Care Home: Carwood Residential Home

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What the care home does well Information about the home is readily available to people at Carwood, and there are easy to read copies. Checks on what people need or want are carried out by staff on a regular basis, this to ensure their individual plans are accurate and tell staff about how best to support them.People living at the home aresupported by a staff team that they say they can talk to, ask them what they want and who listen to them when they need some help and support.Staff knows the people they support well, this helping them pick up on non verbal communication.Staff show people living at the home respect and maintain their privacy and dignity.People who are ill receive very good support and access to health care is prompt, appropriate and in accordance with individual wishes.The home has established systems in place to monitor how well the service runs, and people living at the home are very involved in contributing to this.The home has a robust system for the protection of people living at the home, and concerns or complaints are dealt with promptly. What has improved since the last inspection? The home has continued to develop its approach to person centered planning with the input of dedicated staff based outside the home.The home has retained Shropshire`s Healthy Eating Gold award (assessment of healthy food choices, smoke free facilities, compliance with Food safety and staff training). The home has maintained staff training that ensures staff are skilled and have the appropriate knowledge of individual`s needs. The home is recruiting more casual staff that are familiar with the home and the people that live there. What the care home could do better: HOTCOLDThe home needs to ensure that any issues with the temperature within the building are resolved so that areas are not too hot or cold.People living at the home would like to have more spontaneous access to community activities, and some would like to be more involved in maintaining their rooms.SPACE?People living at the home tell us they would like additional communal space so they can meet with people in private without use of lounges or bedrooms. Additional space for sensory room would also be appropriate.It would be helpful to have a pharmacist review the homes management of medication to support the homes own medication checking system. Key inspection report Care homes for adults (18-65 years) Name: Address: Carwood Residential Home 16 Carwood Stirchley TELFORD Shropshire TF3 1YA The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jonathan Potts Date: 2 3 1 2 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Carwood Residential Home 16 Carwood Stirchley TELFORD Shropshire TF3 1YA 01952381490 01952 381490 paul.shirley@telford.gov.uk Telford & Wrekin.gov.uk 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) : Telford & Wrekin Council care home 13 Number of places (if applicable): Under 65 Over 65 13 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 13 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) 13 Date of last inspection 1 9 1 0 2 0 0 6 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 36 16 Carwood is a care home registered to p r ov i d e a c c o m m o d a t i o n and personal care to a maximum of 13 adults with a learning disability (of either gender). CLOSE TO The home is situated in S t i r c h l e y, n e a r Te l f o r d town centre and the facilities this offers such as access to shops, leisure facilities, t ra n s p o r t a n d r e l e va n t support services. The home is owned and m a n a g e d b y Te l f o r d a n d Wr e k i n C o u n c i l . M r. Pa u l S h i r l e y i s t h e Re g i s t e r e d M a n a g e r a n d is supported by a team o f s t a f f. Carwood comprises of f i ve f l a t s a c r o s s t w o floors. The home has a passenger life and each flat has its own lockable f r o n t d o o r. E a c h f l a t has a number of single bedrooms with toilet Care Homes for Adults (18-65 years) Page 5 of 36 a n d wa s h i n g f a c i l i t i e s , a kitchen/dining room, a lounge, laundry room and a bathroom. There a r e a d a p t a t i o n s f o r a ny people living at the h o m e w h o h a ve a p hy s i c a l d i s a b i l i t y. The home aims to p r ov i d e s u p p o r t t o people with a learning d i s a b i l i t y, b a s e d o n individual needs as identified through checks and consultation. The home also aims to support p e o p l e t o h av e i nvo l ve m e n t i n t h e l o c a l C o m m u n i t y. Information about the h o m e i s ava i l a b l e i n books about Carwood t h a t a r e ava i l a b l e o n site. This states that fees (based on the contribution people h ave t o m a ke w h e n receiving benefits) ra n g e f r o m 6 3 . 9 5 pounds to 98.60 pounds a week. Care Homes for Adults (18-65 years) Page 6 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home Our surprise visit to Carwood Flats was carried out over one day, and followed review of all the information we have received about the service over the 12 months since the last main inspection. This included information sent to us every year by the manager Paul Shirley and information from different organizations. We have checked the homes performance against key standards and looked at outcomes for people living at the home. This was carried out by us talking to 4 people using the service, and asking staff about these peoples needs. We also looked at care plans, medical records and daily notes for 3 people living at the home. Taking Part, an independent advocacy organization also provided f e e d b a c k f r o m p e o p l e l i v i ng a t the home, this based on our survey forms. Care Homes for Adults (18-65 years) Page 8 of 36 ABOUT CARWOOD We also looked at the building, a number of management records and talked to management. We also received some completed survey forms, 3 from people living at the home, 1 from a relative and 4 from health and social care professionals who visit. What the care home does well