration so that people live in an environment that is well maintained. Staffing vacancies have been recruited to to ensure that there is consistency of care provided to people living at this home. There has been an improvement in ensuring that agency staff who work at the home have worked there before which means that people living at 53a Ipstones Avenue will be consistently supported by agency staff who are familiar to them. What the care home could do better: The home must review its current practices in respect of checking on people through the night time period and risk assessments must be in place that states the reasons for these checks and for what purpose. This process needs to be completed in a multidisciplinary forum so that decisions made are in the best interests of the individual concerned.All prescribed creams/lotions must be stored appropriately in lockable facilities to protect all individuals who live in the home from harm. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 53A Ipstones Avenue 53A Ipstones Avenue Stetchford Birmingham B33 9DZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Seel     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 34 Information about the care home Name of care home: Address: 53A Ipstones Avenue 53A Ipstones Avenue Stetchford Birmingham B33 9DZ 01217846054 01217856054 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Accord Housing Association Ltd Name of registered manager (if applicable) Miss Norah Flannagan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. 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) 5 Date of last inspection Brief description of the care home 5 Over 65 0 care home 5 Care Homes for Adults (18-65 years) Page 4 of 34 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: One inspector undertook this fieldwork visit to the home, over a day period. The registered manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were five people living at the home on the day of the visit and the inspector arrived before people living in the home had left for the day. Information was gathered from observing people who lived at the home. Two people were case tracked and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people Care Homes for Adults (18-65 years) Page 5 of 34 who use the service. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example, the people chosen have differing communication and care needs. Staff files, training records, health and safety documentation and reports about accidents and incidents in the home were reviewed in the planning of this visit. People who live at this home have communication needs that meant discussions with them could not take place and/or some people chose not to speak with the inspector. In view of this we spoke to staff on duty in order to find out about the support people receive. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. What the care home does well: What has improved since the last inspection? What they could do better: The home must review its current practices in respect of checking on people through the night time period and risk assessments must be in place that states the reasons for these checks and for what purpose. This process needs to be completed in a multidisciplinary forum so that decisions made are in the best interests of the individual concerned. Care Homes for Adults (18-65 years) Page 7 of 34 All prescribed creams/lotions must be stored appropriately in lockable facilities to protect all individuals who live in the home from harm. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 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 34 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 given enough information about the home and are able to spend time there so that they are able to make informed decisions as to whether the home is right for them. Evidence: This is the first inspection visit to 53a Ipstones Avenue since it has been re-registered with us as the sole provider being Accord Housing. We found that the organisation as reflected this change in their statement of purpose and service user guide which shows that these have been updated since our last inspection visit. These information guides tell people about the home, what to expect from the service, people who live there and what training staff have received to enable them to meet individuals needs. The service user guides are available using pictures to illustrate the written word and we found in the care records that we examined. Also the service user guide says, the complaints, core values and confidentiality are available on CD formats and can provide information in other languages, large print and or Braille. We were also told that people considering living at the home are able to spend some time there and this Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: is also pointed out in the service user guide, An over night stay is arranged and admission plan/risk assessments are completed. This means regardless of their abilities, people considering living at the home are able to access information that will help them decide whether they want to live there. 