Care Home: Ashmill

What the care home does well Overall people are happy to live at the home and view the service as their home. People have access to health services and their medication is administered well and this helps to ensure they remain healthy. Most of the care staff have achieved an National Vocational Qualification level 2 in care which means that overall the home has exceeded the core training standard. People have personalised bedrooms, where their interests adn hobbies could be displayed. They had available to them communication equipment where necessary. People are assisted to gain disability aids to improve their independence and to maintain their physical well being. What has improved since the last inspection? The home has reviewed its Service User Guide and this means more up to date information is available to people that may be interested in coming to the home. There are individual hoist slings for people and this helps to improve safety and infection control. All complaints are now being logged and this means that the management can look for any themes and put them right. The home is cleaner, more organised and has a better atmosphere. There has been more attention to infection control, with new mop and clinical waste storage, cleaner kitchen and food storage and cleaner communal bathrooms. People told us: - `The atmosphere and the cleanliness have come on leaps and bounds.` `My bedroom is kept tidy.` The communal areas have been reorganised to make it easier for people to move around. There is a large screen television, new carpets and furniture. The lounge dining area and conservatory had been redecorated. Staff are being set tasks in a more organised way and this has led to a calmer environment for people. The manager and deputy manager have been in the home and this leads to some stability in how the home is managed. We were told: `No one was happy here we were really miserable. She (the new manager) has made it homely again. You can go to the office and sort things out I`m happy again.` `I like it here a lot now` `The service is much better now it`s been a long haul...its not perfect.. Staff speak to us more..... (The manager and deputy manager) have put in 100 percent..... they come on the nights and weekends.` There are clear structures in place to monitor the performance of the service. What the care home could do better: Although the care plans are becoming more organised more development is needed to ensure that they give clear concise information to staff. More work is needed to make the plans more individual to the person. People should be encouraged to set goals in areas that interest and are important to them. This should ensure that education, activities and leisure pursuits are more individually organised. People wanted more outings. Records of what has happened to people through out the day need to be completed. Records indicated that some people were not eating well and had no activities although contact with people living in the home and relatives indicated that this was improving. Where risks are identified such as risks to healthy skin or epilepsy then clear plans need to in place to manage this and these risks need to be reviewed regularly. Two staff were observed talking to or assisting people in a way that did not preserve their dignity or recognise that they could make choices. Although it was clear that training was being provided some staff had not availed themselves of this and the management need be sure that each shift has the skills required. The manager needs to register with the commission. The management of people`s money needed some further systems to ensure all valuables were accounted for and so any errors quickly spotted. Key inspection report Care homes for adults (18-65 years) Name: Address: Ashmill 141 Millfield Road Handsworth Wood Birmingham West Midlands B20 1EA     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: Jill Brown     Date: 2 5 0 1 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 34 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Ashmill 141 Millfield Road Handsworth Wood Birmingham West Midlands B20 1EA 01213586280 01213586280 ashmill141@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashmill Residential Care Home Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 18 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: Physical Disability (PD) 18 Date of last inspection Brief description of the care home Ashmill is registered to provide personal care and support to 18 adults with a physical disability, who have been assessed as requiring full assistance with daily living tasks. A number of adaptations are in place in order to meet peoples assessed needs. People who live at Ashmill are encouraged and supported to maintain links with their families and the local community. The service is situated in the Handsworth Wood area of Birmingham in a quiet residential road. It is close to local amenities and there is parking available at the front of the premises this is up a steep incline. The fee for this home is 650.00- 1200.00 pounds per week. Additional charges include Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 18 0 5 1 0 2 0 0 9 Brief description of the care home those for aromatherapy, hairdressing and chiropody. 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: 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: We visited the home unannounced on a day in January 2010. We completed a key inspection which means we inspected the homes performance against the Key National Minimum Standards and the issues raised in our inspection in July 2009. The home gave us information in an Annual Quality Assurance Assessment before the inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what improvements to the service they intend to make. During this inspection an expert by experience accompanied us. An expert by experience is a person who, because of their shared experience of using services and/or ways of communicating, visits a service with inspectors to help them get a picture of what it is like to live in or use the service. The expert by experience spoke to three people individually and looked around the building. We spoke to a number of people living in the home informally and spent time in the lounge looking at records Care Homes for Adults (18-65 years) Page 6 of 34 and observing practice. During the inspection we case tracked two peoples care. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedrooms. We also looked at parts of two other peoples care records. We looked around parts of the building. We also looked at records about the safety of the building, complaints accidents and so on. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? The home has reviewed its Service User Guide and this means more up to date information is available to people that may be interested in coming to the home. There are individual hoist slings for people and this helps to improve safety and infection control. All complaints are now being logged and this means that the management can look for any themes and put them right. The home is cleaner, more organised and has a better atmosphere. There has been more attention to infection control, with new mop and clinical waste storage, cleaner kitchen and food storage and cleaner communal bathrooms. People told us: - The atmosphere and the cleanliness have come on leaps and bounds. My bedroom is kept tidy. The communal areas have been reorganised to make it easier for people to move around. There is a large screen television, new carpets and furniture. The lounge dining area and conservatory had been redecorated. Staff are being set tasks in a more organised way and this has led to a calmer environment for people. The manager and deputy manager have been in the home and this leads to some stability in how the home is managed. We were told: No one was happy here we were really miserable. She (the new manager) has made it homely again. You can go to the office and sort things out Im happy again. I like it here a lot now The service is much better now its been a long haul...its not perfect.. Staff speak to us more..... (The manager and deputy manager) have put in 100 percent..... they come on the nights and weekends. There are clear structures in place to monitor the performance of the service. Care Homes for Adults (18-65 years) Page 8 of 34 What they could do better: 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 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. People can be confident they have all the information they need in an easy form for them to understand and make a decision about the home. There are procedures in place to ensure that the admission of a new person to the home is done well Evidence: Information was available to people before they were admitted to the home in the form of a service user guide. The Service User Guide had been updated in August 2009 and gave good information to people and their families about the service they could expect from the home. We were told that the service user guide is now in a disk format which will allow changes in font size and use with a computer. The Annual Quality Assurance Assessment told us that the homes website has been updated. In addition to general information about the building, staffing and management there is also information about what the range of fees for the home are and clear information about what the fees include. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: There have been no new admissions to the home since the last inspection. There was one vacancy at the time of the admission so we looked at the homes admission procedure. We found that some of the information in the service user guide about visiting the home and the settling in period could usefully added to the admission procedure. In addition to this some reference should be made to the Mental Capacity Act to ensure that peoples agreement to be admitted is assured and peoples liberty is not deprived unintentionally. 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. Although people have care plans these are not developed enough to support peoples goals and lifestyle. Although some risk management practises are improving this is not always supported by the paperwork and this could lead to inconsistent care. Evidence: We looked at two peoples care records in detail and looked at a further two peoples care records in part. We looked to see if care records described how care should be given and looked to see if care was given in that way. We found that how peoples care records were being organised was changing. Some peoples records had not been reorganised others had been started. Further work was needed on this so a clear system is in place that is easy for staff to gain the information they need quickly. The manager showed us how they were going to Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: separate information and recordings about peoples health conditions into individual health folders so that staff and health professionals can find the latest information quickly. (See Personal and Health care support) All of peoples care records were being kept securely and this means that information was not being separated to put some under lock and key. This makes it easier to determine what is happening in peoples care. Care plans generally remained lengthy and although they covered the needs identified were not sufficiently a working tool for staff. For example a plan had been discussed with a person that staff would not assist the person to get up until 10:30am as they were not a morning person. This was a negotiation to improve the persons behaviour. We observed that the person was dressed and in the lounge before this time and conversations with staff and some records indicated that the person usually was assisted at about 8.30. Staff were not working to this and there had been no review of the instruction to see if it was working or whether it was still needed. In addition whilst there was internet information for staff about