Information about the home is readily available to people at Carwood, and there are easy to read copies. Checks on what people need or want are carried out by staff on a regular basis, this to ensure their individual plans are accurate and tell staff about how best to support them. People living at the home are Care Homes for Adults (18-65 years) Page 9 of 36 supported by a staff team that they say they can talk to, ask them what they want and who listen to them when they need some help and support. Staff knows the people they support well, this helping them pick up on non verbal communication. Staff show people living at the home respect and maintain their privacy and dignity. People who are ill receive very good support and access to health care is prompt, appropriate and in accordance with individual wishes. Care Homes for Adults (18-65 years) Page 10 of 36 The home has established systems in place to monitor how well the service runs, and people living at the home are very involved in contributing to this. The home has a robust system for the protection of people living at the home, and concerns or complaints are dealt with promptly. What has got better from the last inspection The home has continued to develop its approach to person centered planning with the input of dedicated staff based outside the home. Care Homes for Adults (18-65 years) Page 11 of 36 The home has retained Shropshires Healthy Eating Gold award (assessment of healthy food choices, smoke free facilities, compliance with Food safety and staff training). The home has maintained staff training that ensures staff are skilled and have the appropriate knowledge of individuals needs. The home is recruiting more casual staff that are familiar with the home and the people that live there. What the care home could do better HOT COLD The home needs to ensure that any issues with the temperature within the building are resolved so that areas are not too hot or cold. Care Homes for Adults (18-65 years) Page 12 of 36 People living at the home would like to have more spontaneous access to community activities, and some would like to be more involved in maintaining their rooms. SPACE? People living at the home tell us they would like additional communal space so they can meet with people in private without use of lounges or bedrooms. Additional space for sensory room would also be appropriate. It would be helpful to have a pharmacist review the homes management of medication to support the homes own medication checking system. Care Homes for Adults (18-65 years) Page 13 of 36 If you want to read the full report of our inspection please ask the person in charge of the care home Mr. Paul Shirley If you want to speak to the inspector please contact Jonathan Potts Inspection West Midlands Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 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 14 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient information available at the home, and the pre admission checks for people looking to move in are sufficient detailed and robust, so as to ensure Carwood can met their individual needs successfully. Evidence: We saw at the time we visited the home that a book that tells people who the service is for (statement of purpose)and one as to how the service works (service users guide) was readily available in a communal area of the home. These books contained a range of relevant information that would tell individuals about Carwood and the service it offered. The service users guide was available in an easy read format so as to make the information within it more accessible to individuals. The manager also told us about how staff are developing information that can be made available through a DVD. There have been no recent admissions to Carwood. We therefore looked at the home procedures in respect of admission, this covering how the home makes a decision about Carwoods suitability for an individuals needs, and the as to how they are introduced to the home. It was clear that any referrals to the home are through Social Services as private referrals would not be accepted. The manager told us that a copy of the homes Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: statement of purpose and service users guide would be made available to people at the point of their first visit to the home, this then leading to an individual spending time at Carwood in the form of short visits leading up to an overnight stay, this we were told dependent the individuals needs and wishes. The manager also told us that the social workers assessment would be used, in conjunction with the homes own to make a decision as to whether the individuals needs could be met successfully at Carwood. The manager also stated that an individuals satisfaction would be reviewed during and after any admission, and where there was a need they would look to involve independent advocates to help and support the individual. We saw that the homes admissions procedure reflected what the manager told us, although the manager did provide additional information as to how he would ensure the admission process went as smoothly as possible for the individual concerned. Our decision from the last main inspection of Carwood, where we did look at current evidence related to a recent admission showed us that pre admission checks were robust. Evidence we have heard and seen does show that this is still the case. We heard that following Carwoods refurbishment individuals that live there were involved in such as choosing how their rooms were decorated and furnished, this based on comments that they made to an independent advocacy agency. Care Homes for Adults (18-65 years) Page 17 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Easy to read individual care and support plans enable staff to offer people living at the home choices that assist with decision making, as well as delivering support that people want. Evidence: We looked at three peoples individual care plans (which we saw are supplemented by easy read versions) and