Care Home: Beulah Road (55)

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What the care home does well All the written and verbal feedback we received from the people who use the service and staff who work there was extremely positive about the home and the impact of the relatively new management team. Typical comments included, `Its better here now - I like it`, `the whole places looks more homely and welcoming since the refit`, `the new manager and her deputy have done wonders to the place`, and `you know where you stand with the new manager - shes firm, but also fair.` All the staff observed were seen and/or heard interacting with the people who use the service in a very kind, respectful and professional manner at all times during this site visit. Staff met, including the new managers, demonstrated a good understanding of the needs, wishes, and preferences of all the people who use the service, including how to deal with incidents of challenging behaviour as set out in individuals risk management guidelines. As identified at the services last random inspection the atmosphere in the home continues to be extremely relaxed and congenial. What has improved since the last inspection? We agree with the statement made in the services AQAA about how it perceives its own performance in the last 12 months - `the recruitment of a new manager and deputy manager has been at the forefront of improving the service in offering stability and continued positive outcomes.` In our opinion this has been the single most significant change made at the home in the past year. The service is now run for the benefit of the people who use the service, as opposed to staff, and the new management teams `tough` stance regarding `poor practise` has resulted in approximately 50% of the former staff team being either appropriately disciplined, dismissed, or otherwise let go before being offered a permanent contract to work at the home- because they had all failed too significantly improve their practise and perform to a higher level expected by the new managers. Those staff that remain and new recruits are very clear that a culture of abuse that previously existed at 55 Beulah Road will no longer be tolerated. Much improved staff training, supervision, and recruitment arrangements introduced by the new management team have ensured the people who use the service are now supported by a much more competent and motivated staff team. All the outstanding requirements and good practise recommendations identified in the services previous key Inspection report, which largely pertained to staff training and the interior layout and decor of the home, were all found to have been met in full at the time of the services last Random inspection carried out in March 2009. Staff met demonstrated a good understanding of the preferred communication style of all the people who use the service, which was clearly recorded in their care plans. The home has also introduced a wide variety of innovative ways to enable everyone who uses the service to express their views, and generally have more opportunities to be consulted and be involved in making major decisions about how their home is run. For example, the service has developed easy read pictorial menus and menu planning books; communication passports, mat, and other tools to promote choice; Pinned upvarious information boards with all the social activity and household chores people who use the service have expressed an interest in doing each day; photographs of all the staff on duty each shift are conspicuously displayed in the entrance hall; and the manager has reintroduced monthly one to one keyworker sessions and residents group meetings. The services arrangements for enabling the people who use the service to take greater control of their lives has also improved in the past year. Staff have more of a `can do` attitude toward supporting the people who use the service to take `responsible` risks. For example, one individual who is willing and capable of travelling more independently in the wider community has been actively encouraged and supported by staff to achieve this goal, while others have been given the chance to take greater control of their own medication or participate in far more household chores around their home. One person who uses the service told us that although they did not always like the fact that staff were always telling him to tidy up their flat, they did acknowledge they felt more independent and was probably a good thing overall that they were being encouraged to do more for themselves. Finally, it was evident from practises observed, comments made by staff, and records kept, that all the people who use the service have far more opportunities to engage in more stimulating and interesting activities both within the home and in the wider community. In the past year a new sensory room and vegetable patch have been established at the home, and all the people who use the service are engaging in more community based recreational activities in the evenings and at weekends. What the care home could do better: All the positive comments made above notwithstanding the new manager openly concedes the service is far from `perfect` and could do better in a number of areas. All the services staff should receive understanding autism and Makaton training This will ensure all the people who use the service have their communication needs met. All the people who work at the service should have their overall performance in the past 12 months and their training needs appraised by the manager on an annual basis. This will ensure the people who use benefit from being supervised by a suitably competent and well supervised staff team. The person in day to day charge of the service should re-register with us and take a fit person interview, and complete her Registered Managers Award (NVQ4 equivalent). This will ensure the service is run by a suitably `fit` and qualified manager. The way the service ascertains and then makes the results of all the feedback received from major stakeholders, including the people who use the service and their relatives, should be reviewed. A report of the services findings should be made available to all interested parties on an annual basis. Finally, the manager wrote in the AQAA that although activities had significant improved in the past year there remained considerable scope to improve the opportunities the people who use the service had to engage in more meaningfulpursuits in the wider community. Progress made by the service to achieve this aim will be assessed at its next inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beulah Road (55) 55 Beulah Road Thornton Heath Croydon Surrey CR7 8JH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lee Willis     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Beulah Road (55) 55 Beulah Road Thornton Heath Croydon Surrey CR7 8JH 02086536377 T/F02086536377 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care Management Group Ltd (trading as CMG Homes Ltd) care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 7 Date of last inspection Brief description of the care home 55 Beulah Road is a residential care home that is owned and managed by CMG, which provides accommodation and personal support for up to seven generally younger men with varying degrees of learning disabilities, communication needs, and behaviours that challenge. Pat McGarry was appointed the services new acting manager in May 2008 and has now submitted her application to be registered, subject to a fit person interview with the CQC. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home Located on a suburban street close to the centre of Thornton Heath the home is within easy walking distance of a wide variety of local shops, cafes, pubs, and banks. The home is also very close to numerous bus stops and a local mainline train station with excellent links to central Croydon and the surrounding areas. The main house comprises of six single occupancy bedrooms, a newly decorated and furnished open plan lounge/ dinning area, a suitably adapted and well equipped sensory room, a recently refitted kitchen, a seperate office, and laundry room. There is also a one bedroom self-contained flat situated at the rear of the property that has its own cooking and en-suite bathroom facilities. The garden at the rear of the property is well maintained and includes new decking areas. All the people who use the service and/or their representatives have been supplied with up to date information about what services and facilities are provided at 55 Beulah Road and how much they can expect to be charged for them. 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: three star excellent 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: The outcomes the people who live at 55, Beulah experience has continued to improve over the course of the past 12 months. We have therefore decided to increase this services rating from a one to a three star excellent performing care home. From all the available evidence gathered during this Key and the services previous Random inspection it was evident 55 Beulah Road now has far more strengths than areas of weaknesses, and where shortfalls emerge the new management team now recognise and manage them well. The service has developed a far more proactive, as opposed to reactive, approach to stamping out poor practise within home. As a direct consequence the service now delivers excellent outcomes for the people who use the service, and is now a much better place to live. Care Homes for Adults (18-65 years) Page 6 of 33 We spent 4 hours at the home as part of this key inspection. During the site visit we met three people who use the service, the new acting manager and her deputy, and three support workers. We also looked at various records and documents, including the care and health action plans for two people who currently use the service. The remainder of the visit was spent touring the premises, which included the self contained flat at the rear of the property and the garden. Five of our satisfaction surveys and Annual Quality Assurance Assessment (AQAA) form where returned to us when we asked for them. One of our surveys was completed by a person who uses the service and the rest were filled out by members of staff. The services self-assessment (AQAA) form was completed by the acting manager, which tells us what she feels the service does well, how it has been improved in the past year, and what they could do better. What the care home does well: What has improved since the last inspection? We agree with the statement made in the services AQAA about how it perceives its own performance in the last 12 months - the recruitment of a new manager and deputy manager has been at the forefront of improving the service in offering stability and continued positive outcomes. In our opinion this has been the single most significant change made at the home in the past year. The service is now run for the benefit of the people who use the service, as opposed to staff, and the new management teams tough stance regarding poor practise has resulted in approximately 50 of the former staff team being either appropriately disciplined, dismissed, or otherwise let go before being offered a permanent contract to work at the home- because they had all failed too significantly improve their practise and perform to a higher level expected by the new managers. Those staff that remain and new recruits are very clear that a culture of abuse that previously existed at 55 Beulah Road will no longer be tolerated. Much improved staff training, supervision, and recruitment arrangements introduced by the new management team have ensured the people who use the service are now supported by a much more competent and motivated staff team. All the outstanding requirements and good practise recommendations identified in the services previous key Inspection report, which largely pertained to staff training and the interior layout and decor of the home, were all found to have been met in full at the time of the services last Random inspection carried out in March 2009. Staff met demonstrated a good understanding of the preferred communication style of all the people who use the service, which was clearly recorded in their care plans. The home has also introduced a wide variety of innovative ways to enable everyone who uses the service to express their views, and generally have more opportunities to be consulted and be involved in making major decisions about how their home is run. For example, the service has developed easy read pictorial menus and menu planning books; communication passports, mat, and other tools to promote choice; Pinned up Care Homes for Adults (18-65 years) Page 8 of 33 various information boards with all the social activity and household chores people who use the service have expressed an interest in doing each day; photographs of all the staff on duty each shift are conspicuously displayed in the entrance hall; and the manager has reintroduced monthly one to one keyworker sessions and residents group meetings. The services arrangements for enabling the people who use the service to take greater control of their lives