Care Home: 87 Church Road

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What the care home could do better: Sometimes people have to come to the home when there is not much time to first look around. The home should write down how this is done to make sure people feel good about it and the staff know how to help them. We saw some good notes about how staff understand people, but not every care plan had these notes to help the staff understand what people are trying to tell them. People told us they liked the food, but we think there could be more choice and more fresh food used to make sure people always eat good food. The staff told us the food could be better. The staff might need more time and know how to prepare fresh food rather than take it out of the freezer already prepared from the shops. How staff give people their medication is better and more checks are made, but we want some more changes to make sure it is safe and staff will not make mistakes.Some new things are planned for the home, which means the kitchen will be decorated and there will be some new carpets. We would like the wooden floor to look better and a few other small things done around the home. There are too many staff that may not know the people living in the home very well as they are not the usual staff. This should be put right soon to make sure people are always well cared for. Some of the notes for staff to read about how things are done in the home need to be looked at to make sure they are right. Key inspection report Care homes for adults (18-65 years) Name: Address: 87 Church Road 87 Church Road 87 Church Road Frampton Cotterell South Glos BS36 2NE 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: Kathryn Silvey Date: 1 8 0 6 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 34 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 87 Church Road 87 Church Road 87 Church Road Frampton Cotterell South Glos BS36 2NE 01454250028 01179709301 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) : admin@aspectsandmilestones.org.uk Aspects and Milestones Trust care home 8 Number of places (if applicable): Under 65 Over 65 8 8 8 0 learning disability physical disability Additional conditions: May accommodate 1 named person with acquired brain injury May accommodate up to 8 persons aged 18 years and over with learning difficulties who may also have physical disabilities. This may include persons age 65 years and over. Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Aspects and Milestones Trust, a non-profit making organisation, operate the Home. The building is an extended, large bungalow that can accommodate up to eight residents with learning disabilities and physical disabilities. This may include residents 65 years and over. The Home is located in a semi-rural area approximately seven miles from Bristol City centre. There are local shops within walking distance of the home. Transport is required to enable residents to access facilities further from the Home. The Home has two vehicles to take people out, one vehicle has facilities to take a person in their wheelchair. All bedrooms are single occupancy and have washing facilities and a call alarm. There is a bathroom with assisted bath hoist and a separate walk in shower room. Shared space consists of a lounge, dining room and conservatory. There is a patio and garden area that is fully accessible to residents. The fees charged for staying at the Home are £978.50 a week. The aim of the home is to provide a person centred service. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home The last inspection for this service was 14/05/2008 We, the Care Quality Commission (CQC), completed this surprise key inspection in two days with one inspector. We spoke to all seven people living in the home and watched the care staff talking to them. We also spoke to the manager, and four of the care staff. During the inspection we spoke to a carer visiting from a domiciliary care agency, a student nurse and the homes aromatherapist. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of three people were looked at in detail, and we spoke to the manager about the care of the other four people living in the home. We looked around the home and saw how people spent their day and what food they had. The manager had completed the Commissions Annual Quality Assurance Assessment (AQAA), this is information sent to CQC each year telling us about the home and any improvements there. What the care home does well The staff know how to plan for a new person to visit the home to help them make up their mind about moving in. This usually means that people visit several times and meet everyone that lives there, and the staff, before they decide. Each person living in the home has a care plan about how they want to be helped and what they want to do most days. The staff make sure that people are well looked after if they have a health need and the doctor and other people like them visit and help take care of them. The staff in the home look after people well and help them to make choices every day. People go out with the staff and enjoy meeting people in other homes, in church, at a music club and when going shopping. Some people go on holiday with the staff. A person comes to the home to give a gentle massage that smells good to help people feel relaxed and help any aches or pains. One person told us they enjoy the massages. Care Homes for Adults (18-65 years) Page 7 of 34 Each person can choose a carer called a keyworker, the keyworker makes sure they have everything they need, and that they can talk about buying new clothes and planning trips out. The home makes sure that staff know how to stop people from coming to any harm. The staff have special training about telling someone if they think there is a possibility of any harm. People living in the home can help choose new staff and there are lots of checks on new staff to make sure they are the