Care Home: Bath House

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What the care home does well Staff did not change much, so it was easy to get to know them. They were kind and friendly. One relative said staff were fantastic.During the day, staff helped people to go out and do things.People were kept safe as new staff were recruited properly. What has improved since the last inspection? New easy to read words, symbols and pictures were now used around the home, helping people feel more included.One person`s bedroom had been decorated and looked lovely. What the care home could do better: People thinking of living at the home did not have the right information to help them decide.More information for people still needed to be helpful and easy to understand.Care plans needed checking more often to make sure they were still right.People should have help to be more independent with their money.People needed to a key worker to help them enjoy living at the home.More help to go out and do things on an evening was needed.To keep people safe, medicines should only be given out by staff who have been trained.More changes were needed to make Bath House feel homely.The new group meetings needed thinking about more because people were talking about private things and staff who needed to talk privately could not.New staff needed more training and support to help them do a good job.All staff needed to be trained in British Sign Language so they could communicate with people living in the home.The manager still needed to be registered with us.The manager still needed to find out what everybody thought about the home.The owners and manager need to work together so things kept getting better. Key inspection report Care homes for adults (18-65 years) Name: Address: Bath House 21 Cromwell Road Links Resource Centre Eccles Gtr Manchester M30 0QT 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: Sarah Tomlinson Date: 1 4 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 42 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 © (2010) 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 42 Information about the care home Name of care home: Address: Bath House 21 Cromwell Road Links Resource Centre Eccles Gtr Manchester M30 0QT 01617078856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Abbotsound Limited care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD The maximum number of people who can be accommodated is: 3. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home Bath House is a care home for up to 3 people with learning disabilities. The two people who live there have a hearing impairment. Each person has their own bedroom. Nobody has to share. It costs from £112.19 to £256.25 per week to live in the home. Care Homes for Adults (18-65 years) Page 5 of 42 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 Care Homes for Adults (18-65 years) Page 6 of 42 How we did our inspection: This is what the inspector did when they were at the care home The home did not know we were coming. The inspector was there for 2 days. An Expert by Experience also came on the 2nd day. This was a person who had used learning disability services so he could help the inspector understand what it was like to live in the home. We met and talked to people who lived in the home. Care Homes for Adults (18-65 years) Page 7 of 42 One relative told us what they thought about the home in our survey. We talked to the manager and some of the staff. We looked around the building. We looked at some of the paperwork. Care Homes for Adults (18-65 years) Page 8 of 42 What the care home does well Staff did not change much, so it was easy to get to know them. They were kind and friendly. One relative said staff were fantastic. During the day, staff helped people to go out and do things. People were kept safe as new staff were recruited properly. Care Homes for Adults (18-65 years) Page 9 of 42 What has got better from the last inspection New easy to read words, symbols and pictures were now used around the home, helping people feel more included. One persons bedroom had been decorated and looked lovely. Care Homes for Adults (18-65 years) Page 10 of 42 What the care home could do better People thinking of living at the home did not have the right information to help them decide. More information for people still needed to be helpful and easy to understand. Care Homes for Adults (18-65 years) Page 11 of 42 Care plans needed checking more often to make sure they were still right. People should have help to be more independent with their money. People needed to a key worker to help them enjoy living at the home. Care Homes for Adults (18-65 years) Page 12 of 42 More help to go out and do things on an evening was needed. To keep people safe, medicines should only be given out by staff who have been trained. More changes were needed to make Bath House feel homely. Care Homes for Adults (18-65 years) Page 13 of 42 The new group meetings needed thinking about more because people were talking about private things and staff who needed to talk privately could not. New staff needed more training and support to help them do a good job. All staff needed to be trained in British Sign Language so they could communicate with people living in the home. Care Homes for Adults (18-65 years) Page 14 of 42 The manager still needed to be registered with us. The manager still needed to find out what everybody thought about the home. The owners and manager need to work together so things kept getting better. Care Homes for Adults (18-65 years) Page 15 of 42 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Tomlinson CQC North West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 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 16 of 42 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 17 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Details about