Care Home: Creynolds Lane

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What the care home does well There is user friendly information about the service, tenancy, terms and conditions. Management arranged specialist independent support for people to complete our surveys. People told us they are happy in the home and make daily decisions about what they do and who they see. They said "...x...helps me clean my room"; "staff are always nice to me"; "I like colouring and going to the pictures"; "I like going on trains and to the pantomime." Care plans are tailored to individuals. Needs for personal care, health care, social stimulation and emotional wellbeing are met. Care is discreet and maintains dignity. There is good access to specialist health care, a safe medication system and competent staff. Activities are suited to needs, such as multi-sensory stimulation. Community facilities are used in friendship groups. One person manages their money with support, and the home protects everyone`s financial interests along with appointees. Relationships with relatives, friends and advocates are maintained, consulted along with professionals in line with mental capacity law. Staff are trained to recognize and report abuse. Most people know how to raise a concern inside and outside of the service. Staff have guidance to support decision making and spot distress. There have been no complaints or adult protection concerns. The environment is homely, safe and well maintained inside and in the garden and transport is adapted for hoists. Equipment and facilities are appropriate for people`s needs, age, gender, culture and conditions. People help to choose furnishings and take part in the running of the home and looking after their belongings. The home is clean, smells fresh and there are infection control measures in place. There are enough staff to meet people`s needs, including mealtimes and first aiders on each shift. Staff training and qualifications exceed standards. Staff respond quickly to changes in people`s conditions and ways of working are up to date. Management provides good staff support, supervision, clear directions to support people. We complimented good practice on our visit. Communication systems ensure the smooth running of the home. An excellent quality system ensures spot checks and audits are recorded, analyzed and acted upon so that the home continues to learn and change. People and representatives are consulted in several ways to develop of the service. There is an experienced management team they know what they want to improve and are progressing changes. Records are up to date and securely kept for confidentiality. What has improved since the last inspection? The service user guide was made more accessible with symbols, photographs and user friendly language and font. New communication diaries record people`s needs, likes and dislikes. A total communication strategy was introduced to help people participate in care planning and make daily decisions. One person was supported to buy their own car, adapted to their needs. Another person helps to prepare food. The home had a successful environmental healthinspection with no requirements. New front windows were installed and a new dining room table. New corporate risk assessments are being progressed along with health action plans, and the home is planning for the needs of people growing older. Prescriptions can now be copied in line with the home`s medicines management protocol. Training took place about adult protection, risk assessing, mental capacity, total communication, epilepsy and autism. What the care home could do better: The public need accurate information about current management, and an application to register a manager has not yet been sought from the Commission but is planned. Statutory advocates are needed for serious decisions, and may be available for care reviews for people with no active representatives. Healthy lifestyles and diabetes care need more promotion, with diet, exercise, foot care and a smoke free environment that meets government and best practice guidelines. Management acted immediately to address minor food labeling and an infection control measure, and confirmed a doctor`s agreement about covert medication in best interests. There were minor medication administration record gaps, and weekly audits need to show action taken. The Commission should be notified about medication errors and missing medication to work in partnership with the home to protect people. A screening system is needed so that risks of malnutrition and pressure sores can be prevented and responded to at early points. Care planning could extend to advance decisions, especially for people growing older or with degenerative conditions. The home needs to prepare for a new law about deprivation of liberty safeguards to protect people`s rights. As policies and procedures are revised, older versions should be removed so that staff have ready access to the correct process. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Creynolds Lane 268 Creynolds Lane Cheswick Green Solihull West Midlands B90 4ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tina Smith     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Creynolds Lane 268 Creynolds Lane Cheswick Green Solihull West Midlands B90 4ET 01217443570 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Solihull Care Trust Name of registered manager (if applicable) Mrs Julie Gray Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category of service only: Care Home only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 4 Date of last inspection Brief description of the care home Creynolds Lane has been newly registered with the Commission as ownership transferred to a newly formed Care Trust, but the home has been open for many years. It is in a leafy residential area of Solihull, with car parking and public transport nearby. There is wheelchair access by ramps at the front and to the garden. Accommodation is provided by tenancies with Bromford Housing Association in single furnished bedrooms. Care is provided to four people with learning disabilities by the Solihull Care Trust. There are communal toilets, wetroom and bathroom adapted so Care Homes for Adults (18-65 years) Page 4 of 36 care home 4 Over 65 0 4 Brief description of the care home that staff can assist if needed. There is a lounge/dining room, kitchen and conservatory, with a ramp at the front and to the enclosed garden at the back. Activities are provided in the home and community. The fee range is £1203.89 to £1217.93 per week, inclusive of clothing and holiday allowances. Extra charges apply to toiletries, hairdressing and chiropody. This information was correct at the time of our visit. Enquiries should be made to management for up to date information. