Care Home: Bethany Lodge

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What the care home does well The house is homely, people have nice bedrooms and their own bathrooms.People are being supported with their personal care needs and assisted to have their own image and clothes they like. People have their needs written in their care and health plans and records relating to these are detailed. People`s medication and money are being looked after safely.Page 8 of 36Care Homes for Adults (18-65 years)People are supported to take part in activities they enjoy and go out regularly. People enjoy the good quality meals provided. People are being helped to learn new skills.Proper checks are carried out on people who want to work at the home. Staff are working hard to support people in the way they need and prefer, while respecting their choices. There are enough staff to support people in the way they need. Staff are trained to help protect people. What has improved since the last inspection? More work has been done to improve the decoration in the house. A new care planning system has been set up. Staff are receiving better training. The manager has clear ideas and plans for improvement. Complaints are clearly recorded. Support for staff has improved. What the care home could do better: The home must become more personalised in the way helps people make decisions about their life and support needs.Staff should be encouraged to take responsibility for monitoring all of a person`s emotional, social and physical well being. All professionals should record their involvement with people their care plan, so the home can show what specialist help they have. Training in specialist communication and accredited medication training should be available for all staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Bethany Lodge 222 Malvern Road Worcester WR2 4PA 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: Emily White Date: 1 2 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Bethany Lodge 222 Malvern Road Worcester WR2 4PA 01905420088 01905420402 manager.bethanylodge@tracscare.co.uk suehullin@tracscare.co.uk TRACS LTD Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Ferguson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: The maximum number of serivce users to be accommodated is 8 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 Disabilities (LD) 8 Date of last inspection 1 6 0 2 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home Bethany Lodge was registered on 16 April 2004. The house is situated on the outskirts of Worcester on a main road in a residential area. It is close to all the facilities in Worcester city and close to link roads to other towns in the region. The service provides residential, personal and social care for up to eight younger adults who have a learning disability and who may have a primary diagnosis of Autistic Spectrum Disorder. All but one of the bedrooms are on the first floor, which is accessed by the stairs. Each person has their own single en-suite bedroom. On the ground floor there is a lounge, a dining room, kitchen, sensory room, small laundry and a private garden. The company have information about the home that can be sent out to interested parties and there is also a web site. Information about fees can be seen in the service guide. Care Homes for Adults (18-65 years) Page 5 of 36 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 Care Homes for Adults (18-65 years) Page 6 of 36 How we did our inspection: This is what the inspector did when they were at the care home We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: Information sent to us from the home. Surveys that were sent to us. Information about complaints. Previous visits. What other people have told us about the home. Care Homes for Adults (18-65 years) Page 7 of 36 We visited on a weekday and met everyone who lives at the home and several staff. We spoke to everyone we met, observed life in the home and looked at records such as care plans and staff records. We visited the manager on another day. What the care home does well The house is homely, people have nice bedrooms and their own bathrooms. People are being supported with their personal care needs and assisted to have their own image and clothes they like. People have their needs written in their care and health plans and records relating to these are detailed. Peoples medication and money are being looked after safely. Page 8 of 36 Care Homes for Adults (18-65 years) People are supported to take part in activities they enjoy and go out regularly. People enjoy the good quality meals provided. People are being helped to learn new skills. Proper checks are carried out on people who want to work at the home. Staff are working hard to support people in the way they need and prefer, while respecting their choices. There are enough staff to support people in the way they need. Staff are trained to help protect people. Care Homes for Adults (18-65 years) Page 9 of 36 What has got better from the last inspection What the care home could do better The home must become more personalised in the way helps people make decisions about their life and support needs. Care Homes for Adults (18-65 years) Page 10 of 36 Staff should be encouraged to take responsibility for monitoring all of a persons emotional, social and physical well being. All professionals should record their involvement with people their care plan, so the home can show what specialist help they have. Training in specialist communication and accredited medication training should be available for all staff. If you want to read the full report of our inspection please ask the person in charge of the care home. Care Homes for Adults (18-65 years) Page 11 of 36 If you want to speak to the inspector please contact Emily White 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 12 of 36 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 13 of 36 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 about the service is available for people and their representatives. Procedures are in place that should help ensure a prospective resident would have their needs assessed and be given the opportunity to trial the service. Evidence: We viewed the recently updated guide to the service and statement of