Care Home: 58 Worlds End Road

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What the care home does well The home has not had any new people for some time but they have written information to give to new people and would ensure that people get to know the home before they are admitted. There are written plans that say how people will receive help with their personal care, how they will be kept well and how risks to them can be lessened. This helps staff provide the care in a way that meets people`s needs and keeps them safe. There is written information about how people show when they are happy or unhappy and any signs, pictures or objects that the person understands. Information about what the individual person likes and dislikes such as different foods, noisy or quiet places and activities is also recorded. This helps staff provide the care in the way people like and helps them recognise when a person does not wish to be involved. Staff were seen using this information whilst assisting people to eat. People who returned comment cards were happy with the service provided in the home. People received regular health check ups as well as getting help from specialists such as chiropody, community nurses, hospitals and so on if they need it and this helps to keep them well. Medication was given in the way it was prescribed and staff talked to know what medicines are for and this ensures peoples health is maintained. Records showed that money was managed safely and records and money were checked regularly. The home was comfortable, warm, clean and safe and this makes it a pleasant place to live. Staff have training to help them know how to care for people living in the home. What has improved since the last inspection? There is a new system of recording what has happened to a person throughout the day. This includes details of the persons care, mood, activities, health and behaviour. This could help the home spot patterns of poor health or behaviour. The number activities for some people have increased but this still needs to improve further. What the care home could do better: Activities in this home are limited by the number of staff available. People living in home need a lot of support to undertake activities, to get from place to place and spend time outside the home and garden environments. They also need support within the home and occasions there are not enough staff to do this safely.Some further checks on medication could be done to make it easier to see if all the medication was there and that all staff giving medication had recent training. The home could not show us any written agreements about charging people for the use of the transport. The manager told us that people did not pay for taxis however we found in the money records that people had. Information about the recruitment of staff is kept away from the home and there was not a statement about the outcome of checks made on the staff file in the home. Whilst health and safety checks were in place the home could not show us a satisfactory electrical wiring certificate this could affect the safety of people living in the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 58 Worlds End Road 58 Worlds End Road Handsworth Wood Birmingham West Midlands B20 2NS     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: Jill Brown     Date: 0 5 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 31 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 31 Information about the care home Name of care home: Address: 58 Worlds End Road 58 Worlds End Road Handsworth Wood Birmingham West Midlands B20 2NS 01215235493 F/P01215235493 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Milbury Care Services Ltd Name of registered manager (if applicable) Ms Elizabeth Brown 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 who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 4 Date of last inspection Brief description of the care home 58 Worlds End Road provides accommodation, care and support for three adults with learning disabilities. The home is registered for four persons but this would involve two people sharing a bedroom. The organisation does not intend to seek a fourth occupant. The house is a domestic style, semi-detached property situated in a well-established and pleasant residential neighbourhood in the Handsworth Wood area of Birmingham. There is a range of community facilities within the immediate locality, including shops, places of worship, GP surgery and parks. Main public transport routes are within Care Homes for Adults (18-65 years) Page 4 of 31 care home 4 Over 65 0 4 Brief description of the care home walking distance. On the ground floor of the house, there is a lounge to the front, and a kitchen and separate dining room at the rear. There is also a laundry room, an assisted bathroom with toilet and wash hand basin, as well as one persons single bedroom on this floor. Upstairs are two further bedrooms, another assisted bathroom with toilet and wash hand basin, and a small room, which is used as an office.To the rear of the property is an enclosed garden with ramped access with handrails and a small paved area. The drive at the front of the house can accommodate one vehicle; there is available parking on the road outside. The fees currently paid by people living in the home are between £1224. 29 and 1224.66 per week. This does not include money for clothing, toiletries, hair care, external activities or transport. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 visited the home without notice on a day in March 2009 and undertook a key inspection where we looked at the majority of the National Minimum Standards. The home gave us information in an Annual Quality Assurance Assessment (AQAA) before the key inspection. The AQAA shows how the home rates their performance in the areas set out in this report. During the inspection one persons care was case tracked, this involves looking at all the records about this person and how the home manages their care and we looked at parts of another persons care records. People living in this home have difficulties communicating verbally. Easy read comment cards were sent to the home and staff Care Homes for Adults (18-65 years) Page 6 of 31 completed these with the people. We also received comment cards from a relative and a friend of people living in the home. Two staff completed comment cards as well. We looked around parts of the building and viewed the health and safety checks that had been undertaken. We spoke to 3 staff, the manager of the home and the general manager of the centre. We have received no complaints about the home before we inspected. Information about all of the above is contained in this report. What the care home does well: What has improved since the last inspection? What they could do better: Activities in this home are limited by the number of staff available. People living in home need a lot of support to undertake activities, to get from place to place and spend time outside the home and garden environments. They also need support within the home and occasions there are not enough staff to do this safely. Care Homes for Adults (18-65 years) Page 8 of 31 Some further checks on medication could be done to make it easier to see if all the medication was there and that all staff giving medication had recent training. The home could not show us any written agreements about charging people for the use of the transport. The manager told us that people did not pay for taxis however we found in the money records that people had. Information about the recruitment of staff is kept away from the home and there was not a statement about the outcome of checks made on the staff file in the home. Whilst health and safety checks were in place the home could not show us a satisfactory electrical wiring certificate this could affect the safety of people living in the home. 