Care Home: Bromsgrove Road, 5

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What the care home does well People`s care plans are excellent as they are truly person centred with lots of pictures and few words to enable individuals to have choices and control over their lives. People are actively supported to make decisions about their lives on a daily basis. Consideration is given to people`s interests, hobbies, and leisure pursuits when planning activities. The involvement of relatives and families and friends is encouraged by the home. The home has both a complaints policy and an adult protection policy in place. The complaints procedure has been provided in a format that is meaningful to people. Staff are aware of their responsibilities with regards to protecting people from abuse. People are supported in a respectful manner and their personal care needs are met. Staff are knowledgeable about the people who use this service. They have a good understanding of their roles and responsibilities. Staff are knowledgeable and skilled in meeting people`s needs. Training and staff support is given high priority. Staff survey commented on what the home does well, `Has a stable and consistent staff team` and `Regular training in anything required`. People`s accommodation is clean, fresh and with homely touches. The home presents as well managed, with peoples best interests being seen as of paramount importance to both the manager and staff team who continually strive to improve outcomes for people who live in this family home. What the care home could do better: No requirements were made following this inspection. One good practice recommendation was made with another one being repeated from the previous key inspection. These can be found at the end of this report. The AQAA dated tells us that the manager has recognised the areas which they are looking to improve upon in the next twelve months and some of these are:`Person Centered reviews (working with Helen Sanderson Associates).Continue development of inclusive recruitment. Continue to up date the risk assessment needs. We are delivering training around the Mental Capacity Act and embedding it in practice using our MCA best interest`s decision making form. A new kitchen, new lounge furniture, fund raising. Make information as accessible as possible to our ladies, and to work with them in trying to instil a sense of responsibility and ownership for their health actions and plans. Corporately, we plan to develop a facilitator`s pack on positive approaches to supporting people with their personal relationships and sexuality. Work on a `talking complaints` book and make accessible all information on how to complain. With the help and support from my team to improve on the above management systems, to offer best value and best practice for our service users and families, by listening to feed back, monitoring and checking records, positive team meetings, and training`. Random inspection report Care homes for adults (18-65 years) Name: Address: Bromsgrove Road, 5 5 Bromsgrove Road Droitwich Spa Worcestershire WR9 8LR two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Seel Date: 2 9 0 6 2 0 1 0 Information about the care home Name of care home: Address: Bromsgrove Road, 5 5 Bromsgrove Road Droitwich Spa Worcestershire WR9 8LR 01905774263 Telephone number: Fax number: Email address: Provider web address: www.macintyrecharity.org Name of registered provider(s): Name of registered manager (if applicable) Ms Susan Elizabeth Margaret Dubif Type of registration: Number of places registered: Conditions of registration: Category(ies) : MacIntyre Care care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 4 The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 4 Date of last inspection Brief description of the care home 5 Bromsgrove Road is registered to provide residential care for up to 4 adults who have a learning disability, and may accommodate one person with an additional physical disability. The premises is a semi-detached property, situated on the main road on the outskirts of Droitwich Spa, within easy access of the town centre, and Care Homes for Adults (18-65 years) Page 2 of 14 Brief description of the care home various amenities and facilities. The Registered Provider is MacIntyre Care and the registered manager of the home is Susan Dubif. The stated purpose of the organisation is, `to be recommended and respected as the best provider of services for people with learning disabilities throughout the United Kingdom. Information about the home and the level of fees charged for living there can be obtained directly by contacting the manager. Care Homes for Adults (18-65 years) Page 3 of 14 What we found: The purpose of the visit to the home was to complete a random inspection as the last key inspection of the home was undertaken on the 2nd August 2007. Good outcomes for people were reported at this key inspection and this random inspection was to review the standards of care being provided. This is to ensure that the health and welfare of people who live in the home continues to be actively promoted. This random inspection was undertaken by one inspector who visited the home over a half day period with no prior notice being given to the manager or staff at the home. We did not look at all the standards at the time of this random inspection. On the day we visited the home four people were living there. The home provides care and support for people by the reason of a learning disability. Discussions with all the people living at the home were not appropriate on the day we visited due to the short amount of time we spent at the home and being unfamiliar to people who have various communication needs. The care of two people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as case tracking where evidence of the care provided is matched to outcomes for the people using the service. Before the inspection we looked at all the information about the home that is held on file by us such as notifications of accidents, allegations, incidents and complaints. We also sent an Annual Quality Assurance Assessment (AQAA) to the manager to complete. The manager completed and returned the AQAA containing helpful information about the home in time for the inspection. We also received completed survey forms from six staff working at the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. A number of records such as support plans, complaints records, staff recruitment and training information, visits made by the providers representative and staff rotas were looked at. Resident and staff meetings were also sampled for information as part of this