Care Home: Agnes House

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What the care home does well People spoken with were very content, they were happy there were no undue restrictions on them. The care plans were easy to follow and generally indicated how staff were to meet the identified needs of the people living in the home. People living in the home were supported to keep in touch with people that were important to them. People were able to go out on their own if they were able and safe to do so helping them to retain their independence. People living in the home received the support they needed to enable them to make choices and decisions about their lifestyles. Staff were well trained ensuring they could support the people living in the home appropriately. What has improved since the last inspection? Records showing that people had attended health care appointments and what the outcomes were had improved. This ensured staff had the information they needed to support people appropriately. The systems in place for managing and administering medication had improved. This ensured people received their medication as prescribed. Staff had undertaken more training to ensure they could support people safely. There had been some improvements in the environment enhancing the comforts of the people living there. What the care home could do better: Care plans should reflect all the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Risk management needed to be improved in some areas to ensure the people living in the home were fully safeguarded. People could have more meaningful lives if they were encouraged to develop their independent living skills. Records need to show that people have been offered the foods they like and that special diets are catered for. This will ensure people have their nutritional needs met. The home needs to have a system in place to improve the quality of the service in the best interests of the people who live there. Further improvements are needed to the environment to ensure the home is safe, comfortable and kept to an acceptable standard for the people living there. The home must have a registered manager so that the people living there can be assured that someone is accountable on a day to day basis. Key inspection report Care homes for adults (18-65 years) Name: Address: Agnes House 11a Arthur Road Erdington Birmingham West Midlands B24 9EX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 1 5 0 4 2 0 1 0 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Agnes House 11a Arthur Road Erdington Birmingham West Midlands B24 9EX 01212416825 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Angel Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 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: Mental Disorder, excluding learning disability or dementia (MD) 14 Date of last inspection Brief description of the care home Agnes House was previously two domestic properties, which have been modified and adapted. It is located in a residential area on the outskirts of Erdington and is convenient to local shops, colleges, transport and leisure facilities. Agnes House is owned and managed by Angel Care Homes Limited and the responsible Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 14 2 8 0 4 2 0 0 9 Brief description of the care home person is Mrs Balver Bisla. The home is registered to accommodate up to 14 people with mental ill health. The people living in the home are all male and they all have single bedrooms. The home has three lounges and a dining area. One lounge is equipped with a tea bar where the people living in the home can help themselves to drinks and snacks. The home is suitable for people with near full mobility. There is a large garden to the rear of the home. There is a small amount of parking space on the drive of the home but visitors are also able to park on the road outside the home. The range of fees detailed in the service user guide were not the current fees. People should contact the home directly for the most current information. Care Homes for Adults (18-65 years) Page 5 of 33 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day by two inspectors. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Care Homes for Adults (18-65 years) Page 6 of 33 Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with five of the people living in the home, the acting manager and two staff to get their views on the home. We sent ten Have your Say surveys to people who live in the home and ten to staff members. A total of eight were returned, three from people living in and five from staff. These views have been included in the report. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should reflect all the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Risk management needed to be improved in some areas to ensure the people living in the home were fully safeguarded. People could have more meaningful lives if they were encouraged to develop their independent living skills. Records need to show that people have been offered the foods they like and that special diets are catered for. This will ensure people have their nutritional needs met. The home needs to have a system in place to improve the quality of the service in the best interests of the people who live there. Further improvements are needed to the environment to ensure the home is safe, Care Homes for Adults (18-65 years) Page 8 of 33 comfortable and kept to an acceptable standard for the people living there. The home must have a registered manager so that the people living there can be assured that someone is accountable on a day to day basis. 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. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the information available for people wanting to move into the home was not up to date so people could not be assured they were getting the correct information about the home. Evidence: The AQAA for the home indicated that the service user guide had been updated. A copy was looked at and no changes had been made since the last inspection. The staffing assignment detailed in the documents was not reflected in the home. There was no part time cook, laundry worker or gardener. The registered manager who was detailed in the service user guide had left the home. Also the address and telephone number given for the Commission was incorrect. This could mean if people wanted to contact us to lodge any concerns they would not be able to do so. No one had been admitted to the home since the last key inspection therefore the assessment procedures were not assessed. These were looked at during the previous key inspection. The procedures were found to be comprehensive and ensured staff knew the needs of people being admitted to the home and that there needs could be Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: met. There were also arrangements in