Care Home: Beaconhurst

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What the care home does well Information is available so that people can find out who the service is for, and what it provides. People`s strengths and needs are properly assessed, to provide a sound basis for planning their care and support. People have detailed care plans, so that staff have clear guidance about how to support them in ways that suit them best. Their plans are reviewed regularly, to make sure that important information about their care is kept up to date. People using this service have high-level complex support needs. The staff work hard to include them in day-to-day things around the home and to support them to make choices and decisions, according to their individual abilities. They seek to give them opportunities to try new experiences and be active in the life of the community they live in. This is to encourage their learning and promote their independence. People receive a good standard of personal care and get the help they need to keep important medical appointments. This is to ensure they are supported to stay healthy and well. The layout of the home is designed specifically around the needs of the people who use this service. It provides them with their own personal space so that they can get the support they need in ways they like. People are supported by a generally well qualified and trained team of staff. They have a good understanding of individuals` particular care needs and provide them with one to one support. This ensures that they get the help they need to do the things they value. The home carries out important checks on staff employed, to make sure that they are fit for their jobs. The Manager uses her experience and skills well, to ensure that the service is run in the best interests of the people who use it. What has improved since the last inspection? Clear efforts have been made to meet the requirements and recommendations we made when we last inspected the home. A bank account has been opened for a named resident, so that his financial affairs can be managed more effectively. The service no longer asks people to make contributions for meals they take away from the home, or for fuel for the home`s vehicle. Checks are now made on the temperature of the medication store. There is written guidance about when "as required" medicines should be given. Medication is audited regularly by the local pharmacist. All of these things help to ensure that people`s medication is managed and stored more effectively. A major programme of refurbishment and redecoration has almost been completed at the home. This included a complete new central heating system for the house. This helps to ensure that people can enjoy living in a house that is comfortable, homely and meets their needs. As previously recommended, sealed laundry baskets have now been provided to actively promote better infection control and hygiene. Training is scheduled for staff about the Mental Capacity Act and Deprivation of Liberties Safeguards (DOLS), to make sure they have the knowledge they need to support people appropriately. What the care home could do better: It is recommended that the service reviews the use of person-centred planning approaches. This is to ensure that good use can be made of the knowledge and insights (gained over the past two years) about people`s preferences, and what works best for them individually. Health Action Plans should also be developed. This is to make sure that each person has an individual plan to proactively promote healthier living, so that they get all the support they need to stay healthy and well. Provide training for all staff in autism and working with people with learning disabilities. This will ensure that they have all the knowledge and skills needed to do their jobs well. The Manager should also complete her training, to build upon her experience and skills. Make arrangements for each member of staff to receive regular formal supervision, to ensure they get all the support they need to do their jobs well. Develop quality assurance and monitoring systems to show clearly how residents` views have been used to underpin the review and development of the service. Make the annual report of this available to all interested parties. Key inspection report Care homes for adults (18-65 years) Name: Address: Beaconhurst 1 Gorge Road Sedgley West Midlands DY3 1LF     The quality rating for this care home is:   two star good 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: Gerard Hammond     Date: 2 2 0 7 2 0 0 9 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 29 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 29 Information about the care home Name of care home: Address: Beaconhurst 1 Gorge Road Sedgley West Midlands DY3 1LF 01902882575 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Minster Pathways Limited care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 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: Learning disability (LD) 3 Date of last inspection Brief description of the care home Beaconhurst House is an independent sector Care Home that was registered in the 2005. The service provides accommodation care and support for three people with learning disabilites and autistic spectrum disorders. The home is a converted private residential property located near to Sedgley. It is within easy travelling distance of the local town, community facilities and a public transport network. Accommodation is provided over two levels. On the ground floor is a communal kitchen and bathroom. There are three spacious bedrooms on the ground and first floor each with a separate lounge area. One bedroom has an ensuite. There is a further second bathroom on the first floor. There is a large secure garden area to the front and rear of the property, and off road parking facilities are available for visitors. The service should be Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 3 Brief description of the care home contacted directly for current information about fees and charges. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the homes first key inspection in the current year 2009-10. We last inspected the service on 17 August 2007. We gathered information from a number of sources to help us make the judgements contained in this report. The Manager sent us a completed Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self assessment about how well the service is doing, and provides us with some numerical information about it. We visited the home and saw all three people who use the service. Unfortunately, their complex care and communication support needs meant that it was not possible to seek their views directly during our visit. We spoke with the Manager, staff on duty, and a visiting health professional. We looked at records including personal files, care plans, staff records, previous inspection reports, safety records and other documents. Thanks are due to the residents, Manager and staff for their help and co-operation throughout the inspection process. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? Clear efforts have been made to meet the requirements and recommendations we made when we last inspected the home. A bank account has been opened for a named resident, so that his financial affairs can be managed more effectively. The service no longer asks people to make contributions for meals they take away from the home, or for fuel for the homes vehicle. Checks are now made on the temperature of the medication store. There is written guidance about when as required medicines should be given. Medication is audited regularly by the local pharmacist. All of these things help to ensure that peoples medication is managed and stored more effectively. A major programme of refurbishment and redecoration has almost been completed at the home. This included a complete new central heating system for the house. This helps to ensure that people can enjoy living in a house that is comfortable, homely and Care Homes for Adults (18-65 years) Page 8 of 29 meets their needs. As previously recommended, sealed laundry baskets have now been provided to actively promote better infection control and hygiene. Training is scheduled for staff about the Mental Capacity Act and Deprivation of Liberties Safeguards (DOLS), to make sure they have the knowledge they need to support people appropriately. 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 29 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 29 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 get the information they need, to find out what the service provides. The support needs of people using the service are assessed, so their care can be properly planned. Evidence: There have been no new admissions to the home since the last inspection, and there are currently no vacancies. The last inspection report shows that the home has a Statement of Purpose and Service Users Guide in place, so we did not assess these on this occasion. We did see a copy of the Service Users Guide on the files we looked at. We checked peoples personal records to see if their strengths and support needs had been properly assessed. This is important, as it provides the basis for planning their care. We saw that peoples needs had been assessed before they came to live at the home, and that these assessments had been reviewed regularly since then. This is to make sure that important information is kept up to date. We saw that peoples files also contained a copy of their current contract, so that it is Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: clear what the service should provide. Care Homes for Adults (18-65 years) Page 12 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the support they need in ways that suit them best and ensure they can stay safe. Evidence: We looked at peoples personal files, to see how their care is planned and managed. All of the records we saw contained a detailed care plan. It was clear that plans have been kept under regular review, to make sure the information in them is kept up to date. We also noticed that good use is made of read and sign sheets. This helps to ensure that all staff are familiar with any recent changes to peoples plans. All of the people who use this service have high-level and complex support needs, including learning disability and autistic spectrum disorders. Plans give staff detailed guidance about peoples personal preferences, communication support needs and behaviour management strategies. These include risk assessments, to ensure that people get the support they need to stay safe. We saw that each individual who uses this service had a person-centred plan Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: workbook, but noted that this was completed some time ago. Person centred planning is a way of working with people to meet their needs and help them achieve their goals and aspirations. Working in this way with people who have such complex support needs presents very particular challenges. As a matter of good practice, it is recommended that individuals person-centred plans are revisited, making use of the extra knowledge, insights and experience that the staff team has gained over the last two years. Doing this would build on the good work already done to provide support for the people who use this service, in the ways that suit them best. We saw and heard members of the staff team offering people choices about what they wanted to do, what they wanted to eat and drink, and opportunities to go out, during our visit to the home. We also saw that peoples care plans shows how they are supported to take part in day to day things around the home, according to their individual capabilities and levels of understanding. Care Homes for Adults (18-65 years) Page 14 of 29 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 get the support they need so they can do things they value, go to places they like, and keep in touch with people who are important to them. Evidence: Peoples level of learning disability, communication and high-level support needs meant that it was not possible to seek their views directly. It has to be acknowledged that providing the three individuals who use this service with appropriate activity opportunities, presents the care team with significant challenges. Peoples autism, combined with differing levels of learning disability, may mean that they do not cope well with many things that others take for granted. This might include busy or unfamiliar places, lack of routine or structure, and people they do not know well. Communication difficulties, limited attention span and restricted ability to translate learning from one environment to another can further complicate matters. This means that it may be extremely difficult to plan and deliver structured activity programmes, Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: because these simply do not meet individuals needs and wishes at any given time. The home is staffed to give people one to one support at all times. The care team also includes designated workers to support people with their activities and access the community on a daily basis. On the day we visited, we saw people relaxing at home, as they have just returned from an extended holiday in Wales. We saw that people got up when they wanted, enjoyed taking a leisurely bath and being supported to go out to do some shopping. Peoples records also showed that they are encouraged to do ordinary things around the house, so as to promote their learning and independence skills. These included helping staff tidy and clean their rooms,load the washing machine and peg out the laundry, making snacks in the kitchen and being supported to make drinks and do some cooking. Records also showed that people went shopping, out for meals, walks and day trips to local places of interest. New experiences that people tried are recorded in their Learning Log. At home, people enjoy watching TV, looking at books and being supported to write letters to their families. People get the support they need to maintain contact with the people who are important to them. The Manager has worked very hard supporting one person in particular to re-establish visits to his family home. Previously, this provoked bouts of very difficult behaviour. Working with him at his pace and on his terms has significantly improved this. The house is divided into three self-contained flats, and people take their meals separately in their own areas. This is in recognition of their specific support needs and personal preferences. We saw that people are supported to make food choices by using pictorial aides, and staff said that are also involved in shopping when they want to be. There are no set meal times and people choose when they want to eat. We saw and heard staff asking people what they wanted. Records of meals provide evidence that people have plenty of variety and choice, according to individual preferences. We looked at food stocks: these were adequate and included fresh fruit and vegetables. Care Homes for Adults (18-65 years) Page 16 of 29 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. People can be confident that their personal care needs are well met, and they get the support they need to stay healthy and well. Evidence: We were able to meet with all three people who use this service, during the course of our visit. We saw that they were dressed in clean clothing of good quality, that was age and gender appropriate. It was also clear that they had been properly supported with their personal care. We looked at their records to see how their health care is managed. Each persons file contains a grab sheet: this includes important basic information to use in the event of an emergency or hospital admission. Their records also show that other health professionals are directly involved in the planning and management of their care. There are records of regular reviews by their GP and Consultant Psychiatrist. Appointment records show that people have been supported to see dentists, opticians, podiatrists, specialist epilepsy nurse as required. There are records for monitoring seizures, and of regular appointments for blood screening. Referrals have been made to Psychology services (Intensive Support Team)to assist in development of behaviour Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: management strategies. Peoples weights are monitored regularly, and they have attended well person clinics at their GP surgery. We looked at how peoples medication is managed and stored. Their personal records include information about current medication, including possible side effects and contra-indications. There are written protocols in place for PRN (as required) medication and homely remedies, signed by prescribing doctors. These give staff important guidance about the circumstances in which this medicine should be given, maximum doses in any given period, and so on. Records show that doctors review medication regularly, and take positive action to reduce this, where appropriate. Checks are carried out on the temperature of the medication store, as previously recommended at the last inspection. We looked at the Medication Administration Record (MAR) and saw that this had been completed appropriately, with no gaps. Staff showed us the routine followed each time medication is given. This is done by two people: daily audits of medication stocks are carried out, to help minimise the risks of any errors. We saw that the medication store was clean, tidy and secure. We talked about health action planning with the Manager. We recommended that the good work already being done in the home be built upon, in keeping with the aspirations of the Government White Paper Valuing People. This is to ensure that peoples health care is planned proactively rather than reactively (i.e. positive health promotion rather than reacting when problems arise). Setting clear goals (for example around healthier nutrition and exercise) and evaluating these