found that the information within these was detailed and reflected individuals needs as outlined in regular reviews and checks, this in place in all three instances. The individual plans are also well supported by checks of any risk centered on areas of significance for the individual concerned. The plans are also supported by reactive management plans that detail how staff should respond to any behaviors. We saw that there are some minor recording issues where some tick boxes are not completed or records signed, although discussion with the manager showed he was well aware of this and had plans in place to introduce a detailed auditing tool (as shown to us) that would easily pick up on these issues and also provide useful evidence for the homes Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: quality monitoring. We spoke to two individuals living at the home about their plans and what they told us confirmed that the plans matched their needs and reflected what was important to them. They also told us, or we observed in some instances, that the areas of risk identified are appropriate and detail how these risks can be minimized without compromising independence and choice. Observation of a member of staff whilst with a person living at the home also showed that they provided support that matched the detail in one plan, and we heard comment from one staff member that they felt the plans are easy to understand, this very useful. A summary of comments we received from people living at the home through an advocacy agency (Taking Part) included the following: Staff know the residents they support well and can look out for non verbal signs of communication that will help tell the staff what the residents are trying to communicate. They maintain service user’s respect and dignity by asking to be invited in residents room and personal care areas. Staff know the residents well and are aware of their needs, as they have a good relationship with staff Many of the service users have difficulty with verbal communication; however they are encouraged to make choices and are able to make staff aware of their likes and dislikes. Residents felt that staff will ask them what they want and that staff listen to them when they need some help and support. Care Homes for Adults (18-65 years) Page 19 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes individuals inclusion in a full and active lifestyle of their choice although staffing arrangements have compromised the spontaneity of community activities at times. Peoples contact with their family and/or friends is promoted. Arrangements for meal provision reflect the choices of people living at the home. Evidence: We saw from the care plans we looked at that these are person centered in that they explore those issues that are important for the people they relate to, and are supplemented by information in appropriate formats. These form a base line for staff to explore what peoples aspirations, preferences and goals are in partnership with the individual to whom they relate. This supported the managers statement to us that person centered plans aim to meet the lifestyle needs of people at the home wherever possible. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: We saw in the 3 sets of individuals records we looked at that there are activity plans in place, and detail as to the individuals chosen preferences in respect of daily routines, gender of carer and activities. Records of stimulation and activity that these individuals participate in reflected their choices as recorded in their care plans. We spoke to 2 people who live at the home and they confirmed that the information recorded in their care plan was accurate and that they are involved in activities of their choice, these including occupational (day centres/college) and leisure (discos, trips out) . Two people we spoke to told us that they are involved in domestic tasks around the home, this including laundry, dusting and washing up as well as some food preparation, although one person said to us that they would like more support in learning skills such as cooking and have more involvement in domestic routines. Activities on weekends vary depending on individuals choice with some people using this time to visit family and friends. Comments from people living at the home via an advocacy agency (Taking Part) did state that Evening activities can be restrictive as they have to be planned in advance because there is not enough staff to provide 1:1 support. Residents are supported by staff to plan their weekends and holidays. It is important that these activities are planned in advance because of the individuals needs. Based on this it was felt that the residents would benefit from higher staffing levels, to improve and enable service users to have more choice and control in what they do. These issues are matters the manager was fully aware of and he stated in the information he sent to us before out visit that he was looking at the recruitment of casual staff who could compliment the permanent staff. He was aware of the need for finance as a key issue in improving and maintaining staffing levels, and in discussion with us raised some ideas that showed he was looking at using limited resources creatively. People told us that continued contact with family and Friends is supported and people told Taking Part that staff encourage and support residents to keep in contact with family if they chose to. One relative also commented in writing to us that The staff and management are always helpful and we cannot thank them enough for the care and understanding they have always shown us. Each flat in the house has a separate kitchen area and menus reflect the choice of the people living in the flat. This approach allows more flexibility in providing meals that are in keeping with individual choice, and some people living at the home are involved in the shopping for the homes food stocks. We saw that the staff have recorded what people’s likes and dislikes are as to food choices and we saw that