53a Ipstones Avenue is a home for people with a learning disability and at the time of our inspection visit there were five people living there, all males, who have lived there for a number of years. This means that there have been no new people admitted to the home since the last inspection and there were no vacancies. The standard relating to assessment of people new to the home was not assessed. However records showed that detailed assessments of the ongoing and changing support needs of people are in place, and these are kept under regular review. Information provided in the Annual Quality Assurance Assessment, (AQAA), tells us the asessment of peoples needs includes involvement of the person considering living at the home, their families, community nurses, social workers and advocates. This ensures that staff are able to provide personalised care and appropriate support to individuals throughout their stay both in the home and community. Discussions with staff and from our observations one of the people living at the home has health care needs and needed a lot of care from staff at 53a Ipstones Avenue. This was carrried out with patience shown and sensitivity with regular reviews in place to ensure staff were aware of the individuals needs on a daily basis. Staff were now looking at whether this person had a wish to visit places or complete activities that they had done or never done before in their lives. This is a good example of how people are supported and ensures that their needs and desires are kept under review. In the service user guide it details that all people who live at the home receive an individual contract that covers, the services that are avaliable and covered by the weekly charge, what the charges are and when they should be paid. It also includes what to do if you no longer need the services we provide. We were told that these are all in place and ensure that people undertand their rights and what they can expect whilst living at 53a Ipstones Avenue. Care Homes for Adults (18-65 years) Page 11 of 34 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 are supported to make choices and decisions about their daily lives. There is written information to guide staff in supporting peoples individual needs. Risks are managed positively, whilst keeping safety in mind, with staff mindful of improving the quality of life and independence of individuals. Evidence: We looked at two peoples care records for the purpose of this inspection. We found individual needs and choices are documented in the form of care plans. The care plans contain the persons goals, aspirations and preferred lifestyle within the following headings; how I communicate, important people in my life, my likes and dislikes, my routines, my activities, about my health, things that help me stay safe, what to do when I have a bad day and any other information relevant to the persons needs. It was positive to see that care plans were produced in a format suited to the needs of the individual. For instance sections of the care plans are in diagrams and pictorial to show what the individual likes, such as food, alcohol, relaxing and activities. Peoples Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: dislikes are also noted which is significant as individuals may have difficulty in communicating this information so its important staff know this and act on it to lesson any frustrations. People who live in this home have a key worker and this is a member of staff that gets to know the person and they get to know them. Key worker meetings are held on a monthly basis and we found topics discussed ranged from, health appointments, activities, family contact, behaviour support, acheivements, any complaints and requests. This results in people having someone who they are familiar with to share their worries and or concerns. The key worker is also able to recognise individuals preferences and ensure care is provided in a way that suits the person and at a time they choose. For example, we found photographs of people and their key workers. In one care record it said, We have a good relationship they help me with my medical appointments and we also go shopping together. We found that key workers have been helping people to buy personalised items for their bedrooms to make them meaningful and homely to individuals. Independence is promoted in the care plans we looked at to ensure that staff are aware of a persons abilities when assisting people with their daily living activities. This is important where people cannot easily communicate their needs verbally as it respects what a person can do, what equipment may be needed and gives individuals satisfaction when they complete tasks. Staff told us:Hand and foot massage to help X with circulation. X loves to go shopping. Look at different foods for X from the interent. The two care records looked at included a section on communication these say exactly how best to communicate with an individual, based on the persons preference and other guidance. For example in one we found, My communication should mainly staff showing me objects to enable me to make choices as I will put my hand out to the object or may grab it if I want it. I also mainly communicate through touch, small gestures and facial expressions if I want or dont want something. I do understand what is being said to me and will help you to do things if you ask me to. These details ensure that staff are consistent in the way they communicate with individuals and people are reassured by staff who understand how to do this so that peoples needs are met which reduces individuals frustrations. Positively we found some good social profiles, About me, which gives information about where the person was born, religion followed, past life together with their life at the home. This is produced using pictures as aids which shows value towards a persons own identity, cultural needs and importantly individuals are able to take part Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: iin produciing these. We were told by the registered manager that all care plans are currently being reviewed. This is confirmed in the AQAA, We are currently completing a new care plan and support plan format along with the new care provider Accord Housing. This will explore a more pictorial format and better monitoring system of the service users skills, needs and wishes and incorporates the mental capacity