Care Home: Charles House

Similar services:

• 10 Whitfield Avenue
• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street

What the care home does well There are systems so that people’s needs would be assessed before they moved into the home, so that they know the home could meet their needs.Staff support people well with their personal care to help them to feel comfortable and good about themselves.People who live at the home all have their own bedrooms that contain their personal things.People have regular health checks to help them to stay healthy.Some staff have been employed by the home for a long time. This means that people know the staff who willbe helping them in meeting their needs.Most staff have a qualification in care so they should have the skills and knowledge they need to meet the needs of the people living there. What has improved since the last inspection? Risk assessments have been completed where needed to help ensure people are not at risk of being hurt.Monitoring of people’s health has improved so that people get the care they need to stay healthy.Guidelines about the medication people sometimes need have been reviewed to make sure staff have up to date information about when to give it.The complaints procedure has been reviewed to help people know who to speak to if they are unhappy about something.A book is available in the home to record any complaints received so that these can be monitored.Procedures to keep people safe from the risk of abuse have improved so that people can feel safe.The home has a fire risk assessment to help make sure the risk of a fire happening is reduced. What the care home could do better: People`s care plans and risk assessments need further development to make sure people get the care they need in the way they prefer.The home needs to make sure that the activities on offer to people are meeting their expectations.Records of food provided to people at the home need to be more detailed so that staff can make sure people are having a healthy diet.Medication procedures need to improve to make sure people get the medication they need safely.The home needs to make sure that there are good systems in place for people with communication difficulties to let people know if they are unhappy.New heating needs to be fitted in the conservatory so that it is not too cold for people.Infection control procedures need to improve so that people are not put at risk of being ill from infections.An assessment of the home is needed to make sure it meets people’s mobility needs.Make sure staff get the training they need to help them to meet peoples needs.The manager must apply to us to be registered to manage the home. So that people can be sure they have the right skills and experience to manage the home.The home needs to make sure that the windows are all safe for people to use. Key inspection report Care homes for adults (18-65 years) Name: Address: Charles House 257 Birchfield Road Perry Barr Birmingham West Midlands B20 3DG The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter Date: 0 7 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 42 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 42 Information about the care home Name of care home: Address: Charles House 257 Birchfield Road Perry Barr Birmingham West Midlands B20 3DG 01213314972 01213314972 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) : Not known Alphonsus Homes care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 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) 10 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home The home provides care for up to ten people who have a learning disability. The house is in the Perry Barr area of Birmingham. It is on a main road. At the front of the house is a small, neat garden and limited parking. To the rear of the property is a private garden with flowerbeds, lawn and patio areas. Each person has a single bedroom, and these are on all three floors of the home. One bedroom on the ground floor has its own shower room. There are either bathroom or shower and toilet facilities on all floors. Care Homes for Adults (18-65 years) Page 5 of 42 There is no lift facility in the home, so people living there should have good mobility and be able to manage stairs. On the ground floor is a large lounge, which leads into the conservatory. There is also a dining room, giving access to the kitchen. The home is close to local bus routes and shops. Copies of our reports are available in the home. Care Homes for Adults (18-65 years) Page 6 of 42 The service user guide says that it costs between £1000 to £1400 per week to live there. Care Homes for Adults (18-65 years) Page 7 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Care Homes for Adults (18-65 years) Page 8 of 42 How we did our inspection: This is what the inspector did when they were at the care home This inspection was carried out by one inspector over one day. The home did not know we were going to visit. This was the homes second key inspection for the inspection year 2009 to 2010. The manager sent us information about the home before our last visit, this is called an AQAA. We met with people who live at the home but due to their communication difficulties most were not able to tell us what they thought of the home. We therefore asked staff about their needs. Care Homes for Adults (18-65 years) Page 9 of 42 We looked at the care plans, health records and daily notes for three people. This is called case tracking. We also looked at staff and health and safety records. We looked at some areas of the home to include some peoples bedrooms. We did not send surveys to people before this inspection as we had sent them to people before our first visit to the home. What the care home does well Care Homes for Adults (18-65 years) Page 10 of 42 There are systems so that people’s needs would be assessed before they moved into the home, so that they know the home could meet their needs. Staff support people well with their personal care to help them to feel comfortable and good about themselves. People who live at the home all have their own bedrooms that contain their personal things. People have regular health checks to help them to stay healthy. Some staff have been employed by the home for a long time. This means that people know the staff who will Care Homes for Adults (18-65 years) Page 11 of 42 be helping them in meeting their needs. Most staff have a qualification in care so they should have the skills and knowledge they need to