the home were incorrect and insufficient, so people thinking about moving in did not have enough, accurate information to help them make a decision. Evidence: Bath House provided long term, permanent care. Two people lived in the home, with one long term vacancy. As nobody had moved into the home for some time, at our last inspection we had asked the admission policy to be reviewed. This was to ensure all the necessary information would be obtained and enough thought would be given to meeting the specialist needs of a new person (e.g. any potential risks of restrictions discussed and agreed beforehand; a gradual move-in process provided; and the impact on the two people already living in the home fully considered). This had not been done. A summary of the homes admission policy should be in a formal document called a Statement of Purpose. This told us and any commissioning or referral body (i.e. Social Services) exactly what type of service the home provided. The homes existing Statement of Purpose needed to be extensively revised. A lot of information was factually incorrect Care Homes for Adults (18-65 years) Page 18 of 42 Evidence: as it related to another care home (The Hamlet), plus most of the information we actually required was missing. People thinking about moving in also needed clear and useful information to help them decide whether the home was right for them. The homes brochure (a Service Users Guide) also needed revising to be more meaningful. This included being in a more suitable format - one which people with learning disabilities would find helpful and easy to understand, e.g. with photographs, pictures and easy to read, large print text. Our latest inspection report (with its easy read summary) should also be available for people (including people already living there and staff). We were concerned there was not a copy available. Our registration certificate also needed displaying in a public place in the home (it was currently in the managers office in the main building). Care Homes for Adults (18-65 years) Page 19 of 42 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. New methods of working were being introduced, helping people living in the home be more involved in home life. However, their personal needs and goals were at risk of not being met as care information was not regularly reviewed and not all staff could communicate with them. Evidence: We looked at the care files of the two people living in the home. These provided staff with detailed information about their care and support needs. Risk issues were also recognised, with guidance about how to reduce or manage these. However, it was unclear how much of this information was up to date. Much of it had not been reviewed for some time (some risk assessments dated from 4/2009). We discussed the need for care information to be reviewed more regularly (a six month minimum frequency was needed to meet our standards). External, joint reviews were being held with Social Services, although these were usually on annual basis. Also, there was not always minutes of these meetings and the homes own record was too brief, with no clear action plan. Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: As identified at the last inspection, we again discussed having information in formats that were accessible and meaningful to the people they concerned (e.g. an easy read, pictorial care plan summary). We discussed how the specialist communication needs of the people living in the home were met, as both people were hearing impaired. We were concerned as whilst some staff had the skills (through British Sign Language training) to communicate effectively, some staff did not. The expert by experience said this was not very good. He said the staff member who could not sign (during our visit) had to keep using the staff member who could to communicate with the people living in the home. The expert by experience hoped the staff member would learn sign language soon. We discussed the key worker role and how it should support people living in the home to achieve their goals and ensure their support and communication needs were being met. However, both staff and the people living at the home were uncertain about the role. It was also not identified in care files. In care files it was not always clear what information had been produced by the home and what came from other services (e.g. the adjacent day centre). Staff needed to have clear guidance that was relevant for a residential setting. We discussed the need for all information produced by the home to be clearly identified as such (and also dated and signed). Staff would also find files easier to use if they were in better order, e.g. with old information either archived or held behind more recent updates. We discussed language in care files. The phrase no problems was regularly used. This was rather negative and also gave no indication of the persons wellbeing or care given. At our last inspection we discussed about people living in the home being more involved in its running. Some positive changes had since been made. The selection process for new staff now had a second, informal interview when people living and staying there could meet candidates and give informal feedback. Further good practice was noted, as new signs, symbols and pictures were being used around the home, e.g. on kitchen cupboards. Group discussions had also recently started. However, we were unclear about their purpose as they were held jointly with staff and the people living in the home, with a mixed agenda. The minutes showed people living in the home were sharing personal issues. We were unclear what boundaries had been agreed about this. Also, usual topics of interest were not being discussed, e.g. holidays, social activities, food, television. We looked at how people living in the home were supported to make decisions about their