Care Home: 7 Silverbirch Road

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What the care home does well There is information and ways to try the home, tailored to the individual. People and relatives told us that Silverbirch support the whole family, and staff are available when needed. One person said, "I like to come to the pink room and bring the present they gave me at Christmas." A relative said, "Great service, more people should be made aware about it!" Everyone has a detailed assessment before admission which is used to form a care plan so that the person can continue their lifestyle, culture and beliefs, college and day services as well as having their physical and emotional needs met. Care and support is respectful, dignified and independence is promoted. There is good access to local healthcare if it is needed, and the medication system protects people. Dates are booked in advance and people are matched so that they each have a good experience. Everyone chooses each day what they do, where they go and what they eat at each meal. Food is based on people`s likes and dislikes, and dietary needs are met. People have fun, exercise and use community facilities, including ways to practice their religion. There is a newsletter and family events that relatives told us they enjoy. People are protected by recruitment checks. The arrangements for staffing ensure people are safe and well cared for. Management highly value and invest in their staff with good support and specialist training, so that people and their conditions are understood, and staff skills keep up to date. People know how to report a concern and can have confidence this will be acted upon in accordance with local protocols. There have been no complaints or concerns since the last inspection. Management ensure the smooth running of the home by regular checks and contractors, maintenance, refurbishment and cleaning schedules. There are good safety measures in place. The manager is qualified and experienced. Views of people and families influence the running of the home, service development and the business plan. The home has sustained and improved their quality. What has improved since the last inspection? Since the last inspection five requirements were fully met. Management introduced quality questionnaires at the end of respite stays to encourage communication and learn from people`s experiences. A newsletter now informs families about the findings of quality audits and events. The environment is constantly updated, redecorated and maintained. After consulting people and families, the home purchased more sensory equipment and music, suitable for people with complex needs. Staff were trained in epistasis so they can respond to emergencies in some forms ofepilepsy. Medication policy and individual protocols about invasive processes, such as suppositories were reviewed and improved. What the care home could do better: Management are providing consistency of temporary staff during a delay while new staff are recruited, checked and inducted. Immediate action was taken to ensure the hot water in a shower is in the safe range. This has been added to regular checks. No one was seriously injured after an incident involving failure of a bedrail that we were not informed about. There was appropriate internal audit at the time, and the equipment we saw had been checked to be safe. Timely notifications must be made to all relevant regulators in accordance with their current guidance so we work together to protect people. Medication competence checks that take place should be formally recorded and regularly confirmed. Photographs of people on medicine records and regular reviews of allergies will assist in promoting and monitoring health. The infection control policy uses best practice, but this needs updating and sharing with staff as soon as government advice changes. Health and Safety Executive guidance and Medical Devices safety alerts should also be checked so that the home`s health and safety systems are updated when there are national changes. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 7 Silverbirch Road 7 Silverbirch Road Erdington Birmingham West Midlands B24 0AR     The quality rating for this care home is:   three star excellent 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: Tina Smith     Date: 0 8 0 1 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 32 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 32 Information about the care home Name of care home: Address: 7 Silverbirch Road 7 Silverbirch Road Erdington Birmingham West Midlands B24 0AR 01213821899 F/P01213821899 emma.cavanagh@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Birmingham Multi-Care Name of registered manager (if applicable) Miss Emma Louise Cavanagh Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical 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, Physical disability (PD) 4 Date of last inspection Brief description of the care home 7 Silverbirch Road is in a residential area with good public transport to Birmingham and Sutton Coldfield. The house is semi-detached with some off road car parking. Respite care is provided for up to four adults with a learning or physical disability at one time. Single bedrooms are on the first floor and one room has a double bed for those who prefer more sleeping space. There is a lift in the foyer. On the ground floor there is an assisted bath and Jacuzzi, where the laundry is also done. First floor has a Care Homes for Adults (18-65 years) Page 4 of 32 care home 4 Over 65 0 0 4 4 Brief description of the care home shower, and communal toilets are on both floors. The lounge is spacious, and a dining room leads via a ramp to a patio and large enclosed garden. The fee for respite care is £1011.40 per week. This information was correct at the time of our visit, and enquiries should be made to the manager about up to date fees. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The home was last inspected on 26/02/07. Prior to our visit the home completed their Annual Quality Assurance Assessment (AQAA). The AQAA provides information about what has improved and is planned for the future, and current information about the running of the home. Information from this and from other sources was also used when forming judgements on the quality of service provided at the home. We received surveys twice in the past two years from people, relatives and staff. The home sends us notifications, and we receive reports from other sources. One inspector visited the home over one day so that the morning and afternoon routine to be observed. The home was not informed that we would be visiting. On the day of our visit, one person was in the home receiving respite care. We talked to the Care Homes for Adults (18-65 years) Page 6 of 32 person and toured the home with them, and spoke to staff. Records of two people that management helped us to choose were closely examined. We sampled records about other people, staff and the running of the home and discussed our findings with the manager. There were five requirements from a previous inspection which we found to be fully met. A full list of requirements and recommendations are at the end of this report. What the care home does well: What has improved since the last inspection? Since the last inspection five requirements were fully met. Management introduced quality questionnaires at the end of respite stays to encourage communication and learn from peoples experiences. A newsletter now informs families about the findings of quality audits and events. The environment is constantly updated, redecorated and maintained. After consulting people and families, the home purchased more sensory equipment and music, suitable for people with complex needs. Staff were trained in epistasis so they can respond to emergencies in some forms of Care Homes for Adults (18-65 years) Page 8 of 32 epilepsy. Medication policy and individual protocols about invasive processes, such as suppositories were reviewed and improved. What they could do better: 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 32 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 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a range of information available to people that they need so that they know about the home before coming there. There are thorough admission processes that ensure peoples needs can be met. Evidence: Since the last inspection the home has reviewed their statement of purpose, service user guide and updated the fee range. This is available in pictures, on audio tape, in different languages and is explained to people and families so that they have the information they need to make decisions about the home. The last inspection report is available in the home. People and relatives have told us in surveys that they had enough information and wanted to come to the home more often than the council funding provided for. There have been 3 new admissions and there are 28 people and families who use the home for respite care. Some have used the service for many years. There is a tailor made pre-admission process for each indvidiual that includes an assessment by Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: trained staff where the person lives and in the home before confirming that needs can be met. There can be gradual introductions to the service, at the persons own pace, and one person was admitted as an emergency over Christmas. The council provided information in advance, and their needs were assessed on admission. Another person is having a teatime visit to share a meal and meet other people and staff. Some people try over night stays before deciding about a respite programme. One new person is changing from childrens to adult respite services. People told us about their introduction to the home: Yes I went to visit before I stopped. I had a book about the home and Emma came to visit me at home and we talked about it. A relative said, ...x...only goes to Silverbirch Road for two nights a month, but he is always met well and goes in quiet and happily. Individuals are matched when dates are booked, so that each has benefit from the mix of service users during their stay. A number of families told us that their main worry is about funding for respite stays, which they highly value especially in emergencies. I get information about care homes but find I have to fight very hard to get information about how much respite care we can get and how often we can get this service. Management try to assist families to have access to independent advocacy and direct payments, so that they have more control over care options to meet their needs flexibly. Everyone has an individual contract from the council specifying the service to meet needs, and staffing support required. This is agreed after the home confirms peoples needs can be met. Fees are clear and no payments are made directly to the home. Formal reviews are held with people, their families and funding authorities. Staff have an extensive training programme and are supervised to ensure they have the skills and experience to understand people and their conditions, and to provide services matching the homes statement of purpose. People and their families told us they are happy with life at the home, and one person said: I do not want to be move from this home. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met in the ways they want and need, and with confidentiality. Their communication, decision making and health are promoted. The arrangements to ensure peoples needs are met are consistent, flexible and staff have the necessary skills to support people to participate and try new things. Evidence: Staff told us that assessments and care plans are always available for staff to get acquainted with each persons needs or changes. Assessments are comprehensive in that abilities are identified in addition to needs and key risks. Care plans are kept under monthly review or as needs change and this is checked after every respite stay with people and their families. Risk assessments are periodically reviewed. There was no one in the home at risk of pressure sores. Healthcare, night-time, sensory, mobility and continence needs are met and behaviour is appropriately planned for and managed. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Communication modes are recorded and used to help people express themselves and make daily decisions. Families are put in touch with advocates to help them access direct payments so that they have more flexibility in their choice of care services. Each of the care records seen had care plans drawn up with people and their representatives. Surveys from people told us they make decisions each day about what they do, or their relative chooses, but they all agreed that they can do what they want with the help of my carers. Monitoring charts derived from the care plans were available as were records of NHS and other specialist visits. There are in user friendly language and pictoral format. Records are up to date and appear accurate, and are securely and confidentially kept. The person we saw was involved in the day to day running of the home, such as keeping their room tidy and having pride in doing so. They showed us how they prepare their own breakfast, and told us what they were looking forward to at the day centre. The home ensured they had money for an outing. Although capable of handling their own money, this person prefers the home to keep their money safe. After each respite visit, families are sent a questionnaire. This helps to plan the next respite stay, adjust any preferences, and is also used to develop the quality of the service. The homes policies and procedures are regularly reviewed and most reflect best practice. Care plans are detailed so that staff know how people want and need to be safely supported. Staff support people to express their own decisions or views, including taking risks. Some people manage their own finances, while others choose their own representatives or the home to assist. We checked and found there are up to date accounts of how peoples money is managed, money is securely kept, and spending decisions match peoples needs and lifestyle. This is checked regularly by management, and on the day of our visit the accounts tallied. Care Homes for Adults (18-65 years) Page 14 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the home responds to all their needs. Relationships with family and friends are maintained according to peoples wishes. Activities, outings and food match peoples interests, religion, culture and lifestyle. Meals are nutritious, varied and personal tastes and dietary needs are catered for. Evidence: Everyone has opportunities to learn and use practical life skills, at day services and in the home and community. The person having respite told us they enjoy knitting, watching tv downstairs with staff, and going to their day centre from the home to see their friends. They like to bring a gift they had from the home at Xmas. Each person has their own interests and hobbies including music, arts and craft, dancing, games including a games console at the home. Community facilities are used for outings, when there are visits to the pub, cinema and religious services appropriate to each Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: individual. The home have ensured that people have disability passess for transport and community facilities, which also helps them when with their families. People are encouraged to maintain their cultural interests, and one family are pleased that she listens to Asian music in her own words. People go shopping with staff locally, and are encouraged to help lay the tables or clear up as they are able. Menus and shopping are planned for each person. There is a cooked meal in the evening, and people decide separately what they want and if able help to make it. All staff prepare food and have training in safe food handling. Individual likes and dislikes are noted and updated. Staff have training in health and nutrition so that they promote healthy lifestyles. We were told in surveys and in person that the food is liked. A relative said, ...The food appears to be...a very good choice. The person we saw told us that drinks and snacks are available if they want throughout the day and night. We sampled the menus and found that people are encouraged to have a healthy diet. We saw a mealtime and snack enjoyed where ever the person wanted to eat. They are currently catering appropriately for coeliac disease, diabetes, halal, Sikh and vegetarian diets. Families sign consent forms on admission if the person needs medication administration. People are encouraged to maintain contact with their family and friends during respite, and staff help people to use the telephone. One person said that they go out with their relative to events from respite. One relative told us that they enjoy going on trips with the home, weather permitting. Several relatives told us that they can always ring the manageress... or staff to check on their relative...staff are always helpful and polite. One relative told us that sometimes I need to talk to someone about...x..., and we discussed how whole families are sometimes supported by the home, which is good practice. Care Homes for Adults (18-65 years) Page 16 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have personal support and health monitoring in the way they prefer and need. Staff respect people and their privacy, and support them to have control over their lives. Physical, emotional and cultural needs are met with dignity. The medication system is safe and protects people. Evidence: Following the last inspection, improvements were made to an already good care planning system so that all aspects of health, personal and social care needs and risks are identified and planned for in detail. For example, we saw up to date emergency medication stocks and detailed care plans for specialist procedures. The skills of staff are carefully matched to meet peoples needs during their stay. One person is funded and receives one to one support at specific times to manage challenging behaviour. The person we saw had good personal hygiene and their appearance and clothing was in keeping with their age, culture and lifestyle. Most people bring their own clothing, which is always returned to families laundered and clean. The home keep spare clothing for one person and a stock of sanitary towels so that needs are met for Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: predictable events. Discussions with staff confirmed that they are aware of peoples needs, risks and how care is to be safely provided. However they were not aware of an allergy to food that the person told us about. We recommend allergies are discussed during annual reviews or health checks with families. Records are kept of visits by health and social care specialists, and their advice is incorporated in peoples care plans. There are good links with local health care