place to enable people to visit the home before admission to see if they liked it. Care Homes for Adults (18-65 years) Page 12 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of detail in the care plans could lead to people not having their needs met in the way they prefer. People that live in the home received support to make choices and decisions about their lifestyles. Evidence: At the time of this inspection the care for two people was tracked and one area of care was looked at for a third person. This involved reading the care plans and risk assessments that were in place. The care plans are individualised plans about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. As well as the care plans people had booklets entitled About me on their files. The booklets were written as if the statements had been asked of the people living in the home, for example, special things I want you to know about me and what makes me happy/unhappy. The booklets gave a lot of information about the individuals but the care plans did not always show how any identified needs and preferences would be Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: supported by staff. For example one booklet stated the person liked painting and drawing there was no mention of this on the care plan or how staff would need to support the person to do these things. Care plans were well laid out and very easy to follow. Some areas needed to be further developed to ensure people received the support they needed in the way they wanted. For example one person had some short term memory loss and there was little in the care plans about the specific support this person needed in relation to their personal care. The care plan stated such things as requires encouragement to maintain high level of personal hygiene but little about things such as shaving, oral care and so on. Staff spoken with were aware of the persons needs but if any new staff started the lack of detail could mean this person would not have their needs met as they wanted. The care plans seen did not include detail of any cultural needs the people living in the home may have. For example, one persons culture could have indicated they needed specific treatments for their skin and hair. When speaking to the acting manager she told us that the person did have creams for their skin to avoid it becoming dry. This was not mentioned in the care plan. This could mean this person did not have their needs met. All the care plans that were in place had corresponding risk assessments. These were generally well detailed and informed staff how to keep people as safe as possible. For example, there were good guidelines for staff to follow for people when they were accessing the community where they or others could be at risk. Management plans were in place for any behaviours that were difficult to manage. Some of those seen needed to be further developed. For example, one was clear what staff should do to try and avoid the person becoming aggressive but not what they should do if he did. The records seen indicated that this had happened on two occasions. This could lead to the person and staff being at risk. People generally made decisions about their lives on an ongoing basis. People spoken with were satisfied with the service they were receiving and that there were no undue restrictions on them. People were seen coming and going throughout the day, they chose when they got up, what they ate and how they spent their time. They were aware that smoking in the home had ceased and that they were going outside to a smoking shelter. Records showed this had been discussed with people in their meetings. We were told that the lounge at the front of the home was kept for such things as meetings, reviews, visitors and so on. We explored this with the acting manager as it seemed the people living in the home were not able to use this room Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: should they want to. We were told it was always open and people could use it if they wished. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It could not be shown that all the people living in the home experience a lifestyle that is meaningful and meets their needs and expectations. Evidence: As at the last inspection the About me booklets that were on file for people did include some detail of what people liked to do with their time, who they liked to see and the places they liked to visit. The care plans did not indicate if people needed support to meet their social care needs. For example, for one person his likes were drawing, painting, karaoke and going out. There was no activity plan or care plan that stated how staff would help support this person to undertake these. Records showed that the person was doing some drawing and that there was karaoke in house on occasions. These seemed to happen on an ad hoc basis and were not planned. Daily records included some detail of how people were spending their time, for Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: example, out for a drive, listening to music, in his room, smoking, watching television. Records were brief and did not say if people were enjoying the activities. One entry in the records stated day trip but there was no mention of where people had been. People were seen coming and going throughout the day and when asked people seemed quite content. However there seemed to be little structure to peoples days unless they were going to college or another venue that had to be planned for. One person told us he had been to the shops in the morning and the supermarket later. Another person told us he was going out but did not know where. It was difficult to ascertain if people were leading fulfilling lives as there were no activity plans detailing what people actually wanted to do. Records did show that people were using some of the local facilities such as shops, pubs, colleges and doctors surgeries. There was little opportunity in the home for people to develop independent living skills. Discussions with staff and observations made indicated that people did little around the home. One person used the domestic washing machine that was on site. People were seen making themselves a drink. We were told people were not allowed in the kitchen because of health and safety so they did not help with the preparation of meals. When we asked staff if people helped keep their rooms tidy or make their beds we were told the staff get paid to do this. Efforts should be made to encourage people to become more independent so that their lives are more meaningful. Wherever people wanted to see their family and friends this was enabled and supported by staff. There was evidence that people went to visit their family in their home. There was also ample evidence that families and friends were able to visit the people living in the home. The acting manager also spoke to us