Care Home: Apna House

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What the care home does well People`s needs are assessed before they move into the home so that they can be confident their needs will be met there. People could visit the home before moving in to see if they liked it. There was information available for people in their first language to make it easier for them to understand. People were supported to make decisions about their lives to enable them to remain independent. People were supported to maintain contact with their families so that they did not lose touch with people that were important to them. There were opportunities for people to take part in activities that they enjoyed helping them lead a fulfilling life. Staff were aware of the cultural needs of the people living in the home and ensured activities were culturally appropriate. The people living in the home were satisfied with the meals available to them. They told us the `food is good` and `if you want something just ask and they do it`. Staff were well trained and very knowledgeable about the needs of the people living in the home. This ensured people received their care as they wanted. The home was well maintained and provided people with a safe and comfortable environment to live in. What has improved since the last inspection? Staff had had further training in mental health care awareness and mental capacity so that they could fully understand the needs of the people living in the home. Staff were recording why they were giving PRN (as and when necessary medication) so that it could be shown this was only given when needed. Personal inventories had been drawn up for the people living in the home so that there belongings could be accounted for. There had been further improvements to the environment ensuring people were comfortable. What the care home could do better: The service user guide should include all the necessary information to help people decide if the home is suitable for them. Care plans should include all the current needs of the people living in the home and how they are to be met by staff. This will ensure people receive person centred care on an ongoing basis.To ensure the well being of the people living in the home ongoing health concerns must have robust management plans in place. Any incidents of challenging behaviour should be documented so that it can be determined if there are any patterns to the incidents and that staff manage the behaviour consistently. Records should be kept of the food people living in the home are eating so that it can be shown they have a well balanced and healthy diet on an ongoing basis. The outcomes of professional visits should be recorded so that it can be assured staff have all the necessary information about peoples` needs and how care should be provided. Staff should ensure medication records are accurate at all times so that it can be shown people receive their medication as prescribed on an ongoing basis. To ensure people are fully safeguarded financial records must be robust. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Apna House 6 Park Avenue Hockley Birmingham West Midlands B18 5NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 3 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Apna House 6 Park Avenue Hockley Birmingham West Midlands B18 5NE 01215515678 01215544322 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Apna House Ltd care home 13 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: 13 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) 13 Date of last inspection Brief description of the care home Apna House is sited in the Hockley area of Birmingham. It is well served by public transport affording access to the locality, Birmingham city centre and surrounding areas. The home is close to shopping facilities including specific cultural provision. Nearby are temples, mosques and churches attendant to all faiths represented at the home. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 13 Brief description of the care home Care is delivered in a large, refurbished double fronted house having tarmac frontage, ramped and stepped access to the main entrance and a small patio/garden at the rear mostly laid with tarmac and some small raised lawns. The home provides care, rehabilitation and recovery services to up to 13 adults who are experiencing problems with their mental health. It was reported that people whose first language is not English are able to converse with staff that will also advocate for them in their first language. The home currently accommodates male service users presenting a diverse range of mental health problems. Specific cultural needs are met through the provision of separate facilities for the storage and preparation of culturally appropriate food and adaptations to shower facilities for preparations prior to prayer. There are established links to other relevant professionals involved in mental health recovery services. Information is shared with people who live in the home at regular house meetings. The range of fees charged at the home was not available in the service user guide. People should contact the home for this information. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was carried out on August 10th 2007. An annual service review was undertaken on September 1st 2008 when we decided that the home had continued to ensure they offered a good service to the people living there. This inspection was carried out over one day by one inspector. 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 Care Homes for Adults (18-65 years) Page 6 of 34 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. 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 six of the people living in the home, the manager, responsible individual and three staff to get their views on the home. We sent five Have your Say surveys to people who live in the home and four to staff members. A total of eight were returned, four from people living in the home and four from staff. These views have been included in the report. What the care home does well: What has improved since the last inspection? What they could do better: The service user guide should include all the necessary information to help people decide if the home is suitable for them. Care plans should include all the current needs of the people living in the home and how they are to be met by staff. This will ensure people receive person centred care on an ongoing basis. Care Homes for Adults (18-65 years) Page 8 of 34 To ensure the well being of the people living in the home ongoing health concerns must have robust management plans in place. Any incidents of challenging behaviour should be documented so that it can be determined if there are any patterns to the incidents and that staff manage the behaviour consistently. Records should be kept of the food people living in the home are eating so that it can be shown they have a well balanced and healthy diet on an ongoing basis. The outcomes of professional visits should be recorded so that it can be assured staff have all the necessary information about peoples needs and how care should be provided. Staff should ensure medication records are accurate at all times so that it can be shown people receive their medication as prescribed on an ongoing basis. To ensure people are fully safeguarded financial records must be robust. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is made available to people before they visit the home so that they can make an informed choice about whether to move in. Peoples needs are assessed before they move into the home so they can be confident their needs will be met there. Evidence: The service user guide for the home had been reviewed and updated recently. It was also available in some different languages to make it more accessible to the people living in the home and their families. The surveys returned to us before the inspection indicated that people received enough information about the home before they moved in. It was noted that the range of fees charged at the home was not included. This information should be included so that people know what the costs are. Two people had been admitted to the home since the last key inspection but they had been resident for over a year and much of the documentation in relation to their admissions had been archived. One of the personal files did include an assessment that had been undertaken by the home when the individual was on a day visit to the Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: home. Hospital discharge letters also showed that the individual had had a stay at the home before admission. The manager was very clear about the assessment and admission procedure for the home. She told us people made several visits to the home before admission and overnight stays were also arranged. It depended on the individual how long the process took until they were sure they wanted to go into the home and the home were sure they could meet their needs. The process ensured people were fully involved in the admission process. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could not be confident that their care plans included their current needs and this could lead to their needs not being met. There were effective systems in place to minimise any risks people were exposed to and support them to make choices and decisions about their lifestyles. Evidence: Three care plans were sampled at this inspection. Two were looked at in some depth and only specific areas of the other one. Care plans covered areas such as personal care, mental health, diet, family contact and spiritual and cultural needs. The care plans detailed the aims and objectives of the individuals and the actions to be taken by staff to help people attain their aims. The care plans indicated they had all been reviewed in July 2009. However it was apparent when talking to the individuals, the staff and reading daily records that the care plans were not up to date. For example, one plan stated the individual went to the mosque several times a day, the person concerned was only going to the mosque once a week Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: as this is what he chose to do and using a prayer mat in his room at other times. This was confirmed by the individual and the staff. Another person had had some restrictions in relation to visiting family. These were clearly detailed in his care plan however this had changed and he was now able to visit his family and stay overnight. This was confirmed by the staff and by the records kept in the home. When speaking to the staff they were able tell us about the needs of the people living in the home and how they liked their care delivered as they had been working there for a considerable amount of time. However if any new staff or agency staff should ever have to be used in the home the lack of up to date information in care plans could lead to people not having their needs met. The lack of up to date detail in the care plans also brought into question the quality of the reviews that had been undertaken if current information was not entered at the time. There were appropriate risk assessments on peoples files to ensure staff were able to support people to take responsible risks and promote their independence. For example how people were to be enabled to visit family on their own and using kitchen equipment. There was also good detail of how staff would know if the mental health of people was relapsing and what they should do about this. One person had a very good management plan in place for challenging behaviour. Staff were able to tell us how they recognised this behaviour and what they did about it. This cross referenced to what was written in the management plan. This showed the individuals behaviour was managed safely and appropriately. Staff had also completed some ABC charts that detailed what happened before, during and after any incidents of behaviour. Staff should complete these for all incidents as this may help identify any patterns and will also show that staff manage the behaviour consistently at all times. People spoke to us about the things they make decisions on on a daily basis. These included such things as deciding what they would eat and how they would spend their time. People were seen to come and go from the home during the day. The only restrictions on people were within the bounds of their risk assessments which they appeared to be aware of, for example, not smoking in bedrooms. People told us they had been asked what colours they wanted in their bedrooms when decorated. One person had said he did not want paint but wallpaper this was seen to have been done. The minutes of the meetings held with the people living in the home showed that peoples choices had been listened to and acted upon. For example they had said they would like new sofas in the lounge, these were in place at the time of the inspection. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: People had also said they would like to go to Blackpool and this trip had been planned. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are supported to take part in social and leisure activities they enjoy so that they experience a meaningful and culturally appropriate lifestyle. Evidence: There were activity plans on the files for the people whose care was being looked at. One of these showed the person had some structured activities such as going to college, out to the cinema and home visits. This person required one to one support to access the community and this was seen to be available for him on the day of the inspection and staff told us there was never an issue with this. This enabled this person to maintain a meaningful life. The activity plans for two people stated self directed activity only. The manager stated this because they were able to direct what they want to do on a daily basis and did not want a structured programme. It was clear from daily records and from speaking Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: to the people concerned that they accessed the community quite regularly and did contribute around the home. For example, they spoke of going out shopping, going for walks, visiting and staying with family and helping with tasks around the home such as clearing tables. Both also visited the local mosque regularly. Other people in the home spoke to us about the things they enjoyed doing such as visiting a local social club, going to the local temple, cooking, shopping and going out to the local cinema. We were also told by staff that people enjoyed some in house activities such as barbecues, karaoke and card games. The minutes of the meetings with the people living in the home showed people were asked about what activities they would like to do as a group as well as individually. A trip to the sea side had been arranged as this was what people wanted and other venues were being looked at. One person told us they had good parties at the home. The surveys returned to us told us that people were able to make decisions about how they spent their time and could decide what they wanted to do. The home has sky television which enabled them to have Asian television channels in the home which was reflective of peoples culture. They also had the opportunity to watch English television channels in another lounge if they wished. Staff had made efforts to present information about activities to people in picture format, where this was appropriate to individuals communication needs. People living at the home spoke to us about having regular contact with their family and some people told us about staying with their family at regular intervals. Daily records also showed that peoples families visited them in the home. One person was awaiting a visit from his sister on the day of the inspection and was seen making contact with her on his mobile phone. It was evident that people were enabled to maintain relationships that were important to them. The people living in the home were satisfied with the meals available to them. They told us the food is good and if you want something just ask and they do it. At lunch time people chose from a range of dishes including, biryani, dahl, chapattis, sandwiches, fresh pineapple and peaches. One person told us he likes to have his lunch early at 11.30am and it was always ready for him. Other people were seen to eat later. Records of food eaten were being kept but these were not always fully completed. These are needed so that it can be shown people are having a healthy and well balanced diet on an ongoing basis. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: There are opportunities for people to shop for and cook their own food, where this is part of their plan of care. The home has a small kitchen, separate to the main one, which can be used for preparing and cooking food. One person told us about going out to buy his own vegetables and cooking them. Other people used the kitchen to make drinks and one person made his own sandwiches. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of health and personal needs ensured that the people living in the home did not suffer any ill effects. People who live in the home receive their medication safely and as prescribed by the GP. Evidence: Care plans generally detailed if people needed support with their personal care. Some only needed reminding or prompting and were able to complete tasks themselves. The care plan for one person showed he needed much more support with his personal care. The care plan detailed what he was able to do and what he needed support with. Staff that were spoken with were able to tell us the needs of the individual and these were the same as in the care plan. This ensured staff helped the individual maintain a level of independence. People living in the home had clearly been supported with personal care and grooming at this visit. They were seen to be dressed and groomed according to their ages, cultures and personal choices. Staff spoken with were able to tell us about the ongoing health care needs of people, Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: for example, diabetes and they were also aware of how to recognise when peoples mental health was relapsing. The management plans in place for some ongoing health issues were not adequately detailed to ensure the ongoing well being of the people living in the home. For example, for one person who was diabetic there was little in the care plan about diabetes or what staff should be observing for to ensure the condition remained stable. Staff spoken to did have some knowledge but it was not known if all staff had the same knowledge. There was a sheet with this persons MAR (medication administration sheets) which indicated he was monitoring his own blood glucose levels. There was no indication with the chart as to what the safe range was for the person and records showed this had fluctuated a lot. When staff were asked they had different opinions of this. The manager found an information sheet about diabetes and ranges of blood sugar levels. Had this been applied to the individual there were occasions when a G.P. should have been called. The person was having regular visits to the diabetic clinic and these showed the condition was stable. This person was seena and spoken with and was clearly well at that time. The manager should ensure all the necessary information is available for staff to ensure the condition is well managed and the individuals well being is ensured. The professional visit sheets showed that people had access to a variety of health care professionals including, G.P., nurses, dentists, opticians and that they attended appointments at hospitals and clinics as necessary. One person spoke to us about going to the doctors when he was unwell. The records for visits did not always include the outcome of each visit so it could not be assured that staff had accurate and up to date information about peoples needs and