Care Home: 79 Slade Road

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What the care home does well Each person has a care plan. This tells staff how to help the person.Staff ask people what they would like to do during the day.Staff helped people to go on holiday if they wanted to.Staff helped the people living in the home keep in touch with people who were important to them.Staff gave people their medicine and tablets as prescribed by the doctor.Staff keep records so that they can check how well each person is. Staff help people to go to the doctors if they are not well.People living in the home can choose what they want to eat and drink. Their diet helps to keep them healthy.Bedrooms are decorated in the way that each person chooses. They have the things they like in their bedroom.Visitors said, `Surroundings are clean. Friendly co operative, my X is very happy.` `X has problems but through patience and perseverance they are sorted.` `He is treated on the whole with respect and in a dignified manner. He has all of his care needs met and is generally supported to develop his skills and increase his independence.` What has improved since the last inspection? Risk management plans included more detail of how people were to be kept safe.Care plans told staff a lot more about people so they know more about how to help them.Training for new staff was better so they were able to care for people safely.Different flooring had been put in some parts of the home. It is a cleaner and more comfortable home for people to live in.Some rooms had been decorated so that the home was more comfortable and pleasant for the people who live there. What the care home could do better: People should have activity plans in place that show they are leading meaningful lives and doing what they want to do.The company that owns the home must ensure there is enough money for people to eat what they want and that staff can eat with them if this is what they choose. Staff need to have some more training to ensure people are kept safe all the time.The fire alarm must be tested every week to ensure it is working properly and will alert people if there is a fire so they are safe. Key inspection report Care homes for adults (18-65 years) Name: Address: 79 Slade Road Slade Road, 79 Erdington Birmingham West Midlands B23 7PN The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Brenda ONeill Date: 1 0 1 2 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 40 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: 79 Slade Road Slade Road, 79 Erdington Birmingham West Midlands B23 7PN 01213267152 F/P01213267152 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.CareTech-uk.com Caretech Community Services Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 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 2 2 0 1 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home 79 Slade Road is a care home in Erdington. There are shops, pubs, churches and buses close by. The home provides care and support for four people with a Learning Disability. Each person has their own bedroom. One is on the ground floor and has its own toilet. The home is suitable for people who can use the stairs. Care Homes for Adults (18-65 years) Page 5 of 40 On the ground floor there is a lounge, dining room and kitchen. There is a bathroom on the first floor and another toilet down stairs. There is a garden at the back of the home for people to use. The last inspection report is available in the home for visitors who want to read it. People should contact the home for information about the fees. Care Homes for Adults (18-65 years) Page 6 of 40 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 Care Homes for Adults (18-65 years) Page 7 of 40 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home and did the inspection in one day. The home did not know we were going to visit. We looked at what it is like to live there. We asked the people living there what they think of their home. Care Homes for Adults (18-65 years) Page 8 of 40 We looked at how the home meets the regulations and the National Minimum Standards. We looked at how the home can do things better. Before we visited we looked at things we had been told about the home. The manager sent us the Annual Quality Assurance Assessment (AQAA). It tells us how they think they are meeting the regulations. Care Homes for Adults (18-65 years) Page 9 of 40 Two people who live in the home were case tracked. We do this by meeting and observing them and talking to staff about their care. We also looked at their care files. Tracking peoples care helps us find out what it is like to live in the home. We sent surveys to one of the people who lives in the home, some relatives and staff. Eleven were sent back to us and what they said is in the report. We looked at parts of the home and records about staff and health and safety. Care Homes for Adults (18-65 years) Page 10 of 40 What the care home does well Each person has a care plan. This tells staff how to help the person. Staff ask people what they would like to do during the day. Staff helped people to go on holiday if they wanted to. Care Homes for Adults (18-65 years) Page 11 of 40 Staff helped the people living in the home keep in touch with people who were important to them. Staff gave people their medicine and tablets as prescribed by the doctor. Staff keep records so that they can check how well each person is. Staff help people to go to the doctors if they are not well. People living in the home can choose what they want to eat and drink. Their diet helps to keep them healthy. Care Homes for Adults (18-65 years) Page 12 of 40 Bedrooms are decorated in the way that each person chooses. They have the things they like in their bedroom. Visitors said, Surroundings are clean. Friendly co operative, my X is very happy. X has problems but through patience and perseverance they are sorted. He is treated on the whole with respect and in a dignified manner. He has all of his care needs met and is generally supported to develop his skills and increase his independence. Care Homes for Adults (18-65 years) Page 13 of 40 What has got better from the last inspection Risk management plans included more detail of how people were to be kept safe. Care plans told staff a lot more about people so they know more about how to help them. Training for new staff was better so they were able to care for people safely. Care Homes for Adults (18-65 years) Page 14 of 40 Different flooring had been put in some parts of the home. It is a cleaner and