epilepsy, and some risks identified such as in one file the statement must not be left in the shower due to epilepsy there were no instructions for staff of how to respond if an individual person with epilepsy has a seizure. These responses may differ from person to person. However we note in the care files we looked at the peoples seizures were well controlled. Practices had improved such as people having individual hoist slings and shower chairs. The information about the systems of transfers for each person had yet to be put on to the care plan or on a risk management plan. People have individual risk assessments for bed rails and systems were in place to ensure that the safety of the rails are monitored. There were also risk assessments for bed rails in the care plan files that were no longer the working tool and these needed to be archived as they may confuse new staff. Whilst some goal setting had been done these did not appear to be aspirational, person centred or give steps for their achievement. For example one persons goals were to stop being angry and aggressive, and to go to college. Anothers was to continue to live at the home, have contact with their family, attend college and have a holiday every year. The homes Annual Quality Assurance Assessment told us that the manager is starting to implement This is me care plans individually prepared by people living in the home and this may help people determine their short term and long term goals. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: One person was keen to show us their version of the care plan, this had been reduced so the person could understand it and showed what is important to about them. We read it out to the person and they agreed with what it said. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they will be offered choices of food but further work is needed to demonstrate what is eaten is keeping people healthy. Activities need to be more varied and reflect more peoples interests and wishes. Evidence: We looked at the records on activities undertaken with people, spoke to staff, relatives, listened to and spoke with people that live in the home. There are activity co-ordinators who are employed to provide and enable activities. They keep records of activities provided to which people. These records indicated that some people attend colleges and that there were activities provided in the home such as craft activities such as painting pots, painting, photography and board game activities that people were involved in. It was difficult to determine how often the people, whose care files we looked at, took part in activities. It was also not possible to determine and whether the activities reflected their interests. We spoke to two relatives who told us that at Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: the relatives meeting they raised that activities was an area that needed to be improved. This was especially about the number of times people have the opportunity to have an activity outside of the home. The expert by experience told us and we found that people less able to plan activities outside of the home did not have the benefit of this. The expert by experience thought that more people should have the benefit of an educational activity. He told us that people in the home are happy that the hydro pool is now in action. We saw a person enjoying this experience whilst we were on inspection. Staff spoken to thought that the hydro pool had been available for about the last four weeks. The homes Quality Assurance for October to December 2009 said that 72 per cent of people did not feel there were enough outings. People told the expert by experience that their family and friends were welcomed into the home. One relative told us that the service is much better staff speak to us more. Another relative told us we have always been happy with the service we have received. A person living in the home told us I like it here a lot now, my room is tidy and they take me to the toilet. Later they said they missed their relative. We observed how people were assisted to eat at lunchtime. One member of staff was assisting each resident that needed assistance. Some staff were standing to assist people rather than sitting with them at meal times, which makes it difficult to maintain eye contact. We saw a member of staff not talking to a person whilst they were assisting them and this included when they were moving the persons head. We observed one person made their own breakfast and this helps to maintain their independence. The cook on duty was seen talking to a person about food and this helps to ensure that individual choices are given. On relative told us We are being consulted and (my relative) is being given choices about food. Food is really good; there is not so much wastage. We looked at the food menus, meals supplied on the day and found that people were being given a choice of food. We looked at the food provided and found that many meals had a high fat content. People are not weighed routinely so it was difficult to judge whether this was affecting their health. Food eaten records and detail of daily activities people enjoyed were part of the daily records and these remained poorly completed. This may mean that it is difficult to determine whether peoples health is deteriorating. The homes quality assurance from October to December 2009 indicated that 36 percent of people thought the meals were not nutritious and varied enough. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health services and have their medication needs met and this helps to keep them well. People cannot be assured that all interactions with staff will contribute to their well being. Evidence: People told the expert by experience that they had a choice of when they get up and this ranged from 05:30 to 10:00 and breakfast was provided at that time. People said that they could go to bed when they wished. Although people told the expert by experience that staff did knock on bedroom doors when they had visitors they thought that more could be done to encourage people who have the ability to lock their room to do so. The home has both male and female staff and this enables people living in the home to have contact with staff of the same gender. Care files indicate the gender of the person and the member of staff were considered when intimate care was provided a staff member told us they only give personal care to males. Staff were from a range of Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: ethnic backgrounds reflecting the cultural backgrounds of the people living in the service and this means that people have the opportunity to communicate with a person they identify with. We observed on three separate occasions staff talking to people (a person living in the home and a visitor) in an inappropriate way. This included talking over a person to other member of staff, not recognising a persons ability to make decisions and communicate, and telling off a person as if they were a child. These interactions do not improve peoples wellbeing. We were however also told by a person living in the home that the home was improving they said No one was happy here we were really miserable. She (the new manager) has made it homely again. You can go to the office and sort things out Im happy again. The three people that the expert by experience talked to were happy with the service they received. As stated previously the records are being re organised to separate out health information so that contacts with health professionals can be easily found. However some files looked at had notes in different parts of the file showing contacts with health professionals and this makes it difficult to get an overview on peoples health care. We found that people were given an opportunity to access appropriate services and health checks such as cervical screening, flu injections, appointments for disability equipment and specific health conditions. We looked at the management of peoples skin conditions and found that people had risk assessments saying that they were at a high risk of developing pressure sores without an appropriate risk management plan in place. One persons record indicated that district nurses were attending for a pressure area and another sore area was identified and a medicinal cream prescribed. Two health professional comments indicated that the managemnt of skin care and application of cream was not good enough to prevent recurring problems. We looked at the medication records for four people. The medication was stored securely in the medication room. The temperature of the medication room was being recorded and was on or slightly above the recommended storage temperature for medication. We were conscious that this inspection is being carried out in winter and arrangements for this should be reviewed as some medications can become unstable if stored inappropriately. Generally medication was being given as prescribed with only one error being discovered. Some clarity was needed on some codes on the Medication Administration Record to determine whether people took medication with them when on social leave Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: and the code for other was used without a reason being given and this can make medication difficult to audit. One person had a medication to be given as required without a supporting protocol to say in what circumstances it was to be given, maximum amount to be given and so on. This can mean that the medication could be given in a different way to what the prescriber wants. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are confident their concerns will be listened to. Whilst systems are in place to keep people safe and act in their best interests some further checks are needed in momey management systems to make them robust. Evidence: Since the last key inspection in July 2009 the service has started keeping clearer records of the complaints that people make about the service that is provided. These records showed what was being complained about and in some cases the action taken to investigate the complaint and the outcome were not recorded. The people that the expert by experience spoke to said that their opinions mattered and that any complaint or concern they had would be dealt with properly. Staff were recruited appropriately and that helps to keep people safe. New staff spoken to aware were aware of the need to report any concerns to senior staff but were less aware of outside agencies that also have to be informed. We looked at a sample of three peoples money that was held in the home. The home keeps valuables such as passports, credit cards and bank books for some people and there is not a separate record of these items. There is not a record of the last amount detailed in the bank book they are holding on behalf of a person. We found a cheque book for a person that had stubs stating the amount taken out to pay accommodation Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: charges and so on but we could not see this on the account and it was difficult to audit this without a recent bank statement. The cash held in the home for people matched the balance on the records. Receipts were kept for any service or goods that the home purchased on behalf of a person. One persons receipts did not match the amount spent by a small amount and this was not picked up in the homes audit of the persons finances. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and comfortable environment that generally meets their needs. People are helped to get disability aids that meet their needs. Evidence: We sat in the main lounge during most of our visit to the home and later looked around the home with the expert by experience. Since the last key inspection there have been improvements to the homes environment with the communal areas being reorganised to make it easier for people to move around and with the purchase of a large screen television, new carpets and so on. The lounge dining area and conservatory had been redecorated. One person told us the atmosphere and the cleanliness has come on leaps and bounds. Another person told us that their bedroom was kept tidy. We observed that areas that had been unclean at previous inspections In June and July 2009 were much cleaner on this visit. The home had purchased a storage facilities for mops and clinical waste which had improved their infection control systems. One shower room was not available as a toilet was out of order at this inspection. On Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: this inspection the assisted bathroom had more equipment in it making the bathroom difficult to use than at the random inspection in October 2009. We looked at different care plans to those looked at in July 2009 and found that people were said to want to have the opportunity of a bath. We were told that people do not have baths. Peoples individual equipment was clean. We spoke to two people about their wheelchairs one person was fed up with waiting for their new chair. The member of staff was able to explain the progress on this. Another person told us that they were expecting a new mould for their chair as an assessment had found that the current one was not supporting them as much as it should. We looked in some bedrooms and found that these were generally clean and fit for purpose. We looked at the management of infection control in the home and noted several staff using the appropriate hand gel. The laundry has special nets to put individual peoples clothes in so clothes that need washing can be separated by person. This should assist in ensuring people have the right clothes returned. The laundry was cleaner and more ordered than at the previous random inspection. We looked at the cleaning schedule for the kitchen and found that this is not always being achieved; however the tasks not achieved are made priority for the next week. We noticed that the kitchen is very accessible. During the inspection the person supplying the home with milk walked through with outside work wear, staff and people accessed the kitchen without the appropriate aprons and so on. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that staff are deployed effectively to meet their care needs. Further training is needed to ensure that people can be assured that all staff have the up to date training. Evidence: We looked at the rota of staffing for the home. We were told that the home usually had available on the morning shift seven care staff of which at least one would be a senior care. These care staff start at 7am and all except the senior care would work until 2.30pm. There was also a manager available in the home from 9am. The home has no domestic, laundry or housekeeping staff and a cook works from 10am to 6pm. There is an activity coordinator for some hours each day through the week. At the weekend this changed as there was no manager and the cook works from 7-3. In an afternoon the number of carers lessens to 4 care staff and over night to 2 care staff. We were told by the providers, in the homes Annual Quality Assurance Assessment (AQAA) and by a relative that the number of night staff is to be increased to 3 at night. The AQAA indicated this may be a sleep in staff member but this was not evident on the rota at the time of the inspection. Three staff at night would help to ensure that unexpected need can be met and cleaning tasks completed. During the day the deployment of staff is managed more productively with the use of delegation Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: boards. We looked at the recruitment records of three staff and found that staff had appropriate checks undertaken before they were employed. Staff completed an application form, made declarations as to their health and any criminal convictions, references were obtained and checks were completed with the Criminal Records Bureau. These measures help to keep people safe. Staff spoken to said they had 2 weeks induction before they were part of the numbers on the rota and this gives staff time to become acquainted with people living in the home and their needs. The homes AQAA indicated that all new staff are undertaking skills for care programme and this programme helps to ensure that new staff develop the appropriate skills. We were told that 77 per cent of staff have at least the National Vocational Qualification level 2 in care (NVQ2). This is the recognised qualification for people that are working in care of people. We were given a training matrix which showed the training that people had in the last 8 months. Although the matrix showed that management support had been given in the key mandatory areas staff attendance on such courses as fire awareness, first aid and so on varied. Some people appear to have attended all the external courses others none. This is is more significant for night staff as the home needs to demonstrate the shift is covered with an appropriate number of staff competent in these areas. Care Homes for Adults (18-65 years) Page 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are happy with the improvements in the home. Further improvements in staff training, record management, activities and food are needed to secure peoples continued satisfaction. Evidence: There has been no Registered Manager in the home since November 2008. The current manager has been employed by the service provider since July 2009. She is intending to become the registered manager of the home but we have not received an application for registration and this may cause difficulties if not done soon. All care services are to re register and this is being done in batches all of which will be completed before October 2010. The manager has a Registered Managers Award qualification which is the recognised qualification for managers of care services. The service undertakes Quality Assurance audits and the service provider visits the home on a regular basis and produces reports. These help to ensure a quality of service. The was evidence of surveys being undertaken with people