Care Home: 9 Manor Road

Similar services:

• The Lodge Nursing Home
• Bracken House
• Sunnycroft
• Field Farm House
• Edgeview Nursing Home
• Church Terrace Nursing & Residential Home
• The Forbury

What the care home does well People who are considering moving into the home benefit from having an assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around before agreeing to move in. People living in the home are treated respectfully. Each person has a plan of care and access to health care services so that their health and personal care needs are met. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. The people at the home are being provided with opportunities to get out and about in the local community. This is particularly important for supporting people`s good mental health. The lifestyle people experience in the home matches their preferences. They are supported to maintain their independence and enduring interests that enhances their quality of life. Meals are varied and nutritious. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. The home is well maintained providing a safe, attractive, homely and clean place to live. Visitors are made welcome which supports people to maintain enduring relationships. The atmosphere in the home was friendly and relaxed and staff were available to meet peoples` needs as they required. People are protected by robust recruitment procedures. Health and safety checks were regularly maintained, so that people`s safety and welfare was protected. Staff were well-trained which meant that they were confident in their work. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home.9 Manor RoadDS0000004480.V377428.R01.S.docVersion 5.2 What has improved since the last inspection? The way the service manages people`s medicines has improved, which minimises the risk of harm from medicine errors. This meets the requirement made at the last inspection Work has been undertaken to redecorate areas inside the home and in the rear garden. This should mean that people have improved living environment and an external environment that offers more stimulation to meets people`s interests. Care plans and risk assessment have been reviewed to provide up to date information on the needs of the people who live there. This should ensure the care each person requires is recorded to enable staff to delivered person centred care. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. Consideration has been made with regard to the management of finances to ensure all monies are auditable and people`s independence is promoted and protected. This meets the requirement made at the last inspection. Staff have received training in the Protection of Vulnerable this meets the requirement made at the last inspection. This means that staff should know and understand what action to taken should they have concerns about people`s safety or welfare. What the care home could do better: Key inspection report CARE HOME ADULTS 18-65 9 Manor Road 9 Manor Road Leamington Spa Warwickshire CV32 7RJ Lead Inspector Julie McGarry Key Unannounced Inspection 2nd September 2009 09:00 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 1 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 2 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 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 9 Manor Road Address 9 Manor Road Leamington Spa Warwickshire CV32 7RJ 01926 832552 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Eden Place Limited Richard Mark Bloomer Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Mental disorder, excluding learning disability or dementia (MD) 3 The maximum number of service users who can be accommodated is: 3 21st August 2008 Date of last inspection Brief Description of the Service: 9 Manor Road is part of the Eden Place group of homes. It is a mid-terraced property approximately two miles from Leamington Spa town centre. The home has three bedrooms on the first floor and a lounge, dining room and kitchen on the ground floor. The bathroom is also on the ground floor to the rear of the kitchen. The house accommodates up to three persons in single room accommodation. The communal space is shared. There is a back garden, leading to a rear gated entry. The home offers accommodation to up to three persons with mental health problems. The service is designed for people that are self-caring in meeting their physical needs and require minimum support to maintain their mental health. Information about the service is available in the home’s ‘Statement of Purpose’, which is available in the home. The residents receive a minimal amount of support from staff, which provide house keeping, cooking and domestic duties but have daily access to qualified mental health nurses from Eden Place Nursing Home, which is close by (approximately 50 yards) and within a few minutes walking distance for the residents. Range of fees: £479 per week, this is subject to change. Additional charges 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 5 are made for hairdressing, personal sundries such as toiletries and newspapers, and private chiropody if required. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a two star; this means that people using the service receive Good outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. We carried out this unannounced key inspection over one day. As the inspection was unannounced the registered owner and staff did not know we were going. Before the inspection we looked at all the information we have about this service such as information about concerns, complaints or allegations; incidents; previous inspections and reports. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. We sent surveys to the people who use this service and staff who work there. Five surveys were returned to us, three from people who live there and two from members of staff. At this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents individually and as a group in the lounge discussing their views on the service, and how people are supported and looked after. Information from these discussions were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. There were three people in residence on the day of our inspection. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 7 At the end of the visit we discussed our preliminary findings with the registered manager of Manor Road. What the service does well: People who are considering moving into the home benefit from having an assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around before agreeing to move in. People living in the home are treated respectfully. Each person has a plan of care and access to health care services so that their health and personal care needs are met. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. The people at the home are being provided with opportunities to get out and about in the local community. This is particularly important for supporting peoples good mental health. The lifestyle people experience in the home matches their preferences. They are supported to maintain their independence and enduring interests that enhances their quality of life. Meals are varied and nutritious. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. The home is well maintained providing a safe, attractive, homely and clean place to live. Visitors are made welcome which supports people to maintain enduring relationships. The atmosphere in the home was friendly and relaxed and staff were available to meet peoples needs as they required. People are protected by robust recruitment procedures. Health and safety checks were regularly maintained, so that peoples safety and welfare was protected. Staff were well-trained which meant that they were confident in their work. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: The findings of this inspection indicated that the service is currently performing well. We have made two requirements as a result of this visit. We have made good practice recommendations which the home should consider implementing to improve outcomes for people living at Manor Road. The service must ensure any individuals who manage and self administer their medication are supported to do so within a risk management framework. This is to ensure the appropriate management and support in the administration of all medicines. The system for formally reviewing the quality of service provided should be further developed in order to continually improve the service for people who live there. This includes the need for 26 Regulation visits (providers of registered care homes are responsible for monitoring the quality of service in their care homes through monthly, unannounced visits). Copies of the reports must be kept so that it can be inspected at the next key inspection. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 9 Care plans should be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. This is to make sure people get the care they need to promote their health and well being. Temperatures in the clinical room should be monitored and recorded so the provider can be sure that medicines are stored below 25°C to maintain their stability. The manager needs to ensure all staff have supervision and annual appraisals to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. 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 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. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided for prospective users of the service and their families to help them to decide if the service can meet their needs. People can be confident that their individual needs will be fully assessed prior to being offered a service. EVIDENCE: The AQAA completed by the manager tells us, ‘we conduct a thorough assessment of a potential resident and together with staff decide if we can meet their needs.’ ‘Prospective residents and relatives have the information and are given sufficient opportunity through visits to make a decision about the home’. To find out whether this was the case, we looked at the homes Statement of Purpose and Service User Guide and the referral process from the perspective of the one person who moved to the home since the last inspection. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 12 The home has a Service User Guide and Statement of Purpose in place. Although they have been reviewed since the last inspection, they remain lengthy documents. Both documents would benefit from being reviewed to ensure that they are accessible to those living at the home. We saw that these documents provided a range of information about what a person can expect from the service. One person living at the home has recently moved there from another home within the organisation. No pre-admission assessment was needed for this move as staff already had written care plans and risks assessments in place. The referral process was discussed with the manager and records reviewed. Information recorded in this individual’s file shows that the move from within the organisation was well planned. Records from meetings with other professionals show that a multi disciplinary approach to managing this change was in place to ensure the individual was supported in the move and appropriately placed. Discussions with this individual tells us that the change in home was made with their agreement and in line with their wishes. We are told that this person was able to visit the home on a number of occasions to spend time with other people who live there and enjoy meals with them. This person told us ‘it’s a lot better, I am more independent’. In the three surveys completed by people who use the service, we were told that they received enough information to help them decide if this home was the right place for them. People also told us they had been given a contract with information about the home’s terms and conditions. Two members of staff who completed a survey said that they were always given up-to-date information about the needs of the people they cared for. Intermediate care is not provided at this home. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People using the 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 benefit from choices to enable them to exercise day to day control over their lives and from having their personal care needs met in the way they preferred. EVIDENCE: In the AQAA the manager states that ‘We hold residents meetings as well as regularly asking people individually about all aspects of the home. We are active in getting the balance right between the residents rights, their autonomy and self confidence; and not neglecting our duty of care to encourage them to lead healthy lifestyles.’ 