more comfortable home for people to live in. Some rooms had been decorated so that the home was more comfortable and pleasant for the people who live there. What the care home could do better People should have activity plans in place that show they are leading meaningful lives and doing what they want to do. Care Homes for Adults (18-65 years) Page 15 of 40 The company that owns the home must ensure there is enough money for people to eat what they want and that staff can eat with them if this is what they choose. Staff need to have some more training to ensure people are kept safe all the time. The fire alarm must be tested every week to ensure it is working properly and will alert people if there is a fire so they are safe. Care Homes for Adults (18-65 years) Page 16 of 40 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Brenda ONeill CQC West Midlands City gate Gallowgate Newcastle upon Tyne 03000616161 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 17 of 40 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 18 of 40 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. There was information available for people wanting to move into the home to help them decide if the home was right for them. People could be confident that their needs could be met by the staff at the home. Evidence: Each person had a copy of the service user’s guide to the home. This was produced using pictures and written in an easy read style making it easier for people to understand. We were told this was also available in audio format if needed. The service user guide was quite comprehensive and included all the information people living there would need to know about the home including their individual fees and who was responsible for paying these. The service user guide did not include a range of fees so that people who were trying to decide if Slade Road was the right home for them would not know what they could possibly be paying if they wanted to move in. Other information available in the home was the most recent inspection report, complaints procedure and so on. People would not know this information was available as it could not be left on display as one of the people living there would remove it. It was recommended that a notice was put up in a frame that informed people of what Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: information was available and how they could access it should they want to see it. One person had moved into the home since the last inspection. He had lived at the home before and had moved out to live more independently. He had moved back while his current home was being refurbished. The individual knew the home, staff and the people living there and told us he was happy to be back and had settled well. He told us he was still being encouraged to be very independent and was able to come and go from the home as he pleased. The manager had completed an assessment for the individual. The assessment document covered all the required areas. The document stated such things as I want to live at Slade Road as I know the staff and the people who live there. It detailed the individuals needs in relation to such things as personal care, diet, managing money, medication and so on. It also included information such as how staff would know if the individual was unwell or in pain. The document was very thorough and would enable staff to make a decision as to whether they could meet an individuals needs. The manager was also very clear that if the person being admitted was not known to them there would be several introductory visits to the home and overnights stays before admission. This would give the individual time to decide if they liked the home and decide if they thought the staff could meet their needs. Care Homes for Adults (18-65 years) Page 20 of 40 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. Arrangements were in place to ensure people received the support they needed safely and in the way they preferred. Evidence: The records of two of the people living in the home were looked at. These included an individual care plan. These stated how staff are to support the person with their personal care, mobility, communication, going out in the community, nutritional needs, cultural needs, health needs and their behaviour. The care plans were quite detailed so that staff had the information they needed to support the individual in the way they wanted. One persons care plan included good details of his cultural needs in relation to skin care and that staff may need to remind him to apply moisturising cream. Staff were able to tell us about this showing the care plan was being followed and the individual was receiving the support he needed. Another care plan gave good details of the individual’s preferred daily routine and he was seen to follow this ensuring he received the support he required the way he wanted it. Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: Some areas of the care plans needed to be updated, for example, one individuals care plan included details of a work and college placement and both of these had finished. Care plans should also have included some of the short and long term aims of the individuals in the home. For example one person was hoping to move back into more independent living. Clearly plans were being put in place for this as the individual had a meeting with the quality manager the day of the inspection to discuss how to move forward on this. The staff and the manager of the home spoke to us about this and that the individual would need help with budgeting, shopping etc to achieve this. The individual needed a written plan so that he could see how he was doing and what he needed to achieve. The people living in the home were seen to be encouraged to make decisions about their everyday lives in such things as what they wanted to eat, what they wanted to do with their time if they wanted to go out and where they wanted to go. One person who could not respond to staff verbally was seen to be fully consulted about his choices for the day and he was able to indicate to staff what he wanted to do. Records sampled included individual risk assessments. These stated how staff are to support the person to do things whilst minimising the risks to their safety and well being. These included using electrical equipment, going out in the community, using the kitchen, medical conditions, having their own keys, household tasks, bathing, inappropriate behaviours, and activities in the home. These were generally well detailed. Staff