act. This shows that the organisation are looking at ways to develop care plans to ensure individuals goals are measurable and personal to them; these are regularly reviewed with new goals set. Also we found documenation on care records sampled where people living in the home and or their representatives are encouraged and supported to attend reviews so they are able to participate in how their care needs are met. Risk assessments are in place in the care records that we sampled and these give staff strategies to use to ensure a persons health and safety is maintained at all times. In one care record we found, Things that help me stay safe, fire evacuation plan, night time risk assessment, use of multi-sensory room, unsupervised visits or journeys, visual impairment, travel in vehicles, falling, smoking, wandering, scalding, cot sides, use of lap strap with wheelchair, manual handling. There are also risk assessments to support people who may have behavioural difficulties at times. These instruct staff with coping mechanisms to try, such as, talking with the person to see if they can find out what is wrong, going for a walk and or relaxation. We found examples in the care records that we looked at where people were supported to make choices, such as, staff being able to recognise when a person chooses not to have a drink when offered or wants an object or does not as the case may be. Staff are given clues and hints about a persons behaviour and facial expressions which is important when people have difficulty in verbally expressing their needs and choices. People are also supported to make choices about what and when they eat, when to go out, how to spend their time. Activities are planned and some are spontaneous, these are based on the things the person enjoys, and are monitored to show whether the activity had been carried out. This is an effective way to monitor the goals in the care plan to ensure they are suited to the needs of the individual. As part of their opportunity for self help individuals are encouraged to take part in every day tasks, such as, tidying up, clearing the table, making drinks and helping with shopping. During these observations people received good support from staff. One staff member said, people living in the home like to have a routine. One person has gone to day care, and then staff look at individuals planned activities for the day to ascertain what people are doing and another staff told us, X points to kettle, we help, try to encourage. Washing up and things. In the AQAA it confirms, We offer a Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: holistic approach to service users, we focus on their needs, wants, wishes, hopes and aspirations. This shows people are supported to do the things they want to do and this was reflected in the AQAA, We offer a holistic approach to service users, we focus on their needs, wants, wishes, hopes and aspirations. Daily records are completed for each person living at the home and in one care record it confirmed, I have daily records sheets which staff write for me on a daily basis they record my behaviours food and activities. We found this to be to be the case with each daily record giving an insight into a persons routine each day, their state of wellbeing, meals, medication and any appointments they have attended. This enables peoples care to be consistent and provides staff with a tool for the purpose of monitoring and evaluating on a daily basis so that any difficulties can be picked up in a timely manner. Care Homes for Adults (18-65 years) Page 15 of 34 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. Evidence: When we arrived at the home people were busy getting ready for the day ahead. One person went to a day centre; three people went to a nature reserve and lunch. The other person is no longer able to go out due to their poor health. In care records we sampled we found some good plans which documented individuals social, leisure, education and employment. This was achieved by using phtographs of the individual enjoying their interests and activities. This shows people have been able to take part in choosing what they enjoy doing and what they dont enjoy together with what they would like to try. This is used to inform weekly planners for people who live in the home and we found many activities people take part in, such as, bowling, going for a drive, going fishing, watching films, horse riding, swimming, going to the park and so on. In the AQAA it confirms, We have purchased a new vehicle for the Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: home that accommodates 4 of the 5 service users; we are currently looking into one service user obtaining his own vehicle for his specific needs through his own mobility benefits. This reflects the commitment in relation to how staff will support people in their chosen lifestlye options to achieve their goals and aspirations. Daily records show whether an activity is carried out or not, reasons are recorded where an activity has not been carried out, for instance, local walk was not done due to lack of staff and bath spa did not happen but person went shopping instead. Records also show which staff escorted individuals and what the persons response was to the activity. This assists when monitoring and reviewing activities with people so that goals are measured and people are doing the things they want to do that are specified in their care plan. Also activity planners describe what people had been doing at weekends and during the evenings. In the AQAA the registered manager demonstrates that they are striviing to make further imporvements to ensure peoles cultural identities are upheld whilst living in the home, We have one service user from Irish heritage who is supported to follow his