inspection. The registered manager was at the home on the day we visited and together with staff members assisted us with this inspection visit. We provided the manager with some feedback at the time of our visit and have summarised below what the home does well together with what they could do better. We have also made one good practice recommendation at the end of this report which should be strongly considered to make sure people who live in this home are continuing to receive good outcomes. The outcome of this inspection visit is as follows:We were not able to look fully at the admission process to make sure that this is followed for all new people who come to live at the home. This is because the people who live in the home have lived there for some time now. However, there is a statement of purpose and service user guide. These are information guides that tell people what it would be like to live at the home, what facilities and services are offered. Care Homes for Adults (18-65 years) Page 4 of 14 The care and support provided to two people who live in the home was focused upon to ensure that individuals are supported and encouraged with meeting their individual goals in relation to their specific needs. Each individual had their own care plan. These plans were clear and held sufficient information to enable staff to meet peoples needs. The manager and staff should be commended for their hard work in producing plans that are easy to follow. Pictures are used extensively in the plans with the use of words limited just as it should be for people who may have some difficulty in reading the written word. Areas included routines, personal care, communication, family contact, making choices, meals, behaviour, health, activities and cultural needs. We saw that each persons plan shows clearly how goals are to be achieved together with what staff actions are required in order to assist the person in their daily lives. We also saw communication plans have been developed. This means that any care planning processes use each persons appropriate communication methods and or aids. We saw care plans are regularly updated and reviewed to make sure that peoples needs are effectively met at all times. Staff that we spoke to had good knowledge of peoples specific needs and how these are met. It is good to hear that sign language (Makaton) is used effectively with people to ensure individuals are able to make their preferences known and have support that best suits them. At the last inspection it was reported that care plans were being developed within a person centred approach. We could see that this is being achieved by various methods, such as, named key workers who are building close relationships with individuals. They are gaining knowledge of peoples preferences and dislikes so that consistency of care is maintained. Also people are able to share any issues and or concerns they may have in the presence of a staff member they feel comfortable with. Key workers help individuals to arrange meetings where people are supported to influence their own care planning. This ensures the focus of care is driven by each person who lives in the home, rather than the needs of the service and the limits to what it can provide. It is a nice touch that staff are working hard to introduce people to daily life skills and help them to face situations that can seem daunting at first. For example, shopping at local small shops and progressing to supermarkets. This not only promotes peoples levels of independence but gives individuals more control over their daily lives which enhances their self esteem. At the last key inspection a requirement was made in relation to risk assessments being completed, kept under review and updated as part of enabling people to develop skills and to promote their independence. In the AQAA it informs us that, Risk assessments are used to help the person to take controlled risks while keeping them safe as per our duty of care. Families are shown these at reviews, or their opinions sought earlier where relevant, and they have the opportunity to see them and comment if they wish. All our risk assessments are reviewed according to the schedule, both individual and staff and general household. We take into account any implications from the mental capacity act when completing risk assessments. We certainly found this to be the case as we sampled some peoples risk assessments. This is one area that has improved since we last inspected the home as risks have been reviewed and updated. We were told that staff have also received training in risk and support planning to help inform their practices so that people in the home are protected from harm but unnecessary restrictions are not forced upon individuals. Staff surveys told us what the home does well:- Care Homes for Adults (18-65 years) Page 5 of 14 Supports the ladies that live here and look at all their needs and how they are changing. Supports the people as individuals. Encourages all service users to become involved and voice their opinion on all things. Work as part of a team and meet all the service users needs as well as parents. Although we did not fully inspect the standards relating to daily life, we saw that positively, peoples life stories are documented with words and photographs. These are used for illustration purposes to bring events and peoples relationships alive. These are important to people as they create talking points, help to celebrate the diversity of individuals and are able to be used to make certain individuals interests are followed to bring meaning to their lives. We saw a range of activities documented in peoples care records to show the lifestyles people are leading. All activities and social stimulation is then reviewed as individuals minds change. The AQAA told us how the home have improved in the last twelve months in reference to meeting peoples social stimulation and interests:E.Learning modules, sharing good proactive practise through, for example, MacIntyre road shows. Individuals are supported to attend local colleges. Movement and games, Jamboree making jams and pickles using local , horse riding. New horizons at Malvern college. Supporting individuals to complete their hobbies, i.e. One lady still likes to draw and colour in, and another still likes to play floor games and use the sensory box. Unfortunately the one individual who loves swimming has had to suspend her subscription for the Gym centre due to a recurring ear infection, but the alternative has been sourced by walking. The individual can not only enjoy the benefits of walking, but her family can benefit when they come to see her every