meet the needs of the people living there. What has got better from the last inspection Risk assessments have been completed where needed to help ensure people are not at risk of being hurt. Monitoring of people’s health has improved so that people get the care they need to stay healthy. Care Homes for Adults (18-65 years) Page 12 of 42 Guidelines about the medication people sometimes need have been reviewed to make sure staff have up to date information about when to give it. The complaints procedure has been reviewed to help people know who to speak to if they are unhappy about something. A book is available in the home to record any complaints received so that these can be monitored. Procedures to keep people safe from the risk of abuse have improved so that people can feel safe. Care Homes for Adults (18-65 years) Page 13 of 42 The home has a fire risk assessment to help make sure the risk of a fire happening is reduced. What the care home could do better Peoples care plans and risk assessments need further development to make sure people get the care they need in the way they prefer. Care Homes for Adults (18-65 years) Page 14 of 42 The home needs to make sure that the activities on offer to people are meeting their expectations. Records of food provided to people at the home need to be more detailed so that staff can make sure people are having a healthy diet. Medication procedures need to improve to make sure people get the medication they need safely. Care Homes for Adults (18-65 years) Page 15 of 42 The home needs to make sure that there are good systems in place for people with communication difficulties to let people know if they are unhappy. New heating needs to be fitted in the conservatory so that it is not too cold for people. Infection control procedures need to improve so that people are not put at risk of being ill from infections. An assessment of the home is needed to make sure it meets people’s mobility needs. Care Homes for Adults (18-65 years) Page 16 of 42 Make sure staff get the training they need to help them to meet peoples needs. The manager must apply to us to be registered to manage the home. So that people can be sure they have the right skills and experience to manage the home. The home needs to make sure that the windows are all safe for people to use. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 17 of 42 If you want to speak to the inspector please contact Kerry Coulter West Midlands Region Citygate Gallowgate Newcaste Upon Tyne Ne1 4PA Tel 0300 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 18 of 42 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 19 of 42 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. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. Before people move in their needs are assessed so they know that their needs can be met there. Evidence: People have access to a service user guide that tells them about the home. The guide includes pictures making it easier for people to understand. Information about fees is included so that people know how much it costs to live there. The homes Annual Quality Assurance Assessment told us that it is intended to also provide the guide in an audio format. Since the guide was last reviewed a new manager has started at the home. At the last key inspection we recommended that the guide needed to be updated to reflect this. The manager told us that he intended to update the guide but had not been able to do it yet as the home did not have its own computer facilities. There have been no admissions for a couple of years and there is currently one vacancy. As reported at previous inspections there are systems in place to ensure that individuals Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: needs would be assessed before they moved into the home. Care Homes for Adults (18-65 years) Page 21 of 42 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not always have the up to date information they need to be able to support people to meet their needs which could impact on their safety and well being. Evidence: We looked at the care plans for three people who live at the home. Most of the care plans were detailed on how staff are to support the individual to meet their needs and achieve their goals. They included how staff are to support the person with their daily living skills, during the night, their activities, occupation, personal care, behaviour, social skills, communication, and health needs. It was not evident that all of the plans had been reviewed at least six monthly, this should be done to make sure all of the information is up to date. One persons care plan was first devised in 2007. It said the community nurse was exploring options with them for getting in and out of the bath. It had been reviewed since 2007 but there was no update regarding the outcome of the community nurse input. Records show that this person was currently able to use the bath but needed the support of two staff to do so. Care Homes for Adults (18-65 years) Page 22 of 42 Evidence: Care plans include peoples goals for the future, this is generally person centred and progress sheets are completed to check actions are being worked towards. However goals do not appear to change from year to year and progress sheets are repetitive in content. It is not clear if the people themselves have decided on their goals. The home should look at the current system in place to make sure that people are fully involved and that goals set are achievable. At the last inspection we found that care plans were not available in a format that was easier for people to understand. However the homes Annual Quality Assurance Assessment told us that the home intended to develop pictorial care plans in the next twelve months. At this inspection we found that the process of introducing more user friendly formats had started. Personal planning books are now being completed with people. These are in an easy read pictorial format and include details about things that are important to the person. We observed members of staff supporting people to make choices about what they wanted to do and where they wanted to go. Records sampled included individual risk assessments. These stated how staff are to support the person to minimize risks such as being scalded, using the kitchen, accessing the community, shaving, falls, using stairs and steps, and the risk from behaviours of people who live at the home. Assessments had been completed for all areas of identified risk but some need to be further