were able to tell us how they managed the behaviours of the people living in the home and examples of this was seen throughout the day which cross referenced to the risk assessments. This ensures peoples behaviour was managed safely and consistently. Observations of some practices also showed that general every day tasks such as making cups of tea were appropriately supervised to ensure people were safe. We received some very positive comments about the service offered at the home including, Surroundings are clean. Friendly co operative, my X is very happy. X has problems but through patience and perseverance they are sorted. He is treated on the whole with respect and in a dignified manner. He has all of his care needs met and is generally supported to develop his skills and increase his independence. Care Homes for Adults (18-65 years) Page 22 of 40 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. Arrangements are not always sufficient to ensure that the people living in the home experience a meaningful lifestyle on an ongoing basis. Evidence: The people living in the home did not have weekly activity plans in place. There was some detail of where people were going to go through the month and these were signed off as completed. However it was difficult to know what was planned for people on a daily basis and if they led fulfilling lives on an ongoing basis. There was evidence that people went out to local pubs for lunch, to the cinema, shopping, garden centres and just for a walk. Staff were able to tell us what people liked doing, for example, one person liked spending most of the weekends keeping up with sporting events and watching football in the pub. Another person enjoyed spending most of his time drawing and making paper chains when at home. This was seen during the day and he was clearly very happy when doing this. Another person had decided it was time for him to retire and told us he did not want to do much. Staff told us he would go Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: out if there was a specific purpose. He had recently gone out supported by staff to buy a Christmas card for a relative. During the day of the inspection one person went to the local Caribbean barbers ensuring his hair was cut in the style he liked. One of the people living in the home told us he comes and goes from the home as he pleases. He goes to a club twice a week for which he uses ring and ride. He was quite happy with the life he was leading and enjoyed living at Slade Road. Records showed that people had all had a holiday of varying lengths and at various locations. Staff were also making plans for next year. Two people had attended college courses one of these had finished and another had broken down. One person told us he was hoping to do a computer course the manager said she was looking into this for him. Records sampled showed that people are involved in household tasks regularly, which would help them to develop their independence skills and also take some responsibility for how they lived. These include cleaning, helping to prepare meals, shopping and doing their laundry. People were seen to be asked to change their bed, make their own drinks and help with meal preparation. One person told us he had helped paint the dining room. The people living in the home were supported to maintain relationships that are important to them. One person told us he was in touch with his relative and spending Christmas with them. One person has an advocate who also helps him. The advocate told us, The service welcomes the involvement of independent advocates. Another relative told us they had a good relationship with the manager who kept them up to date with what was happening in the home. We were told that menus were planned with the people living in the home on a weekly basis. However the manager did acknowledge that sometimes this was difficult to do as people did not always want to sit and plan the menu. Staff were aware of the likes and dislikes of the people living in the home. Records showed that cultural diets were catered for and that people ate a variety of foods. People were seen to be asked to choose what they wanted for lunch. Staff told us that people without any verbal communication indicated their preferences by pointing. The systems in place ensured people could eat the foods they liked and that specific diets were catered for. People were encouraged to eat healthily however the staff acknowledged how difficult this was particularly when people went out on their own as they had no control over what people were eating then. This had been recognised as an issue with one person who needed to follow a specific diet. This had been followed up by the manager and an Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: appointment made with the dietician to try and ensure the individuals well being. The manager raised some concerns with us about a recent cut in her the budget with which she purchases food. This budget had reduced quite considerably and she was concerned that over a period of time this would affect the variety and quality of food that she would be able to purchase. One of the homes policies states It is accepted good practice that staff on duty will eat wit clients at meal times, unless the client indicates otherwise. The manager stated that the reduction in the budget was making the provision of staff meals very difficult. This situation needs to be monitored and reviewed if it is detrimental to the people living in the home and could mean their nutritional needs are not met and that they miss out on the social aspects of meal times. Care Homes for Adults (18-65 years) Page 25 of 40 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 personal and health care needs of the people living in the home were being met in the way they preferred. Evidence: Peoples personal care needs were detailed in their care plans. Details included what people were able to do for themselves and what they needed support with. The support people needed varied greatly some being quite independent and some needing substantial amounts of support. The people living there had been well supported with their personal care. People were dressed appropriately to the weather, their age, gender and the activities they were doing. This is good for their self esteem and well being. Peoples care needs were met in a way that promoted their dignity and that enabled them to do as much as possible for themselves. Staff were seen to gently remind someone about shaving and staff told us how one