purpose. These give a clear focus on rehabilitation and independence in daily living skills. There is a lot of detailed written information in these documents but the service is able to provide an audio guide or verbal information from staff. No new people have moved into the house and at present there are five residents who have lived there for some time. Following concerns in 2008 a requirement was made that The registered person must not provide accommodation to people unless there has been appropriate consultation with them or their representative regarding the assessment and the ability of the home to meet their needs. Placements must be in peoples best interest and the needs of current residents considered. The last key inspection reported that the owners of the home have issued a reassurance that any new admissions would be managed differently to reduce the risk of negative outcomes for the person or those Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: already receiving a service. The AQAA tells us that the assessment process is extremely detailed and assesses all needs and wishes. It includes all relevant parties in liaison with the client and a very detailed assessment report is compiled. A care plan is developed prior to admission from this assessment and then reviewed and updated regularly. From looking at the care files of people who currently live at the home, we can see that the needs of the current residents are regularly reassessed, for example one person had had a full assessment carried out by the home in January 2010 and and independent life skills assessment in March 2009. This shows that the home regularly re assesses whether they are able to meet the needs of those people who have lived at the home for some time. We discussed with the manager whether any new people would be moving to the house. There is space for two more people at the time of writing this report. The manager is assessing people but is considering their needs carefully, given the age and gender of the people already living at the home. The manager is aware of the need to balance the needs of people who already live there. Care Homes for Adults (18-65 years) Page 15 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs recorded in their care plans and these are being kept under review. They are being supported to take risks and make some decisions in their lives. Better person centred planning and monitoring could help increase opportunities for people in both these areas. Evidence: Surveys received from staff, external professionals and peoples relatives tell us that there is usually or always enough information to help make decisions, the home usually meets peoples needs, usually gives the support needed and expected and usually supports people to live the life they choose. Comments include: The home is good at working in a way that enables our clients to achieve an independent lifestyle as much as possible X has their own self contained flat which she has furnished and she is able to focus on what is important to her. The model combines personal development and reduction of risk. I hope this model will encourage other providers to be more creative when supporting vulnerable adults Staff have been good at letting me know when X has had a good day as well as concerns. They try out lots of different ways and contact different people to help her with her behaviour Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: Following the last key inspection three recommendations were made: Discuss peoples needs more fully at the staff meeting ensuring these are being met consistently and fully Develop person centred action plans for the short and longer term Develop a care plan relating to peoples abilities to make decisions for themselves The AQAA tell us that the home has provided more care plan training for staff. Staff tell us they have two team meetings a month, one of which is specifically for training and updating on practice issues. In discussion staff show a good awareness and understanding of peoples needs. The AQAA also tells us: We have developed care plans to include additional information and allow for more efficient recording. We have developed a care plan review sheet to allow for more detail to be documented when a support strategy is reviewed. Staff that we met are aware of the new care plans, and most have read them. Staff tell us that they have not been implemented yet but will become live documents when all staff have been trained. The new care plans set out peoples routine for the week, which includes personal care and chat about what I would like to do today. There is space for recording all contacts with professionals and families and staff daily observations. The care plans look at areas such as interactions, communication, imagination and understanding, sensory needs, health needs, personal care and lifestyle. We also looked at peoples old care files which are being used until all staff have been trained to use the new ones. We saw that people have set objectives such as washing own hair, domestic routines, or caring for pets. People have a six monthly review of their plan which includes an assessment of their goals and areas of concern. The manager tells us that as part of the new care planning system key workers will review care plans every month. This will help to ensure that people are working on the right goals for them and help to assess when they are ready for new challenges. The new care plans provide detailed information for staff about how to support people but are not personalised to individuals. The manager confirms that one person has a person centred plan at the moment. The new care plans have a small space for recording a life story and a section my own needs and wants which includes what the person wants to achieve/do/learn/change. These had not been not yet been completed. We discussed with the manager the importance of setting up a person centred plan appropriate to the needs and understanding of the individuals living at the home, with their full involvement. We spoke to staff about peoples communication, behaviour, and how staff support people to make decisions. Some staff had some good ideas about showing objects of reference to people who do not have verbal communication. Other staff expressed concern