records of meals taken reflected these choices in the 3 individuals files we looked at. We saw that where people need support with diet there are clear eating and drinking plans in place to support and assist with people having a safe and varied diet. We saw that directions for the preparation of food, to limit the risk from choking are readily available to all staff who may need them. We saw certification to evidence that the home has achieved Shropshires Healthy Eating Gold award (assessment of healthy food choices, smoke free facilities, compliance with Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: Food safety and staff training). The home also has a 5 star rating for Food Hygiene from Environmental Health. Care Homes for Adults (18-65 years) Page 22 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported with personal care that considers their preferences. Access to health care is readily promoted by staff in accordance with individual choices. Evidence: Feedback we received from Taking Part from discussions they have had with people living at the home indicate they have good relationships with the staff at Carwood. This was reflected by the positive interaction we saw between staff and individuals living at the home during our visit. We also saw from observation and discussion with staff that they are aware of peoples preferences (as detailed in support plans), and we saw this put into practice from observation of staff, with consideration given to such as provision to the gender of the carer so that this reflects individuals preferences. Based on the care and support plans that we looked at, we saw that these are detailed and outline the personal support/care and health care needs of the individuals that they relate to. They clearly outline what support people receive from health care professionals, with recording showing that access to these people is timely and appropriate, or as needed based on individual choice. We saw that the home is responsive to changes in health care needs as we saw was the case for one person who was unwell, with the Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: support provided by staff appropriate and responsive to their needs at the time. Where people chose not to receive a service we found that this choice was clearly documented. Comments we received from health professionals that support the individuals living at Carwood include the following: Any difficulties or concerns about clients health has arranged staff meetings to discuss new care plans or any other concerns they may have about individual clients which has worked well. They are very attentive to their clients needs. They will seek medical review in a timely and appropriate manner. They look after their clients with respect and compassion. I think they all do a fantastic job and provide a marvelous service for their clients. Likes to train staff well to support residents. Checks constantly that support is appropriate We saw that people are weighed on a regular basis and this helps to ensure that their health is maintained. Use of body mass indicators would as a prompt regarding weight loss or obesity. We reviewed medication arrangements as part of the inspection. We looked at the how medication was stored and recorded in 3 of the flats and found that records are well documented, with suitable storage on an individual basis, this in peoples bedrooms. This means that the staff that give the medication only handle one persons at any one given time. We confirmed with some people living at the home that they are happy with the arrangements in place for management of their medication. We saw that there is a robust checking system in place, where the manager or a senior checks medication arrangements on a regular basis, with any possible improvements clearly recorded and actioned. Where there have been any medication errors the manager has notified us of these and also taken every possible action to ensure that they do not happen again. We did however suggest to the manager that a check on the homes systems for medication management by a pharmacist may be useful and support the checks that are carried out in house. Care Homes for Adults (18-65 years) Page 24 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have access to an effective complaints procedure, and are protected by robust safeguarding procedures that staff follow so as to keep people safe. Evidence: We saw that the home has a clear complaints procedure that is on display within Carwood, and is supported by easy read formats. People living at the home told advocates recently that if they had concerns they would speak to staff or the manager which reflected comments that those people we spoke to made. People also told us that staff do listen to what they say. We heard that some people understood that they are able to speak to the advocates from Taking Part should they wish to, these advocates having an on going involvement with the service to support people living there. Complaints or concerns we saw are well documented when received at the service, this in the blue book. This showed us that any issues that arise are well documented and any actions, investigations undertaken are fully recorded. Any issues that have arisen we saw have been constructively resolved. The home has a robust safeguarding procedure that was readily available in the home, this supported by pictorial information that people living at the home are able to access. We have seen from the homes practice since the time of the last main inspection that any issues related to protection are promptly referred to the Telford and Wrekins safeguarding team. We have also seen that the manager is proactive in assisting with any Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: investigation or meetings that may occur as a result. We discussed safeguarding with some of the staff who showed a good awareness of what they should do if they had concerns and who they should report this to. Staff are well trained in this area and this ensures that