developed. For example one person had a new assessment regarding the risk of falling at night. The assessment did not make clear what the level of risk was and was brief regarding the control measures in place. This means that staff may not have all the information they need to safely support people. Care Homes for Adults (18-65 years) Page 23 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements may not always ensure that people experience a healthy and meaningful lifestyle, which could impact on their well being. Evidence: During the day most of the people who live at the home attend local daycentres or colleges. One person who was not attending their daycentre during our visit went out with staff to a local shopping centre and for lunch. We looked at the activities on offer for people when they are not attending the daycentre or college. One person told us I have just got a new pass, I never get bored here. People had individual activity plans in place but these seemed to be for the benefit of staff as they were not in a format that people would understand. Records show that people have opportunities to participate in activities that include aromatherapy, mobility classes, going out shopping, to the cinema and for meals out. One person case tracked did not always go out as often as their activity plan said they Care Homes for Adults (18-65 years) Page 24 of 42 Evidence: should. Where people have chosen not to go out this is usually recorded. Sometimes records showed that planned community activities did not happen but did not say why. Records of activities showed that often activities at the weekends involved watching the television. It was not clear from the records if this was what people had chosen to do. Records show that people are supported to keep in touch with their family. Some stay with families for weekend visits and also receive visits at the home. Care plans stated who the persons relatives were but did not have any information about how staff are to support people to make new friends or keep in contact with friends and family. Discussion with the manager and records shows that people were supported to buy presents and cards for their relatives at Christmas. One person who lives at the home told us the food is okay. People were having breakfast when we arrived at the home. We saw that different choices of cereals were available to people. Food stocks were examined and supplies were ample, including fresh fruit. Menus showed a high proportion of processed foods such as beef burgers, fish fingers and sausages and so need to be reviewed to make sure a healthy diet is on offer. Food records sampled for people would not enable staff to properly track if individuals were having a healthy diet. Records do not record how much people eat and usually do not record the type of fruit or vegetables that people had and the menu sometimes did not record this. This would also mean that staff cooking meals might give people the same type of vegetables they had the previous day which people may find repetitive. Staff told us that if people do not like what is on the menu then an alternative is always available. The homes Annual Quality Assurance Assessment told us that the home intends to develop pictorial menus. This will help people to be more involved in planning menus and choosing what they would like to eat. Care Homes for Adults (18-65 years) Page 25 of 42 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. Arrangements help to ensure that individuals personal care and health needs are met so ensuring their well being. Evidence: Care plans sampled detailed how staff need to support each person with their personal care. Records showed that people are supported to visit the hairdressers regularly. People were well dressed and this was appropriate to their age, gender, their cultural background and the activities they were doing. When we visited the weather was very cold and people were due to go out. It was therefore good that people had been supported to wear suitable clothing such as jumpers. Interactions between members of staff and people who live at the home were seen to be informal and relaxed, and support was given respectfully and in a warm and friendly manner. Records sampled showed and staff said that a range of health professionals are involved with individuals to help meet peoples health care needs. For example one person at the home has epilepsy and there were records to show this is regularly reviewed with their doctor. People also have annual health checks to make sure they are well. Care Homes for Adults (18-65 years) Page 26 of 42 Evidence: Records sampled included an individual Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. These plans generally detail the frequency that people need to attend appointments such as the dentist or optician. Records sampled showed that people have regular check ups with the dentist and optician where necessary to ensure they keep healthy and action can be taken if a persons health is deteriorating. One person has recently been unwell and had to go into hospital. It is good that during their stay in hospital the home allocated a staff to stay with them. This helps to make sure the experience was less frightening for the person as they could be supported by a staff they knew well. Since the last inspection assessments have been completed for people regarding the risks of them developing a pressure sore. Discussion with the manager indicates there is no one at the home who is at high risk of this. At the last inspection we found that two people had repeatedly refused to be weighed by staff. There was no evidence that consideration had been given to using a different type of scales or a different method to try and establish if people were at a healthy weight. Significant loss or gain of weight can be an indicator of an underlying health need so it is necessary to monitor individuals weight regularly where possible. The home have since referred people to the weight clinic and are looking at alternative methods for establishing if people are at a healthy weight. Medication is stored securely within a locked cupboard. Medication Administration Records (MAR) sampled included a photograph of the person at the front so if unfamiliar staff were giving medication they would know who to give it to. MARs had been signed appropriately indicating that medication had been given as prescribed. Some handwritten additions had been made to the MARs. These should be checked and signed by two staff to make sure