that staff do not have the skills in signing, use of picture-based communication methods, or Makaton, which some people using the service know how to use. The Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: manager tells us specialist communication training is planned throughout 2010 and we saw a planner which showed the training had been booked in. Our observations during the day showed staff communicating verbally with people which seemed satisfactory. The service supports people who may express distress or behaviour that staff find challenging. This may affect people being able to be supported outside of the home or what activities they are able to do at home. Staff in general show good understanding of the people who live at the home but tell us that there are particular individuals who they find challenging. These people have a behaviour support plan in place which is regularly updated and describes in detail what actions staff can take and what might lead to an incident. We asked staff how they monitor patterns in peoples behaviour. Staff were not very clear about the purpose of this and said they do not review the incident forms that they complete, which is done by a senior member of staff. Staff tell us that the TRACS behavior advisor is often involved with individuals and provides supportive and useful information. We could not find records of the visits of the behaviour advisor in individuals care files. We would expect to find records of all visits to show that people who are experiencing problems are being monitored by a professional specialist in that area. The AQAA tells us that: Risk assessments are drawn up prior to admission for identified risks and following admission any additional identified risks are developed as needed. Risk assessments are reviewed by the Home Manager and Clinical Support Nurse and any unnecessary restrictions are removed. The care plan identifies any risk reduction training required. We saw that peoples care plans include general risk assessments for health and safety as well as individual ones for activities chosen by the individual. We saw that appropriate measures are in place so people can show agreement to medication administration, management of finances, and understanding of fire safety. Care Homes for Adults (18-65 years) Page 18 of 36 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 are being offered a variety of appropriate activities and are accessing the local community. People are being given some opportunities for personal development and they are being supported to stay in contact with their families. The quality of the food is good and mealtimes are relaxed. Evidence: During our visit we met or observed all five people currently living at Bethany Lodge. During the day everyone participated in an activity on a one to one basis with different staff through the day. We saw people engaged in household tasks, shopping, craft in the activities room, listening to music in the sensory room, baking, and being taken to the snoezelen. There was music playing in lounge and sensory room through the day. We looked at peoples care files and saw that specific planned tasks are set up to suit each person, and these were being following. Staff told us that all activities are planned but there is flexibility, so people do not have to do things if they have changed their minds. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Peoples care plans show that there is a mixture of activities based on fun and based on learning and gaining independence. These might include caring for pets, domestic tasks, arts and crafts, DVDs, meals out, baking, writing practice, table games, make up and pampering, one to one drives or walks, the snoezelen, swimming, and cinema. People are supported to keep in touch with their families and everyone who has families regularly has trips to see them for weekends, and to keep in touch by telephone. One person keeps an activities diary to help her tell her family what she has been doing. Staff who are key workers said they liaise with the families and keep them in touch or involve them in decisions. The AQAA tells us that Activity sheets are updated weekly in accordance with care plans, which clients were involved in setting. Staff are constantly seeking new social and community activities for clients to attend. Clients are given responsibilities within the home to include housekeeping. Some people living at the home need two staff to support them when they go outside of the home. We observed this happening with one person during our visit. This enables people to be part of their local community. Staff report that there is one person who has not been able to access community activities as she has done in the past because of her behaviour. There are clear guidelines for support for this person however staff say they are still concerned about taking this person out. A recent social work assessment for this person highlighted computer courses at college and discos as areas to be explored. This person had a six monthly review in November 2009 where it was highlighted that this person should be supported to participate in community activities appropriate to their age. We discussed with the manager her plans for personalising the service. She told us she has plans for changing the activity planners so that they are not all the same but reflects the persons abilities to get involved in planning their time. It is important that the service regularly reviews activities and occupation as part of the therapeutic activity mentioned in the statement of purpose. This will ensure that activities and planning are personalised and have a purpose, their goals are monitored and they are able to access new and different occupations. The AQAA tells us that We are focusing on food provision within the home and are about to launch our own award for meeting certain standards set by the company. The providing food policy is also being revamped. Menu planning and food records show that people have a varied diet. Food looks appetising, staff eat meals with residents, there is no set timetable for eating and people can eat where they like. Staff report that mealtimes and food are often a trigger for distressed behaviour, which we observed during our visit. We saw that staff dealt with Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: these incidents appropriately and showed good knowledge and understanding of the people they were supporting. The kitchen is kept locked which prevents freedom of movement but allows individuals to spend one to one time in the kitchen with staff, which helps their independent living skills. Staff report that a new kitchen is due to be put in which will improve facilities for independent living skills. Care Homes for Adults (18-65 years) Page 21 of 36 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. Improvements have been made so that 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 cannot manage their medicine, the home supports them with it in a safe way. Evidence: Surveys we received from staff, outside professionals and peoples relatives tell us that: Staff have up to date information and they are able to share information appropriately; the assessment arrangements gather accurate information about people; peoples needs are properly monitored, reviewed and met; the home seeks and acts on advice, supports people with medications, respects their privacy and dignity, and keeps in touch with family. The care plans sampled contained helpful details about how people prefer to be supported with their personal care needs. The new care plans highlight the areas that the person can do for themselves for example choose their clothes or put deodorant on. The AQAA tells us that: Care plans contain details of all general and specific health care needs and in addition a health care action plan is drawn up for clients with learning Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: disabilities. All medical appointments are documented on Medical Appointment Sheets and any follow up appointments are noted. Specific monitoring records such as sleep pattern, food intake and personal care records are all being kept as needed. Staff record daily observations which are very detailed with regular entries through the day and records of incidents, and peoples moods, behaviours and activities. Daily records show that people have attended recent medical appointments such as psychiatric reviews, nurse and dentist appointments. As discussed in the previous section, we could not find records of the visits of the behaviour advisor in individuals care files. We would expect to find records of all visits to show that people who are experiencing problems are being monitored by a professional specialist in that area. We saw a recent six monthly review report for one person. This showed that staff and the manager are aware of all the areas of concern or development for this person. Peoples families are invited to their six monthly review if appropriate. We spoke to several staff who all showed a good understanding of peoples current needs. Health Action Plans are handwritten but contain details of contacts and health needs. It was not clear from the Health Action Plans how often they are reviewed or updated. For example, staff are aware of health concerns such as when someone has put on weight. The six monthly review also mentions this. Peoples weights are recorded on personal care record but we could see no evidence of more regular monitoring, or an action plan relating to this. As mentioned in the previous section, monthly key worker reviews including the Health Action Plans would help to ensure significant health concerns are regularly monitored. The AQAA tells us that the home would like to improve the medications system by storing each individuals medication within their bedrooms. At the moment there is an appropriate storage cabinet and a controlled drugs cabinet which was not used for controlled drugs at the time of the inspection. People living at the home have details about their medications in their care plans, including any potential difficulties with taking medications. People have an assessment for whether they can take medications independently, and have given consent to have their medications administered when appropriate. We saw that peoples medications are all accounted for with good practices being used such as recorded dates when boxes are opened. Some people have medications as needed, and there are written protocols in place for those who have these. Staff show a good understanding of what these medications are for. Care Homes for Adults (18-65 years) Page 23 of 36 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. Concerns about the service are looked into and action taken to put things right. The home has improved the way it safeguards people from abuse, neglect and self-harm. Evidence: During 2009 concerns had been raised by the local authority at the number of referrals made to the safeguarding team. Concerns had been raised that the manager and staff did not fully understand the safeguarding process. The home put in place an action plan to ensure training and supervision for staff is in place to improve understanding of safeguarding. A member of the local authority safeguarding team has visited the home to raise awareness of the local process. The AQAA tells us that We have appointed a qualified trainer for POVA training in house. She has developed a training pack for all staff. We have begun recording compliments as well as complaints. We have reviewed our Wake Night Policy following concerns of night time practice, which has now been issued. We are currently arranging meetings with all wake night staff to discuss competencies and roles. We spoke to several staff who all showed understanding of what constitutes abuse and are aware of how to report concerns within the home. Staff were not sure of the local process and some said that they had not had training from the local authority about this. One staff member who had been trained by the local authority in safeguarding told us it was some of the best training she had had. Staff tell us they feel competent to deal with incidents and feel their colleagues are. Staff did tell us the they find one persons Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: behaviour challenging but could not give examples of what they do to monitor or understand that behaviour. Detailed incident logs are kept which record possible triggers and what helped. These are kept separate from individual care plans and the manager tells us