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is the first inspection since registration. Prior to our visit the home supplied information to us from their legally required Annual Quality Assurance Assessment (AQAA). Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us notifications, and we receive reports from other sources. We received 10 out of 14 surveys sent to people, relatives and staff. One inspector visited the home over one day, and the morning and afternoon routine was observed. The home was not informed that we would be visiting. We talked to people and staff, and saw their records. We sampled records about other people, staff and the running of the home and discussed our findings with management. There were no requirements as a result of our visit. Recommendations are at the end of this report. Care Homes for Adults (18-65 years) Page 6 of 36 Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? The service user guide was made more accessible with symbols, photographs and user friendly language and font. New communication diaries record peoples needs, likes and dislikes. A total communication strategy was introduced to help people participate in care planning and make daily decisions. One person was supported to buy their own car, adapted to their needs. Another person helps to prepare food. The home had a successful environmental health Care Homes for Adults (18-65 years) Page 8 of 36 inspection with no requirements. New front windows were installed and a new dining room table. New corporate risk assessments are being progressed along with health action plans, and the home is planning for the needs of people growing older. Prescriptions can now be copied in line with the homes medicines management protocol. Training took place about adult protection, risk assessing, mental capacity, total communication, epilepsy and autism. What they could do better: 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 9 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 10 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. User friendly, useful information tells people about the tenancy and care, along with fees, terms and conditions. There are ways to visit and try the home to decide if it is suitable, and a thorough process to assess and confirm peoples needs are met. Evidence: The home arranged for a Speech and Language Therapist to help people complete our surveys, which is good practice. People told us that they had enough information and wanted to come to live there. There is a service user guide and statement of purpose with very helpful features for people and their families to learn about the home, services and philosophy. The guide uses symbols, photos and user friendly language. People in the home told us about looking at this big book with staff, and visiting a lot before move in. The statement of purpose will soon be updated with assistance from speech and language specialists to be user friendly. Management details in the homes information need accuracy. There is a manager who oversees more than one home who is not registered by the Commission as stated, and Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: an Acting Assistant House Leader at Creynolds Lane, who oversees day to day. The roles of the housing association and care trust are well explained. There have been no new admissions or discharges and no vacancies. Four people have lived in the home over 12 months, funded by the council and national health service. There is a pre-admission assessment by trained staff, with flexible opportunities to visit, meet other people and staff and try the home at the persons own pace. Gradual introductions are also used to confirm that peoples needs can be met and that personalities are compatible, which is good practice. After admission there is a 28 day trial period and a formal review with people, their families and funding authorities. We saw this in all care records. Needs and risks are reviewed at least six monthly or when there are changes. Annual reviews take place with people, their representatives and funders. Everyone has a tenancy agreement with terms and conditions that set out individual fees, but not care costs. The agreement is user friendly and explains services and allowances included in the fee and attracting extra charges. We were not clear how charges apply to care management arrangements for activities outside the home and recommend this is transparent in the homes information and tenancy agreement. Contract reviews are managed by care trust commissioners. Care Homes for Adults (18-65 years) Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and representatives set goals and take part in decisions; some people may need statutory advocates. Staff have clear directions and guidelines on communication to support people the way they want. Independence is promoted by people taking part in the running of the home and in their care. Evidence: People are able to make decisions about their life and participate in care planning about their needs, goals, and choices. There are weekly, monthly and quarterly meetings. People plan the next weeks food and activities with keyworkers. Holidays and outings are planned as a group, but individual preferences and friendship groups are considered. Tenancy group meetings are held monthly to develop the service and facilities. These are all documented in a user friendly way and securely stored for confidentiality. Surveys from people told us they make decisions each day about what they do and who they see on weekdays and weekends, and we saw people choose what they eat. Communication diaries are prepared with speech and language Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: therapist advice, and pictoral activity plans are on display. Where someone has no speech there are non-verbal cues recorded so that