how care should be provided. We were told only four of the staff at the home administered medication as only they had been trained. This ensured people received their medication from staff trained to administer it safely. We were told there was no controlled medication or homely remedies in the home. The majority of the medication was administered by a monitored dosage system. The records for this were sampled and found to be well managed and showed people received their medication as prescribed. Some of the boxed medication was audited. The majority of the amounts remaining in the boxes corresponded with what had been received and administered. There was a discrepancy with one lot of medication but after further investigation this appeared to be because the incorrect balances had been entered on the MAR at the start of the cycle. Balances should be checked by two staff at the start of the 28 day cycle so that it can be accurately shown that people have been receiving their prescribed Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: medication. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures in place to listen to peoples concerns and complaints and safeguard them from the risk of harm. Evidence: The home has a complaints policy and procedure that is made available in a variety of languages including English which is reflective of the needs of the people living there. The home had not had any complaints raised with them since the last key inspection and none had been raised with us. The people living in the home were very comfortable in the presence of the staff which would give them the confidence to raise any issues they may have. People were seen to approach staff throughout the day who were able to communicate with them in the appropriate languages. The surveys returned to us indicated that people knew how to raise any concerns and were satisfied staff would listen to them. Meeting minutes also showed that the views of the people living in the home were listened to and acted. For example, colours they wanted in their rooms, where they wanted to go on day trips and so on. Staff surveys indicated they knew what to do should any one raise any issues. Staff spoken with were aware of the importance of having time to listen to people and act Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: on what they say should this be necessary. There had been one adult protection issue at the home since the last inspection when some money went missing. This was managed appropriately and new security measures were put in place to avoid this happening again. There were appropriate systems in place to ensure people were safeguarded from harm. Staff spoken with had a good understanding of adult protection issues. They were able to tell us what should be reported and who to should they witness or suspect any abuse. The training matrix for the home indicated all staff had received training in adult protection issues and managing challenging behaviours as part of the homes safeguarding policy. There were also written policies and procedures on site in relation to protecting vulnerable adults. The staff were helping some people manage their personal allowances. The records for this were sampled. These showed that staff recorded all income and expenditure and receipts were available for any expenditure made on behalf of people. It was recommended that an explanation should be included on the records as to where the change from any expenditure had gone, for example, one person had his own change and this was not detailed on the records therefore they were difficult to reconcile with the receipts. This will ensure people are fully safeguarded. The manager had ensured that everyone had a personal inventory of their belongings as recommended at the last inspection to ensure peoples belongings were accounted for. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well furnished, warm, clean and well decorated which provides a comfortable and safe environment for the people who live there. Evidence: Apna House is located off the Soho Road near to Birmingham City Centre. There are public transport routes nearby, which is important to the people who live in the home as they use buses to access their local community. Places of worship including the Mosque and Gurdwara are also conveniently situated and well used by the people who live at Apna House. The home is a large double fronted building with ramped access to the front door and has some off road parking space for visitors cars. The AQAA detailed several improvements in the environment including new carpeting, new bedding and curtains, redecoration and improvements outside. All the communal areas of the home were seen and some bedrooms. The stated improvements were evident in the home. People were clearly very comfortable and had lots of communal space in the home. There were two lounges and a large dining room. All were nicely furnished and Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: decorated giving people a very pleasant environment in which to live. Further work had been undertaken in the rear garden and people had a large smoking area which was important to them and many people were seen to use throughout the day. The bedrooms that were seen were very personalised and people told us they had chosen the colours and the carpets they wanted. One person spoke to us about his love of videos and DVDs and several of these were seen in his room with the equipment so that he was able to play them. The building was clean and hygienic throughout. There were established policies and procedures in place for the control of the risk of infection and all staff had undertaken infection control training which should ensure safe standards of hygiene are maintained within the home. The people living in the home told us the home was always clean. The home was well maintained and safe. Any maintenance issues were managed promptly ensuring the building was always kept to an acceptable standard for the people living there. For example, there had been problems with one of the boilers recently which had been acted on quickly and the boiler replaced. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience 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 the home were being cared for by a well recruited, trained and stable staff team that was able to meet their needs. Evidence: There had been no staff turnover at the home over the last year which is very good for the continuity of care of the people living in the home. Staff were seen to interact very well with the people living in the home. They were able to communicate with them in their first languages. The people living in the home told us staff are good and staff are good to me. Of the thirteen staff employed, just under half of the team were male, which is reflective of the gender of the people currently living in the home. The staff team reflect the cultural backgrounds of people who live in the home and from observation of their practice it was clear that they demonstrate effective knowledge of individuals cultural needs. Staff spoken with were very knowledgeable about the needs of the people living in the home and were able to tell us how people liked to be cared for and what they needed assistance with. This ensured people received their care in a way they wanted. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: The staffing rotas, comments from staff and the people living in the home indicated that staffing levels were good and that there were always staff available to take people out when they wanted to go. As there had not been any new staff recruited at the home since the last key inspection the recruitment records were not sampled. However at the last inspection the recruitment procedures for new staff were found to be robust and ensure that only staff suitable to work with vulnerable adults were employed. Staff told us and records confirmed that they had received a considerable amount of training since the last inspection. The training matrix showed that all staff had received training in several topics including, mental health awareness, fire procedures, health and safety, infection control, food hygiene, protection of vulnerable adults and managing challenging behaviour. Staff had also recently completed a common induction which included aspects of autism awareness and the Mental capacity act. The records showed that the requirement made at last inspection in relation to specific training for mental health had been met ensuring staff were equipped to work with the people living in the home. The AQAA indicated that all the staff working at the home had either NVQ level 2 or 3. This was confirmed by the information on the training matrix. This is considered as very positive as the recommended ratio in the National Minimum Standards of staff to have NVQ is fifty percent. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is well run. General practice promotes the health, safety and well being of people who live there. Evidence: There had been no change in the management of the home since the last inspection. The registered manager had been in post for a number of years and was supported by a Deputy and Senior member of staff, who took responsibility for designated managerial tasks. It was evident throughout the day that the manager had very good relationships with the people living in the home. They approached her with ease and were very comfortable in her presence. The staff were very positive about their relationships with the manager saying she was approachable and supportive. One staff member stated the running of the home is done very well. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: There were systems in place to ensure the quality of the service offered was monitored and that the people living in the home were involved in this process. For example, there were regular meetings with the people living in the home to get their views and ideas on such things as meals, activities, decoration of the home and so on. Satisfaction surveys were given out to visitors and relatives at regular intervals. The comments seen on these were very positive about the service offered at the home and included: Excellent home good food my uncle is well looked after. Culturally appropriate for Asian clients. Overall good staff and we are happy that we chose this home. Very friendly welcoming place. I am very impressed by the home the staff are very friendly and helpful. The manager undertook in house audits on such things as care plans, policies and procedure and the environment to identify any shortfalls. A representative of the company conducted regular unannounced visits to the home to oversee the general management of the home. This contributed to the effective management of the home for the benefit of the people who lived there. The health and safety of the people living in the home and the staff were well managed ensuring peoples well being. Staff had received training in safe working practices. The AQAA received before the inspection indicated that the servicing of the equipment in the home was up to date. The records for the gas equipment, hard wiring and legionella checks were sampled and all of these were up to date. The in house checks on th fire system were all up to date and fire drills were being undertaken on a regular basis to ensure people were safe. Accidents and incidents were being reported to us when necessary so that we could be assured they were being managed in the best interests of the people living in the home. The home had recently had a visit from the environmental health officer and the home had received a very favourable report which stated good standards of food hygiene Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: and procedures evident during inspection. Good improvements have been made. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should include all the necessary information to help people decide if the home is suitable for them. Care plans should include all the current needs of the people living in the home and how they are to be met by staff. This will ensure people receive person centred care on an ongoing basis. ABC charts should be completed for all incidents of challenging behaviour so that it can be determined if there are any patterns to the incidents and that staff manage the behaviour consistently. Records should be kept of the food people living in the home are eating so that it can be shown they have a well balanced and healthy diet on an ongoing basis. Ongoing health concerns should have robust management plans in place. This will ensure staff have all the necessary information to ensure the well being of the people living in the home. The outcomes of professional visits should be recorded so that it can be assured staff have all the necessary Page 32 of 34 2 6 3 9 4 17 5 19 6 19 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 information about peoples needs and how care should be provided. 7 20 Staff should ensure medication records are accurate at all times so that it can be shown people receive their medication as prescribed on an ongoing basis. Financial records should show where the change from any expenditure has gone. This will ensure people are fully safeguarded. 8 23 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!