cultural identity through music, food and going to St. Patricks day parades. We were also told by staff that other events are celebrated too, such as, St Georges day, individuals birthdays and so on. This demonstrates that people continue to have access to a range of activities that meet their preferences as part of a lifestyle that holds meaning to them. The registered manager told us in the AQAA, continued links with families have improved enabling home visits and stays. Staff also confirmed this to be the case, Families, regularly visits. X goes home. When it is a persons birthday they go shopping one to one with key worker. Christmas party every year with family. This ensures that people within the service are encouraged to maintain contact with families and people who are important to them. Staff said that menus are planned according to the likes of people who live in the home. We sampled these and found a good variety of meals. We were told that although there are menus in place people are also able to choose alternatives on the day if they do not feel like what is on the menu. We were showed a weekly menu for a person who has a medical condition which means that their food needs to be blended due to their swallowing problems. Positively we found on each weekly menu staff are reminded of individuals dietary choices, such as, where individuals have a medical condition, where people need a diet that conforms to their cultural and or religious needs and states, Ensure clients have at least 5 pieces of fruit and vegetables each day. These portions of fruit and vegetables are recommended to enable individuals to maintain a healthy diet. Records were seen showing individuals daily food intake which is important when monitoring their nutritional needs and weight records were in place. The AQAA tells us, More staff to be able to cook cultural dishes,. This demonstrates Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: staff are being proactive in promoting healthy eating and nutrition with a regard to individuals needs. We indirectly observed lunch which was relaxed and one person who was I the home at this time was fully supported by staff to eat their meal and this was achieved using lots of patience and maintaininig the persons dignity throughout. It was positive to see that the kitchen area is open access so that people can independently clear the table, and or get drinks or snacks for themselves. Care Homes for Adults (18-65 years) Page 18 of 34 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 are well cared for by a staff team who knows them well. They are assisted to get help from specialist and other health professionals to help keep them healthy and well. Arrangements are in place to make sure that they get their medicines at the right time and in the correct amounts. Evidence: We observed that staff had paid attention to each persons personal care; people were wearing clothes in good condition suitable to their age and gender. We were told people living in the home are able to choose whether they prefer assistance with their personal care tasks from either a female or male. This positive practice promotes individuals choices and dignity. As mentioned earlier in this report care plans and risk management systems are currently being reviewed. This also applies to care planning for health needs. Health action plans were in place for each of the five people living in the home. The two looked at were up to date, and detailed all the significant health history. For instance, how an individual expresses pain, how they take medication, skin problems and how Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: these are managed, footcare and a weight record to ensure problems with weight are monitored carefully. This ensures appropriate action taken before it becomes problematic and underlying medical conditions do not go undetected. The registered manager advises in the AQAA, each service user undergo a yearly examination by their GP if they wish, service users also have access to a consultant psychiatrist, dentist, optician, chiropody, speech and language, community nurses, diabetic clinic and dementia specialist team. We found this to be the case as plans contained good detail of appointments and treatments and the outcome of these. There is a system to ensure follow up appointments are recorded so that people get the treatment they need to stay healthy. Care plans were in place which reflected the guidelines that staff require to support individuals with their physical needs to ensure health and safety is maintained. For example, in one record it said, My routines, exercise twice a day once at night and in the morning please follow my physiotherapy exercise programme. Morning routine I have a bath in the mornings using a electric bath with shower chair. I also use a hoist with a mesh sling for bathing which is a size large two staff member must assist me whilst using hoist. We cross referenced this with this persons risk assessments and found good details are provided to staff so that all moving and handling is completed with safety and these were easy to understand which is important for new staff who may have never supported the person before. We also found risk assessments to manage and support individuals behaviour with known triggers detailed. This ensures people living in the home remain safe with their emotional health needs fully supported. We discussed with the registered manager the reasons why individuals were checked through the night period as we could not fully establish specific reasons for this practice. We were told that this has been acknowledged practice which has been done in the home for some years. Therefore we recommended that this practice is reviewed within a multidisciplinary forum to