people living in the home are well protected. Discussion with the manager showed that he had a good understanding of what a deprivation of liberty was, and if issues in respect of such should arise what steps to take to ensure that these are managed appropriately. This protects the rights of people living at the home. We also saw that detailed low arousal plans relating to possible challenging behavior are in place, and staff understand these. The majority of staff have also received training in responding to challenging behavior. We saw that the home has robust procedures in place that make it clear to staff how peoples money and valuables should be managed safely, with recording of the same seen to be of a good standard and accurate. These records are mostly verified by two signatures, although there was the odd occasion where we noted there was only one. There are however regular checks by management and we saw receipts are available to verify any expenditure. Care Homes for Adults (18-65 years) Page 26 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Carwood is clean and well maintained providing people with a safe and homely environment although the temperature has not always met with peoples preferences. People living at the home would like to see additional meeting/ communal rooms although the design of the house does support small groups with privacy in terms of their living arrangements. Evidence: The homes statement of purpose accurately describes Carwood as comprising of five self contained flats all which have their own kitchen, dining and lounge area. All flats also have their own bathroom with single bedrooms having en suites (this including a toilet sink and shower). These flats are accessed via their own front door, with small groups of people sharing them. We observed that people can bring in personal possessions and decorate their bedrooms as they wish. We also saw that where able people living at the home hold keys to their rooms and flats (this subject to checks where there maybe risk issues). We sampled the checks that the home carries out on the equipment and saw that hoists are serviced regularly to ensure that people are kept safe. We also saw that the house was clean and there was no unpleasant odours noted at any point during the course of our visit to the home, this confirming what people living at the home told us. People did Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: however tell us and Taking Part that they would like more involvement in maintaining their own rooms. Issues with floor coverings at the time of the last main inspection have been addressed, with the fitting of easier to clean and attractive flooring. The homes quality checking system has identified that there is a lack of private space for people to meet with visitors or have meetings without restricting the communal areas or using peoples bedrooms (this the case at the time of our last main inspection). This still remains an issue as people told Taking Part that a common room would be good for social gatherings such as birthdays and Christmas parties. A white room or sensory room would also be beneficial for service users to have some sensory stimulation and would also encourage staff to support service users to do more activities whilst they are at home. The homes review of security arrangements has led to the installation of CCTV around the exterior of the building. We noted at the time of the visit that staff have been monitoring the temperature of the building and when we spoke to some of the people living at the home they told us that areas of the home are not very warm at times. We saw that one person had two duvets on their bed and there was additional heating available to supplement the central heating in areas. The manager had also told us that he had recent concerns with the heating (since the weather had become alot colder) and arrangements made later in the day led to the heating been switched on constantly until an engineer (who was called on the day) could resolve the issue. We did note that there are regular checks on water temperatures by the staff, and we did not note any concerns as to people having access to overly hot water, as has been the case at the time of our last main check on the home. Care Homes for Adults (18-65 years) Page 28 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite some staffing issues that may have impacted on spontaneous community activity for people living at the home, they do have access to a staff team that is competent and well trained. Robust procedures also ensure that the staff that work at the home are safe to work with vulnerable people. Evidence: Records of staff working patterns and discussions with the manager showed that due to sickness and staff vacancies agency staff have been employed recently. People living at the home told us that staffing levels can affect their ability to take part in spontaneous community activities particularly at weekends. In addition a visiting professional said that Whenever I visit it always seems they are stretched in terms of manpower. The manager has robust plans to stabilize the team and provide consistency. He has started to recruit casual staff who know the home and the people living there. He has also produced an informative induction plan for agency staff and uses the same people from the agency wherever possible. We looked at some staff files, although not all recruitment records are held at the home. The manager did however have a good understanding of what needed to be done to ensure that appropriate staff are employed. This was confirmed by staff we spoke to. The manager also told us that some of the people living at the home are involved in staff Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: recruitment, this confirmed by some of the individuals we spoke to. Taking Part also told us that people said to them that before a new member of staff starts work they are introduced to them first. Staff we spoke to said that they felt well supported by managers and