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 14 To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from the point of their admission to the present time. We also talked to the people using the service, the manager and staff, and looked at the information in surveys that three of the staff had filled in. Each person living at the home has a care file. Care files were looked at to case track all three peoples experience of the service. Care records include important background information about them, and identify their care needs with any support needed to meet them. The care plans covered all the main areas of care including medical history, personal care, nutrition, medication and mobility. Good levels of information about each persons personal routines and likes and dislikes are recorded so that staff are able to support people in the way they like. There was evidence that peoples care plans are updated when there is a change in their needs. This should mean people get the support they need. People spoken to confirmed that they had seen their care files and are aware that staff maintain records about them. From discussion with staff and people who use the service, it was evident that people are encouraged to maintain and develop their independence. People have low dependency needs and are able to clearly communicate their needs and wishes. For example, one person told us that they travel independently or with another resident to Warwick every week using public transport. They also informed us that they manage their own medication with minimal support from staff. Another person told us that the back garden has been transformed and residents are growing their own vegetables. They told us that they take responsibility for watering and maintaining the garden. Two residents spoken to expressed their pleasure in maintaining the garden and were able to talk to us in detail about their achievements. The manager told us in the AQAA and during the inspection that staff are now recording their meetings with residents to ensure any matters raised are acted upon. Residents were able to confirm the meetings took place and that they feel confident to raised concerns or wishes and know that staff will act upon them. For example, one person told us about their interest in computers and that the home is looking into having broadband installed. Another person told us that they requested drinking chocolate and a trip on a canal boat, and staff made arrangements for both. Staff hold weekly meetings with the people who live there to make decisions about menu choices and activities preferences. Care plans and daily records also detail information on promoting people’s independent living skills like rota 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 15 for house cleaning cooking, recording temperatures of foods after people’s have cook with staff support. Risk assessments were available for mobility, nutrition, self-neglect, social isolation, and risk to self and others. Information held in the records showed that levels of assessed risk was consistent with the six monthly reviews held with mental health professionals The home has an open visiting policy. People are encouraged to maintain links with their family, friends and local community. People living there told us their visitors are made welcome and there are no restrictions on the time of visits. The home has a minibus and there are weekly trips out. One staff member spoken to was enthusiastic and had a positive attitude on promoting peoples independence. Staff records show that they receive training that covers respect, privacy, dignity, equality and diversity. People met at the inspection were well dressed in appropriate clothing suited to the weather. One person spoken to told us I like it here, and agreed that all ‘the staff were nice’. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, and 17. People using the 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 people living in this home are supported to make choices about their lifestyle and to develop life skills. Daily activities promote independence and opportunity for people to live ordinary and meaningful lives in the community where they are living. EVIDENCE: In the AQAA the manager states that ‘Residents are able to enjoy a full and enjoyable lifestle, and are supported in independantly providing their own meals. Increasing the number of staff involved in the residents and therefore their choices’. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 17 To assess whether this was the case, we observed the interactions between people and staff, talked to the people who receive a service, and looked at the programme of activities. Lifestyle records were seen in individual care plans and showed that people do different things each day either in small groups or on a one to one basis with staff. From looking at the information in the care plans of the two people case tracked, it was evident that the activity planners reflect individual preferences. The home promotes flexible routines for the people who live there that respect their difference and individuality. People are supported to lead ordinary lives as far as possible and are involved in aspects of decision making on a day to day basis. People are supported to get out and about to shops or when appropriate, go shopping independently. People visit local attractions including visits to the Old Bank at Warwick and other places they enjoy so that they take part in the like of the local community. One person told us about a barge trip, and going to the Spa Centre to a 60’s show. Another told us that they went to Snowdon summit at the end of July and explained the benefits of their aromatherapy sessions. People told us : ‘I do the things I want to do’. ‘I go to the Old bank every week, and use my bus pass to get there’. ‘We have meetings every week’. Some of the people maintain links with their family. There was evidence in daily records that peoples needs with regard to keeping in touch with friends and relatives had been recorded. One person continues to visit family in Spain each year and when we spoke with them, they confirmed that the home was supporting them in panning