person was enabled to bathe alone with some discreet supervision from a member of staff who stood close by the bathroom. Records showed that people had access to a variety of health care professionals to ensure there general well being. The records had improved since the last inspection and were Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: easier to track ensuring staff would know where to look for information. People had input from G.Ps, opticians, dentists and chiropodists. There was also evidence of more specialise input where necessary, for example, dieticians, psychologists and psychiatrists. Records showed that health acre issues were followed up very quickly by staff, for example, one person had had a seizure and professional help had been called immediately as this had not happened for a long time. This was now being followed up with hospital appointments. The manager spoke to us about working with the continence advisors to help one of the people living in the home. Records also showed that where people were able to decide and they had refused treatment this had been respected, for example, one person refused the flu vaccination. The systems in place ensured peoples health care needs were met in ways that suited them. The majority of the medication in the home was administered via a monthly monitored dosage system. There were some boxed medicines and the records for these were sampled. All medicines had been acknowledged when received into the home and signed for when administered. The balances that were checked were found to tally with what had been received and administered. This showed people were receiving their medicines as prescribed. There were protocols in place for the administration of PRN (as and when necessary) medication and these had been placed with the medicine administration charts as recommended at the last inspection. This ensured staff had easy access to them. One of the people living in the home was administering his own medication. This had been risk assessed to ensure he was able to do this safely. The manager was also undertaking compliance checks to ensure the individual was taking his medication safely and as prescribed to ensure his well being. Care Homes for Adults (18-65 years) Page 27 of 40 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. Arrangements are in place to ensure peoples views are listened to and that they are safeguarded from harm. Evidence: The complaints procedure was produced using pictures making it easier for the people living there to understand how to make a complaint if they wanted to. No complaints had been raised with the home or us since the last inspection. There were good relationships between the staff and the people living there. This would give people confidence to raise any issues. One person had no verbal communication, staff were able to tell us how they know if he is unhappy by his body language and gestures. One person told us if he was not happy about something he would go to Jill (the manager) he was satisfied that she would resolve any issues. One of the people living in the home had an advocate who could help them raise any issues if necessary. The manager and staff were well aware of their responsibilities in relation to safeguarding the people living in the home. One incident had occurred in the home that we were notified of and that the manager had referred to the appropriate agency as a safeguarding issue. This had resulted in a staff member being dismissed. The training matrix for the home showed that half of the staff had received training in safeguarding issues and we were told that further training was planned. This will ensure all staff have all the knowledge they need to safeguard the people living in the home. Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: We spoke with three staff during the course of the inspection and they were very clear about their responsibilities to report any suspicion or event of abuse in the home. They were aware of the different forms of abuse and who they should report issues to. One of the staff spoken to had not had any formal training for safeguarding but had been given some information during his induction. This should ensure the people living in the home are safeguarded from abuse. The majority of staff had received some training in relation to the Mental Capacity Act and we were told that training in relation to Deprivation of Liberty Safeguards was being planned. These govern decision making on behalf of adults and applies when people lose mental capacity at some point in their lives or when they have had an incapacitating condition since birth. The manager spoke to us about a best interest meeting that had been arranged for one of the people living in the home in relation to a medical examination. This will ensure that if this is done it is based on a multi disciplinary decision and in the best interest of the individual. Systems in place for helping people to manage their money. Records for this were sampled and showed that all income and expenditure was recorded. Where purchases were made on behalf of the people living in the home receipts were available. All the balances of the money held that were checked were correct. The system in place should ensure peoples money is spent appropriately and that they are safeguarded from abuse. The people living in the home can sometimes display behaviour that can be challenging. Staff were able to tell us how they managed the behaviours and what they told us cross referenced to the management plans that were in place. Staff were observed to manage behaviours confidently and in such a way that people were kept safe. It was noted that the incident forms for recording any challenging behaviours did not include how staff had managed the behaviour. It was suggested this be included so that the manager could audit the forms and ensure staff were managing the behaviours consistently and safely. Care Homes for Adults (18-65 years) Page 29 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made to the environment to ensure that people lived in a more homely, comfortable and safe environment. Evidence: There were several concerns raised about the environment at the last inspection. The vast majority of these had been addressed at the time of this visit making the home more comfortable and safe. Corridors and the upstairs landing had been redecorated and laminate flooring replaced the old carpets. The lounge had been redecorated and hard flooring had been installed with a large rug making it much more modern. There was ample seating for the people living in the home. It was noted the cushions on one of the sofas had little support left in them and could become uncomfortable if people sit on them for any amount of time. There was a television with free view channels in the lounge giving people quite a wide range of what they were able to watch. All the people living in the home also had televisions in their bedrooms if they wanted to watch the television in private. The net curtain was quite grubby and needed to be washed or replaced to ensure it was kept to an acceptable standard. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: The dining area had been redecorated. It had a dining table that could seat six people. The dining area was in constant use as it was also used for activities. This did mean that people could move away from each other if they wished and that activities would not interfere with anyone watching the television. The bedroom on the ground floor has an en-suite facility. There was one toilet on the ground floor of the home and a toilet and bathroom upstairs. These were adequate facilities for the people living in the home. The toilet on the ground floor and the bathroom were quite basic and could have been made more homely. The flooring in the bathroom was stained and needed to be replaced to make it more acceptable for people. Due to the needs of one of the people living in the home the toilet paper had to be kept out of reach in the bathroom and paper towels could not be left in there. This has been an ongoing issue for a considerable amount of time. The manager had tried to address this issue to ensure good hygiene practices. Hand gel had been made available for people to ensure their hands were clean however it was strongly recommended that installation of a hot air dryer be looked into. The people living in the home showed us their bedrooms. We were told people had chosen the colours they wanted for their bedrooms. People told us they were happy with their rooms and that they were comfortable. Two people kept their own keys. One person chose not to have a key and another preferred staff to lock his room for him. He was seen going to staff and fetching them to unlock his door they responded straight away so that he could access his room whenever he wanted. There were personal possessions in all the bedrooms that reflected the preferences of the occupants, for example, their favourite football teams, preferred DVDs and CDs. It was noted that one bedroom had some broken drawers which needed to be replaced. The manager told us she had ordered new drawers for this individual a little after the inspection. We were told that the issues raised at the last inspection about the window opening in one of the bedrooms had been addressed ensuring the occupant was safe. The kitchen was modern and domestic in style which suited the home and met the needs of the people living there. The odour control problems highlighted at the last inspection had been addressed ensuring people lived in a pleasant environment. The home was clean and the people living there are involved in cleaning their home. Care Homes for Adults (18-65 years) Page 31 of 40 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. Arrangements generally ensure that the people living in the home are supported by staff that are qualified and competent to meet their needs. The recruitment practices protect the people living there so they are safeguarded from harm. Evidence: Staffing has been much more stable over the last year. The AQAA indicated no new staff had been employed recently and the manager confirmed this. This is good for the continuity of care of the people living in the home. Two staff had been transferred from another home as this was being refurbished. The manager told us that in addition to herself there are three support workers on duty throughout the day. This was confirmed by the rotas and the staffing levels on the day of the inspection. These levels seemed to meet peoples needs at the time. Staff were available to take people out, facilitate in house activities and prepare meals. There were very good relationships between the people living in the home and the staff team. Staff were able to tell us what the needs of the people were and how they liked to be cared for, for example, one person preferred a male carer, one person needed moisturiser for his skin due to culture and so on. This ensured people received their care in the way they preferred. Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: The staff team reflected the genders, ages and cultural backgrounds of the people living in the home ensuring they had a choice of who supported them. One staff member told us since being transferred to Slade Road he had undertaken a lot of training to ensure he was confident to support the people living there. He had induction training and had been off site for two days for this. The manager told us the induction training for new staff had been further developed since the last inspection. It was now part of the learning disability qualification and followed the specifications laid down by Skills for Care. The induction involved staff having some training off site then completing a work book over the first twelve weeks of their employment. This was then sent off for verification to show staff were competent. Staff told us they had received a variety of training including food hygiene, infection control, first aid, health and safety and more specialised training such as autism and managing challenging behaviour which relate directly to the people they are supporting. Staff were very satisfied with the training they had and were receiving. It was noted that fire training was a little out of date. Staff need this updated to ensure they are able to keep people safe. The training matrix indicated that six of thirteen staff employed had either NVQ level 2 or 3. This is a little under the recommended fifty percent but other staff were working towards achieving this. On the whole the training staff received ensured they had the skills and knowledge to be able to meet the needs of the people living in the home. No new staff had been appointed so the recruitment procedure was not looked at in any depth. However the issues raised at the last inspection were looked at and these had been addressed. For example, the proformas showing staff had had all the appropriate checks were in place and were completed with names of referees. Where the date of POVA first checks were not detailed the actual