professionals and the manager told us that a District Nurse provides insulin injections when one person stays, so they have continuity of healthcare. Staff have appropriate training about most individual health care needs, such as epilepsy and epistasis management, autism, and any invasive medication has a detailed care plan to guide specific staff trained by the NHS, such as suppositories and rectal diazepam. Everyone has nutritional screening so that peoples cultural and dietary needs are met, their abilities to participate in cooking are assessed and met, and risk of malnutrition is assessed. We saw that appropriate staff support is provided, if needed. There are individual shopping plans, and choices are provided that are healthy and that people will like. No one currently self manages medication. Occasional use medication was correctly recorded and stored during the respite for headaches and asthma. Medication, if it is needed, is well managed and recorded so people are protected. Medication is checked into the home by two staff and there is good key security and storage, including temperature control. Arrangements for the receipt, storage, administration, recording and disposal of medicine comply with the homes policy and this standard. Allergies are noted on medication records. There are photos of people in care records, but we recommend these are also in medication records for futher protection. People choose whether to take their medication, and refusals are not forced but staff try later. One person has cyclical obsessional behaviour, sometimes linked to medication effects and their condition. Medication effects are regularly queried with families,. We were told of an example where the home recommended medical advice was taken and a serious condition was subsequently diagnosed and treated. All staff are trained for their roles in the medication system, and regular in house updates are provided. Three staff have accredited training to administer medication, and other staff have medication awareness and witness training so that they can understand and monitor peoples conditions. Named staff have specialist training to administer suppositories and rectal diazepam and people have specific care plans about this as an emergency precaution because of their conditions. Staff told us it has never been necessary to use this, but they keep their skills updated and management Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: arrange shifts so that there are always trained staff available to meet their needs day and night. The manager administers medication and conducts spot checks on staff, which are discussed in supervision. Staff medication competence is checked and discussed but no records are kept. We advised that this should be formalised so that medication knowledge and competence can be regularly confirmed through appraisal. There is a monitored dose system which the homes pharmacist provides along with pre-printed medication administration records. The pharmacist advises on request, and audits their medication system six monthly. The manager conducts monthly unannounced spot checks on stocks and storage. This ensures that people have effective medication, as their doctor intends for their health and wellbeing. The manager explained that people who attend day services have their own medication stocks and administration records at those centres. Care Homes for Adults (18-65 years) Page 19 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can voice concerns and can have confidence these will be taken seriously and acted upon. Staff are trained to recognise abuse and poor practice, and know how to report this so people are safeguarded. Evidence: The complaints procedure is available in different formats and languages, and this is explained to people and their families on admission. The homes complaints and adult protection policies are robust, and linked to local council protocols. During the past year there has been one complaint, which the home investigated within appropriate timescales. There have been no adult protection concerns. People and relatives told us they know how to report any concern, and have confidence this will be acted upon. Some told us that their relative would need help in whatever they do, so would depend on staff noticing a concern. And one person told us that their mother makes the staff aware if they are unhappy. Staff know what to do if someone has a concern, and said this is acted upon by management - if not during the respite stay, then for the next occasion. Management introduced questionnaires after each stay so that this can be checked. The home has policies in keeping with national guidance and best practice, such as physical intervention and managing challenging behaviour. Safeguarding is taken Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: seriously, and policies are linked to disciplinary procedures. There is a whistle blowing policy. Staff receive training in adult abuse and protection. They sign to confirm they have read and understood the policies. There are plans to guide staff on the management of behaviour and self harm, if there is an assessed need. Sometimes the home takes people in emergencies because they need safeguarding. This may be because of family illness or circumstances involving abuse. The home knows how to support people during the respite stay. The person we spoke to is very independent. We sampled other records and found there are manual handling assessments so that staff assist people safely. People who need a staff escort have assessments and best interests decisions recorded about this, with consultation in keeping with the Mental Capacity Act and peoples rights. There is a record of money and transactions that are sent home at the end of each respite stay. Peoples interests are protected, and property so that it wont go missing. Some people are able to manage money they bring with them, with minimal staff support. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, safe, clean and well maintained. People have the equipment they need and privacy. They can bring their own possessions and contribute to decisions about improving the environment. Policies and checks need rapid updating when there are national changes and alerts, to further promote health and safety. Evidence: The home is not distinguishable as a care home as there is no sign on the door. They describe themselves as an ordinary home in an ordinary suburb...designed to meet very specific needs. It is comfortable and there is a good standard of decor and furnishings, maintained and replaced according to schedules that prioritise peoples needs and comfort. There is a homely and welcoming atmosphere, for example there are photos of people using the service in the dining room. Photographs of staff were used to answer a persons questions about who is on duty that day. The home is secure from intruders in and people wandering out. There is an accessible large garden which is safe, well planned and maintained. A cloth gazebo provides protection from the sun. People use communal areas and the garden for activities or privacy and quiet. One person likes the bench and swing; others like the computer games console, music and art equipment. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: There is equipment people need, such as a portable bathroom hoist, bedrails, and there is adequate space to bring individual aids. We checked and found the bedrails safe after finding an incident report about their collapse on one occasion. We found examples of creative solutions to meet peoples needs. There is no emergency call system, but staff conduct night checks and one person uses a preprogrammed mobile phone to summon staff at night. Another person has a fear of toilets, so a commode is provided. Repairs are timely. We sampled contractor certificates, safety checks and discussed the homes fire safety, food safety and general health and safety risk assessment. We found all to be satisfactory, including radiators and window restrictors to prevent falls and burns. There are fire drills twice a year, and the manager said the homes risk assessments and evacuation plans are kept up to date. Contractors ensure the homes water system is safe from bacteria. Hot water, fridge and freezer temperatures, and the temperature of heated food are checked regularly and are mainly within the recommended safe range. Hot water checks take place monthly. The shower has a thermostatic valve to control the temperature, but there were no hot water checks of the maximum setting. The manager made immediate arrangements for a check within the safe Health and Safety Executive range. Cleaning is undertaken to a well planned schedule, and there is an infection control plan based upon best practice. On the day of our visit the home was very clean and smelled fresh. People using the service all told us it was always this way. We discussed one survey with the manager as a relative told us that the bath is not always clean, and the manager will check this in future. Best practice government guidance to prevent the spread of infection has been used to form an action plan for the home, and all staff have mandatory training about this. The policy was reviewed in Nov 08, but we discussed with the manager that the section on outbreak recognition and management needs regular updating as national guidance is often changed. The home had Health Protection Agency guidance but had not yet used it. We looked around the building including bedrooms, with the person in the home. They liked the colour of their room, and each room has a different colour scheme which helps people to choose. Rooms suit peoples age, culture, lifestyle, conditions and preferences. There is sufficient storage space for personal belongings and equipment. Each person has a lockable tin for their valuables. Rooms have door locks for privacy, Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: and management can get to people in an emergency. There is a safe enclosed garden and communal areas that people have free access to. Toilets and assisted bathing facilities are shared. Management regularly seek peoples views about how facilities can be improved and act on these, such as purchasing sensory equipment. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing the home ensure peoples needs will be met. Staff are well trained and supported to maximise peoples quality of life and respect their rights. There are robust recruitment practices to ensure people are in safe hands. Evidence: We sampled rotas to learn how the home is currently staffed. Management have had to use a lot of temporary staff to cover a period of change after 3 staff left. On our visit we learned that new staff have been recruited but are not yet in post. There are stable temporary staff, when necessary, who are used consistently so that peoples needs are known and effectively managed. Staff are on duty 24 hours a day when required, and there are staff trained in first aid on each shift. Staffing hours match peoples needs. There is an ethnically diverse workforce, so people in the home have some choice about who helps them with personal care. All staff on our visit are female, so male service users will not have choice of gender for help with personal care. Management are aware of this and have used this in their recruitment approach. Staff cook, do laundry and domestic tasks in addition to care and support activities. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: There are communication systems that work well, so that staff are aware on a daily basis of any changes. The manager arranges regular staff meetings when there is a full complement, and seeks staff views on the running of the home. We sampled staff files which show that the recruitment process meets the national minimum standards. Staff have police and vetting checks before they start work, employment histories and qualifications are checked. There is an induction to safe working practices, the homes code of conduct, their policies and procedures. This is followed by an induction and training programme that meets Skills for Care standards. Two thirds of staff have at least NVQ 2 qualifications, and there are opportunities for staff to gain further qualifications in learning disability. There are excellent training opportunities, and a staff development plan. The appropriate level of mandatory training is undertaken in accordance with staff roles. A training matrix includes: fire safety, infection control, chemical safety, food safety, moving and handling, challenging behaviour, abuse, care planning and risk assessment. Medication training was discussed earlier. There is