money. All their money (including savings) was held by the home (the majority in the homes bank account, with small amounts of cash on site). We discussed financial Care Homes for Adults (18-65 years) Page 21 of 42 Evidence: vulnerability should not prevent people retaining as much control as possible and living an ordinary life. For example, people could have their money in individual interest bearing accounts with local building societies or banks. When money was needed, they would then go out into the local community to withdraw it (even if it still needed to be held by staff on their return). Care Homes for Adults (18-65 years) Page 22 of 42 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 living in the home were supported to lead ordinary lives, taking part in a range of activities in the community. However, a lack of evening activities outside the home put this at risk. Evidence: With regard to how people living in the home spent their days, one person liked to keep very busy, e.g. playing computer games, visiting the adjacent day centre to play pool and going out in the local community. The other person preferred being at home, but enjoyed going swimming and was until recently going to the gym twice a week. Neither person was doing any college courses or voluntary work at the moment. We discussed staff shift patterns, regarding the 8pm finish time for day staff (with a lower number of night staff then coming on duty). This did not easily enable staff to support people living in the home to do evening activities in the community. Although staff did change their shifts on occasion to support people to go out, with a resident group of two younger adults, regular evening activities outside the home should be taking Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: place. The shift pattern meant this was impractical and unrealistic. One person living in the home went to bed very early, a possible consequence of staff shift patterns and activity levels. There were opportunities to develop practical life skills. Housework was shared between staff and both the people who lived in the home. Food shopping was also done together, although staff did most of the food preparation and cooking. At our last inspection, it had been unclear how nutritious and varied meals were. Daily records were now being kept and showed a reasonable menu. We discussed to reduce duplication, individual separate records were not needed (unless there was concerns about a persons diet, which would be detailed in a care plan). One central record, with details of alternatives being served (to confirm people had a choice of what to eat), was acceptable. We discussed ways of introducing new and unfamiliar dishes, e.g. having meals with a combined social and culinary theme such as a Mexican night. Having a healthier diet could also be promoted, e.g. trying fortified white bread; and having a light hearted record about how well everybody (staff included) did regarding reaching their 5 a day target of fruit and vegetables. The manager confirmed all staff had completed emergency aid training, which included the management of choking. People living and staying in the home were actively supported to keep in touch with family and friends. Care Homes for Adults (18-65 years) Page 24 of 42 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 health and personal care needs of people living at the home were generally well met. However, inappropriate medication practices put this at risk. Evidence: We spent time watching how staff spoke to and cared for people who lived at the home. Staff were polite, patient and caring, and relationships were warm and friendly. We received very positive feedback from one relative who said staff did a fantastic job. The expert by experience thought people seemed happy and were well supported by the staff who could use sign language. Both male and female staff worked at the home. Good practice was noted, as intimate personal care was provided by staff of the same gender. Information was available for staff about peoples preferred routines and likes and dislikes. As noted, in order to be most useful this needed to be kept up to date. The health of people living in the home was promoted. Healthcare needs were monitored; health checks offered; and a range of healthcare facilities accessed (e.g. GP, dentist, and psychologist). Accident records were being completed appropriately. We discussed the manager needed Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: to develop a system that would allow him to monitor accidents and incidents, e.g. for possible patterns regarding certain times/staff/situations, enabling preventative action to be taken. We looked at how medicines were managed. Neither person was currently administering their own medication. We discussed, in accordance with the Mental Capacity Act 2005, the decision making process behind this now needed to be clearly documented for each person and regularly reviewed. There was a clear audit trail of medicines entering the home, being administered and any unwanted items returned to the pharmacist. We discussed storage space. This was not suitable as all care homes were now legally required to have a Controlled Drugs cupboard. One will need fitting in the home to comply with this change in legislation. Medicine administration record sheets (MARs) were generally completed well. We discussed having a staff initial and signature list for audit purposes. We discussed how people were given their medication when they were out. Staff took medicines out of prepacked blister packs and put them in another container. This was secondary dispensing and carried a high risk of error. Also, we were concerned these medicines were then administered by staff who had not received medication training. This also meant the MARs were inaccurate, as the person who administered the medicine was not the