staff can understand peoples communication methods. This is used to orient people, help them express views and make choices. They are also used to review preferences, achievements and relationships. We complimented good communication practice by staff on our visit. Records have detailed care plans drawn up with people, relatives, advocates and other professionals from thorough assessments. Changing abilities and conditions are identified in addition to needs and risks for health, wellbeing and personal safety. Best interest decisions are usually recorded where people are assessed with incapacity, and staff understand their current legal role under mental capacity law. For instance, one person has a degenerative condition and needs more space in their room for safe mobility. A relative was invited to help the person choose belongings no longer needed so the room could be re-arranged. We also saw behaviour plans using least restrictive alternatives and distraction techniques that avoid the need for restraint. This reflects best practice is known and used. There are good personal safety assessments that consider needs inside and outside of the home, during transport and when on holiday. We saw care records to prevent choking and falls, about bed rails, road safety awareness, seizures, and fire evacuation. Some people have identified needs for staff escorts, room monitoring at night, and other security measures and controls upon movement and life to make incapacitated people safe or to monitor health and wellbeing. Management had training and are planning staff learning about a new law for deprivation of liberty safeguards. We advised that the home assess whether applications will need to be made in April 2009 to authorize this if it is necessary, and recommend this is regularly discussed in reviews. Generally care plans are reviewed at least six monthly or when there are changes. Annual reviews can be delayed by commissioners, but we saw that the home ensure they take place. One person has an advocate. Another person in the home does not have visitors or an advocate. If assessed as incapacitated to make care decisions then a statutory independent mental capacity advocate should be involved for any serious care or treatment decisions and may be available for annual reviews through the Care Trust contract. On our visit we saw people choosing food at mealtimes even if they had no communication system. Staff try another way or another type of food until a choice is made, including a choice to refuse a meal or activity for instance as this is not forced. One person was drawing and another watched TV. Two people went out separately with staff. The weeks menu is individually planned, but food shopping is the subject of the homes health and safety risk assessment and is now done by staff. People go shopping for smaller items or for their personal needs. Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: Peoples rights are protected by staff supporting risk taking and trying new things for personal development. For example, we were told that one persons goal to own a car was achieved. Activity plans are individual and show that involvement in the day to day running of the home is dependent upon abilities and daily mood, and this changes as people develop. For example, one person helps to prepare food. One person manages their own bank account, cigarettes and lighter. On our visit they went with staff to obtain their birth certificate in order to change the name on a joint account to a sole bank account. There are risk assessments and control measures, and the person is able to make a choice to smoke. Staff ensure they have opportunity while protecting others health and safety. Promoting health could be further improved, discussed in other report sections. Care plans are detailed so that staff know how people want to be supported, safely with equipment as necessary. There are individual guidelines about personal and healthcare, social care and behaviour, manual handling, and medication. The housing association are appointees for other peoples finances, but the home manage day to day spending and make purchasing decisions in partnership. We checked and found up to date accounts of how peoples money is managed and securely kept. Spending decisions match peoples needs and lifestyle, and the terms and conditions of the service. This is checked regularly by management, and on the day of our visit accounts tallied. Over time the home are now working with people and families to express advance wishes and make funeral plans, including choice of music. This is good practice but should also include advance decisions and end of life care for people growing older and with degenerative conditions . No one currently has a will, and independent support should be considered or the Court of Protection if appropriate. Care Homes for Adults (18-65 years) Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for personal development and activities appropriate to individuals in the home and community. Relationships with family and friends are maintained according to peoples wishes. Personal tastes in food and dietary needs are met. Promoting healthy lifestyles could improve. Evidence: There are age, peer and culturally appropriate activities and use community facilities such as parks, pubs, cinemas, meals out. The Trust have allotments at wheelchair height, where people help to grow their own vegetables and fruit. The produce also provides fresh nutrients for their diet. There is encouragement to vote, open their own mail and to participate in looking after their own room and belongings. They are supported to lead independent and responsible lives. Some people need routine and structure to the day and week, such as those with autistic spectrum disorders; others Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: want flexibility. One person is growing older and wants to go out less often. Each person has their own interests and people told us what they enjoy: I like colouring and going to the pictures; I like going on trains and going to the pantomime. Another person reads the newspaper each day. Some people are calmed or stimulated by multi-sensory experiences and hand massage, at the home or at a day service provided by the Care Trust. An activities coordinator is shared between homes. Music and movement is noted in some activity plans, but this was cancelled in January 2009 due to staffing. The home want to expand activity opportunities; we recommend opportunities for exercise are reviewed to promote healthy lifestyles. Religion is noted in each care record, and a TV church service is provided. No one currently shows an interest in attending local services. Friendships and relationships are maintained. One person told us ...my...