check was on the file. These records indicated that the recruitment process was robust and ensured only appropriate people were employed to work with the people living in the home. Care Homes for Adults (18-65 years) Page 33 of 40 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. The manager ensured the home was run in the best interests of the people living there. Evidence: The registered manager had been in post for just over two years and had the appropriate training and experience to be able to run the home in the best interests of the people living there. There had been a number of improvements since the last inspection including, a safer and more comfortable environment, care plans and risk assessments had been further developed to include more details of individual needs, staff induction training had improved and equipment had been regularly serviced. These improvements ensured the service was developing and improving for the benefit of the people living in the home. The manager was very receptive to all the comments we made throughout the inspection and clearly wanted to improve the service further. Staff spoken with said the manager was very approachable and worked well with them making a nice atmosphere for the people living there. Care Homes for Adults (18-65 years) Page 34 of 40 Evidence: The home has a quality monitoring system in place that includes the quality manager undertaking audits of the service. The monitoring forms for this show what needs to be improved and the manager has to action. There is also an action plan drawn up after every key inspection detailing how any issues will be addressed. A representative of the company visits the home every month to oversee the management of the home. The home has tried having meetings with the people living there but have found these to have been of little use. Staff now talk to people on an individual basis to try and get their views on the service by asking questions about food, activities, how the home is run and so on. Some evidence was seen that the comments made by the people living in the home had been followed up for example, people wanting to go to the museum and this had been done. The AQAA indicated that the servicing of the equipment had been undertaken. The records for this were sampled and found to be up to date. This had improved since the last inspection with the servicing of the gas equipment and the water system being checked for the prevention of legionnaires disease. The in house checks on the fire system were sampled and until recently had been done weekly but had lapsed over two weeks. The last check highlighted a fire door not closing properly the manager stated she had reported this but there were no records to show this had been addressed. The manager was to address these issues straight away to ensure people were kept safe. We were informed two days after the inspection that the door had been repaired. As mentioned earlier in the report the manager did need to ensure the fire training for staff was up to date to ensure they could keep people safe. Fire drills were being carried out twice yearly as required to ensure staff knew how to keep people safe should there be a fire in the home. The notification of accidents and incidents to us had improved so that we could be assured incidents and accidents were being managed in the best interests of the people living in the home. Care Homes for Adults (18-65 years) Page 35 of 40 Are there any outstanding requirements from the last inspection? Yes  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 Care Homes for Adults (18-65 years) Page 36 of 40 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 Description 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 Description Timescale for action 1 42 23 Staff must have their fire training updated. 31/01/2010 This will ensure staff are able to keep people safe. 2 42 23 The fire alarm must be tested every week to ensure it is in working order. This will ensure people are kept safe. 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 07/01/2010 1 1 There should be some indication in the home as to where people can get information such as the inspection report or complaints procedure. This will ensure information is accessible to everyone. There should be some information about the range of fees charged available for people thinking of moving into the Page 37 of 40 2 1 Care Homes for Adults (18-65 years) 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 home so they have some idea of the costs. 3 6 Care plans should include the aims of the people living in the home to ensure they are supported to achieve what they want. Care plans should include all the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Activity plans should be in place that show people have meaningful activities planned on an ongoing basis and records retained of what has been undertaken. This will show people lead meaningful lives. The food budget must be monitored and reviewed to ensure the reduction does not mean the nutritional needs of the people living in the home can not be met. Incident forms should include details of how staff manage any behaviours so that it can be seen that they are managed safely, consistently and in the best interests of the people living in the home. All staff should receive training in safeguarding issues to ensure they have all the knowledge needed to ensure people are safeguarded from harm. Any broken furniture in the bedrooms should be replaced so that people are able to use it fully. The bathroom and toilet on the ground floor should be upgraded to make them more homely and comfortable for the people living in the home. The net curtain in the lounge should be washed or replaced to ensure it is kept to an acceptable standard for the people living in the home. The sofa in the lounge should be replaced to ensure it is comfortable for the people living in the home. To enhance good hygiene practices consideration should be given to installing a hot air dryer in the bathroom. Fifty percent of staff should be qualified to NVQ level 2 to ensure they have all the necessary skills and knowledge to Page 38 of 40 4 6 5 12 6 17 7 23 8 23 9 10 25 27 11 27 12 13 14 28 30 32 Care Homes for Adults (18-65 years) 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 care for the people living in the home. Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 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 © (2010) Care Quality Commission (CQC). 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