ensure individuals rights to privacy is not encroached upon. We found funeral plans in care records we looked at which ensures peoples wishes are respected at this time in their lives. This is particularly important as indivduals living in this home would need support to verbally express their choices. Medication is stored in a locked cabinet. The medication is supplied by the pharmacist in blister packs using the monitored dosage system, which makes it easier for staff to know what medication to give to the person and when. Medication Administration Records (MARS) had been signed appropriately and these cross referenced with the Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: amount in the blister packs indicating that medication had been given as prescribed. Some people are prescribed PRN (as required) medication and individual protocols were in place that stated when, why and how much of the medication should be given to ensure that it is given only when needed. In one of the bedrooms we found prescribed cream which had been left out on show and we confirmed with the registered manager that all prescribed creams need to be in lockable facilitities in peoples bedrooms to ensure that all individuals living in the home are safeguarded. This is important as bedroom doors are not locked either. The homes training matrix indicates that five staff have received training in safe medicine handling with a further four having dates to do training this year. This means that people who live in the home are protected from unsafe medication practices by staff who have the necessary understanding. Care Homes for Adults (18-65 years) Page 21 of 34 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 living in this home can be reassured that their concerns and views will be listened to and acted upon. Staff have the skills necessary to protect people from abuse and know when incidents need to be reported. There are positive attitudes amongst the staff team towards protection matters. Evidence: We were told that the home have received no complaints in the last twelve months and this is also confirmed in the AQAA. An easy read complaints procedure is available to each person who lives at this home making it more accessible for people with communication support needs. This included the relevant and required information so it was clear how people could make a complaint if they are unhappy with the service provided at the home. The levels of learning disability of most of the people living in this home indicate that they would require a great deal of support or advocacy to ensure their rights are protected. Therefore the one to one time that people have with their key workers is important as individuals are able to comfortably raise any concerns and or complaints knowing these will be listened to and action is taken appropriately. The AQAA also states, We have access to advocacy services, each service user has a leaflet that clearly explains what to do if they are unhappy with any area of their care and who they may contact, and although this is done in a user friendly format we have read this leaflet to be service users as well. This ensures people have a voice and have external independent support when required. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: We were advised by the registered manager that they do hold monies for people living in the home and we found robust systems are in place to ensure individuals are protected. For example, we observed staff completing handover of individuals monies to the next staff shift on the day of inspection. This ensures that monies are checked regularly to ensure amounts are known and match any receipts. It also means that there is an audit trail and any errors can be seen in a timely manner which means peoples finances are protected in this home. In the AQAA it is confirmed that there have been two adult protection referrals made to the local authority and the Commission have been made aware of these, which have now been concluded. Staff members spoken to on the day of our visit were able to describe the actions that they would take if they witnessed any form of abuse. Staff recruitment procedures demonstrates all staff are subject to CRB and Protection of vulnerable adults (POVA) checks prior to taking up post to ensure they are suitable to work with vulnerable people. The training matrix highlights that some staff have received POVA training which provides staff with abuse awareness although we recommend that sufficient numbers of staff receive this important training as the matrix only documents that four staff have completed this. Care Homes for Adults (18-65 years) Page 23 of 34 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. This home is comfortable, clean and well maintained. Facilities meet the visual, hearing and mobility needs of people so that they are able to enjoy living in a safe and homely environment. Evidence: 53a Ipstones Avenue is a large purpose built bungalow situated in a residential area of Stechford in Birmingham which is close to public transport. We are told by the registered manager in the AQAA the home, was originally built for the existing client group, with their abilities in mind. We found this to be the case as it is wheelchair accessible, as electronic key pad system on the front door and equipment is provided for individuals inside the home. Each person have their own bedroom that have been decorated making it a nicer place to live, and people are being supported to purchase items to personalise their rooms. In each bedroom there is a hand wash basin for people to use. These are complimented by a communal bathroom with an adpated bath and a shower room giving people who live in this home choices in relation to washing and bathing facilities. There