person who was later signed the MARs. To avoid secondary dispensing, the persons pharmacist and GP might be able to change the frequency or timing of the medicine dose (avoiding the need for it to be given at this time). If this was not possible, staff should request the pharmacist to supply a separate container of medicines (e.g. just for lunchtime use). Care Homes for Adults (18-65 years) Page 26 of 42 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. Arrangements were in place to protect people living in the home from abuse or harm. Evidence: No complaints had been received by us or the manager since the last inspection. We discussed how people living in the home were encouraged and supported to make complaints, e.g. knowing about independent advocacy. The relative survey we received said the person did not know how to complain. The manager and staff needed to be proactive in encouraging relatives and third parties to raise any complaints or concerns. The manager was planning to start a family forum to facilitate relative involvement. As noted, the home did not have a current brochure to tell people about how to complain and the complaints procedure was still missing from the homes Statement of Purpose. No new safeguarding alerts had been made since our last inspection. The manager had correctly informed us of one serious incident. This had not been a safeguarding issue and the manager and staff had responded appropriately. Good practice was noted, as safeguarding training continued to be provided to staff. Criminal Record Bureau disclosure certificates for staff had also recently been renewed. We informed the manager of the new forthcoming additional legal requirement for staff to be registered with the Independent Safeguarding Authority before they can work. With regard to money held on behalf of people living in the home, this was being stored safely with appropriate records kept. Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: We discussed the introduction of the new Deprivation of Liberty Safeguards (DOLs), which include a new specific legal role for care home managers. Good practice was noted, as the manager and senior care staff had attended DOLs training. The manager confirmed no person living or staying in the home was currently being deprived of their liberty. Care Homes for Adults (18-65 years) Page 28 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient routine repair and refurbishment work meant communal areas were not to the same good, homely and comfortable standard as peoples bedrooms. Evidence: The home was within a larger building that used to be Victorian swimming pool. The whole building (including the home) was owned by Abbotsound Ltd. The company ran several other services for people with learning disabilities from the building. There was another care home (The Hamlet); a large day centre; and a supported tenancy project. Bath House had 2 floors. On the ground floor there was a small lounge and a kitchen/dining room. On the first floor there were 3 single bedrooms (none had en-suite toilets or wash hand basins), 1 unassisted bathroom and a toilet. There was no outside space, although people living at the home were able to use The Hamlets back yard. With regard to access, there was a back door into the main building and a front door to the outside. The two people living in Bath House visited the other home in the building (The Hamlet) on a daily basis. Staff said this was because there was not a lot of room in Bath House. The home was small and as noted had no outside space. As part of any admission process, the manager would need to consider the impact a third person living in the home would have. Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: Since our last inspection one persons bedroom had been redecorated. At this inspection we identified some repair and redecoration work - the light switch in the lounge was loose; the walls in kitchen/dining room were marked; the new kitchen tiles needed finishing off by the extractor hood; the paint on the bathroom and toilet tiles was peeling off; and an old wardrobe door had been left in the bathroom. We were concerned to find a broken window pane in the empty bedroom, with staff unable to lock the door (as the lock had been removed). The manager confirmed immediately after the inspection that a lock had been put back on the bedroom door and this room would be kept locked until the window was repaired. Whilst bedrooms were attractive and highly personalized, communal areas of the home looked tired and did not appear very homely. The lounge was cold and also looked bare, with no personal effects of the two people who lived there (e.g. photographs on walls and ornaments). The kitchen/dining area was rather uninviting with bare walls and a fluorescent rather than a domestic light fitting. (Staff notices had also been on display, although these were taken down by the end of our visit). There was no light shade in the toilet. We also discussed the bolts on the outside of the bathroom and toilet doors and the very large bolt on the inside of the toilet door. We discussed about having entrance/exit doors better identified (e.g. with a house number, name and letter boxes). As well as helping visitors (e.g. the expert by experience found it hard to find his way), these changes would also mean mail could be delivered directly to people living in the home (it was currently delivered as part of a general bundle to the main building reception). As a service for people with learning disabilities and a hearing impairment, we discussed how the home met these specialist needs. As noted, signs and symbols were now on kitchen cupboards. Special flashing lights also alerted the people living in the home to a fire. However, there was no system to alert them when somebody called at either the front or back doors, or staff calling at their own bedroom