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home supplies adequate written details to people to enable them to make an informed decision about moving into the home. Information about the process of assessment suggests that peoples needs would be looked at and a decision made before they are admitted whether the home can meet the persons needs. This means that placements are more likely to be successful. Evidence: At the last inspection the statement of purpose was comprehensive. There have been no new admissions to the home since the last inspection. Fees were available at this inspection for the three people in residence; there is no intention to admit another person at the moment. One person is now 65 years old but the home remains the appropriate place for the person to be. The methods used for the last two admissions indicated that senior staff gathers sufficient information to determine whether the home can meet the individuals needs. The manager advised that the following actions are usually taken: Comprehensive pre-admission assessment carried out by the manager Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Obtaining reports from external professionals Numerous visits to the home by the prospective resident to determine how they interact with the people already living in the home. Both the individual and staff need to be confident that good relationships will develop with between people. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are detailed and they provide staff with information about how peoples needs are to be met. People are helped to make decisions and supported to do what they wish to do. Evidence: Each person has a written care plan and one of these was looked at in depth. This was found to be extensive and provided good staff guidance about what they need to do to ensure that peoples needs are met. It was clear that care plans were updated with details such as photographs of the person being redone to ensure they remain current. Information included a personal profile about the person and their background and relatives and friends. They described the persons preferred daily routines and when staff assistance is needed to complete them. They gave details of how the staff can communicate with the person for example what Makaton signs the person knows and objects of reference that they use to show the person they are needed in the kitchen Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: or it is time for a bath. Information was available about how the individual person shows they are happy or upset. Discussions with staff and observations showed that staff were aware of the information in the plans and were working in the way the care plan said they should. Files contained information about peoples contact with family and friends. There was good information about peoples food likes and dislikes. All care plans were accompanied by a risk assessment. These included personal care, health care needs, activities within the home and going out into the community. This is viewed as being good practice in minimising the risks of accidents and injuries. One person was observed to constantly wander around the home and garden requiring lots of supervision. Staff were diligent in carrying out this task and did not make any attempts to restrict the individual. People were encouraged to take part in daily life tasks such as taking their pots into the kitchen and scraping any left overs into the bin and this assists them in keeping some skills. The home has developed a new system of recording the persons day this included a record of challenging behaviour, mood, personal care, health contacts and activities. This gave a good structured overview of their day. A summary of this over a month would give good feedback to relatives, health and social care professionals. We received three comment cards from people living at the home, which were completed by their support worker. We also received two comment cards one from a relative and one from a friend. All of these showed that they were happy with the service. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and social opportunities are limited by peoples conditions, staffing and facilities in the service and this may mean that peoples wellbeing is compromised. People receive a varied and wholesome diet and assistance to eat that takes into account their personal preferences and needs. Evidence: There had been some improvement in the activities arranged for people in the home. However staffing for activities remained difficult. There are now two people living in the home that each require two staff to engage in some external activities. The staffing rotas from 16 February 2009 to 08 March 2009 indicate that whilst on occasions there are 3 staff available in the morning this is not always the case and activities for people are compromised. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: One person attends college once a week and another goes twice a week, both require to be accompanied for the outward and return journeys. When people go out into the community they need to be accompanied, as does the individual who attends church services. This impacts on remaining staff available to cater for the needs of the people who are still in the home during those periods. The person case tracked for the month of February and until 04 March 2009 activities were, watching TV, listening to music, 3 drives, went to the barbers, attended a centre, 3 walks, went to the park, went once a week to college, went to a cafe. The majority of their time was watching TV and in the garden. During the inspection 2 people were at the home all of the time and one person went to a church centre for lunch. Formal activities such as going to college are reviewed with the service. People had been to Blackpool for the day in January and 2 people went to Burnham on sea for a few days. It is acknowledged that peoples complex needs, high level of support needs and short attention span may mean that engaging them in purposeful activity is not a simple