is a lounge with a television and a dining room with table and chairs so that people can choose to eat together if they wish. A tour of the premises indicated that a lot of consideration has gone into ensuring the Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: environment has been redecorated including new flooring. These are improvements that have been made since the homes last inspection when it was reported that it was showing signs of tear and wear. Also in the AQAA the registered manager is striving to keep the home well maintained, Further development of the homely touches and decoration within the home, and development of the garden area. Throughout the day we observed people moving around the home freely and choosing where they wanted to be. As mentioned earlier in this report the front door has a key pad code entry system so that there are no risks for those people considered to be at risk if they went out without staff. The enviroment meets the visual, hearing and mobility needs of the people, and this was supported by the assessments in place. There is a sensory room equipped with sensory objects with various lights. All the people access this room and are able to relax and enjoy this space. As discussed earlier in this report the kitchen area of the home is an open space where people living in the home are able to access freely as they choose which promotes individuals independence in making drinks and snacks where possible with support from staff. The environmental health officer has visited the home and awarded four stars which is very good food hygiene and cleanliness practice so people can be confident that there are good practices in relation to infection control meaning people are protected from infections. There is a large garden area at the rear of the home which has grass and shrub borders to provide people with some greenery where they are able to sit as they choose. There is also a small garden with a patio and garden furniture. All the indicators are that the home is kept clean, substances that could be harmful are locked away and certificates were evident to show equipment is serviced to ensure it is safe to use. Care Homes for Adults (18-65 years) Page 25 of 34 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 living at this home are supported by a staffing team that is competent, qualified, trained, and supervised. The arrangements for recruitment, development, and support of staff are good and indicate that the main focus is to provide good outcomes for peole living at 53a Ipstones Avenue.. Evidence: There were three staff on duty on the day we visited and the registered manager was working a day shift. We were told three members of staff work the early and late shifts. One member of staff is awake through the night period and another sleeps so that if the waking night staff need assistance at any time they are able to call on their colleague. We sampled the rotas and staffing levels did vary which meant that agency staff were needed to work some shifts. At the previous inspection the registered manager was required to ensure recruitment of staff must be a priority to ensure vacancies are filled in a timely manner so that care provided to people living in the home is not compromised. However, we were told agency staff are used who had worked at the home before which should mean people living at the home have consistency of care. The registered manager has acknowledged in the AQQA, Staff has tried to stay motivated and positive within their roles whilst the uncertainty surrounding the transfer of providers took place, and the staff shortages we have Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: experienced over the last 12 months. On the day we visited we observed staff assisting individuals in an unhurried manner and activities were continuing to take place, for instance, three peole who live in the home went with staff to a nature reserve and to have lunch and one individual remained in the home supprted and assisted by staff. This demonstrates that people are continuing to have their needs met in an individualised style. Two staff files were sampled and we found appropriate recruitment documentation, such as, Criminal Record Bureau (CRB) checks, and completed application forms. Files included two written references for each person and a copy of an application form. This demonstrates that recruitment procedures within the home are robust as appropriate checks are made to make sure staff employed by them are suitable to work with vulnerable adults. We were told that there is a good mix of both males and females in the staffing team which means individuals are able to have their preferences met whilst being assisted and supported with their personal hygeine needs and activities. Staff told us that they enjoy working at the home and a member of staff said, Staff seem to gel so well together and another staff said, Team pulls together, best interests of clients at heart. We observed staff to be caring and responsive in their interactions, and knowledgeable about the individual care needs of people. They were observed to be competent in supporting people with their daily tasks, and particularly skilled in their knowledge about individuals likes and dislikes. The AQAA confirms that six members of staff have achieved their National Vocational Qualification, (NVQ), Level 2 in Care. This meets the standard of 50 . The AQAA confirms, Each new member of staff undergoes a thorough work place induction. They are then required to complete Accords induction process, during this period they will receive mandatory training. The training matrix also confirms that generally staff have been maintaining their mandatory training in health and safety, moving and handling, food hygiene, safe handling