another visit this year. People who live in the home do not access local community day service provisions. Support is provided by the staff team on a 24 hour a day basis to enable them to participate in whatever activities they choose to undertake. Staffing changes are planned to help ensure greater one to one support is offered to people to participate in more activities of their individual preferences. People who live at the home were able to tell us that they have been informed of the proposed staff changes and welcomed the introduction of a third member of staff to help them achieve their goals and wishes. The home does not employ catering staff. People at the home are encouraged to make everyday choices such as what they do and what they eat. People are involved in planning the menus so they can choose the meals they like to eat. Care staff prepare all meals and snacks with the residents, alternatively people have the choice of joining the neighbouring home for their meals. Records show that both staff members have completed training in food hygiene. All three people spoken with said that they enjoyed their meals. People have the 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 18 choice of joining the neighbouring home for meals, but can stay in their own home if they prefer. Menus and records of food consumed by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples needs and preferences. All food being stored in the kitchen looked fresh and was well within the use by date. 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. People using the 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 benefit from up to date care files with information about their needs. People are supported by staff who respect and promote their dignity and privacy. Management of medicines has improved to ensure medication is appropriately administered at all times. EVIDENCE: The AQAA tell us ‘Residents receive appropriate personal support and have their health care needs met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines’. To check if this was the case we looked at three peoples care files, audited the medication records of three people, spoke to the people who live at the home, 9 Manor Road DS0000004480.V377428.R01.S.doc Version 5.2 Page 20 spoke to staff about peoples needs and observed staff interactions with people living at the home. It is evident that the manager has made efforts to improve the quality of the care plans. The manager said that consultation with staff regarding the care plans had taken place and feedback from staff has guided management in the development of the care plans. Care plans show that the personal and health care needs of the residents are identified and care is offered in a person centred way. That is each individual resident is offered support in a way that they personally prefer and meets their individual needs in regard to all aspects of their daily living, for example support for their personal hygiene and their preferred routines. Records are kept of all the support people receive from staff. Everyone was well groomed and dressed in age appropriate good quality clothing indicating they are supported to maintain a good self image. Care records provide information about residents medical history conditions and any current health issues showing how they should be monitored and dealt with and by whom. The records in peoples care plans are dated to show when they were last reviewed or amended. The dates on the records seen indicate that most documents including information about personal care and risk assessments are being reviewed periodically or as needs change to keep the information up to date. One person spoken to openly discussed their physical and mental health needs and the support they receive at Manor Road. They told us that since moving to Manor Road their mental health needs and general wellbeing had improved. We were told about health goals this individual had set themselves and described how staff are supporting them to safely achieve them. One health goal is to lose weight. This person told of how successful they have been in their efforts to lose weight with staff support, however there are no plans in place to demonstrate how staff are supporting this individual to lose weight in a safe manner or if their GP has been consulted in their weight loss program. Good practice in managing people’s health needs was noted. One residents requires blood tests every four weeks. Records show that this is happening and samples are being sent for analysis. Results of each tests are recorded and guidelines are in place should any concerns be identified from the tests. Information was available to confirm that people continue to be offered routine health care appointments such as the dentist, optician, and chiropodist at the recommended intervals. Information was also available to demonstrate that more specialised health care needs are addressed as appropriate such as mental health professionals. We examined the systems for the management of medicines in the home. One person keeps their medication in their own room. All other medication is stored at the close by sister home. Medication is safely stored in locked cabinets, which are kept in a locked clinical room. We audited the medicines of three people by comparing the quantity in stock against the signatures on the medicine administration records (MAR). The audits indicated that the medicines had been administered correctly. Medication is supplied to the home by Boots Pharmacy in blister packs that are accompanied by medication administration records (MARs). A sample of blister packs were audited and found to be correct. There is an amount of positive risk taking taken into consideration to promote independence. One resident manages and administers their own medication. Weekly adults are carried by staff to ensure medication is managed appropriately, and staff when on duty also supervise that medications have been taken appropriately. Residents are supplied with a secure facility in their room to safely store medicines, however, this person chooses to keep their medicines in an unlocked drawer. On the day of the inspection, we observed that this person’s room was unlocked during the time they were in the home. The home must ensure that all