week. This same lady attends movement and games twice a week backing up our change 4 life board which has encourage the ladies to look at healthy eating, living and exercise. One lady has just started a weight watchers scheme via her local G.P. who had concerns about her weight. Three of the individuals still enjoy attending a local weekly Mencap Club which offers a weekly assortment of activities e.g. Bingo, craft, going out to the pub for a meal, painting, going out for day trips. All individuals are encouraged and supported in domestic routines around the house, including their bedrooms. Staff encourage involvement of individuals to participate in choosing their meals, going out shopping, putting the shopping away, and then preparing and cooking meals if they would like to. One lady enjoys assisting staff with the fridge and freezer temperature checks and also enjoys putting together the weekly picture rota. At meal times individuals set the table properly, mats, cutlery, drinks, condiments, and Care Homes for Adults (18-65 years) Page 6 of 14 all meals are set around the individuals needs and comforts. They are not unhurried and the main meal of the day is seen as a wind down of the day and discussion is usually around the individuals day and plans for the evening this still continues, and is a very important part of the ladies day. We have widened our circles of support e.g. community links. Pictorial menus and extending choice have promoted communication and great interactions. A lot of work has gone into developing individual interests, whilst helping those people with a tendency to isolate themselves to become more involved in group activities and learn new social skills as mentioned above. Macintyres internal audit the Big respect to be carried out by MacIntyres Care Practise officer who has autism and is very keen to visit Bromsgrove rd to offer his advice and support he will also be concentrating on great interactions and communication. Entries in peoples health records show that they are being supported to attend health care appointments to monitor and treat diagnosed health needs. Peoples records show that they are being supported to attend routine health appointments such as annual health checks, dental check ups, chiropody support, and eye tests. The management team and staff should be commended on the way they tried to resolve the dilemmas that were apparent when a person had an injury which prevented them from climbing the stairs in the home. We acknowledge this must have been a very difficult time for the person and staff but we saw that intervention plans were very clear in reminding staff to be aware of preserving this persons privacy, dignity and respect at this difficult time. As was reported at the last inspection information is available regarding peoples and their relatives wishes in relation to death and dying which include preferred funeral arrangements. This ensures that peoples preferences are respected and carried through at this important time in their lives. One area that we strongly recommend is improved upon is that of regular weight checks as we saw in one persons care records that they had lost some weight but the last time they were weighed was in February 2010. Although the manager did try to find some more up to date weight records these could not be found on the day we visited. Therefore we made a strong recommendation that people are weighed on a regular basis. This will ensure individuals are not losing or gaining a significant amount of weight that could be an indicator of underlying health needs. The manager assured us that peoples weights would be completed and recorded. We were told that there have been no complaints made in the last twelve months and this is also confirmed in the AQAA together with the complaints log we saw which is kept in the home. We saw that the complaints procedure has the relevant and required information so it was clear how people could make a complaint if they are unhappy with the service provided at the home. People who live in this home would need some support to state their concerns and this has been recognised in the AQAA, All staff are aware of the need to look out for changes in people that indicates there may be a problem. We also liaise with families and day places and ask them to tell us of any concerns that they may have. Also the one to one time that people have with their key workers is Care Homes for Adults (18-65 years) Page 7 of 14 important as individuals are able to have the opportunity of comfortably raising any concerns and or complaints knowing these will be listened to and action is taken appropriately. Also an independent advocate does visit the home so that views can be gathered from people about how they feel the service meets their needs and what improvements could be made. In agreement with the manager at the time of our inspection we have repeated the recommendation made at the last key inspection which is to include a statement in the complaints procedures showing how behavioural indicators of concern are responded to. There have not been any referrals made about matters that could affect the safety and welfare of the people living at the home since the last inspection. Required policies and procedures are provided to promote peoples welfare and protect them which include multi agency procedures for the Protection of Vulnerable Adults (POVA) recognising abuse and whistle blowing. It was noted that staff said they had received training in the protection of vulnerable adults from abuse and the AQAA confirms this is the case together with the staff training planner. Following the last key inspection we saw that there are staff recruitment summaries that are kept in the home and was a recommendation made at the previous key inspection. We looked at a sample of these and found that all the relevant employment checks are in place to ensure that people living in the home are protected from people who are banned from working with vulnerable people. We looked at a sample of staff training profiles and the planner that is used to make certain staff receive mandatory training in a timely way and any refreshers can be planned in advance. The AQAA shows that 7 staff work at the home and five 5 staff are trained to NVQ level 2 or above, and that training provided meets national standards and statutory guidelines. We are aware from looking at a sample of staff training files that mandatory training, such as, infection control, health and safety, medications and first aid are being completed with the required refresher training as needed. The AQAA also informs us that 7 staff have received training in