Care Home: Beechlawns

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What the care home does well Information is available to help people decide if this service provides what they are looking for. People have the opportunity to come and visit the home before making a decision about whether or not to use the service. People get the support they need to stay in touch with their families and friends, where this is possible. They enjoy some opportunities to do things they value and go to places they like. Their daily routines are flexible, not rigid. Staff look after their basic care needs well. They treat them with warmth and friendliness and respect their rights to privacy and dignity. They support them to keep important medical appointments and make sure they get their medicines in the right amounts and at the right times. People benefit from living in a house that is comfortable, safe and homely. The staff team works hard to keep it clean, maintain good standards of hygiene and support people to enjoy their home. The service has retained a stable core group of well trained and qualified workers, so that continuity of people`s care is promoted. Important checks are carried out before new staff start work, to make sure they are fit for their jobs. What has improved since the last inspection? Clear efforts have been made to meet recommendations made at the time of the last inspection. It should be acknowledged that the Acting Manager has been in post for a relatively short time to have been able to deal fully with all of these. The home`s Statement of Purpose and Service Users` Guide have been updated, so that people have current information about the service. A lot of work has been done to develop people`s care plans, to provide guidance about giving support to each person. Work has begun on developing "communication passports" to support people in making their wishes known and expressing their choices. Advice and assistance has been sought from other professionals to develop more appropriate activities for people and to promote healthier lifestyles. These are works in progress. Other recommendations made at the last inspection that have been met include: People now have opportunities to be involved in shopping for food if they wish. Creams and lotions are now labelled and stored appropriately. People`s weights are now being monitored regularly, with records kept. Night time care plans have been reviewed.Staff have received an annual appraisal of their performance and development needs. These things show that the home has taken some positive action to improve the service provided, for the benefit of the people that use it. What the care home could do better: Explore other formats to make information about the service more accessible to people who have difficulty reading. Review people`s contracts so that all parties are clear about their responsibilities. Develop people`s care plans to include clear goals with measurable outcomes. Evaluate these regularly so that judgements can be made about what is working and what needs changing. Develop the use of person-centred approaches so that care plans reflect what people want rather than what the service currently provides. Make sure that there are clear links between people`s activity opportunities and their assessed needs and agreed goals. Develop opportunities for people to do individual activities. This is to ensure that people get the support they need to achieve the things that are important to them. Give staff training and support to make sure they can use the care planning tools effectively. Develop Health Action Plans in order to proactively promote individuals` good health and wellbeing, and manage their healthcare more systematically. Review and develop the ways in which concerns and complaints are managed and recorded. This is so that the service can show clearly how people`s concerns have been listened to and dealt with. Improve the frequency of formal supervision and staff group meetings. Ensure that staff receive training in safe manual handling. This is to ensure that they have the knowledge and skills and get the support they need to do their jobs well. Complete quality assurance and monitoring activity and report on the findings, sharing this with all interested parties. This is to show how the views of people using the service have underpinned its review and development. Ensure that the Manager has sufficient time allocated so as to meet her management responsibilities within the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Beechlawns 20 Wood Street Wollaston Stourbridge West Midlands DY8 4NW     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: Gerard Hammond     Date: 0 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 33 Information about the care home Name of care home: Address: Beechlawns 20 Wood Street Wollaston Stourbridge West Midlands DY8 4NW 01384835050 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Select Health Care (2006) Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) Date of last inspection Brief description of the care home Beechlawns is a large detached property located in the Wollaston area of Stourbridge. It is situated in a quiet residential area and is within walking distance of the local village, which has numerous shops, public houses and other local amenities. The town centre of Stourbridge can be accessed by public transport. There is a small car parking area at the front of the property. The gardens are situated to the rear and side of the property. There is a ramp leading to the front door and into the garden. The Home was initially registered in 1993 to provide care for seven adults with learning disabilities. Resident accommodation is on the first and ground floor. The Home has a stair lift. All users accommodated on the first floor are fully mobile. There are seven single bedrooms. Residents bedrooms are all decorated individually and reflect residents Care Homes for Adults (18-65 years) Page 4 of 33 2 7 0 1 2 0 0 9 7 Over 65 0 Brief description of the care home differing tastes and personality. Residents can bring some of their own furniture if they wish. The Home has two bathrooms one with separate walk in shower. There are toilets located on the ground and first floors. There are two lounge areas and a dining room. Beechlawns provides care for residents with a range of learning disabilities and with complex communication, mental and health care needs. A statement of purpose and service user guide are available to inform residents of their entitlements. To obtain up to date fee information the home will need to be contacted. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the homes first key inspection of the current year 2009-10 and was unannounced. We gathered information from a number of places to inform the judgements made in this report. The Acting Manager sent us a completed Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self assessment of how well the service is doing, and provides some numerical information about it. We visited the home and met all of the people currently using the service. Their communication support needs and levels of learning disability meant that it was not possible to seek their views directly. We were able to directly observe interactions between people using the service and the staff looking after them. We spoke with the Acting Manager and staff on duty and looked around the home. We looked at records including personal files, care plans, staff records, previous inspection reports, health and safety records and other documents. Care Homes for Adults (18-65 years) Page 6 of 33 Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? Clear efforts have been made to meet recommendations made at the time of the last inspection. It should be acknowledged that the Acting Manager has been in post for a relatively short time to have been able to deal fully with all of these. The homes Statement of Purpose and Service Users Guide have been updated, so that people have current information about the service. A lot of work has been done to develop peoples care plans, to provide guidance about giving support to each person. Work has begun on developing communication passports to support people in making their wishes known and expressing their choices. Advice and assistance has been sought from other professionals to develop more appropriate activities for people and to promote healthier lifestyles. These are works in progress. Other recommendations made at the last inspection that have been met include: People now have opportunities to be involved in shopping for food if they wish. Creams and lotions are now labelled and stored appropriately. Peoples weights are now being monitored regularly, with records kept. Night time care plans have been reviewed. Care Homes for Adults (18-65 years) Page 8 of 33 Staff have received an annual appraisal of their performance and development needs. These things show that the home has taken some positive action to improve the service provided, for the benefit of the people that use it. 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 Care Homes for Adults (18-65 years) Page 9 of 33 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people decide if the service provides what they need. Peoples strengths and needs are assessed, so that their care and support can be planned properly. People have written contracts but these need to be improved so that everyone is clear about their responsibilities. Evidence: We saw that the home has updated its Statement of Purpose and Service Users Guide since the last inspection. These documents tell people about what the service provides, and who it is for. We also saw that a picture / symbol version has been produced. This is in Widgit format, so would only be of value to people familiar with this programme. It is recommended that the service explores other accessible formats, to make the information about the service more available to people who may have difficulty reading written documents. There has been one new admission since the last inspection. We looked at this persons personal records and saw that there was a schedule of visits and a transition Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: plan. This shows that positive efforts were made to introduce her to the home gradually and give her opportunities to see what it was like before she moved in. We also saw that an assessment of her needs had been completed before she came to live at the home. We looked at the personal file of another person that has lived at the home for several years. We saw that his assessment had been reviewed by a social worker during the last twelve months. It is important that peoples needs are assessed and kept under regular review, so that their care and support can be planned properly. The files we looked at both contained contracts. However, we noted that the contract for the most recent admission did not identify the room allocated, and was not signed by a representative from the home. The other persons contract was signed by a relative, but dated 2007. Peoples contracts should be reviewed to make sure they contain all the required information and are signed and dated appropriately. This is so that all parties can be clear about what the service has agreed to provide, and all of the terms and conditions that apply. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and management need improvement to ensure that people get supported in the ways that suit them best. Evidence: We looked at peoples personal records to see how their support is planned and managed. It should be acknowledged that the people using this service have high level and complex support needs. Files we looked at contained written care plans and risk assessments. We saw that each person has a named key worker, and that there are systems in place designed to ensure that plans and risk assessments are kept under regular review. However, significant work is required to ensure that systems are used efficiently, so that peoples care and support can be planned and managed more effectively. One of the peoples files we looked at included care plan and risk assessment information from her previous placement. It was difficult to differentiate between previous and current care plans. These should be signed and dated appropriately at all Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: times. It is also recommended that care plans and risk assessments be indexed and cross-referenced. This is to ensure that important information can be found quickly and easily. The level and complexity of peoples support needs means that there is a high volume of information to be managed. We noticed that files contained significant amounts of paperwork that may no longer be current. It is recommmended that records are reviewed so that information that has been superseded (or is no longer current or required for day to day care management)be removed. These should then be disposed of or archived as appropriate. Information about peoples care should be readily acessible, so that their care plans are working documents providing staff with clear guidance about how to provide support. The practice of filing several pages of guidance in plastic wallets should be discouraged, to ensure that information is easily accessible at all times. Each person living in the home has a designated key worker. Staff are responsible for completing a monthly report, designed to ensure that care plans are kept under constant review. In principle, this should be recognised as good practice. However, the ways in which these reports are being completed suggest that staff are not fully aware of how to make the best use of the tools available. It is recommended that the monthly meeting be used to set some clear goals with each person for the period ahead. Goals should have outcomes that can be clearly measured, and be linked to peoples wishes and their assessed needs. Being clear about this should help to guide planning for peoples activities, and their health and personal care support. Goals set can then be evaluated the following month, so that judgements can be made about what is working, and what might need to be changed. Doing this properly will help to keep care plans under review, so that they remain live working documents. Staff need to be adequately trained and supported to carry out these tasks effectively. We saw some evidence of the use of person-centred approaches on the records that we looked at. However, as reported above, it seemed that much of this related to work done at a previous placement. It is recommended that all staff receive training in the use of person-centred approaches. This will help to ensure that the planning and management of individuals care and support is guided more effectively to focus on each persons wishes and aspirations. This is in keeping with a central principle of the Government White paper Valuing People. We also saw that some work has begun on developing communication passports. This should be encouraged and developed further. This is so that people have workable aides to support better communication. The importance of improving peoples opportunities to communicate more effectively cannot be overstated, as this underpins all aspects of their lives. We directly observed staff asking people what they wanted for their breakfasts. They Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: supported them to make choices by showing them different things to select from. Staff encouraged people to do as much for themselves as they could. We saw staff encouraging one person to set the table. It has to be acknowledged that peoples ability to participate directly in the day to day running of the home, and to make decisions and choices is limited by their high level and complex support needs. Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activity opportunities for people who use this service are limited: improvements are needed to the ways in which these are planned and managed. This is to ensure that people get the support they need to achieve their agreed goals. Evidence: Peoples communication support needs meant that it was not possible to ask them directly about their opportunities to do things they value. Daily records are in place for each person, but the information in these is limited, so that it is difficult to make a fully informed judgement about the range of activities that people enjoy. We saw that there were picture activity boards in the dining room for each person. However, these did not appear to be in use at the time we visited the home. Records about what people actually did were limited to things like ILS (independent living skills), music, TV, ride on the bus,and walking around the home relaxing. The homes Annual Quality Assurance Assessment (AQAA) shows that people attend day centres, Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: go shopping, go to church, and access local community facilities such as the cinema, bowling, drama classes and discos. The home has its own vehicle to support people going out. Unfortunately, activities outside the home were very limited on the day we visited, due to severe weather conditions. Activity planning is in need of significant review and development. The opportunities that people enjoy are a prime indicator of their quality of life. There should be clear links between each persons activity opportunities and his or her assessed needs and agreed goals. These should be reviewed and evaluated on a frequent and regular basis, to ensure that people are able to do the things they value. Activities should be demonstrably purposeful, so that it can be seen how they support people to meet their goals. This might include doing things to learn or maintain skills, for