that the information matches the prescription. One person at the home has medication that staff need to have received extra training from a suitably qualified person to administer. The manager told us that as the home had several new staff who had not had the original training that he would be arranging more training for this. We saw that medication was stored in one cabinet. One of the medications is now stored more securely and staff do daily stock checks to make sure the amount of medication held matches the records of what had been administered. Some people had written guidelines in place for as required medication so that staff know when this needs to be given. As recommended at our last inspection these have now been reviewed to make sure the information is still current. Page 27 of 42 Care Homes for Adults (18-65 years) Evidence: Staff date ointments when they are opened so that they can be discarded when they have been opened for more than 28 days. We saw that some ointments had been open for longer than 28 days and were still being used and so may not have been effective. Care Homes for Adults (18-65 years) Page 28 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems usually ensure that people can be sure their views are listened to and people are protected from abuse. Evidence: People have access to the homes complaint procedure, a copy of the complaints procedure has been put on the notice board in the hallway. It is good that the procedure is in a pictorial format. It has been updated since our last inspection to detail the new manager so that people know who to complain to and are not confused by out of date information. One person told us that they had no complaints about the home but said they would speak to the manager if they had any complaints. Some people at the home do not use verbal communication and the home needs to consider how staff would know if they were unhappy about something. Last years Annual Quality Assurance Assessment (AQAA) told us that it was intended to produce the complaints procedure in an audio format so that it was easier to understand. This has not been done and this years AQAA again told us this would be done in the next twelve months. At our last visit the complaint log was not available. A log is now available in the home. A grumbles book is also available and this is where people can record minor concerns where they do not wish to make a formal complaint. The manager told us that the home Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: had not received any complaints since the last inspection. We have not received any complaints about the home in the last twelve months. At our last inspection we found that the home had not notified the local authority about a potential safeguarding incident. We therefore made a requirement for the home to report such incidents. The home has since improved and a recent incident was reported to the local authority. However they decided that it did not need to be pursued under their safeguarding procedures. At the last inspection a safeguarding investigation was underway regarding one person who lives at the home, this has now been closed by the local authority. The records of one person had showed that it was common for them to have unexplained bruises. The home has now improved their documentation when bruises have occurred and introduced guidance for staff about when bruises need to be reported under safeguarding procedures. Most staff have completed training in the protection of vulnerable adults, and policies and procedures to include whistle blowing are readily available to them. Some new staff need to attend training and the manager said he was trying to arrange this. Minutes of a staff meeting showed that signs of abuse and the procedure had been discussed with staff. Staff at the home have been given basic information about the Mental Capacity Act and the Deprivation of Liberty Safeguarding Legislation. However it would increase staffs knowledge if they received some specific training on this. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. At the last inspection people had sometimes paid for things that the home should provide. At this inspection we sampled the financial records for two people. These showed that people had not paid for items that the home should provide. Receipts were seen to be available for all expenditure. Care Homes for Adults (18-65 years) Page 30 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to make the home more comfortable for people to live in and to meet their assessed needs. Evidence: Charles House is an old property that has character and is homely in style. We looked at all communal areas and some bedrooms at this visit. Communal areas were homely in style and generally in good decorative order. There were some areas of decor that needed some minor attention but the manager told us that redecoration was planned for the next month. The home was a comfortable temperature with the exception of the conservatory. This was too cold for people to use. The manager told us that the heater had to be disconnected the previous week as it had been found to be unsafe to use. The manager was not sure what arrangements were being made for a replacement heater or when this would happen. This needs to be done as soon as possible as several people in the home like to spend time in this room. When we last visited the home several new windows were being installed. At this visit we Care Homes for Adults (18-65 years) Page 31 of 42 Evidence: found that restrictors had not yet been fitted to the windows. This means that to make sure people are safe the windows need to be kept locked. This does not give people the option of opening windows if they want to. This is further detailed in the management section of this report. Peoples bedrooms are individual in style according to gender, age and culture, and personal effects and possessions are in evidence. These include personal televisions, video / DVD players, music systems and computer games, so that people can enjoy private time on their own if they so choose. Some people who live at the home need assistance with their mobility. It is not clear that the design of the home best meets their needs. There are several steps to the front of the home. Some peoples care plans record they need support from two staff to get in and out of the home. The homes most recent quality report recorded that one relative had said they felt that a ramp to the front of the home may be needed. Some peoples