also training in peoples conditions, such as epilepsy, or about specialist procedures. Various training providers are used, including the council and national health service. There are detailed guidelines on how care is delivered, about peoples conditions, side effects and contra-indications for drugs and diet. This with the managed training programme ensures that staff can effectively monitor peoples health and wellbeing and recognise when to seek specialist advice and help. Staff are supervised the required six times a year, and topics include their practice, peoples needs and progressing their learning. Staff performance is appraised annually, and there are written records of observations of their practice and quality audits to confirm competence. This can improve regarding medication competence, discussed earlier. People, relatives and other professionals told us that staff have the knowledge and experience to meet peoples needs, and specialist advice is followed. The home work in partnership with families and representatives to make best interest spending or care and treatment decisions. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the arrangements for managing and running the home. Their best interests and rights are promoted, and views about the home are used to develop the service. There are effective systems, spot checks, and policies for health, safety and welfare. Evidence: The manager is experienced and qualified, with an NVQ Level 4 and Registered Managers Award. Their knowledge is kept up to date, for example about new laws and person-centred care. People and relatives said the manager is approachable and responds to their requests and any concerns. This was evident from the homes and our own surveys, and when we spoke to people and staff on our visit. There is an excellent quality audit system, including unannounced spot checks, meetings and surveys so that the service can continue to develop and learn. Care is quickly adjusted to peoples changing needs, and new things are tried. For example the home are trying out visual communication aids to find the right mode for some Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: people. The last inspection report and action taken was explained to people, and they now have a newsletter to share their own quality audit findings and actions. People and families influence facilities, how the home is run, food and outings provided. The business plan takes into account changing expectations of commissioners and families. They plan to have at least one or two people on respite each week, because people are no longer funded to enable the home to run at maximum capacity. There were 3 new families using the service in the last year and one placement breakdown when someones needs could no longer be met. Policies and procedures are reviewed annually, along with the homes health and safety, fire safety and evacuation plans. We sampled the homes records and contractor certificates to confirm this. The manager is well organised, and has daily and monthly schedules for maintenance, safety checks and cleaning. There are safe working practices that staff are inducted and trained to, including fire drills and manual handling. The manager took immediate steps to respond to matters raised during the inspection. It is advised that various regulator, government guidance and safety alerts are regularly checked so that health and safety is up to date and appropriate notifications are made. We discussed with the manager that a Riddor report was not made to the council and the Commission were not notified when a bedrail collapsed. This was otherwise appropriately acted upon internally and logged as an incident. We sampled policies about medication, physical intervention, sexuality, infection control, and we discussed improvements with receptive management. Audits of the systems for medication, care planning and complaints are effective. Peoples records are up to date and kept securely; staff have access when needed. Consent and confidentiality are taken seriously, for example we saw consent forms for information to be shared with the Commission as standard practice. People have access to records that are put into an Easy Read Format or are explained. Staff files are organised and contain all required documents and checks before confirming people are protected. A matrix is used to progress training, qualifications and appraisals. The recruitment strategy and human resource policies consider equality and diversity matching peoples needs. Recruiting new staff was described as a challenge for a respite care service, as they are choosy about staff having the right attitude and skills. Recently they have found that the nature of short stays does not suit all staff and sometimes job offers are Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: turned down or staff do not stay. Considerable efforts have been made to advertise the posts in the community and media. There is an effective interim plan so that people have staff who know them well. New staff have been recruited and are currently going through checks and induction. Management highly value staff and invest in their support, development and training. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 20 During annual reviews or health checks, we advise that allergies are reviewed with people and families, as they can develop at any time of life. We recommend that medication administration records have photographs of individuals, as further protection that medication is given to the right person. Observations pf medication practice, and discussions about staff knowledge and audit findings should be recorded so that competence can be periodically confirmed through staff appraisal. It is recommended that the home register online to receive MHRA and HSE safety alerts. The Infection Control Code of Practice and staff understanding should be updated whenever national guidance changes to prevent the spread of infection. Notifications must be made to all relevant regulators in accordance with their current guidance to work in partnership to protect people. This includes the Commission, Riddor Reports and/or MHRA reports about incidents involving equipment failure. 2 20 3 20 4 5 30 30 6 42 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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