about someone not wanting to speak to relatives on the telephone and this was not seen as an issue. These arrangements ensured people were able to keep in touch with people that are important to them. The menus and food records at the home showed that there was a good choice of food available for people to choose from. Staff were able to tell us the likes and dislikes of the people living in the home. for example, one person did not like spicy foods and records indicated these were not given. We were told that one person had some cultural needs in relation to diet and that these were catered for. The food records did not support this and the person concerned was not able to comment ton this. The acting manager said these foods were offered but the person did not always want them. Records need to indicate that peoples preferred foods are being offered and that any specific diets are being catered for. People spoken with were generally Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: satisfied with the food at the home saying it was good and there was plenty of it. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place to make sure people stay healthy and well were robust and ensured the well being of the people living in the home. Evidence: There was some information in care plans about the personal care needs of the people living in the home however as previously stated this could have been further developed. The staff we spoke with were aware of the needs of the people living in the home in relation to their personal care. They were able to tell us how they supported people and what people were able to do for themselves. People were dressed in individual styles that were appropriate to their ages, personal tastes, the weather and their culture. People did not have health action plans in place but any ongoing health concerns were detailed in their care plans, for example, diabetes. Care plans gave some good detail of how staff would recognise if an individuals mental health was relapsing and what they should do about this. Records showed that people got the appropriate attention when their mental health deteriorated, for example, visits from home care teams or Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: hospital admissions. Records showed that people had access to a range of health care professionals as they needed including doctors, opticians, dentists and so on. The acting manager was also able to tell us about one person who she was concerned about as his physical health had deteriorated and the staff were finding it more difficult to meet his needs. This person had been reassessed and was waiting for a nursing care placement. Recording of health care appointments had improved and staff were using the appropriate sheets which made it much easier to track peoples health care needs. This ensured staff had the most recent information and could meet peoples needs accordingly. Staff did need to be mindful that all appointments were recorded. For one person it looked as though he had not had any chiropody treatment for over a year. We were told by the acting manager this was not the case. People were being weighed on a regular basis to ensure they were not losing or gaining significant amounts of weight which could be a sign of underlying health concerns. Medication management had improved and ensured people were receiving their prescribed medication. All medication had been booked into the home and was signed for when administered. A random audit of the medication was undertaken and all the balances of medication left in the home that were sampled were correct. It was noted that one person was using an inhaler as and when necessary. This needed a protocol in place that detailed when this was to be administered. The controlled medication records were appropriate and the balance held correct. It was noted that medication other than what was controlled was being recorded in the controlled drug register. The acting manager said she was using this as a type of audit tool it was recommended that a different record be used for audit purposes to avoid any confusion. Care Homes for Adults (18-65 years) Page 20 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to listen and act on peoples views and to safeguard them from harm. Evidence: A copy of the complaints procedure for the home was seen on the wall in all the bedrooms and people received a copy in the service user guide. The acting manager needed to ensure the contact details for the Commission in the procedure were correct. This will ensure people have the correct information if they wish to raise any concerns outside the home. Good relationships between the people living in the home and the staff were evident and individuals had no problems with approaching the acting manager. This would give people the confidence to raise any issues. The surveys returned to us indicated that people knew how to make a complaint and who to speak to if they were unhappy about anything. There was a complaint in the complaint log but this was an incident between a person living in the home and a staff member. This had been addressed with the person concerned and the outcome was documented. We had not received any complaints about the home. As at the last inspection it was suggested that any minor grumbles and how they are addressed are documented as evidence that people are listened to. Further evidence Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: of this could also be shown in the minutes of the meetings with the people living in the home if their actual comments were recorded and then following meetings commented on any actions that had been taken when issues had been raised. The majority of the staff at the home had received training in safeguarding issues. Staff spoken to were able to tell us what they would do if they witnessed or suspected any incidents of abuse. This should ensure people are safeguarded. The manager told us about a referral she had made for one of the people living in the home under the Deprivation of Liberty Safeguarding legislation as she was not sure that he had capacity to make some decisions. The outcome of this was that the person did have capacity. This ensured all the appropriate people had been involved in making this decision. Staff needed to be mindful of what they wrote when filling in incident forms. Two were seen that could have been deemed as adult protection issues. When the acting manager explained the circumstances it was not exactly as was written. Staff must write exactly what happens so that it can not be misinterpreted. Some of the people living in the home managed their own financial affairs other needed assistance from the staff at the home. The records for this were sampled. All income and expenditure was detailed and receipts were available for any purchases made on behalf of people. All the balances checked were correct. Four of the people living in the home were having money paid into an account in the name of the Company this had been set up specifically for this purpose and although not ideal was a way of ensuring people had access to their money. It was recommended there was a record kept on site to show what money had gone into the account and what is held in there for each person on an ongoing basis. This will ensure there is a full audit trail and show people are fully safeguarded. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There had been some improvements made to the environment. Further improvements were required to ensure the home was kept to an acceptable standard throughout for the people living there. Evidence: There had been some improvements to the environment since the last inspection but other areas still needed to be addressed. The use of some of the communal areas in the home had been changed. The smoking room had been changed to the dining room. A shed had been erected outside for people who smoke. The former dining area is now another small lounge area. The other two lounges remained as before. All the communal areas had been redecorated and some new carpet and furnishings had been purchased. Some of the new chairs in one lounge were showing signs of wear and tear and will need replacing shortly. People were quite comfortable in the communal areas. New flooring was needed in the hallways and on the stairs as this was well worn and badly stained in some areas. The carpet by the door in one of the lounges was loose and a tripping hazard. The manager was advised to address this to ensure people were safe. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The surface temperatures of some of the radiators in the home were very hot. A risk assessment must be undertaken to ensure people will not burn themselves on these. There were few aids and adaptations in the home as these were not needed by the people living there. However one person needed the use of a wheelchair in the home. It was noted that staff were using the chair without footrests. This could cause the person injury. This was discussed with the manager and she was advised that using wheelchairs without footrests must be risk assessed and the outcome recorded to ensure people are safe. Bedrooms in the home varied in size and some included basic en suite facilities. One of the bedrooms had been refurbished to quite a good standard with new furniture and fittings. However some of the furniture had been broken by the occupant and needed to be addressed. Some of the other bedrooms were generally clean, tidy and decorated to an acceptable standard however the majority remained in need of some upgrading. This will ensure bedrooms are kept to an acceptable standard for the people living in the home. There were adequate numbers of bathing and toilet facilities around the home for the people that were living in the home. There was a wet room on the ground floor with a walk in shower that was accessible to people with mobility difficulties. We were told that another bathroom had been refurbished to a high standard. This had been done to only a very basic standard. One toilet had been refurbished. The laundry was suitable located and equipped. There was also a small domestic washing machine that the people living in the home could use if they wished. The room where this was located also housed one of the homes boilers. There were some strong fumes in this room that the acting manager was advised to get checked. She stated this had bee done before and evidence was seen that the boiler had been serviced. We were notified the day after the inspection the room had been checked again and was safe and they had installed a carbon monoxide monitor to ensure safety on an ongoing basis. As at the last inspection it was strongly recommended that the home employed a cleaner for the communal areas in the home as staffing levels did not allow support staff enough time to clean the home effectively, for example, cleaning carpets without this impinging on the life of the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 33 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. The staffing levels at the home were appropriate for the needs of the people living there but did not ensure good housekeeping around the home. People living in the home can be confident that their needs will be met by well trained staff. Evidence: As at the last inspection although staffing levels for the needs of the people living in the home were appropriate there were insufficient staff to ensure good housekeeping around the home. Staff were seen to spend a considerable amount of their time cleaning. One staff member stated they spent about half their shift cleaning. As stated in the previous section of the report it was strongly recommended that a cleaner was employed at the home. This would ensure the support staff could spend more time with the people living in the home and enhance their quality of life more. Good relationships between the staff and the people living in the home were evident. The people living in the home were comfortable approaching the staff throughout the day. Staff spoken with were aware of the needs of the people living in the home. This should ensure people receive the support they need in the way they want. There had been some staff turnover since the last inspection. The recruitment files for three staff employed at the home since the last inspection were sampled. These Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: showed that generally all the appropriate checks were undertaken to ensure people were safe to work in the home prior to them commencing their employment. Records included completed application form, POVA first check, CRB check and two written references. It was noted that for one person there was only one written reference and this had been received after the person started working at the home. The acting manager said they always obtained two references however the other one could not be found. The staff surveys returned to us and staff spoken with told us that staff were very satisfied with the training provided. The arrangements in place for training ensured staff had the appropriate skills and knowledge to support the people living in the home. An updated training matrix was sent to us the day after the inspection. This showed staff had received training in topics such as, infection control, first aid, fire safety, mental health awareness, protection of adults and handling medication. Staff spoken with told us about their induction training and two of the files sampled included evidence that staff had completed induction training in line with the specifications laid down by Skills for Care. One file did not have any evidence of this training. The information on the AQAA showed us that seven of the ten staff employed had a