infection control. This makes sure that people can be confident that their needs are met by staff who have the knowledge and skills to do this. We saw that audits are being carried out at the home to ensure the quality of care delivered is monitored for example, Regulation 26 visits. Regulation 26 visits must be carried out at least once a month by a registered provider or another appropriate person of the organisation who is not directly concerned with the conduct of the care home. This is to inspect the premises of the care home, speak with people who live at the home, and with permission their representatives, to form an opinion of the standard of care provided in the care home and prepare a written report on the conduct of the care home. Copies of recent reports of the visits were seen and read informing of improvements that need to be made together with where the service is doing well. The AQAA tells us that the home has made the following changes as a result of listening to people who use their service:Inclusive recruitment, we have introduced wish lists for the recruitment of staff. Holidays, interior decoration and many activities. We have updated our service summary including photos of the service and of the ladies we support with their permission to include in recruitment packs. Further work carried out involving inclusive recruitment this year, we have introduced a competency framework introducing the need and importance of the quality of interactions Care Homes for Adults (18-65 years) Page 8 of 14 when interviewing future staff. Macintyre as an organisation uses trainers for change which is people who use the services helping with staff training, and asking staff to think about how they work from the perspective of those who use the service. We have identified times on the rota which best suit the service users to have individual time, and have planned this so that the less verbal and assertive people have equal opportunities for 1-1 time to spend as they wish. The recently decorated interior of the house has been chosen by the ladies we support. The Great interactions Policy has been introduced and all communication profiles have had a complete make over to individuals needs and to enable staff to communicate with the ladies using their preferred methods of communication. We did not inspect the homes environment at this visit, however we did see that an additional stair rail has been fitted and we were told that a stair lift is being considered. This shows that this service is always considering the future needs of people who live in the home and planning how needs will be met as time goes by. This is important as the home has a challenging environment for people who have limited physical abilities. This is expressed by staff in their surveys:...would benefit from living in a bungalow in the same town. More space for the ladies i.e. bathrooms, bedrooms, garden. The staff work well within the limits of their surroundings. We could see that the home was welcoming with homely touches. We also saw that it was clean and there were no malodours on the day we visited. The AQAA tells us Home is clean, warm, well lit and pleasant. Area Manager monthly visits monitor the house and environment we have recently redecorated the lounge and the ladies were fully involved in the choice of decor. The garden has some raised beds we work with the ladies to include sensory items in the garden. Contractors have cleared the garden of brambles and weeds, sheeting was laid and covered with stone to make the garden more manageable. Plants and the painting of the decking added character and brightness to the garden area. We certainly found this to be the case as we did see the garden area and lounge. Accident and incident records are kept and notified appropriately to the Commission and relevant other agencies. These are some of the things staff surveys told us what the home could do better:The physical surroundings are not ideal for the people we support. More hours for the ladies needs. Better communication between staff. We saw that staff meetings are taking place where staff are able to share any concerns Care Homes for Adults (18-65 years) Page 9 of 14 and or complaints they have within a collective forum if they wish. These processes enable staff to share any issues they may have to ensure that the home is run in the best interests of people who live there. What the care home does well: What they could do better: No requirements were made following this inspection. One good practice recommendation was made with another one being repeated from the previous key inspection. These can be found at the end of this report. The AQAA dated tells us that the manager has recognised the areas which they are looking to improve upon in the next twelve months and some of these are:Person Centered reviews (working with Helen Sanderson Associates). Care Homes for Adults (18-65 years) Page 10 of 14 Continue development of inclusive recruitment. Continue to up date the risk assessment needs. We are delivering training around the Mental Capacity Act and embedding it in practice using our MCA best interests decision making form. A new kitchen, new lounge furniture, fund raising. Make information as accessible as possible to our ladies, and to work with them in trying to instil a sense of responsibility and ownership for their health actions and plans. Corporately, we plan to develop a facilitators pack on positive approaches to supporting people with their personal relationships and sexuality. Work on a talking complaints book and make accessible all information on how to complain. With the help and support from my team to improve on the above management systems, to offer best value and best practice for our service users and families, by listening to feed back, monitoring and checking records, positive team meetings, and training. 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 2. Care Homes for Adults (18-65 years) Page 11 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 12 of 14 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, 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 19 The recording of individuals weights needs to be completed in a consistent manner so that any losses and or gains in a persons weight is identified in a timely manner to make sure there are no underlying medical conditions which would otherwise go undetected. Consideration should be given to including a statement in the complaints procedure, showing how behavioural indicators of concern are responded to. 2 22 Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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