doors. The latter was particularly important as a means of protecting a persons privacy. We discussed contacting Social Services sensory impairment team and/or arranging for an occupational therapy assessment for further advice about available aids and adaptations. We found the home smelt fresh and was generally clean and tidy. However, more thorough cleaning was needed, as the light switch in the lounge was dirty, as was the toilet. With regard to promoting hand hygiene, we reminded the manager that liquid soap and paper towels should be available at communal wash hand basins. We discussed where cleaning products were kept, as although we were told they were meant to be locked away, on both days of our visit this did not happen. We discussed there was no need to restrict access if there was no risk to the people living in the home. For example, the lock could be removed form the under sink cupboard (with an entry in the homes Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: health and safety risk assessment to this effect). To support a more homely environment and ordinary living, we also discussed buying domestic cleaning products (e.g. washing up liquid), rather than using products ordered for the day centres industrial kitchen. Care Homes for Adults (18-65 years) Page 31 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who lived in the home benefited from a small, stable staff team who were safely recruited. However, this was put at risk as people were at times supported by staff who could not communicate with them. Evidence: Good practice was noted, as the staff team was stable, with little change. This meant people living or staying in the home got to know each other well. Staff were employed to work at both Bath House and The Hamlet, as a shared staff team. This team consisted of the manager, 4 team co-ordinators, 13 support workers and a small number of bank staff. At Bath House there was a minimum of 2 staff during the day and 1 waking night staff. The two people who lived in the home had 1 to 1 support during the day. During our inspection enough staff were on duty to meet the needs of people living in the home. A random sample of rotas from the last 12 months showed these levels were being maintained . At our last inspection, rotas were confusing as it was unclear which staff were working at Bath House (and which at The Hamlet). Rotas had now improved, enabling staffing levels to be confirmed. We discussed having a daily rota in a format suitable for people living in the home, so they would know who was coming into their home. Care Homes for Adults (18-65 years) Page 32 of 42 Evidence: We discussed introducing a short overlap between shifts (e.g. 15 minutes). This would support communication by enabling a formal handover to take place. This was particularly important when supporting people with complex and specialised needs. As noted, we were still concerned the 8pm finish time for day staff did not support evening activities out in the community. Communication within the staff team also used to be supported by team meetings. However, recent changes meant these were now taking place jointly with people living in the home. We were concerned this prevented staff from having the opportunity to confidentially discuss the needs and goals of people living in the home (e.g. whether care plans were working or not; if review goals were being achieved). We also discussed maximising attendance. For example, team meetings used to be held in the day with night staff often not attending. We discussed occasional meetings could be held in the evening. Bank staff who were working near full time hours could also be paid to attend. Individual staff support took place through regular formal supervision. This was now accompanied by annual appraisals. We looked at recruitment records for three people. These were in order, with interview records now kept and all necessary checks in place. Although we advised a photograph must be kept on each staff file. We discussed improving induction training for new staff to ensure they had the basic skills and competencies to work with a group of people who had complex and specialised needs. For example, the induction checklist was often completed in a very short period of time and the shadowing they did had no structure, with it left to chance regarding what was observed. A checklist could be developed of the necessary tasks and skills to be observed and then demonstrated back (at a later time) with each person living in the home, and on which the new starter would be assessed as competent. Earlier supervision would also be useful, as it was not taking place until the end of their probationary period (e.g. to give feedback on performance and provide an opportunity to discuss care practices). We also looked at training for existing staff. Generally good practice was noted, as staff completed a range of mandatory courses, e.g. moving and handling; fire safety; emergency first aid; and food hygiene. However, as noted, medication training could not be confirmed for all relevant staff. With regard to staff having the skills and knowledge specific to this client group, all staff completed challenging behaviour and restraint training. However, as noted, we were concerned not all staff who worked in the home could communicate with the two people who lived there. The manager was aware more staff needed to undertake British Sign Language training as soon as possible. We also discussed training about learning disabilities and advised the manager to check the content of courses currently attended was adequate. With regard to NVQ training, over Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: 50 of the staff team had achieved at least a level 2 award. Commitment to staff achieving above this was evident as 10 had now completed the level 3 award (and a further 3 staff currently undertaking it). Care