regularly, could help to provide some structure for achieving this. It is suggested that this could be done as part of regular monitoring already carried out by key workers. This recommendation is made merely as a matter of developing existing good practice. Care Homes for Adults (18-65 years) Page 18 of 29 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. Peoples concerns are listened to, taken seriously and acted upon. They get the support they need to stay safe. Evidence: The home has a complaints policy and procedure in place. We looked at the homes complaints file and saw that matters raised had been acknowledged and dealt with appropriately. We have not received any complaints in respect of this service. It has to be acknowledged that formal complaints policies and procedures have little relevance to the individuals who live at Beaconhurst. Their levels of learning disability and complex support needs mean that they rely on the vigilance of the staff looking after them to recognise if anything is amiss. Staff showed that they are knowledgeable about and sensitive to peoples behaviours, body language and specific ways in which they communicate pain, discomfort or unhappiness. We also talked to staff about safeguarding (adult protection). All of the staff have done training in this area. They were able to show an understanding of the nature and forms that abuse can take. They were also able to describe the kinds of things they know they must watch out for. They showed that they know what action they must take in the event of witnessing or suspecting that abuse has taken place. This included reporting to senior management, and ensuring that people are supported to be safe. We looked at staff records to make sure that systems for recruiting people to work at Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: the home ensure the safety of the people living there. We saw that staff files contained evidence that checks had been made with the Criminal Records Bureau (CRB) before people began working at the home. This shows that the service takes positive action to make sure that people employed are fit for their jobs. Recommendations and requirements in this area made at the last inspection have now been met. A bank account has been opened for one of the residents, and the Manager said that she has contacted the Local Authority to request they act as his Appointee. People using the service are no longer charged a contribution to fuel or meal costs. As mentioned above, all staff have now completed safeguarding training. Care Homes for Adults (18-65 years) Page 20 of 29 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 enjoy living in a home that is comfortable and clean: it is furnished and equipped to meet their individual assessed needs. Evidence: We looked around the home with the Manager. A lot of work as been done to redecorate, refurbish and upgrade the home. A new central heating system has been installed. The work to do this was carried out while the residents were away on holiday. This was specifically planned, as the people who use this service are sensitive to excessive noise, disruption to their familiar routines, and having unfamiliar people in the house. Unfortunately, the installation took longer than anticipated, and this had a knock on effect on the completion of other refurbishment and redecoration. The holiday was extended to take account of this. On the day we visited, most of the work had been finished, but there were still some items outstanding (e.g painting new boxwork around pipes) though these were largely cosmetic. We were able to see two peoples bedrooms. We saw that furnishing appeared minimal, but this in keeping with individuals assessed needs. For example, people are intolerant of any window dressing (i.e. curtains, blinds etc.) and will destroy these. Windows are fitted with one-way glass in order to preserve peoples privacy and dignity. Colour schemes and lighting are muted, in order to provide a low arousal Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: environment, again in order to meet peoples assessed needs. Staff do their best to personalise individuals rooms within these confines. We saw that people had pictures and family photographs fixed to the walls. Room decoration also incudes astroceilings with light sensitive patterns for visual interest. Each person has his own lounge / living room area. This means that people can be supported on a one to one basis, without impinging on the needs of the other people in the house. We saw that people had their own possessions such as televisions and music players. One person had a collection of model cars and also books,which he looks at during his leisure time. Another has his own computer. The high level and complex nature of peoples support needs places a high level of wear and tear on fixtures and furnishings around the home, and this should be acknowledged. The service has made clear efforts to upgrade the environment in order to make it as comfortable and homely as possible for the residents. The homes washing machine is still located outside in a wooden outbuilding. Consideration was given to resiting this inside the house, but a suitable location could not be identified without making the machine inaccessible to the residents. A previous recommendation to provide sealed laundry baskets has now been met, to promote better hygiene. We saw that the home was clean and tidy, with a good standard of hygiene maintained throughout. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the service works well to ensure that people employed to work at the home are properly recruited, trained and qualified. This is to ensure that they are fit for their jobs, and have the knowledge and skills they need to do their jobs well. Evidence: We looked at staff records to see how people are recruited, trained and supervised. All of the files we looked at contained completed applications with full work histories. They also had two written references, declarations of physical fitness, and evidence of checks with the Criminal Records Bureau (CRB). These things show that the service acts positively to make sure that people employed are fit for their jobs. During our visit we saw that the home is staffed to provide one to one support for each person using the service. Additional staff are also employed to support people doing activities out in the community. There are two waking staff on duty at night. This is in keeping with individuals assessed needs and agreed care plans. The staff team present very positively and spoke about the people in their care with warmth and affection. The Manager and staff said that they work well together as a team, and that there is low turnover of staff working at the home. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Information provided by the Manager in the Annual Quality Assurance Assessment (AQAA) and staff training plan shows that nearly seventy per cent of the team are qualified at NVQ level 2 or above. The plan shows that staff are training towards higher level qualifications, and that this is ongoing. We noticed that only three of the current team have completed training in autism. It is recommended that all of the staff team receive this training, taking account of the identified needs of the people using the service. The plan also shows that four staff have not yet done specific training for working with people with learning disabilities, and it is also recommended that these workers complete this training. We looked at staff records of formal supervision. Records available when we visited did not provide evidence that staff supervision is currently up to the recommended standard. This is six meetings in any twelve-month period (pro-rata for part-time staff), with written records kept of each meeting. Similarly, records of staff group meetings were not up to the standard. We talked to the Manager about this. It should be acknowledged that the team has had to cope with significant disruption during the recent refurbishment, and in rallying round to support the residents extended holiday. Staff also told us that they felt well supported and made use of the Managers open door policy, to deal with issues on a day-to-day basis as they arise. We directly witnessed this in practice during our visit to the home. The Manager told us that she has drawn up a new schedule to ensure that supervision meetings are properly planned and take place in future. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run for the benefit of people who use the service. Evidence: Previous reports show that the home is run by an experienced and competent Manager. We saw that she presents very positively and works hard to develop the service for the benefit of the people who use it. Staff told us that she is very approachable and inclusive, and that they are very comfortable in raising any matters of concern with her. We witnessed staff and residents interacting with her throughout our visit to the the home, and saw that all were clearly at ease with her. We also spoke with a visiting health professional who said she gives the home a very strong lead, and communicates very well with the residents. She said that her care management skills had contributed significantly to recent reduction in episodes of difficult behaviour in the person whose care she had come to the home to review. We saw that reports required under regulation 26 (Care Homes regulations 2001) had been completed each month. The Manager told us that she feels well supported by senior managers within the organisation. The views of people who use the service are Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: sought regularly through weekly individual meetings with staff. Systems for quality assurance and monitoring should be developed so that the way in which their views underpin the review and development of the service, can be clearly demonstrated. This should be included in the annual quality assurance report, and made available to all interested parties. It is recommended that information provided in the Annual Quality Assurance Assessment (AQAA)be more detailed, and linked specifically to the relevant standards in future. We looked at some records to see how matters related to health and safety are managed within the home. We saw that an audit of these is completed each week. There is a current workplace risk assessment in place. Regular checks are carried out on the fire alarm and emergency lighting systems, and fire evacuations drills have been completed. We saw the records of temperature checks carried out on water outlets, the fridge and freezer and cooked food. We saw that staff had labelled packages of food stored in the fridge with the date of opening. We saw the record of regular checks carried out on the homes vehicle. These things show that service takes positive action to make sure that people living and working in the home are supported to stay safe. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Develop the use of person-centred approaches, to ensure that people get all the support they need to achieve their goals. Develop peoples health action plans so that it is clear what steps are taken to support them in actively promoting good health Provide staff with all the training required to ensure that they have the necessary knowledge and skills to meet the assessed needs of the people in their care. Provide staff with regular formal supervision, to ensure that they have all the support they need to do their jobs well. The Manager should complete her training to develop her knowledge and skills further. Quality assurance systems should be developed to reflect how the views of the people using the service have underpinned its review and development. This should be included in the homes annual report and made available to all interested parties. 2 19 3 35 4 5 6 36 37 39 Care Homes for Adults (18-65 years) Page 28 of 29 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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