therapeutic reasons, or just because people enjoy them -for fun. Staff need to be clear about what they are doing and why, in order to achieve this properly. It has to be acknowledged that the support needs of this particular group of people pose significant problems for planning and facilitating activities. The level of learning disability, capacity for understanding and learning, attention span, previous experiences of institutional care and communication support needs are all factors to be considered. The Acting Manager showed us that she has requested support from the local Occupational Therapy service, to help the staff team plan and provide a more suitable range of activities for the people using this service. This initiative is to be commended. This should include developing opportunities for people to do things on an individual basis. People are supported to keep in touch with family members and friends, where this is possible. We were able to meet with one persons relative, who visited while we at the home. She said that she is a regular visitor, and that the manager and staff made her welcome whenever she came to the house. We saw that routines in the home are flexible, so that people can get up and go to bed when they like. Activity records show independent living skills, but this needs to be addressed more systematically than it is at present. Staff should be clear about what they are trying to achieve by involving people in tasks around the house, and this should be reflected in the goals set in their support and activity plans. Records of meals showed that people enjoy a varied and balanced diet. We saw people eating their breakfast and lunch together in the dining room. Staff supported them as required to ensure that they could enjoy their meals. We saw that food stocks were adequate and included fresh fruit and vegetables. The Acting Manager told us that Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: people are now directly involved in shopping for food if they so wish, as recommended at the last inspection. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are generally well met. Developing Health Action Plans would improve this, so that good health is actively promoted. Evidence: We saw that people were dressed in clean clothing of good quality that was age and gender appropriate. it was clear that people had been given the support they needed with their personal hygiene. We saw and heard that interactions between staff and residents were warm and friendly: people are treated with kindness and respect. Staff spoke very positively about the people in their care, and it was clear that both are comfortable in each others company. Records showed that people have been supported to keep appointments with their doctor and other health and care professionals as appropriate. Advice has been sought from the district nurse with regard to regular checks on people during the night, and care plans and risk assessments updated accordingly. We saw that peoples weights are now being monitored regularly and a record kept of this each month. A previous recommendation to gain assistance with completing health action plans has not yet been met. The Acting Manager said that this was not for want of trying. A successful Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: referral to the local health facilitation team was made during our visit. Health action plans should now be put into place to ensure that peoples health care is managed and planned more systematically. The emphasis should be on proactively promoting good health, as opposed to responding reactively when problems arise. We looked at the systems in place for administering peoples medication. Recommendations made at the time of the last inspection have now been met. We saw that creams and lotions were securely stored, and labelled with the date of opening. Staff responsible for administering medication have completed training. We saw that the Medication Adminstration Record (MAR) had been completed appropriately and medicines given as prescribed. We saw that the record included sample signatures, and that written protocols were in place for PRN (as required) medication, in keeping with established good practice. The medication store was clean and tidy, and secure. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recording of peoples concerns and complaints needs to improve, so that the home shows how these are listened to and acted upon. People are generally well protected from abuse, neglect and self harm. Evidence: We saw that the home has a complaints policy and procedure, and that the company has also produced this in picture / symbol format. The communication support needs and levels of learning disability of the people using this service mean that formal procedures and written documents have little relevance to them individually. We were told that no one in the home has an understanding of the picture / symbol format used for the accessible version of the complaints procedure. People are reliant on the understanding and vigilance of the staff team to notice changes in behaviour, demeanour or body language as indicators that they are unhappy or concerned. The homes Annual Quality Assurance Assessment (AQAA)shows we havent received any complaints requiring investigation over the last 12 months, any smaller issues have been dealt with efficiently by staff to prevent escalation. It is recommended that concerns noted by staff are recorded in such a way that information can be shared with the rest of the care team. This is so that the service develops a more open and transparent complaints culture. Acknowledging peoples concerns and sharing these appropriately can provide valuable information for learning, and developing the quality of the service. It may be that the monthly key worker report is the most appropriate Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: place to record concerns