has also improved in the past year. Staff have more of a can do attitude toward supporting the people who use the service to take responsible risks. For example, one individual who is willing and capable of travelling more independently in the wider community has been actively encouraged and supported by staff to achieve this goal, while others have been given the chance to take greater control of their own medication or participate in far more household chores around their home. One person who uses the service told us that although they did not always like the fact that staff were always telling him to tidy up their flat, they did acknowledge they felt more independent and was probably a good thing overall that they were being encouraged to do more for themselves. Finally, it was evident from practises observed, comments made by staff, and records kept, that all the people who use the service have far more opportunities to engage in more stimulating and interesting activities both within the home and in the wider community. In the past year a new sensory room and vegetable patch have been established at the home, and all the people who use the service are engaging in more community based recreational activities in the evenings and at weekends. What they could do better: All the positive comments made above notwithstanding the new manager openly concedes the service is far from perfect and could do better in a number of areas. All the services staff should receive understanding autism and Makaton training This will ensure all the people who use the service have their communication needs met. All the people who work at the service should have their overall performance in the past 12 months and their training needs appraised by the manager on an annual basis. This will ensure the people who use benefit from being supervised by a suitably competent and well supervised staff team. The person in day to day charge of the service should re-register with us and take a fit person interview, and complete her Registered Managers Award (NVQ4 equivalent). This will ensure the service is run by a suitably fit and qualified manager. The way the service ascertains and then makes the results of all the feedback received from major stakeholders, including the people who use the service and their relatives, should be reviewed. A report of the services findings should be made available to all interested parties on an annual basis. Finally, the manager wrote in the AQAA that although activities had significant improved in the past year there remained considerable scope to improve the opportunities the people who use the service had to engage in more meaningful Care Homes for Adults (18-65 years) Page 9 of 33 pursuits in the wider community. Progress made by the service to achieve this aim will be assessed at its next inspection. 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comprehensive Statement of Purpose which ensures that all necessary information about the service is available both for people who use the service and others enquiring about the home. Prospective users of the service can be confident that they will have the opportunity to find out about the home through planned visits and a thorough assessment of their needs and wishes to enable individuals to make informed decisions about whether or not the placement is appropriate for them. Evidence: At the services last random inspection the relatively new deputy manager was able to produce documentary evidence on request that showed us the homes Statement of Purpose and Guide was being been reviewed and up dated accordingly at regular intervals. The manager and her deputy both demonstrated an excellent understanding of what Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: CMGs admissions procedures. In line with best practise the new management team told us a thorough assessment of the services most recent referral had been carried out by suitably trained representatives of CMG in the prospective service users current home, they had obtained a copy of their care management assessment, fully involved the individuals relatives and care manager in the process, and invited them all to visit 55, Beulah Road. The service has also exceeded this Standard by ensuring the prospective new service user has already been designated a keyworker and arrangements made for this member of staff to spend some time with them at their current address in Northern England in order to get to know them before any decision about moving in on a trial basis is taken. The manager was also adamant that she would not accept any new referrals unless she thought the staff had the necessary skills to meet the prospective service users needs and that they were compatible with the others already living in the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes approach to care planning is person centred and focuses on individuals unique strengths and personal preferences. The plans also set out in detail how peoples current requirements and aspirations will be met through positive individualised support. The service has a much more can do attitude to responsible risk taking, which are being managed more positively in order to help the people who use the service lead the life they want. People who use the service also now have far more opportunities to maintain and development their independent living skills and participate in the day to day running of their home. Finally, the communication arrangements that the service has in place have significantly improved since the appointment of the new management team who has ensured the people who use the service have far more opportunities to be consulted about how their home is run, make more informed decisions about how they live their lives, and in general do more for themselves. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: We looked at two care plans in depth. Both plans were person centred and set out in great detail how these individuals current personal, social, and health care needs were being met through positive interventions, and what their unique strengths and preferences were. Two members of staff interviewed told us they thought the care plans used in the home were easy to access and good working documents. One member of staff told us they were - the best care plans they had ever used, and two other members of staff who returned our surveys wrote - we are given all the up to date information about the needs of the people we support in their care plans. Care plans are illustrated with a variety of easy to read pictures, symbols, and photographs to enable anyone who uses the service to understand there content. Since the appointment of the new management team the services arrangements for enabling the people who live at 55, Beulah Road to be consulted and participate in all aspects of life in their home has significantly improved, and now exceeds National Minimum Standards in this area of practise. E.g. Care plans set out in detail individuals specialist communication needs and the unique support they require to express themselves. The new managers have also introduced a vast array of communication tools to enable the people who use the service to make more informed choices. This includes - weekly pictorial menus and a meal planning book; information boars with photographs of all the staff who are on duty, and the social activities and household chores all the people who use the service have agreed to participate in each day; a talk mat; and photographic interpretations of risk assessments to increase service user awareness of personal safety issues. All this information is conspicuously displayed in communal areas throughout the home, including in the kitchen, lounge, and entrance hall. One person who uses the service also told us they that they can join in monthly service users meetings and have one to one meetings with their keyworker on a regular basis. Comprehensive sets of risk assessments were contained in the two care plans being case tracked, which covered every aspects of these individuals personal, social, and health care needs. It was evident from the comments made by the manager and her deputy that they were committed to supporting the people who use the service to take more responsible risks and to do more for themselves where they were assessed as willing and capable of doing so. For example, one service user who returned our survey wrote - staff have helped me to travel by myself to and from my day centre. It was also clear from practises observed during this visit that people who use the service have far more opportunities to get involved in domestic chores around their home. One person who lives there told us they went out when they wanted and now did most of their cooking themselves. This individual was also observed tidying up their flat, Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: which they told us they had agreed to do once a week. As previously mentioned in this report we were very impressed with the easy read risk assessments the new manager had introduced to increase service user awareness of personal safety issues. It was positively noted that in response to a significant incident that nearly resulted in a road traffic accident the manager has called for an urgent review of this individuals care plan with all their representatives, including their care manager and next of kin, in order to explore new ways of minimising the likelihood of a similar incident reoccurring in the future. It was also positively noted that an easy read pictorial road safety guidance has already been established and shown to the individual concerned. All the staff met told us the pictorial personal safety guides were an excellent idea and were proving useful. All the risk assessments and associated management strategies viewed had been reviewed within the past six month and up dated accordingly to reflect any changes. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of social, leisure, and recreational activities the people who use the service have the opportunity to participate in, both at home and in the wider community, has significantly improved since the services last Key inspection. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally well balanced meals. Evidence: On arrival it was noted that most of the people who use the service had either already gone out with staff or were getting ready to go out. Staff met confirmed they were supporting people to attend all the activities identified in their care plans and the weekly activities board for that day. According to entries made in one individuals daily diary notes this service user had far more opportunities to enjoy meals out and visit Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: places of interests than they had previously. A member of staff spoken with told us the number and variety of activities the people who use the service now enjoyed both at home and in the local community had got better in the past year. The member of staff also told us they regularly accompanied the people who use the service users to the local park, cinema and day centres. Two members of staff who completed our surveys wrote - the home was good at supporting the people who use the service to do what they want during the day, evenings, and at weekends. It was positively noted during a tour of the premises that in the past year staff have created a vegetable patch in the garden and converted the old smoking room into a well equipped sensory room, which are both proving popular with the service users. One person who uses the service showed us their Freedom pass that entitles them to discounted travel on local public transport, which they told us they regularly used. As previously mentioned in this report the families of the people who use the service are invited to attend their loved ones care plans reviews and it was evident from comments made by all the staff met that the service has an open visitors policy. As a good practise security measure the deputy politely asked us to sign in the homes visitors book on arrival and sign out again on my departure. One service user met told us they had been provided with a front door key to their self contained flat and did not feel unnecessarily restricted by the keypad device fitted to the front door in the main house because they usually left and entered 55, Beulah Road by the side-gate. The manager has risk assessed the homes keypad device and has determined it is compliant with the relatively new Deprivation of Liberties Act and fire safety regulations. The kitchen door remained open throughout this site visit and a wide varied of fresh fruit in accessible bowels, as well as fresh vegetables grown in the homes new garden, were found in this area. As previously mentioned in this report the service has established some excellent communication aids to enable the people who use the service to plan the weekly menus and choose what they would like to eat at mealtimes. One person who uses the service told us they look forward to having a cooked breakfast every Sunday and that staff help them go food shopping once a week. Care Homes for Adults (18-65 years) Page 18 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique emotional health care needs are continually recognised and met. People who use the use are able to take greater responsibility for managing their own medication where appropriate and are suitably protected by the services medication handling practises and policies. Evidence: Four people who currently use the service were all suitably dressed in well-maintained clothes that were appropriate for the time of year. One individual told us they always bought their own clothes and could chose what they wore each day. The clothes this individual was wearing on the day if the site visit seemed to very much reflect their unique personality. Health care action plans, known as My health, were produced on request for the two people whose care we were case tracking. The records set out in detail the dates and outcomes of all the appointments these individuals had had with various health care Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: professionals in the past year. It was evident from entries made in the My health documents that these individual had received regular input from a number of different health care professionals, including GPs, community based nurses, and dentists. All the staff who returned our surveys ticked the always box in response to the question does the service seek advice from health care professionals and act upon what they say in order to keep the service users healthy. We were notified without delay about one service user being admitted to hospital since the last inspection. The manager confirmed that this significant incident was appropriately and professionally dealt with by staff on duty at the time. No recording errors were noted on any of the medication administration records (MAR) sheets currently in use at the home. These records accurately reflected current stocks of medication held in the home on behalf of the people who use the service, including all as required PRN medication. All medicines stored in the home on behalf of the people who use the service are locked away in a metal cabinet securely attached to a wall in the office. It was positively noted that the one medication administration error that has occurred since the services last random inspection was spotted very Early on by staff as a direct consequence of its much improved medication monitoring arrangements nd appropriate action taken in respect of the staff involved to minimise the risk of a similar incident reoccurring. As part of the service improved medication monitoring arrangements records showed two staff are now expected to sign medication administration records when any medicines are dispensed, which the management routinely spot check. It was positively noted that two people who use the service who have been identified as both willing and capable of having more control over their own medication are actively encouraged and supported to do so. The manager was able to produce evidence on request that showed us recorded risk assessments, discreet monitoring arrangements, and lockable cabinets had all been put in place to minimise all the risks associated with people self medicating. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. The homes arrangements for ensuring the people who use the service are protected and kept safe are sufficiently robust. Evidence: An easy read pictorial version of the services complaints procedures was conspicuously displayed on an information board in the entrance hall. One person who uses the service who we spoke with at length and another who completed our survey both told us - they knew who to speak to if they were unhappy (i.e the manager or their respective keyworkers) and how to make a complaint if they needed too. The manager told us there had been no formal complaints made about the services operation since we last inspected it. The deputy manager also assured us the service always takes any concerns or complaints it receives very seriously and would always follow them up in a timely fashion. Two members of staff who completed our surveys wrote they knew what to do if a service user, relative, or other representatives raised concerns about the home. The services new management team demonstrated a good understanding of what Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: constituted abuse and who they needed to notify without delay, including external agencies such as the host Local Authorities safeguarding team, the police, the CQC, and the relevant placing authorities. The manager confirmed that the one allegation of abuse made since the services last inspection was appropriately documented, reported and dealt within at the time in line with local authority agreed safeguarding protocols. A member of staff informally interviewed was also very clear what was meant by the term abuse and who they should pass information onto if they suspected or witnessed it within the home. This member of staff also confirmed that the use of physical intervention techniques to manage challenging behaviour was not permitted at 55, Beulah Road. They told us they were also not aware of any staff ever using it on people who live at the home. It was positively noted at this and the services previous random inspection that the relatively new managers understood and followed the professionally agreed challenging behaviour management guidelines set down in one individuals care plan. It was evident from comments made by the staff met that the new guidance were also understood by staff and seemed to be working well as the number of incidents that challenge the service has been significantly reduced in the past year. Care Homes for Adults (18-65 years) Page 22 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. The homes layout, decor, and fixtures and fittings, have been significantly improved since its last key inspection ensuring the people who use it have a much more homely and comfortable environment in which to live. The homes cleaning and infection control arrangements are sufficiently robust to keep the environment fresh and tidy and the people who live their safe. Evidence: During a tour of the premises all the communal areas with lots of new pictures on the Walls and ornaments doted about the place looked very homely and comfortable. One person who uses the service told us they liked the new large screen television in the main lounge and new sensory room. We were also impressed with the new vegetable patch in the back garden. The one service user who returned our surveys told us the home is always kept fresh and clean. It was noted at the services last random inspection carried out in March 2009 that the new manager had initiated a comprehensive programme to entirely redecorate and refurbish 55, Beulah Road. The new cosier layout of the lounge and the introduction of two new sofas and a dining room table in this area makes the homes main communal Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: space look and feel more homely and inviting. The kitchen has also been totally refitted with new storage units, worktops, and equipment installed. All the communal areas and two vacant bedrooms were also redecorated and new carpet fitted in the hallway. The manager has also adopted a more proactive approach to maintaining the fabric of the building, which she does by compiling an annual report of all the things that need doing to the environment before it becomes an issue. This report is then submitted to CMGs maintenance team for them to consider the plan and implement it. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have safe and appropriate support as there are enough suitably competent and qualified staff on duty at all times. Peoples needs are also met because staff get all the training they need to carry out their duties effectively, although there remains scope to improve the services annual staff appraisal arrangements. Evidence: All the staff on duty during this inspection were observed interacting with all the people who use the service in a very caring, respectful, and professional manner. One individual who returned our survey told us - staff always treated them well and listened and acted upon what they said. The manager told us that as an interim measure while the service has two vacant bedrooms and one service user in hospital staffing arrangements at night have been temporarily changed, although two staff continue to remain on the premises. One person who uses the service told us - there was always lots of staff about, and two members of staff who completed our surveys wrote - there are always enough staff on duty to meet the needs of all the people who use the service. The manager assured us Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: that staffing levels would be reviewed as soon as the service starts running at full capacity again. The age, gender, and ethnic mix of the current staff team is a relatively good match when compared with the service user group. The manager told that she would remain mindful of the diverse age ranges and ethnic mix and this all male service user group when recruiting new staff, which she is currently in the process of doing. Information supplied in the services AQAA tells us that just under a quarter of all the shifts worked there in the past 3 months were covered by temporary bank or agency staff. The manager confirmed that the service was relatively reliant on temporary staff at present because a large number of the permanent staff team had recently been dismissed for gross misconduct. We highly commended the services management team, which includes the homes new acting, deputy and Regional Director, for their zero tolerance approach to poor practise, which will be discussed in greater depth in the Management section of this report (i.e. Outcome group 8). It was evident from the comments made by the relatively new manager and her deputy that they both strongly believe that the recruitment of good quality carers is the cornerstone of delivering good outcomes for the people who use the service. This service has experienced a culture of poor practise in recent years and the new manager told us to prevent a similar situation reoccurring she was determined to only employ the right people who were willing and capable of doing the job they were recruited to perform. The manager demonstrated her commitment to this aim by giving us some good examples of new members of staff not being offered permanent contracts to work at the home because they had not passed their probationary period of employment to the managers satisfaction. AQAA states that all new staff must complete an induction before they commenced working unsupervised with the people who use the service. Two members of staff who returned our surveys told us - their induction had covered everything they needed to know about the service before they started. One member of staff informally interviewed confirmed they had received a thorough induction from senior staff at the home, which they were able to show us documentary evidence of on request. Two members of staff who completed our surveys told us - CMG carried out satisfactory pre-employment checks on them before they started working there, and a member of staff spoken with at length also confirmed this was the case. Typical comments made by staff spoken with about their training included - its very good, CMG provide us with the training i need, and training is very relevant and enables me to meet the residents needs. All the staff who returned our surveys ticked Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: yes to the questions - Is the training you were given relevant to your role, does it help you understand and met the needs of the service users, and keep you up to date with new ways of working. The manager told us she has carried out an assessment of all her staff teams training strengths and needs, which she was able to produce on request. The manager confirmed that as stated on this training matrix sufficient numbers of staff had received fire safety, moving and handling, basic food hygiene, first aid, safeguarding adults, medication, infection control, person care planning , and understanding sexuality. Furthermore, 100 of the current staff team have either achieved a National Vocational Qualification in care - level 2 or above, or were working towards this aim. The manager also told us that all support workers were now expected to complete E-learning courses on the homes computer. We agree with comments made by the managers that staff would also benefit from attending working with adults with autism and specialist Makaton communication courses. A member of staff met told us they - receive at least one supervision with either the homes manager or the deputy every month. Records were produced by the managers on request that showed us all eight of the homes existing permanent staff team had received at least four supervision sessions with them in the past 6 months. The manager told us that both herself and her deputy had received training from CMG regarding how to conduct staff supervisions. Furthermore, the minutes of staff meetings revealed that these were now also being held on a monthly basis and were well attended by staff. The manager told us if a member staff