National Vocational Qualification (NVQ) level 2 or above. This contributes to ensuring staff are appropriately skilled to support the people living in the home. Care Homes for Adults (18-65 years) Page 26 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs a registered manager so that people are assured there is someone accountable for the running of the home on a daily basis. The home needed to have a quality assurance system in place based on seeking the views of the people living in the home with a view to continuous improvement. Evidence: The owners of the home took it over in 2006 and have not had a registered manager since then. It is important they address this issue so that people can be assured there is someone accountable on a day to day basis for the home. The former deputy manager was the acting manager at the home and she has been in this post for over a year. The acting manager demonstrated a good knowledge of the needs of the people living in the home. Good relationships were evident between the acting manager, the people living in the home and the staff team. There had been some further improvements at the home since the last inspection, for Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: example, medicine management, care plans had been reviewed and there had been some improvements to the environment. However further improvements were needed to some aspects of the care plans and risk assessments. Much of the environment provided only quite basic facilities for the people living in the home. As at the last inspection no progress had been made on implementing a quality monitoring system in the home. There were regular meetings with the people living in the home and the minutes for these were seen. Topics discussed included leisure activities, food and their responsibilities within the home, for example, health and safety issues such as fire procedures. As at the last inspection it was recommended that the minutes for the meetings detailed exactly what people said and how topics or issues that needed to be followed up had been addressed. This would ensure the people living in the home were listened to and their views acted on. There were also regular staff meetings. The home needed to have a quality assurance system in place based on seeking the views of the people living in the home with a view to continuous improvement. Staff had received training in safe working practices. The AQAA indicated that the equipment in the home had been regularly serviced and was up to date. The in house checks on the fire system were sampled and found to be up to date. The records also showed that fire drills were undertaken at the required frequency. During the course of the inspection the fire alarm went off four times. The acting manager told us this was a fault on the system however there was no information anywhere to suggest this had been checked. We were told this had happened before on more than one occasion. The system was quite new and there had been some issues but there was only documentation relating to one call out for this. We advised the acting manager to contact the contractors to ensure this was checked in case it was not a fault. We were advised the day after the inspection this had been checked and it was a fault and had been addressed. The acting manager must ensure she is more proactive when ensuring the safety of the people living in the home and the staff. Other issues that were raised in relation to health and safety at this inspection included the surface temperatures of the radiators and the use of foot rests on wheelchairs. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 There must be robust management plans in place for any behaviours that are difficult to manage. This will ensure people are safeguarded. 31/05/2010 2 24 13 The surface temperatures of the radiators must be risk assessed and any necessary action taken. This will ensure people will not burn themselves. 31/05/2010 3 37 8 An application for the registration of the manager must be forwarded to the Commission. 30/06/2010 This will assure the people living in the home that someone has day to day responsibility for the management of the home. Care Homes for Adults (18-65 years) Page 30 of 33 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 1 The service user guide should be amended to ensure it reflects the current information in the home. This will ensure that the information available for people wanting to move into the home is correct. Care plans should include details of how all the individual needs of the people living in the home are to be met. This will ensure people receive person centred care on an ongoing basis. People should be encouraged to be more independent so that they reach their full potential Daily records should show how people are spending their time so that it can be determined if they are leading fulfilling lives. People should be involved in drawing up their own activity plans so they can be supported to do what they want to do. There should be evidence that people have been offered the foods they like and that diets have been catered for. Protocols for the administration of as and when necessary medication should be in place. This will ensure staff administer the medication consistently. It is recommended that any minor issues and how they have been addressed are recorded to show that the people living in the home are listened to. The audit trail for any money managed on behalf of the people living in the home should be improved. This will ensure people are fully safeguarded. Staff should ensure that recordings on incident forms are factual so they cannot be misinterpreted as adult protection issues. An ongoing and timed redecoration and refurbishment plan for the home should be forwarded to the Commission. This will ensure improvements are made for the comfort of the people living in the home. To ensure people do not trip over all carpets should be fixed down. It is strongly recommended that the home employs an additional member of staff to help with cleaning the home to ensure it is kept to an acceptable standard. Page 31 of 33 2 6 3 4 11 12 5 6 7 12 17 20 8 22 9 23 10 23 11 24 12 13 24 33 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 14 34 Two written references should be obtained for new staff before they start work at the home. This will ensure people are fully safeguarded. Records should show that staff have received the appropriate induction training to enable them to support the people living in the home effectively. The home should have a quality monitoring system based on seeking the views of the people living in the home. This will ensure the service is improved for the benefit of the people living there. 15 35 16 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 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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