had frequent supervision. Supervision records showed that regular sessions take place. The frequency of staff meetings has slipped a little during the later half of last year, although these have still taken place about 2 - 3 monthly. The manager stated that increased stability in the staff team would see a return to monthly meetings. We did however see that there are robust systems in place for communication between staff on a day to day basis including reports, hand overs and diaries. We looked at the homes training plan for staff and found this detailed and informative. It clearly shows the core training that the management expect staff to have and the manager identifies core training so that this is delivered as a priority, although control of this process is through corporate bodies. From sight of the training plan we did see that the majority of staff have received mandatory/core training. We also saw that the home has a commitment to training staff in vocational qualifications (NVQ in care) with a good proportion of staff holding, or working toward their level 2 or 3 qualification. A visiting professional commented to the fact that the manager Likes to train staff well to support residents. Checks constantly that support is appropriate. Discussion with staff about the training they held confirmed the accuracy of the training plan we saw. We looked at the induction training for new staff and found that this is robust and discussion with a member of staff that had recently started at the home confirmed that they are completing this induction, which we saw meets expected national standards. Care Homes for Adults (18-65 years) Page 30 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and well being of people living at the home is promoted through effective management. Evidence: We saw that the homes certificate of registration was on display in the home for all to see, and that the service provided reflects what the home is registered for, and what it says it will do in its books about Carwood. From reading the information the registered manager, Paul Shirley sent us before our visit, and from discussion with him during our visit, it is evident that he is very knowledgeable about the service and the individual needs of the people living there. The people who live at the home and the staff spoke highly of him. This reflects the extensive experience that he has as a manager, and the qualifications he has achieved. Our discussion with him showed he had a commitment to promoting peoples diversity (in accordance with the homes policies) and their involvement in the decision making process. He also promoted the use of Taking Part, an independent advocacy agency in collating comments from people living at the home to inform this main inspection of the home. We also saw that Taking Part play a part in informing the management of issues Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: that are of importance on an on going basis through annual meetings. The manager meets with them to formulate an action plan in respect of issues raised and to feedback on actions taken. The manager was very clear about barriers to improvement and in discussion has identified inventive ways of tackling these. One of the main barriers that hamper the service are a result of the current financial climate and budgetary pressures due to such as increasing utility costs, these impacting on the money available to fund other areas of the service. The manager is supported with looking at such issues by a business manager (whom we met at the time of our visit) that has recently become involved with Carwood. The former builds on the quality checks that the home has in place, with numerous forms of audit that inform the management of the home. We saw and heard that the manager is not complacent and is constantly looking at ways in which these systems and consultation with users of the service can be improved. We have been told that there are regular meetings for people living at the home, although these are not currently documented which would be useful for keeping a record of consultation, issues that may arise and so on. We did receive some comment from a visiting professional that communication could be better at times. The manager did however make us aware of one occasion where he identified in information he sent us that there had been some misunderstanding between the home and health professionals. The manager told us that documentation is now in place to avoid a repeat of this issue. Other visiting health professionals told us that Carwood is a well run service and that I think they all do a fantastic job and provide a marvelous service for their clients. We saw that health and safety checks are carried out as appropriate and on a regular basis. The home had achieved a corporate health and safety award at the time of the last main inspection, and we saw systems in place that ensured safety standards are maintained. These systems we saw are supported by robust checks on risk factors within the home. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 11 To look at how people living in the home can have more involvement in maintaining their bedrooms if this is their wish. To adopt the use of a B.M.I. (Body Mass Indicator) rating when weighing people so as to provider an indicator of weight loss or obesity outside of what is considered normal healthy ranges. To explore the possibility of an audit of the homes medication systems by a pharmacist to support the current medication checking systems. To continue monitoring the temperatures of the home to ensure that any issues with temperature fluctuations are resolved. More space should be available to allow people living at the home to meet with friends and family in private without use of existing Page 34 of 36 2 19 3 20 4 24 5 28 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations communal space or bedrooms. Provision of such as a white room for sensory stimulation should also be considered. 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