medicines are appropriately stored in compliance with the Royal Pharmaceutical Society guidelines. A medicines fridge is available and daily records are maintained to demonstrate the temperature is within recommended limits. Daily room temperature records are not being maintained for the clinical room therefore the home is unable to demonstrate that medicines are stored within recommended limits to retain their stability. When the manager was informed of this, staff took immediate action to locate another thermometer and made a daily recording sheet available for staff to complete. The manager advised us that staff trained in the administration of medication would be advised that this temperature record needs to be completed. During the visit it was noted that all people living at this service are treated with respect and dignity. Each person was able to spend time where they choose and it was observed that the staff and those living there had a comfortable and trusting relationship. Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. EVIDENCE: The AQAA tells us ‘Systems currently in place in the home protect residents from potential abusive situations, and their views about the home and the life they lead is listened to. Our recruitment and probation practices reduce risk.’ To find out if this is the case, we looked at the concerns, complaints and compliments folder, looked at staff records and talked to staff about complaints and safeguarding the people who live there. The home has a formal complaints policy which is displayed at the home to advise people living in the home and their families on how to make a complaint. People are encouraged to raise their concerns with the manager. The manager discussed his proactive style of dealing with minor concerns that are raised, stating that any daily issues raised are dealt with immediately and this prevents issues turning in to major complaints. Residents were observed to be familiar with the staff on duty and felt confident to make requests. People told us that they would be confident in raising concerns with staff and felt any concerns would be listened to and acted upon. People told us that they have not had to make any complaints about the quality of care and support they receive. Comments made by people who use the service include: ‘The support is smashing, I would always find someone to talk to’. ‘The staff are very good, helpful’. ‘There is the right balance of support and independence’. ‘I don’t anything to change’. The staff member spoken with was fully aware of how they should respond in cases of alleged or actual abuse. They could explain what would be abuse and were aware of Whistle Blowing procedures. The organisation’s policy and procedures on the safeguarding of vulnerable adults is detailed and up to date, however the homes local policy would benefit from being updated to include Warwickshire multi agency policy, which provides guidance and support for staff in responding to suspicion or allegation of abuse. Training records show that both members of staff who work at the home have received abuse awareness training. We saw that there are policies and procedures, secure facilities and a suitable recording system for managing money on behalf of people living in the home. We checked the balances of the money held for the three people and found them to be correct. This means that people should be protected from financial abuse. Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, and 30. People using the 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 appearance of this home creates a pleasant, comfortable and homely environment that is well maintained. The home presents as clean and hygienic. EVIDENCE: The AQAA tells us ‘We provide a good environment for our residents. We proceed with the continual process of renewal. Our new resident wanted to move out from Eden Place and is interested in gardening so we have relandscaped the back garden providing vegetable and flower growing areas along with a new greenhouse. We have completely refurbished the bathroom including the flooring and walls and we have re-floored the Kitchen’. To check that this is the case, we looked at the home, people’s individual rooms, communal areas and the gardens. We spoke to the people who live at the home and the manager. It is evident from speaking with the residents and staff at the home, the service has made carried out work at the home to improve the standard of décor and increase people’s involvement in the daily running of the home. As stated in the AQAA, new flooring is in place in the kitchen and bathroom and a new three piece bathroom suite has been fitted. These changes have improved the living environment for people who live here, as well as improving hygiene and infection control management. One person living at the home told us that ‘new rotas in the kitchen and cleaning duties to keep the home clean and tidy’ are in place. The kitchen was clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. To help maintain good infection control procedures, staff are now supplied with paper towels in the kitchen area rather than using shared cloth towels. Laundry facilities are suitable to the needs of the people who live there, and they are supported in undertaking some laundry and cleaning duties. People living at Manor Road have a cat, which they care for with some support from staff. During the inspection there were no offensive odours and the home presented as homely and clean. Staff have received training on the prevention of infection and management of infection control. Residents at the home with support from staff have developed the rear garden to enable residents to grow their own vegetables. A greenhouse has also been supplied. Residents talked to us about the work that has been put into the development and maintenance of the garden to ensure its success. Two residents also talked about the pleasure they have received from this activity, and welcomed the improvements the service has made to the home since the last inspection. Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the 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 are sufficient competent staff on duty to meet the needs of people living in the home. People are protected by robust recruitment procedures. EVIDENCE: The AQAA tells us ‘we have a strong Philosophy which is backed up by robust recruitment and managerial practices. We have a very capable and experienced senior management Team and the home is well run. Staff know what is expected of them. There is good Teamwork in the staff in giving these Residents the appropriate support’. To check that this is the case, we looked at two staff files, spoke with one member of staff and the manager. There are currently two members of staff who work approximately four hours per day, Monday to Friday on a rota system, but residents also have regular access to the staff at Eden Place. Whilst these are the average hours worked, the manager was able to demonstrate that this could be changed according to the needs of the residents at any one time, and that the start and end times of a shift were flexible to respond to trips, outings or appointments. From discussion with the manager and staff and observations, it was confirmed that there are enough staff available to meet the needs of the people living at Manor Road. People living at the home are aware which member of staff works on which day, and what systems are in place to cover leave and sickness. The three people met at the inspection spoke highly of both members of staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB) Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. As noted at the last inspection staff are not receiving formal supervision six times a year. Additionally, no appraisals of staff performance have been carried out. The manager has agreed to implement this with staff. A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records demonstrate that staff complete an induction programme and receive mandatory training in food and hygiene, infection control, first aid, abuse awareness, fire safety and challenging behaviour. This should mean that staff are updated in safe working practice. Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the 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 benefit from being supported by a service that is consistent, well planned and managed. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the service manager was completed to a good standard. It states The senior management team are very competent in running the home, and residents benefit from the policies, procedures and ethos of the home, which has their safety and best interests at heart’. The manager is well qualified to manage this service, and discussions with him show an open, positive and inclusive approach to management. From discussion with people living at the home staff the manager the examination of records, and observation of care practices show that a competent and skilled manager runs the service. The Annual Quality Assurance Assessment (AQQA) completed by the service manager was completed to an adequate standard. Information provided was supported by some evidence, and informed us about changes the home has made and where improvements still need to be made. People who live at the home are consulted more regularly on how they want the service to go forward. This includes regular house meeting and one to one meetings between staff and residents. The manger informs us that the annual quality questionnaires are due to go out to people living at the home to further seek their views on the service. The manager states that this information will be collated and any areas identified for improvements will be actioned through an action plan. The manager tells us that the owner visits the home to carry out regulation 26 visits. Registered providers are required to carry out such visits at least once a month. The manager could not provide us with copies of the visits. Regulation twenty six visits must be carried out monthly and records of the visit report made available for inspection The service has access to equipment and resources to ensure the service runs efficiently for the benefit of the people of use this service. There is good and safe storage for records, and sufficient space and equipment such as telephones and computers to enable the manager and staff to conduct their duties efficiently from Eden Place. The health and safety of people living in this home is protected by good staff training, up to date safety checks and regular maintenance of the building and equipment. We sampled some of the safety certificates and found them to be in order. Fire procedures and fire checks were all up to date. As previously mentioned, the personal monies of the three people were audited. The home was able to demonstrate good and safe practices in the management of people’s monies. The manager has shown throughout our visit and within the completed AQAA that he is determined to make further improvements to the home so that people living there have good quality outcomes. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 x 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement The service must ensure any individuals who manage and self administer their own medication are supported to do so within a risk management framework. Timescale for action 30/10/09 3. YA36 26 This is to ensure appropriate management of all medicines in compliance with the Royal Pharmaceutical guidelines. Regulation 26 visits must be 30/10/09 carried out at least once a month by a registered provider. This is to comply with the Care Homes Regulations 2001. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Service User Guide and Statement of Purpose should be reviewed and updated to ensure it is reduced in length and produced in a format that is accessible to people who 2. YA19 2. YA20 3. YA36 live in the home and any prospective residents. Care plans should be developed for all areas of need and should be reviewed and updated to include current information regarding care needs. This specifically relates to supporting one individual’s nutritional needs and physical exercise program. It is recommended that the clinical room temperature is monitored and recorded so the provider can be sure that medicines are stored below 25°C to maintain their stability. The service should ensure all staff have supervision at least six times a year and annual appraisals to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. 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