in the home and Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: analysis of the outcomes of the surveys had been done and the home were aware of areas where improvements could be made. Relatives have also asked for monthly meetings between them and senior management. There were no people living in the home that were subject to a deprivation of liberty authorisation at the time of the inspection. Admission procedures had not been updated to include an assessment of peoples willingness to be admitted to the home and this may be important given the homes registration. ( see Choice of Home.) We looked at a number of health and safety records for gas, fire, water, vehicle and lifting equipment safety and found that these services were maintained and inspected as required. Maintenance records were available and indicated that where maintenance were raised they were being attended to. We found a record of a person having a fall and being found on the floor and although this did not result in injury this should be put in the accident record as sometimes injuries become evident later. The expert by experience requested that those people who are able to manoeuvre themselves into their wheelchairs independently have their wheelchairs charged in their rooms. This is so they can access them in case of fire and this seemed a sensible suggestion. A set of ladders was found to be propped up in one of the storage buildings these need to be secured when not in use to prevent them being a danger to staff. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 24A You must provide us with an 30/09/2009 improvement plan following the receipt of your final report. The report was finalised February 2010 a new inspection has been completed. This is to assure us that the home has a timetable of improvements to secure the wellbeing of people living at the home. Care Homes for Adults (18-65 years) Page 29 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 1 6 12 (1)(a)Where people have a diagnosis of epilepsy, a plan needs to be in place to determine what actions are appropriate for that person should they have a seizure. This is to ensure that staff the information to give immediate appropriate help to the individual person. 04/04/2010 2 9 13 (4)(c) risk assessments of moving and handling should result in a plan that shows details of how the person is moved from place to palce safely. This is to ensure that people are moved from place to place safely adn in a way that is comfortable for them. 05/03/2010 3 17 17 (2) Schedule 4(13) Records must be kept of the food people eat. This is to ensure that a 05/04/2010 Care Homes for Adults (18-65 years) Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action judgement can be made whether the persons diet is appropriate to keep them healthy and well. 4 18 12 4(a)Arrangements must be made to ensure all staff act in a way that maintains the dignity of the people living in the home. This is to ensure the emotional wellbeing of people living in the home 5 19 12 (1)(a)Where the risks to skin health have been identified as high, or where a persons has had skin care difficulties plans and other measures must be put in place. This is to ensure that skin health remains good. 6 20 20 Where medication is prescribed as required a protocol for its administration must be in place. This is to ensure that medication is only given as the prescriber wishes and lessens the risks of overdose or interaction with other medications. 05/04/2010 05/04/2010 30/04/2010 Care Homes for Adults (18-65 years) Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 23 17 (2) Schedule 4(9)(a) Where 05/04/2010 people give the home valuables (such as bank books) a separate up to date record needs to be kept. This is to ensure that the service can account for all monies including the transfer of money to pay accounts 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 6 Care plans should include information to ensure that peoples short term and long term goals are recognised and steps identified to meet them. (14) A more varied activity, leisure and educational plan should be developed for each person that has a relationship to their goals and aspirations. This is to ensure that people feel that they have active, varied and challenging lives. People should always receive appropriate communication when being assisted to eat. Measures to reduce the temperature in the medication store cupboard should be considered in advance of the summer months to ensure that the temperature of medication remains below 25 degrees centigrade. When the code other is used on the medication administration some comment should be made as to the reason this assists in auditing the medication. Actions taken as a result of a concern or complaint being made should be recorded and the outcome of these actions for the complainant. This is ensure that concerns aresatisfactorily resolved wherever possible. 2 12 3 4 17 20 5 20 6 22 Care Homes for Adults (18-65 years) Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 9 23 30 36 Audits of money need to be robust enough to detect small discrepancies. Consideration should be given to limiting access to the kitchen area so that people only access it appropriately. The home needs to be able to show that night staff have received up to date mandatory training. This is so there is an appropriate number of staff on duty that has the skills to manage peoples care in a crisis. The manager must be registered with commission this is to ensure clear responsibility paths, and to ease re registration pathways. The services admissions procedure must take into account the Mental Capacity Act considerations. Ladders should be secured at all times when not an in use to prevent accidents. It is recommended that people that can transfer from bed to wheelchair have access to their wheelchair at night. 10 37 11 12 13 40 42 42 Care Homes for Adults (18-65 years) Page 33 of 34 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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