Homes for Adults (18-65 years) Page 34 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management arrangements did not support the effective running of the home. Evidence: The home was managed by Mr. Brian Booth (who also managed the other care home in the building, Bath House). Mr. Booth was not yet registered with us as the Registered Manager. At our last inspection we had required Mr. Booth submit his application for registration. Mr. Booth had started this process but it had not been correctly completed. Consequently, Mr. Booth needed to start this again. Mr. Booth had worked in the learning disability care field for approximately 10 years. He had now achieved the NVQ level 4 management award and was aware he still needed to complete a NVQ level 4 award in care. As noted, Mr. Booth had not received a copy of our last inspection report and was therefore unaware of its content. We were concerned the owners had not shared the report with him. We were also concerned both they and Mr. Booth had not then devised an improvement plan about how they would meet the requirements and recommendations we had made in this report. At this inspection we discussed the need Care Homes for Adults (18-65 years) Page 35 of 42 Evidence: for the owners to be involved in the running of the home through monthly unannounced quality monitoring visits. At our last inspection, we had also been concerned no feedback was sought from either people living in the home or from relatives or stakeholders. As noted, group meetings had started with people who lived in the home. However, as also noted, the purpose of these were unclear. The manager was planning to seek feedback from relatives by starting a family forum. We advised feedback from community stakeholders still needed to be sought (e.g. surveys sent to involved social work and specialist health teams and GPs). With regard to safe working practices, the manager had confirmed before our inspection that safety and maintenance checks were up to date. During our visit we confirmed these were in order for fire extinguishers. Care Homes for Adults (18-65 years) Page 36 of 42 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 37 7 An application for registration of the manager of the service must be submitted without delay. This will ensure that the regulatory process will be followed which ensures as far as possible care homes are run and managed by people who are fit to do so. 27/03/2009 Care Homes for Adults (18-65 years) Page 37 of 42 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 4 The Statement of Purpose must be revised. 31/05/2010 To provide accurate and necessary information about the service. 2 1 5 The Service Users Guide must be revised. 31/05/2010 So people thinking about moving into the home have adequate and appropriate information. 3 6 15 Care plans and risk 31/05/2010 assessments must be reviewed more often (e.g. at least every 6 months). To ensure the changing needs, goals and aspirations of people living in the home are met. Care Homes for Adults (18-65 years) Page 38 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 4 20 13 Medicines must only be administered by staff who have received certificated medication training. 26/02/2010 To protect the health of people living in the home. 5 24 23 The repair and maintenance work identified in this report must be carried out. 31/08/2010 So people living in the home have an attractive and comfortable environment. 6 39 26 The Responsible Individual or 31/03/2010 an appropriate person must make unannounced monthly visits to the home, interviewing staff and the people who live or stay there and inspecting the premises and records of events and complaints. A written record must be kept of each visit, with a copy forwarded to us each month. To monitor the running of the home. Care Homes for Adults (18-65 years) Page 39 of 42 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 3 The admission policy should be reviewed to ensure care needs, risks issues and compatibility with people already living in the home are fully considered. (This was asked for at our last inspection). 2 6 Both people living in the home should be supported at all times by staff they can communicate with (who can use British Sign Language), so their needs and personal goals can be fully understood and supported. The key worker system should be reviewed so everyone is clear about this role (e.g. in actively providing 1 to 1 support; in keeping the care plan up to date; and in ensuring all staff know the persons current needs). To support people living in the home to make decisions and lead ordinary lives, the system of the home holding all their money, rather than it being in individual bank or building society accounts, should be reviewed. To meet the specialist communication needs of people living in the home, information for them should be in suitable and accessible formats. (This was asked for at our last inspection). 3 6 4 7 5 8 6 7 8 9 13 20 32 33 People living in the home should be supported to take part in regular evening activities outside the home. To reduce the risk of error, medicines should only be dispensed from their original containers. All staff should have the skills to communicate with people living in the home. To support staff communication and team working, staff should regularly meet as a team without people living in the home. To ensure new staff understand their role and have the initial skills and knowledge to support people with complex and specialist needs, induction training should be developed. To gain feedback about the home, the planned family Page 40 of 42 10 35 11 39 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 forum should start and ways of seeking the views of involved community stakeholders devised and implemented. Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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