and action taken in the first instance. The complaints log need not be confined to matters requiring formal investigation. Information gained from recording concerns and complaints in this way should be analysed and evaluated as part of the services quality assurance monitoring. Acknowledging concerns and complaints should be viewed positively, and provide key opportunities for demonstrating the ways in which the service listens to and responds to peoples concerns. We have not received any complaints about this service since we last inspected the home. We talked to staff on duty about safeguarding (adult protection). They were able to show that they understand the nature of abuse and the different forms it can take. The showed that they understand their responsibilities and the action they must take in the event of witnessing or suspecting abuse. Staff records show that most of the current team have completed training in this area, as well as training relating to the Mental Capacity Act and Deprivation of Liberties Safeguards. We also saw that important checks are carried out on staff before they start work a the home, to make sure that they are fit for their jobs. We have not received any safeguarding referrals in respect of this service since we last inspected it. At that time we recommended that the procedures for people to access their money be reviewed. The Acting Manager told us that this has been done, and that a key to the safe is now available at all times. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the benefit of living in a comfortable, safe and homely environment. Evidence: We looked around the house in the company of the Acting Manager. The home is large detached house in an established residential area. Accommodation is spread over two floors, and there is a cellar which houses the laundry. Access to the first floor is via the main stairway: a stair lift is also available, though the Acting Manager said that no one uses this at the moment. On the ground floor there are two lounges, a separate dining / living room and a small room at the back of the house which used to be the designated smoking area. The Acting Manager advised that the possibility of converting this into a sensory room is being investigated. The large kitchen is accessed down a step off the dining room. There are two bedrooms on the ground floor and a bathroom with level entry shower. The remaining bedrooms are all on the first floor. There is also a bathroom and toilet on this floor, and another separate toilet. None of the bedrooms has en suite facilities, but there are ample washing and toilet facilities for the number of people using this service. We saw that peoples bedrooms were individual in style, with personal effects in evidence. These included pictures, ornaments, family photographs, music players Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: and televisions. A rolling programme of decoration and refurbishment is in place: some of the bedrooms are now due for redecoration, and the landing carpet is in need of replacement. The hallway and lounge areas have been redecorated since the last inspection. Staff work hard to keep the house clean and tidy, so that it is a comfortable, safe and welcoming environment. Good standards of hygiene are maintained throughout. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff employed at the home to meet peoples basic care needs, but this should be reviewed so that peoples opportunities for individual activities and support can be increased. Important checks are carried out to ensure that staff employed at the home are fit for their jobs. Arrangements for training and supervision of staff need some improvement. This is to ensure that they get all the support they need to do their jobs well. Evidence: We looked at records to see how selection and recruitment of staff is managed. Files we saw contained completed applications with employment histories, two written references, and evidence of checks with the Criminal Records Bureau (CRB). This shows that the service takes positive action to ensure that people employed at the home are fit for their jobs. On the day we visited there were two members of staff on duty, plus the Acting Manager. Night cover is provided by a waking member of staff, with support from an on call worker if required. Staffing arrangements are adequate to meet peoples Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: basic care needs, but this should be reviewed so as to provide additional scope for people to be given support for individual activities. We saw the homes training matrix: this showed that staff have received most statutory training, with the exception of moving and handling. Arrangements should be made for this training to be delivered as soon as possible. Though people using the service do not currently require routine moving and handling, it is still very important that staff receive this training. This is to protect their health and wellbeing, and ensure that they have the knowledge and skills they need should these be required (e.g. if a resident became unwell or had an accident that impaired their mobility etc.). The Acting Manager advised that the company is introducing an e-learning programme to provide staff with training in the near future. It is important that the training policy be updated to reflect these changes. Staff should be given the time and support they need to follow any new programme effectively. Arrangements need to be put in place to ensure that competencies are assessed appropriately following completion of learning modules. Records for this should be maintained and available for inspection. It is recommended that the training and development plan be extended. This should show (for each member of staff) all training completed and qualifications gained, with dates. The plan should show the dates when refreshers are due, and when outstanding training is scheduled to be delivered. Maintaining this in a spreadsheet format should provide the manager with an instant overview of the teams training and development needs. This should be a useful tool for planning and scheduling future training. We looked at staff supervision records and saw that these were variable. Action needs to be taken to ensure that supervision meetings are scheduled and take place regularly. It may be that some of this work could be appropriately delegated to senior staff, following suitable training. Similarly, records show that staff group meetings currently fall below the recommended National Minimum Standard (six per year). These things need to be addressed to ensure that staff get all the support they need to do their jobs well. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action needs to be taken to ensure that the Acting Manager has sufficient time allocated to fulfilling her management responsibilities in the home. Quality assurance systems need to be implemented fully, to ensure that the experiences and views of people using the service guide its review and development. Regular checks of essential equipment are carried out, to promote peoples health and safety. Evidence: The Acting Manager told us that she has been working at the home full time for the past six months. She has worked for the organisation for several years, most recently as Support Manager, prior to taking up the position at Beechlawns. She told us that she is appropriately qualified and that her application to become registered as the manager for Beechlawns is to be made shortly. Staff told us that she is open and approachable, and that they feel comfortable raising any concerns with her. We noticed from the rota that she is not generally on duty at weekends. She told us that she still acts in her peripatetic support role (on average) one day each week, helping other managers in the organisation. She said that senior staff at Beechlawns are Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: experienced and long serving, and competent to take charge when she is away from the home. This may well be true, but current arrangements mean that she is only present in the home for four out of seven days per week. Taking account of issues identified earlier in this report (care planning and management, organisation of activities, staff supervision, training and development etc.) it is recommended that this be reviewed, to ensure that she allocates sufficient time to ensure that she is able to fulfil her management responsibilities. A recommendation was made at the last inspection to fully implement effective quality assurance and monitoring systems, based on seeking the views of service users, stakeholders, families and advocates. We saw that this is a work in progress, and should acknowledge that the Acting Manager has not been in post long enough to complete this task to date. We saw that reports required under Regulation 26 (Care Homes Regulations 2001) have been completed each month, and that other quality assurance measures are being introduced in the home. Work on this needs to be completed, so that information gained can be evaluated and reported on. The findings should then be shared with all interested parties. We sample checked a number of records relating to health and safety in the home and saw that important checks of equipment and the environment are carried out on a regular basis. This helps to ensure that everyone living and working in the home is supported to stay safe. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Explore other accessible formats, so that information about what the service provides can be made more widely available. Review and update contracts to ensure that everyone is clear about their responsibilities. Develop the use of person-centred approaches, so that people get the support they need in ways that suit them best. Ensure that staff get the support and training they need to use care planning tools effectively Index and cross reference care plans and risk assessments, so that important information can be found quickly and easily. Develop clear links between activity plans and individuals agreed goals. This is so that people get the support they need to do the things that they value. Develop opportunities to enable people to be supported to do things on an individual basis. Review peoples involvement in routine tasks around the house (independent living skills) so that these activities are purposeful, and staff are clear about what they are trying Page 31 of 33 2 3 5 6 4 9 5 14 6 16 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 to achieve. 7 19 Complete and fully implement Health Action Plans so that peoples healthcare is managed more systematically, and good health and wellbeing actively promoted Record all concerns and complaints, so that it can be seen how these have been acknowledged and dealt with. Review staffing arrangements so as to provide more opportunities for people to undertake individual activities Ensure that staff receive training in safe manual handling. Develop training policy to take account of new e-learning programme. This is to ensure that staff have the support they need to gain new skills and competence. Ensure that staff receive regular supervision and have regular staff group meetings: this is so that they get all the support they need to do their jobs well Review priorities to ensure that the Acting Manager has sufficient time allocated to enable her to fulfil her management responsibilities. Complete quality asurance and monitoring processes so that information can be collated and analysed, and the findings shared with all interested parties. This is so that the home can demonstrate how the experiences and views of people using the service guide its review and development 8 9 10 22 33 35 11 36 12 38 13 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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