care plans also record that they need help to use the stairs. One person has an ensuite shower but has to step in to the shower tray when a level access shower would be easier to access. The home does not have an adapted bath and one person is assisted by two staff to get in and out. Due to some peoples mobility needs assessment that the building and bathing facilities meets their needs should be undertaken by a competent and qualified person. This is something we have recommended at previous inspections. The manager told us that it was intended to refurbish bathrooms this year and the provision of level access showers would be looked at. Bathrooms, toilets and the kitchen had satisfactory hand wash facilities. The floors to the bathroom and ensuite shower room are carpeted. This is not an ideal floor covering for this type of area as it is not easy to keep clean. Discussion with the manager indicates the carpet will be replaced when the bathroom is refurbished. We also saw that the plug at the bath was tied on with string instead of a chain. This is not good for infection control as the string will soak up used bath water and dirt from everyone using the bath. Care Homes for Adults (18-65 years) Page 32 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements are variable and may not always ensure that peoples needs will be met. Evidence: Direct observations of staff interactions with people who live at the home show they have a good relationship with people in their care and a good general understanding of their needs. New staff are given the opportunity to complete the Learning Disability Qualification (LDQ). 90 of staff are either working towards or have a National Vocational Qualification in care. This helps staff to have the skills and knowledge they need to meet the needs of the people living there. On the day of the inspection there were only three staff on duty, usually there are four or five staff on duty. We were told that a member of staff had phoned in sick that morning and they had been unable to get another staff. We spoke with staff, observed them working and discussed staffing levels with the manager which indicated that there are usually enough staff on duty to meet the needs of people currently living at home. Due to the behaviour of one person at the home there has been increased pressure on staffing levels as staff have to maintain close supervision to make sure other people are safe. The manager told us that an advert had been placed to recruit additional staff. Some staff have been employed by the home for a long time. This ensures that people know the staff who will be helping them in meeting their needs. Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: At the last inspection we looked at the recruitment procedures followed for new staff and found some areas of poor practice. We made a requirement for recruitment practice to be improved. We could not fully assess at this inspection that this has happened as no new staff had been recruited. We will look at recruitment practice at the homes next inspection. The training matrix for the home was not up to date and so it was difficult to assess if staff have had all the training they need to meet peoples needs. As discussed earlier in this report staff would benefit from training about the Mental Capacity Act and the new Deprivation of Liberty Safeguards. Discussion with the manager indicates that staff need to have refresher fire training, he said this was to be arranged. Some staff at the home have had training in meeting the specific needs of people to include epilepsy and diabetes. As under half of the staff team have had this training it is recommended it is arranged for staff who need it so they have a better understanding of peoples health needs. Staff have had training in manual handling, previous discussions with the manager indicated that this was via a DVD and written test. Recently the manager has undertaken training to enable him to deliver manual handling training. He said he would be arranging to do some more practical manual handling training with staff and this will help to update their knowledge. There have been no staff meetings held since our last inspection. Staff meetings are important as they keep staff up to date with issues of good practice, peoples needs and the homes policies and procedures. All staff had received supervision in October but supervision records showed that staff were not having this at least every other month. Regular supervision is important for staff as it enables them to reflect on practice and identify their training and development needs. Care Homes for Adults (18-65 years) Page 34 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements may not always ensure that the home is well run to ensure the safety and well being of the people living there. Evidence: The home has had a new manager in the last twelve months. We have not yet received an application from them for registration. This is required so we can be sure that the new manager has the right skills and experience to manage the home. The manager told us he was in the process of completing the application form. During the inspection the manager demonstrated good knowledge of peoples needs and seemed committed to improving the home for the benefit of people living there. The manager told us that he had recently enrolled on a management course. Prior to the homes last key inspection the new manager completed the Annual Quality Assurance Assessment and returned it when we asked for it. Quality assurance systems are in place. The service manager visits the home and writes a report of their visit to see if it is being well managed. Reports available did not show that these visits happened every month. The reports do not show that staff or people who live Care Homes for Adults (18-65 years) Page 35 of 42 Evidence: at the home have been consulted as part of the visit. This should be done so that people are as involved as possible in how the home is run. Other quality assurance systems in place include an annual quality assurance audit. Satisfaction surveys had been completed by some people who live at the home or their relatives. The previous manager had collated the results of the surveys and completed a report that detailed what action had been taken as a result of listening to people. The new manager said that the next stage was to complete an annual development plan for the home. A number of health and safety checks are undertaken by the home. A number of these were