right people. The staff have a lot of training and they told us that the person in charge of the home helps them to improve. The person in charge of the home has had a lot of training and has looked after people with learning needs for many years. The home is well run with the regular care staff helping people living in the home to choose how they spend their day. People are asked about their home to make sure that things are right for them and they can make choices. People are safe in the home and staff know about fire safety. What the care home could do better Sometimes people have to come to the home when there is not much time to first look around. The home should write down how this is done to make sure people feel good about it and the staff know how to help them. We saw some good notes about how staff understand people, but not every care plan had these notes to help the staff understand what people are trying to tell them. People told us they liked the food, but we think there could be more choice and more fresh food used to make sure people always eat good food. The staff told us the food could be better. The staff might need more time and know how to prepare fresh food rather than take it out of the freezer already prepared from the shops. How staff give people their medication is better and more checks are made, but we want some more changes to make sure it is safe and staff will not make mistakes. Care Homes for Adults (18-65 years) Page 8 of 34 Some new things are planned for the home, which means the kitchen will be decorated and there will be some new carpets. We would like the wooden floor to look better and a few other small things done around the home. There are too many staff that may not know the people living in the home very well as they are not the usual staff. This should be put right soon to make sure people are always well cared for. Some of the notes for staff to read about how things are done in the home need to be looked at to make sure they are right. 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 Kathryn Silvey Colston 33 33 Colston Avenue Bristol Avon BS1 4UA 01179307110 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 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a pre-admission assessment format and procedure that ensures people are well assessed before they come to live in the home. Visits to the home are arranged before people make their mind up about living there. The admission procedure will be better when an emergency admission policy is added to help safeguard people. Evidence: We looked at the new pictorial service users guide where there were many clear pictures of the home. The staff told us that they had read the guide to a new person who was registered blind. There is a complaints procedure in the guide. The manager told us that people have a copy of the guide and copies of their contract and receive an annual letter to inform them of any changes. The Statement of Purpose had been updated since the last inspection and the homes inspection report is available for people to see. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: We looked at the homes admission procedure and recommend that there is a procedure for emergency admission included There have been no new admissions since the last inspection. We looked at an assessment for a new person, admitted eighteen months ago as an emergency admission. We spoke to the person briefly, as she was feeling unwell on the day of the inspection Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are being assessed and improvements have been made in identifying and supporting people to make decisions about their lifestyles. Risks are being managed to help ensure that people are safeguarded. Evidence: We looked at the individual care plans for three people and all aspects of their personal, social and healthcare needs were assessed and plans made to met them. A pen picture is completed about peoples lifestyles, family, interests and their hopes and wishes. We discussed with the manager that currently the people living in the home are unable to take up any work placements due to their age or disability. There were no Care Programme Approach actions regarding mental health problems, however most people were being supported by the multidisciplinary Community Learning Disability Team (CLDT). The support was mainly occupational therapy where peoples mobility was limited and risk assessments had been completed with additional adaptations provided as required. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: The AQAA told us that the home is working with a Person Centred Plan facilitator, with a long term goal to adopt Essential Lifestyle Planning as the model for service delivery at the home. Currently regular one to one meetings with people living in the home, and general residents meetings, identify the hopes, anxieties and concerns of people, and they are included within individual support plans. Two good communication care plans were seen as people had difficulty making themselves understood. We saw staff engaging with people and the staff were able to understand quite quickly what the person was trying to communicate. One care plan did not have a communication care plan, which should be completed as agency staff may be unable to communicate effectively. People go out with staff regularly to include local functions and social activities. People are supported to take risks and assessments are completed to minimise them and maintain their safety in the home. It was evident that people had different routines to suit their individual needs and choices and staff were seen respecting their differences. A person requesting to return home was being supported by the CLDT to decide mental capacity and subsequent best interests actions. The manager had contacted the Deprivation Of Liberty (DOL) authorisation team at the local council to ensure that the correct procedures to enable and support the person were being implemented. This is good practice and will help staff to learn about DOL and the implications for future use. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People take part in the local community activities and have holidays they enjoy. Their leisure activities are improving with additional resources provided within the home. Links with friends and family where possible are maintained, and people are involved in decisions made within the home. The quality of the meals provided could be improved to help ensure that people choose from a variety of nutritious and healthy foods prepared by staff that have the time and ability to use fresh ingredients. Evidence: We looked at the minutes from a residents meeting, which included the following; what people should do when there is a fire alarm, knowing who their keyworker is and what they should do, the keyworker to book holidays for people, jobs around the home people can do, their approval of an ancillary worker becoming a carer, planning to visit a garden party at another home in July and discussing afternoon activities. The manager told us that he helps people to decide what questions they can ask people when they join in with recruiting new staff. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Using staff photos people are helped to choose their own keyworker with a facilitator from another home. The keyworkers complete monthly records for each person, which includes any future plans and choosing preferred trips out. The records also gave examples where staff had helped people organise their wardrobe and buy new underwear. One keyworker helped a person to choose pictures to brighten up their bedroom, which has previously been discussed during staff supervision with the manager. Another keyworker had helped a person choose new furniture for her bedroom. Two people were going out on the evening of the inspection day to to a local music club. Two people go to church every Sunday and people from the church visit the home. Two people are supported by their keyworker to write letters to friends. Another person visits their sister every week in another care home and has three days out of the home, as the local day centre has closed. A person we spoke to is a member of Slimbridge Wildfowl Trust and enjoys visits there, and another person had a recent holiday with the manager and other care staff in a caravan in Devon. The recent visit by the Trust recorded that the service is getting better at understanding service users, particularly with regard to activities and working towards Person Centred Plans. Peoples views had also been sought and recorded. Acquisition of a second (wheelchair adapted) vehicle in the last twelve months has helped to ensure that more people can be taken out regularly. We looked at the activities timetable for each person, that usually take place between 13:30 and 15:00, these include arts and crafts, cooking, gardening, pampering, watching old films and staff generally engaging in conversation with people individually. We discussed the gardening with the carer that organises it, and he told us that three people were enjoying growing salad vegetables to eat. We visited the garden, which is a safe and pleasant area for people to use, and saw where people were growing some lettuce. The aromatherapist was visiting during the inspection and people were able to choose what area they wanted massaged and were obviously looking forward to the treatment. The aromatherapist told us that staff in the home treat people with respect and that she saw some good food provided including fresh fruit. She also told us that she often saw people going out on shopping trips with a carer. A person living in the home told us that he goes to see his girlfriend and she visits him and that there are lots of trips out to clubs, and some really good holidays organsied. Page 16 of 34 Care Homes for Adults (18-65 years) Evidence: We looked at the menus and the food being provided was different to the menu. Staff told us that the meal that should have been provided was not available so an alternative was found. All food provided must be recorded when alternatives are used. Convenience foods were given on both days of the inspection and pork pies were a substitute for one main meal. The main meal of the day is provided in the evening and staff said they may start preparing it at 15:00. This is a time of day when only two staff are on duty and activities take place or people may want to go out. The staff we spoke to thought the food could be improved. People choose what they wanted from what appears a limited choice and there was little variation from week to week. They do not have the benefit of food provided by an experienced cook who can deliver a variety of wholesome nutritious food from fresh ingredients. We recommend that more planning and preparation is given to the provision of fresh food and that people have nutritional assessments. People have a light lunch, which usually includes a variety of sandwiches. The preparation of food was highlighted at the last inspection, as staff preparing food have varying cooking skills and are employed as care staff without any training in how to cook good food, and may not have sufficient time to complete this very important task. All but one person ate their meals in the dining room where there was a relaxed and friendly atmosphere with staff joining in. People said they enjoyed the food provided, however, it looked bland and unappetising. The AQAA told us that the eleven permanent staff all have food hygiene training. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare needs are well met with healthcare professionals providing support and advice when required. Medication records were correct and recent improvements had been made to help ensure that errors do not occur. However, additional medication administration improvements remain necessary. Evidence: The person centred care plans identified peoples healthcare needs and the support by healthcare professionals was well recorded. A person with epilepsy was well supported by the Epilepsy Nurse who visited during the inspection and planned to return. The record we looked at of seizures for two people were detailed, and there were protocols in place for administration of as required medication for seizure control. Risk assessments for falls were well recorded and there were comprehensive health action plans. Healthcare professionals visit the home to include; the district nurse , speech and language therapist, continence adviser, dentist, doctor, physiotherapist, occupational therapist and psychiatrist. The care plans and risk assessments we looked at were very good. During the inspection one person visited the dentist with a carer and returned having coped well with the experience. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The home has made some medication errors since the last inspection and advice was given by the Care Quality Commissions pharmacists. The manager informed us about the medication errors and followed the homes procedure to inform the doctor and seek advice. The home had an Aspects and Milestones medication policy that had not been reviewed since 2005, this policy must be reviewed as soon as possible. An administration procedure from the local pharmacy for the monitored dosage system is used. The Royal Pharmaceutical and the Commissions medication guidance were also available. The homely remedy procedure required updating to include new people admitted to the home since 2007, which was when the doctor last agreed what remedies the home could administer. The medication records were very good with a pen picture about each person and a photograph. The medication administration records were complete and included additional drug information sheets, and recorded why people were taking their medication. This is good practice and provides staff with some excellent information to enable them to learn about peoples medication and any possible side effects. The folder for all this information was bulky and it was recommended that some medication information may be kept in a separate folder. This would enable medication administration sheets to be more easily accessible for the eight people accommodated. All medication not on the monitored dosage system are counted by two staff each time they are administered. We looked at protocols for as required medication for a person that may have a seizure and require additional medication and for another person for pain relief. The protocols were clear and the reasons for giving the medication were detailed, one had been agreed by the doctor. The staff have in-house medication training using a video and their competence is checked by the manager. The local pharmacy also provide medication training. We looked at the weekly medication audit records, which included as required medication, and returns to the pharmacy. A protocol seen for administration of a cream should be more specific with regard to the amount of cream to apply and when the skin condition would require it. The medication was stored securely and correctly, two staff were seen administering the medication. There is very little space, in the sometimes busy office, to administer medication. Staff must take the administration record to the person and medication in the original container to minimise the risk of errors. The person giving the medication must be the same person that takes the medication from the original container and signs the record. A lockable carrying case or secure medication trolley should be used to safely transport medication in the home as sometimes staff are walking a long way with a tablet in a small container with no records with them to identify the person. On the day of the inspection two new agency staff and one temporary staff member were on duty, as all Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: other permanent staff were on a training day. The temporary carer had retired a few months ago, and knew the people there quite well. However, this was not good practice as some people take a lot of medication and all but one person requires assistance. We discussed medication administration with the manager on the second day of the inspection and it was agreed that changes would be made to ensure safer administration. There was also a record of staff annual medication administration competencies completed in 2008 and 2009. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff deal with daily concerns people may have and the manager intends to improve the recording to ensure that minor issues are always dealt with correctly. People are safeguarded by well trained staff that know how to recognise the different forms of abuse and what they should do. Evidence: There is a good complaints procedure in the service users guide with the correct information in an easily understood format for people living in the home. We looked at the complaints record in the home and there were no complaints for over a year. We recommend that a separate page is used for each record of a complaint to promote data protection. The AQAA told us that the manager hopes to implement a monitoring system for minor niggles to ensure that there are no underlying bigger issues that need to be addressed. We discussed the information regarding the Deprivation of Liberty with the manager, who had good knowledge of the procedures used for emergency use, and how to obtain authorisation from the local council. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: We looked at the homes safeguarding policies and procedures, which the manager had updated in 2007. The contact information for the local safeguarding team was included. We spoke to staff about protecting vulnerable people from abuse, and they told us they had been trained to identify abuse and knew what to do should they witness or suspect abuse. The AQAA told us that there are robust systems for ensuring the safety of service users money and property in the home. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained home where identified improvements are made or planned for where necessary. There are infection control measures, however, minor improvements should be made. Evidence: The bedrooms were well personalised, and two people showed us their bedrooms and were obviously pleased with them. The kitchen is due to be refurbished in the next twelve months. The lounge and four bedrooms have been redecorated since the last inspection. We looked around the home, which was well maintained and found a few minor issues that require addressing. One bedroom had a wardrobe where the drawers required repair. One bedroom had a curtain that required rehanging. The home has an assisted bathroom and a shower room, people bath daily and can choose which they prefer a bath or a shower. The shower room had aprons and gloves for the promotion of infection control, however, there were no paper towels to enable staff to wash their hands. The AQAA did not tell us how many staff have had training in infection control. Infection control training should be provided for all staff. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: Many of the bedrooms had non-slip flooring. The wooden flooring in the passageway requires refurbishment as it looks unsightly. The conservatory was warm when we visited, and all the temporary staff on duty were unaware that there was an air conditioning unit there. The manager informed us on the second day that there was an air conditioning unit in the conservatory All but one person sit in the dining room to have their meals, and this was peoples choice. The Laundry should have guidance regarding infection control procedures for all staff to see, particularly as agency staff are sometimes used. The cupboard containing cleaning materials was unlocked, the manager told us that there is a risk assessment to allow a person living in the home access for personal use. The home should also ensure that other people and visitors are not at risk from this practice. A recent monthly visit recorded by the Trust indicated that the new kitchen and new carpets had been approved and that the staff had decorated two bedrooms. The home has been accredited by the Environmental Health Officer. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Too many temporary staff are currently being employed, however, the trust is aware of this and decisions will soon be made to ensure there is a more stable staff group. Recruitment records were correct, which helps to protect vulnerable people. The staff are well trained and have regular meaningful supervision and staff meetings. Evidence: The home is going through a transition stage with staff where the deputy manager is working at another home temporarily, and there are currently two staff vacancies. The manager told us the use of agency staff is currently higher due to a staff secondment. The AQAA told us that during a recent three month period 26 shifts were covered by agency staff, this is poor practice for such a small home. However, the providers are planning to make a permanent decision for staff redeployment in August 2009 and recruitment is continuing. The deputy manager completes the staff rota, and we looked at a copy. There are three staff on duty each morning and two during the afternoon and evening, and one member of staff is on duty at night. There is a thirty minute overlap between a shift to help ensure that staff are able to report any changes to the staff coming on duty. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: We discussed with the manager whether there were sufficient staff to regularly take people out in the afternoons and evenings. The manager told us that additional staff are on duty when people are taken out to the Joshua club one evening each week and one person has a Home Carer that comes each week to take her out for several hours. We spoke to the Home Carer from a domiciliary care agency who visits the person each week for 2.5 hours and has known her for six years. The Home Carer told us that there is a six monthly plan decided by the person receiving care and a weekly activity plan where outings are risk assessed. The Home Carer takes the person where she wants to go, and the carer told us that when she visits the home the staff are always helpful and the person supported is happy living there. We looked at two recruitment records, which were complete, and included interview records and the exploration of any gaps in employment. People living in the home are also part of the recruitment process. We looked at the induction process, the last one was completed within six months, however, health and safety aspects are completed first. We spoke to four staff during the inspection and they all told us the training was very good, including the bank staff. The manager told us that since the last inspection he had completed mental capacity and deprivation of liberty training, both one day courses. He had also attended a moving and handling conference as a trainer, which was completed during two days, and fire risk assessment training. One of the care staff had completed a study day for the extended role of health and safety as he was responsible for monitoring any risks in the home. Some staff had completed Makaton training to enhance communication for people. Three staff are working towards NVQ level 3 training and one has NVQ level 2 training. The staff had completed mandatory training, to include; manual handling, first aid, health and safety and fire training. Various other training completed included; challenging behaviours, epilepsy, continence care and the protection of vulnerable adults. One carer told us that they were completing an Empowering Practice in Leaning Disability course at the local university. We asked the staff about the person they were a keyworker for and they were able to explain the care and help they gave to empower them to improve their lifestyles. In one persons case a carer told us how they had gradually helped the person to feel confident enough to go out on trips. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: We looked at a record of a recent staff meeting and the medication error was raised and any further errors will be investigated by the Trust. More art materials were required for activities, and the Aromatherapist, that visits the home to give treatment, had advised staff which oils they could safely use. The holidays planned for people living in the home were discussed and some general housekeeping arrangements. The manager told us that supervision is completed regularly, and the staff spoken to agreed they found it useful. At supervision the staff performance is recorded and any further training requirements are identified, each staff member also has an annual appraisal. One carer told us that supervision was completed monthly and that staff meetings were held, and there was good communication with the manager who had an open door policy to enable staff to talk to him at anytime. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run by an experienced manager and supportive care staff. Quality assurance procedures are good and include external facilitators that engage with people living in the home. Some procedures in the home had not been reviewed for three years. Evidence: The home is well run by a qualified and experienced manager who is a qualified learning disabilities nurse. His career record shows he has a number of years of experience working with people who have learning disabilities and is awaiting feedback from the final units of the Registered Managers Award. The office door was unlocked and peoples files were accessible. The manager told us that this had been risk assessed and as people could not enter the home without staff knowing the situation was monitored. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: We looked at the homes fire safety audit and risk assessments, the records were excellent and staff competence is assessed using a fire simulation annually. All staff passed the test this year, they also watch a fire video to update their knowledge. A health and Safety audit is completed annually and staff monitor health and safety during the year. We looked at the maintenance log where the maintenance person dated and recorded any safety issues addressed. Quality assurance is monitored externally, a person centred facilitator from another home talks to people individually. We looked at the quality assurance summary and action plan for February 2008, as the most recent one for 2009 had been sent for typing. The record included all aspects of living in a home and was very detailed. The AQAA identified that some procedures had not been reviewed for three years, this should be completed as soon as possible. The AQAA also told us that equipment, and services have been serviced or tested as recommended by the manufacturer or other regulatory bodies. who Care Homes for Adults (18-65 years) Page 29 of 34 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 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 Care Homes for Adults (18-65 years) Page 30 of 34 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 17 17 A detailed record of all of 31/08/2009 food provided must be kept to determine whether the diet is satisfactory in relation to nutrition. When food is not available there should be a record of what is provided to help ensure that people have a varied and nutritious diet, to include any special diets required. 2 20 13 The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines in the care home. 31/08/2009 The medication procedure must be reviewed. Staff must always have the medication record with them when administering to a person and be familiar with the person and their medication, to help minimise the risk of errors. 3 33 18 The registered person must 31/08/2009 ensure that the employment of people on a temporary basis will not prevent people from receiving continuity of care as is reasonable to meet their needs. Care Homes for Adults (18-65 years) Page 31 of 34 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 The regular use of agency staff must be avoided to ensure that peoples needs are met by care staff that know them well. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 We recommend that there is a procedure for emergency admissions added to the admission policy. We recommend that all care plans include a detailed communication plan for people that require support to make themselves understood. We recommend that more planning and preparation is given to the provision of fresh food and that people have nutritional assessments. We recommend that some medication information be kept in a separate folder. This would enable medication administration sheets to be more easily accessible for the eight people accommodated. We recommend that a separate page is used for each record of a complaint to promote data protection We recommend that there are paper towels in communal areas for people living in the home and the staff to wash their hands We recommend that the manager should ensure that other people and visitors are not at risk from cleaning material being accessible in the home. 2 6 3 17 4 20 5 6 22 30 7 30 Care Homes for Adults (18-65 years) Page 32 of 34 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 8 40 The AQAA identified that some procedures had not been reviewed for three years, this should be completed as soon as possible Care Homes for Adults (18-65 years) Page 33 of 34 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 © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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