of medications, infection control and fire training. We are confident the registered manager will strive to ensure all staff working at the home have completed their mandatory training as we were told that training dates have been booked. The training matrix confirmed that some staff have also received some specialist training in, epilepsy, breakaway techniques and learning disability qualification. This compliments the mandatory training that staff receive and ensures that staff are also meeting the specific needs of people who live at 53a Ipstones Avenue. Staff told us about their supervision sessions, I like my supervision as it is a chance to say how I feel, what if any problems and get support and another staff member said, Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: I quite like my supervision get issues off your chest. Staff files informed us that supervision sessions are structured and in the main happening on a monthly basis. This ensures that people living at the home can be reassured they are receiving assistance from well supported and supervised staff. Care Homes for Adults (18-65 years) Page 28 of 34 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. This home is well run for the benefit of the people who use it. Clear efforts are made to find out what people feel about the quality of the service they receive so as to meet their needs and wishes. Important safety checks are carried out regularly to make sure that people living and working in the home can stay safe. Evidence: Miss Nora Flanigan is the registered manager of 53a Ipstones Avenue. Miss Flanaghan has the Registered Managers Award and NVQ Level 4 and has extensive experience of working with people who have a learning disability. The registered manager has been the manager of this home for a number of years and staff spoke positively about the manager stating they are approachable and supportive. We found this to be the case on the day we visited as the registered manager took a hands on approach to assisting and supporting staff with tasks that required doing. We asked the registered manager to fill out an Annual Quality Assurance Assessment, (AQAA). The AQAA was detailed and contained relevant information that was Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: supported by examples of good practice which corresponded with the records sampled in the home, discussions with staff, and observations of practice all of which are documented throughout this report. 53a Ipstones Avenue has a quality assurance system. It has all the elements for seeking views, analysis of findings and feeding this back to all concerned. The findings are linked to identifying improvements, and training needed to improve outcomes. The registered manager demonstrates their proactive approach to giving a good quality service to the people living at this home and this vision is stated in the AQAA, By staff being involved in this process it has given them greater insight into to the importance of quality monitoring and the benefits of it in how it helps us to maintain and improve the service we offer. Staff told us that they are thinking of three new activities for each individual to experience and participate in to see if it is meaningful to them. A representative of the registered provider also visits the home on a regular basis to report on the standard of care provided. These reports show that views of the people who live and work at the home are actively sought. Discussions with staff confirm that staff meetings take place monthly and they are encouraged to participate and raise ideas, suggestions, and improvements. As mentioned earlier in this report staff handovers take place between each shift to ensure good communication and there is always a shift leader who takes reposnibility for each shift. The handover observed included reference to the significant key pieces of information that arose during the day. This is important practice as agency staff are being used and effective communication means people receive care in a consistent way. The registered manager recognises that a consistency in agency staff means that they will be familiar with people who live in the home as staff changes can disrupt peoples behaviours. A number of checks are made by staff to make sure that peoples health and safety is maintained. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is maintained in good working order. Regular fire drills are held so that staff and people living at the home know what to do if there is a fire. These records show that individuals are protected from any risks to their health or care needs within their living environment. The gas safety certificate and certificate for the electricity circuit are both in date. Portable appliance testing has been carried out on electrical equipment kept in the home. Regular testing and recording of water temperatures have been completed, and the homes COSHH store was secure. This means that the home is free of potential hazards ensuring a safe environment for the people who live there. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: Accident and incident recording was appropriate and notifications had been sent to the Commission as is required by legislation. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 18 To review the practice of checks undertaken during the night for service users. (If this level of monitoring is deemed necessary it must be discussed and agreed as part of a multi-disciplinary team with outcomes and guidelines for staff to be documented in individual care plans). YA20 All prescribed creams should be kept in lockable facilities so that people are protected from harm. 2 20 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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