consistently fails to attend these meetings they will be sent a letter reminding them of their support worker responsibilities to join in these forums. It was positively noted from the minutes of many of these monthly staff supervision sessions and group meetings that a lot of the poor practise issues the new management team had identified in the past year were openly discussed at these forums as a means of stamping them out. Once again the services relatively new management team are highly commended for their proactive approach in dealing with poor practise issues. The manager told us none of her current staff teams overall performance in the past year has been appraised, but was fully aware of this shortfall and was in the process of making arrangements to rectify it. Progress made to achieve this aim will be assessed at the services next inspection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit from living in a home that is now being extremely well run by a very experienced and competent new management team. The quality assurance systems CMG have in place enables the people who use the service to feel confident their views are listened to and taken into account when raising standards at the home, although the way CMG give stakeholders feedback regarding the results of their input could be improved. Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: As mentioned throughout this report it was evident from comments made by the people who use the service and staff that the relatively new management team at 55, Beulah Road have had a very positive impact on the service in the past 12 months. The services Regional, acting, and deputy managers have a wealth of experience of Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: running residential care services for adults with learning disabilities and as previously mentioned work extremely well together as a team to ensure 55, Beulah is a much better place to live and work than it has been in recent years. The manager told us her line (Regional Director) and deputy managers are extremely supportive of her and are always on hand to offer her advice. Documentary evidence was produced on request that demonstrated the relatively new management team uses all the powers at their disposal, including staff disciplinary procedures, training, one to supervision sessions, group meetings, and staff recruitment - to ensure the home has sufficient numbers of highly competent and motivated staff to effectively meet the needs and wishes of all the people who use the service. The new managers are also much better at delegating tasks amongst the staff team to ensure it continues to be effectively run in their absence. Typical comments made by all the people who use the service and staff about the management team included - they are very approachable, no problems - they are excellent, and its great we (staff) are being given more responsibility to help them run the place. The manager is aware that she needs to have completed her Registered Managers Award to be suitably qualified to run a residential care service, and will also have to re-register with us as the manager of 55, Beulah Road. The manager completed and returned our Annual Quality Assurance Assessment when we asked for it, which tells what the service does well, has improved recently, and plans to do better. This self assessment was comprehensively filled out and demonstrates to us this service continues to move in the right direction under the leadership of the new management team. The positive outcomes of all the monthly Regulation 26 visits in 2009 and a quarterly quality assurance assessments undertaken by senior managers representing CMG reinforces this view. The manager conceded that the results of all the feedback received from the services major stakeholders, which includes the people who live at the home and relatives, was still being assessed. Progress made by CMG to publish the results of there internal audit of stakeholder views will be assessed at its next inspection. The manager told us she had received from very positive feedback from the homes neighbours about all the improvements they had noticed at the home in the past year. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis and that three fire drills have been undertaken since September 2008, which involved all the services day and night staff. A member of staff told us they had been involved in at least one fire drill within the first 3 months of commencing work at the home and where very clear what they need to do in the vent of the fire alarm being activated. No fire safety issues were identified in the homes last local fire Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: authority inspection report. The temperature of hot water emanating from a ground floor bath was found to be a safe 43 degrees Celsius when tested at midday. Certificates of worthiness were produced on request to match the information given to us in the AQAA to show us that suitably qualified professionals had tested the following equipment as recommended by the manufacturer or regulatory body; including its gas installations, portable electoral appliances, electrical circuits, fire detection and fire fighting equipment, and heating system for legionella. Care Homes for Adults (18-65 years) Page 30 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 31 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 35 All staff should attend an understanding autism and Makaton training courses. This will ensure all the people who use the service have their communcation and autism needs met. All the people who work at the service should have their overall performance in the past 12 months and their training needs appraised by the manager at least once a year. This will ensure the people who use benefit from being supervised by a suitably competent and well supervised staff team. The person in day to day charge of the service should reregister with us and complete her Registered Manager Award (NVQ4 equivalent). This will ensure the service is run by a suitably fit and qualified manager. The way the service ascertains and then makes the results of all the feedback received from major stakeholders, including the people who use the service and their relatives, should be reviewed. A report regarding the services findings should be made available to all interested parties on an annual basis. 2 36 3 37 4 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: 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 © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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