task. One relative commented (my relative) is helped with their disabilities by relaxation classes which (they are) taken to every week. (They) are taken to lunch at local pubs. (They) enjoy eating out. A comment was made about how nice it would be to have a sensory room in the garden, a room where there could be activities undertaken. The home appeared to have an open policy in respect of visiting. Files contained information about maintaining relationships with families and friends. Food records were being kept that included what and the amount of food people ate. The records indicated that people had cereal and toast most mornings, a light meal at lunch time and their main meal usually on an evening. The home had recently been given some cards with pictures of food and recipes. This is to help people have wider choice of healthy food but was not being used at the point of the inspection. Peoples health records showed any limitations on types of food and their care plans indicated any likes and dislikes. We observed a person being assisted during breakfast, and another through the lunch time meal and the staff member did this well. Verbal instructions were given as well as signs to remind the person to slow down as they were at risk of choking. People living in the home were encouraged to take their plates into the kitchen when they had finished eating. This helps to promote their independence. Care Homes for Adults (18-65 years) Page 16 of 31 Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for monitoring and responded to any health concerns are good and this helps to ensure that people are kept as well as possible. People can be assured that medication is administered appropriately and this helps to maintain peoples well being. Evidence: Health Action Plans were in place to ensure that people had planned health care. There was evidence of regular sessions with external professionals such as GP, chiropodist, optician, dentist and district nurses not only when there was a health problem but also for routine checks. This included for example medication reviews, flu injections and well person clinics. People had access to specialised services if needed including speech and language services and community nurses. One person case tracked had been discharged from these services over the last year. Where people develop conditions the home ensures that people attend appointments to have these investigated so that appropriate treatment can be started. Information about known health conditions was kept in the Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: persons health action plan for staff to read and become familiar with the characteristics of these conditions. Peoples healthcare needs were being well met. The management of medication was found to be good, meaning that people receive their prescribed medication correctly. Drugs were being audited upon receipt from the pharmacist to ensure that the dispensing methods were accurate. Copies of prescriptions were being kept by the home to enable them to complete the auditing process. The MAR (medication administration record) charts were appropriately completed. People had medication care plans that included what medications were for and how medications were to be administered to the person. As required medications, such as medications for constipation or behaviour, had instructions to staff about when medications could be given. In general these were appropriate. One person had an as required medication for known behaviour, records showed that behaviour had been happening but the medication had not been administered. The instructions did not state the intensity of the behaviour before the medication is given and this should be reviewed. One tablet could not be accounted for, and one medicine did not have the amount left over carried forward from a previous MAR and this made it difficult to audit. One member of staff did not have medication training but they were not administering medication. The manager and another member of staff responsible for administering medications were aware of what medications were for and were able to say if special precautions needed to be in place with specific medications. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 the home are dependent on staff to react when they are not happy with the services. Staff understanding and practices protect people living in the home from risks of abuse. More clarity and independence is required on transport arrangements to ensure that peoples rights are maintained. Evidence: At the last inspection the complaints procedure was seen and judged as having sufficient advice about what the complainant should do and the anticipated outcome. People living in the home have limited communication and staff use the persons individual communication plan to determine when a person is unhappy. No complaints have been received by the home or us since the last inspection. The home uses the Department of Healths Practical Guide to Protection of Vulnerable Adults and was also noted to also have a copy of our Safeguarding Adults Protocol and Guidance. Staff talked to at the inspection understood their responsibilities in safeguarding the people living in the home from abuse. They were clear about the other agencies that monitor intervene and investigate safeguarding matters. We have received no information that has required a safeguarding referral. The home holds small amounts of personal monies on behalf of the people who live Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: there. These monies are checked daily to ensure that the right amount of money remain in the home. We checked the money against the records for 2 people living in the home and this was correct. People have their money spent on: - hair care, toiletries, tranquility and relax away, aromatherapy, a TV and bracket for their bedroom, bedding and a quilt and a wheelchair. We were told that since November 2008 the home has been charging people for money for the use of the homes transport. The amount charged is dependent on the amount of Disabled Living Allowance (mobility) that people receive. The manager advised us that there was no written agreement with the representatives of these people about this and that that people would have all of their transport needs met including taxis. The records of people living in the home suggest that people since November have been charged for taxis. There is a lack of clarity and independence in these arrangements as the provider is also the appointee for at least two people. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have the benefit of a home that is comfortable, warm, homely and hygienic. Evidence: The home is a two storey domestic style semi-detached house. The property is generally well maintained, tidy and clean. The fixtures, fittings and furniture are of a good standard and are in keeping with the age group of the people living in the home. There is a lounge, separate dining room, kitchen and a laundry room. Both the lounge and dining rooms include a television and music centre. The ground floor also includes a bathroom containing an assisted bath, wash hand basin and toilet. There are three bedrooms, one situated on the ground floor and two on the first floor. The first floor also has an assisted shower room with wash hand basin and toilet. A small office is also located on the first floor; medications are stored in this room. The enclosed rear garden is accessed via a ramp. It has a small paved area as well as a lawn. The numerous trees and bushes around the perimeter of the garden enables people to relax in privacy. Bedrooms were noted to have been nicely decorated and individually styled; personal Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: possessions were in evidence. In one room we looked at we checked the bedding and found the mattress remained serviceable and the duvets and pillows were clean. One bedroom contained items to promote sensory stimulation to assist the occupant in relaxing. Staff work well in maintaining a clean and safe environment for people to live in. In the bathroom and kitchen areas this would be made easier by extending the tiling in splash back areas. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels at times are not sufficient to ensure that people can enjoy activities, remain safe and all tasks of care home undertaken this puts people living in the home and staff at risk of harm. Staff receive training to give them the knowledge and skills to carry out their roles effectively. Evidence: The staffing rotas from 16 February 2009 to 08 March 2009 indicate that whilst on occasions there were 3 staff available in the morning this is not always the case. Three staff were not available throughout the day. People living the home have high needs, escorting to activities means that there is often one person looking after two people that have high needs and their safety is compromised. After the last inspection we received information that a third carer would be rostered to ensure safe staffing levels and assist with appropriate recreations for people. This action has not been sustained although there were two staff and the manager on the day of the inspection. The manager was not on the rota as being on duty. We looked at files of 5 staff including someone who had recently started at the home. The recruitment information is kept at the head office of the organisation so it was not Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: possible to check the recruitment process at this inspection. Staff files do not indicate when checks were returned to them or the results of these checks. However we have been assured by the service provider of the process of checksat the head office and the risk assessments they undertaked. The person had two references on file. The homes annual quality assurance assessment told us that they have 6 out of 10 staff with the National Vocational Qualification level 2 in care. We noted that there were 11 staff excluding the manager on the rotas supplied making 54 of staff qualified. This means that this number of staff have had training in the care of people. In addition to this people have training in mandatory subjects such as health and safety, first aid, moving and handling and so on. A number of this training is now completed on a computer system whilst staff are on duty. There was evidence of training in specific training to meet the needs of people living in the home such as epilepsy, the mental capacity act, autism, non violent crisis intervention and diabetes. Not all staff had undertaken all of the training. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home provides good health and personal care for people, peoples social needs and development opportunities are restricted by staffing levels and this is not in the best interests of people in the home. The home monitors health and safety and maintenance. This means that peoples safety is protected. Evidence: The registered manager had been at the home for a considerable time. She possesses the knowledge, skills and experience to effectively manage the home. She is supported in the day to day running of the home by two senior carers. The manager keeps her skills updated and this has recently included undertaking management development training. Staff interviewed at the home were comfortable with the management of the home and were clear about the management structure of the organisation. The home has an established quality assurance programme. An annual report is collated and where shortfalls are identified an action plan is developed including Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: timescales to resolve the issues. The home completed an Annual Quality Assurance Assessment and this could be used as part of the homes improvement strategies. A file containing Regulation 26 reports was reviewed. A senior person within the organisation should carry out monthly unannounced audits of the home and produce a written report that is given to the manager. October 2008, November 2008, and December 2008 reports were found but none since. We looked at records for gas, electrical, lifting equipment, water temperature and fire safety. We found that there was good information about how to evacuate the home in case of fire and that fire safety checks had been completed. Gas, lifting equipment and water temperature safety checks had been done. The homes electrical wiring certificate was in place. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 11 16(2)(m) People living in the home 31/03/2008 must be offered meaningful recreations to meet their preferences and aspirations. This is necessary to promote people to experience a quality lifestyle. Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 16 (2)(n) Staffing levels must 22/05/2009 be increased to allow further development of activities inside and outside of the home. This is to ensure that people living in the home have a varied life. 2 20 13 (2) 12(1)(a)Quantities of medication left over from the medication administration record must be carried forward. This is to ensure that medication is easily auditable. 15/05/2009 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 6 A summary of the daily records is done on a monthly basis as this will give valuable feedback for both families and social and healthcare professionals Page 29 of 31 Care Homes for Adults (18-65 years) 2 3 20 23 One as required medication protocol should be reviewed to make clearer the circumstances for its administration. Written agreements must be sought for arrangements for payments for transport. These must details what transport costs the person is or is not responsible for. Wall areas in the bathrooms and kitchen that are subject to a lot of splash back would benefit from more tiling to make it easier to clean. 4 30 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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