they are regularly monitored by a senior staff member. Monitoring of behaviour by all staff, particularly key workers, is crucial for safeguarding individuals, particularly those who are not able to communicate verbally or clearly express a complaint. For this reason it would be good practice to keep individual incident and behaviour monitoring forms with individuals care files so that staff can easily access information about an individual when needed. Recommendations from the last key inspection included: Keep clear records of concerns or complaints and the action taken to address these. We saw that a complaints log is being kept with outcomes recorded. Surveys we received from peoples relatives and a social worker said that they know how to complain and that the home always responds appropriately to concerns. Care Homes for Adults (18-65 years) Page 25 of 36 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 are living in a clean home that is comfortable and homely. They have personalised bedrooms and have en-suite facilities. Maintenance arrangements have improved and are continue for the next twelve months. Evidence: The last key inspection identified a number of maintenance tasks that should be carried out and improvements to the furniture were needed. Recommendations from the last inspection report included: Review the arrangements where staff base their planning and paperwork in the residents lounge. Address all the shortfalls reported under the environment section. Consider providing a disabled access worktop area when the new kitchen is fitted. Staff also told us in surveys that the home could do with redecorating. The AQAA tells us that: Maintenance within the home is ongoing. Efforts are being made to improve the environments, new curtains have been purchased for the lounge, new flooring for the corridors and the communal corridors are to be painted. We have reviewed all health and safety procedures. The review of food hygiene procedure to incorporate new safer food model is now complete. We observed during our visit that the whole house had been redecorated. The upstairs Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: and dining room have been made more attractive with new paint, bright coloured doors and paintings, table covers and new lampshades. There is a sensory room and activities room. Part of house has been converted into a small flat with kitchen, living room and ensuite bathroom. This flat and peoples bedrooms are very personalised. One person has attractive new solid wood furniture in their bedroom ad a large flat screen television. There are further improvements which are planned for this year. The manager tells us that the old carpet is going to be replaced with vinyl flooring, the boarded up fireplace is going to be covered over, and new hard wearing furniture is being made specially for the lounge. The new kitchen is due to be fitted. This will include two hobs so that different people may use the kitchen at the same time. There are some rooms in the house that are not in use and we noted that staff were still using the table in the lounge to complete their paperwork. The manager tells us that the use of the rooms is being reconsidered and staff will have a designated room for paperwork. Care Homes for Adults (18-65 years) Page 27 of 36 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 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. Peoples needs are met and they are supported because staff get the right training, supervision and support they need from their managers. Evidence: The home has recently recruited several more staff and there are now five staff working in addition to the manager. This offers one to one support for people living at the home and is important for those who need two to one support outside of the home. There is also one waking and one sleeping night staff. We saw two files relating to the recruitment of new staff, which showed that background checks had been done and references received before they started work. We met some staff who had been recruited in the past year. Not all staff have previous experience of working with people with autism or learning disabilities however we observed them working competently with people during the day. These staff told us that they has an induction and have been well trained and supported since they started work at the home. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: We received some staff surveys which told us that their induction covered what they needed to know very well or mostly; they have relevant training which helps them understand and meet peoples needs and keeps them up to date; there are usually enough staff and they usually have enough support and experience to do their jobs well. The AQAA tells us that the home: Provides comprehensive induction training within the first twelve weeks, which includes Studio III Managing Challenging Behaviour, First Aid, Understanding the Clients Perspective and a clinical induction for example Acquired Brain Injury, Learning Disability, Mental Health, and Autism. We are an accredited provider for Learning Disability Induction Award. There were three recommendations from the last key inspection: Provide staff with the opportunity to gain the Learning Disability Qualification and NVQ2 Provide all staff who administer medicines with accredited medication training Provide all staff with training about epilepsy The training plan shows that people have received epilepsy training, and internal medications training, but only the manager has attended an external accredited medications training course. The company does not offer the LDQ however the manager tells us she is looking into alternative training in this area. All staff have had the mandatory health and safety training. Some staff have had training in communications and Deprivation of Liberty Standards. The AQAA identifies areas where training for staff could improve: Ten staff members are currently working towards their NVQs of relevant levels. We plan to maintain above minimum standard for NVQ target. Inductions could be completed more efficiently with a weekly meeting with the staff member. We plan to develop waking night staff competencies and plans for involving clients in recruitment During our visit we spoke at length to three staff members and observed others during the day. Staff tell us that the staff team is more settled, there has been more training and the service is better organised. Staff say the manager is approachable, her door is always open and they have regular supervisions with the manager or senior staff. Staff told us about a recent strategy day where they all had input in how the service could improve, all staff had found this to be really helpful. Staff show good knowledge and understanding of the people they support, and people are key workers understand their role. The main areas that are problematic for staff are stress arising from supporting people with challenging behaviour, and learning specialist communication skills. Staff say the management is aware of their concerns and is supportive. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. The environment is safe for people and staff because health and safety practices are carried out. Evidence: Significant improvements have been made since the last key inspection. Staff tell us that the manager is approachable and encourages new ideas. The people who live at the home are unable to give their views but they seem relaxed around with the manager and some spend time in the office with her. The AQAA is well completed and shows good awareness of equality and diversity in relation to people living at the home. The last key inspection report recommended that: The quality assurance process and annual report should result in a clear action plan for the year ahead. Plans should then be shared with those who contributed to the process and who have an interest in the service such as social workers, families and staff. The AQAA tells us that: Tracscare send out annual client, staff and external Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: questionnaires which are collated by the quality director. We facilitate a client focus day, run by clients in order to gather additional feedback. We have changed the questions in the Regulation 26 visits to ask clients very specific questions such as what is good? what is not good? etc. Clients attend the morning meetings and activities are discussed with them for the day if possible. Regular care review meetings are held, where clients are invited to share opinions and make decisions about the care that they receive We met the manager to discuss future plans for the home. Many of these have been mentioned in the report. The manager understands the importance of giving senior staff and key workers more responsibility for monitoring the overall well being of people living at the home. This will allow the manager more time to focus on improvements and planning for the overall service. The manager also understands the importance of depersonalizing the service so that individuals who live at the home receive the support they prefer. The last key inspection report recommended that the home should: Ensure all staff are clear about the night time fire evacuation arrangements and who is responsible for calling the emergency services. The staff we met were clear on fir safety procedures and other health and safety procedures. A random sample showed that health and safety records are being kept up to date. Staff have had mandatory training and were observed to be working in a safe and hygienic manner during our visit. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 12 The service must, with the 12/03/2010 involvement of each person using the service, set up person centred plans appropriate to that persons needs and abilities. The plans must show the goals and aspirations of that individual and that they are being regularly monitored. This will ensure that the goals and aspirations of the individual are being considered by staff as well as their care and support needs. 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 The manager should ensure that all staff attend the planned training sessions in communication and as a Page 33 of 36 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 minimum peoples key workers are able to communicate with individuals in their preferred specialist communication method. This will ensure that people are able to communicate their wishes and decisions at all times. 2 7 As part of the new system of monthly key worker reviews, key workers should be encouraged to take responsibility for the whole of an individuals needs. This should include monitoring peoples goals, communication and behaviour. People using the service can then be confident that staff working with them are aware of all the areas that may be affecting them at a particular time. It is important that the service regularly reviews activities and occupation as part of the therapeutic activity mentioned in the statement of purpose. This will ensure that activities and planning are personalised and have a purpose, peoples goals are monitored and they are able to access new and different occupations. It would be good practice for all professionals, including those employed by TRACS but external to the home, to record their involvement with individuals. This will ensure that staff are up to date with the most recent specialist advice and are able to meet peoples needs appropriately. Monitoring of behaviour by all staff, particularly key workers, is crucial for safeguarding individuals, particularly those who are not able to communicate verbally or clearly express a complaint. For this reason it would be good practice to keep individual incident and behaviour monitoring forms with individuals care files so that staff can easily access information about an individual when needed. Staff should be provided with accredited medications training which is regularly updated. This will ensure people have support with medications in a safe and appropriate way. It would be good practice for the manager set out a clear plan for how the service can become more personalised for the individuals who live there. Giving staff more responsibility for monitoring peoples overall needs will Page 34 of 36 3 12 4 19 5 23 6 32 7 39 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations allow more time for the manager to oversee improvements and maintain standards. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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