sampled. Staff test the water temperatures to make sure they are not too hot which could put people at risk of being scalded. Records showed that these were within the correct temperatures so that people were not at risk. Monitoring of the water temperatures is normally done on a monthly basis however they were overdue when we visited. The manager said he would make sure they were done. Staff regularly test the fire equipment to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. At our last visit to the home the manager was unable to locate the homes fire risk assessment, this was seen to be available at this visit. We spoke with one member of staff about the homes fire procedures. They had a good awareness of what to do to keep people safe should a fire occur. Training records indicated that most staff had up to date first aid training so that they should know what to do in an emergency. Certificates were available to show that gas and electrical installations had been checked to make sure they were safe. During our visit a maintenance staff was at the home undertaking safety checks on the homes portable electrical appliances. As stated earlier in this report the home has had some new windows fitted but these do not yet have restrictors fitted to make them safe. We found that one of these windows was unlocked and so may pose a risk to people. The manager locked the window when this was brought to his attention. We also found that two restrictors on some of the homes older windows were broken. As the maintenance staff was already working in the home arrangements were able to be made for these to be repaired. We asked what procedures the home had in place to make sure the environment was safe for people. We were told that staff undertake a monthly health and safety audit of the home. However we found that audits were only available in the home up to August 2009. The home should review the procedures in place that identify and rectify any health and safety risks to the people living there. Care Homes for Adults (18-65 years) Page 36 of 42 Care Homes for Adults (18-65 years) Page 37 of 42 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 1 37 11 An application for 29/09/2009 registration must be made from the manager of the home. So that people can be sure they have the right skills and experience to manage the home. Care Homes for Adults (18-65 years) Page 38 of 42 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 42 13 Complete an audit of all the windows in the home and take action where needed. 08/02/2010 To make sure people are safe and are not put at risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide for the home should be updated to reflect the new manager arrangements. So that people have up to date information about the home. Review the system in place regarding peoples goals for the future to make sure that people are fully involved and that goals set are achievable. Peoples care plans should be reviewed at least every six months or when their needs change to make sure that staff have upto date information about peoples needs. Risk assessments should be further developed to make 2 6 3 6 4 9 Care Homes for Adults (18-65 years) Page 39 of 42 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 sure they make clear what the level of risk to the person is, and the control measures in place. 5 12 Activity records should be improved to detail if people have enjoyed the activities participated in, and if an activity has not taken place the reason why. This will help staff to effectively monitor if peoples lifestyles are meeting their preferences and expectations. People should be supported to help plan the things they want to do in a way that is meaningful to them. Care plans should state how people can be encouraged to make new friends and keep in contact with friends from their past to improve their well being. Menus should be reviewed and food records should be recorded in more detail. So that staff can monitor peoples food intake so help them to have a healthy diet that suits their individual needs. Creams and ointments should not be used after twenty eight days of opening to help ensure that people have creams and ointments that are in good condition and effective. Where handwritten additions are made to medication administration records these should be checked and signed by two staff to make sure that the information matches the prescription. The systems in place to assist people who have communication difficulties in making staff aware they are not happy about something should be reviewed. So that people can be sure their concerns will be listened to and acted on. Staff should receive training in the Mental Capacity Act and Deprivation of Liberty Safeguards legislation. So that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. New heating needs to be fitted in the conservatory so that Page 40 of 42 6 12 7 15 8 17 9 20 10 20 11 22 12 23 13 24 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 it is a comfortable temperature and people can continue to use this room. 14 27 Refurbishment of the bathroom and ensuite shower room is needed to make sure they are in good decorative order and meet peoples needs. The entrance to the home and bathing facilities should be assessed by a suitably qualified person to make sure they meet individuals mobility needs. Infection control procedures need to be improved to make sure people are not put at risk of infection. Update the staff training matrix and review the training schedule to make sure all staff get the training they need to meet peoples needs. Staff should have at least six formal, recorded supervision sessions a year with their line manager. This will ensure they are supported in their role to meet the needs of the people living there. There should be at least six staff meetings a year so that staff are updated with best practice and know how to support the people living there to meet their changing needs. A representative of the provider should visit the home monthly and write a report of their visit. These should include seeking the views of the people living there and staff to ensure they are involved in the running of the home. Review the systems in place that identify any health and safety risks to the people living there to make sure any risks to people are quickly identified and resolved. 15 29 16 17 30 35 18 36 19 36 20 39 21 42 Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Adults (18-65 years) Page 42 of 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!