[relative]...visits on Saturdays. People attend a monthly reminiscence group to meet friends they have made throughout the years in services. Staff help them to keep in touch with friends and relatives, have 3 phones so that people can talk privately , and they go out for a drink with friends. Holidays and outings are usually taken in friendship groups, but some people respond better to day trips. Everyone has opportunities to learn and use practical life and social skills, at day services and in the home and community. People take part in their own care according to their ability and mood. One person did not want to get their own breakfast or clothing on our visit, so staff assisted. Some people keep their room clean and tidy, make their bed, and help to prepare food. Everyone brings their washing to the laundry. One person had a job in the past, and has literacy and numeracy skills. They are supported to manage their own money. There are two cars used that have shared use by agreement and fair repayment of petrol expenses. These records show us how often individuals go out, and some do more than others. We queried why public transport is not used and learned it is not easy to use as there is a decreasing bus service where the home is sited. Everyone currently needs staff escorts to go out. There are weekend rituals such as having a lie in and brunch rather than breakfast on Sundays. Shopping is planned so that individuals have daily choices about food they will like, and people have appropriate assistance to eat. People choose at each meal what they want to eat and told us they like the food. All staff prepare food and have food safety training. We watched several skilled staff assist each person differently at meal times. Some Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: people had food cut up small or in small portions to prevent choking, and two people were fed sensitively. One person does not like cold drinks. Meal times were unhurried, and some staff ate their own meal with people. This is good practice that creates a homely atmosphere conducive to eating well. We sampled food intake monitoring records, menus and toured the kitchen. The food on offer is nutritious, varied and large stocks are not kept. There are occasional meals out. We were told that staff have training in health and nutrition, and that management want to improve nutrition. We recommend that government advice about healthy eating is promoted in more depth by checking for instance if oily fish is on offer. Peoples dietary needs are met, but we advised that the care plan of someone with diet controlled diabetes needs to ensure there are no long gaps between meals, especially on Sundays. Drinks and healthy snacks such as fresh fruit are available throughout the day and night. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and health needs are met in the way people prefer and need, with dignity and risks managed. Additional screening is needed so that interlinking malnutrition and pressure sore risks can be acted upon at early points. The medication system is managed by competent staff and regular checks ensure this protects people. Evidence: Staff accurately told us about peoples needs, risks, what people prefer (such as baths or showers) and how care is safely provided. Assessments note peoples abilities to participate in self care, such as brushing teeth and their preferences. Staff prompt or assist with washing, dressing, oral care and continence as needed, and this is adjusted and recorded on a daily basis according to peoples cooperation and mood. On our visit people had good personal hygiene. Their appearance and clothing was appropriate for the temperature, their age, culture and tastes. Personal care was provided discreetly. Mobility aids and equipment match peoples needs and were used safely. There are also detailed plans for healthcare, night-time, sensory, mobility and communication needs. These provide staff with directions and guidance to prevent falls, for manual Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: handling, and how to recognize non-verbal signs of wellbeing, discomfort or pain, which is good practice. There is one male staff member so that people can have choice of gender for help, but we did not see a choice offered in care records. People who need prompting to use the toilet or continence aids have clear care plans day and night so that their dignity and confidence is maintained inside and outside of the home, although there is no policy about this and the role of specialists. Staff have additional training to understand peoples conditions, such as epilepsy, and techniques, such as stoma care. We recommend there is further learning about diabetes so that best practice is used, for example with diet, nail and foot care in addition to the annual blood test and eye tests undertaken. Records are kept of visits by health and social care specialists, and their advice is incorporated into care plans. There are a range of health specialists supporting people and the home, including psychiatry, speech and language therapy, district nursing, dieticians. Seizures are monitored and evaluations of clusters lead to proactive involvement of specialists. Good monitoring records and communication systems between staff mean that changes in peoples conditions, behaviour and moods are noticed. Care is then quickly adjusted, or doctors and specialists are contacted. This benefited three people, one who had a life threatening condition spotted in time for treatment. There are qualified first aiders on each shift so that people have skilled help in an emergency. An on-call management system supports staff; it is required for decisions about certain occasional use medication. One person has an up to date emergency medication pack taken on outings. Staff are trained in epistasis and there is a detailed care plan to manage this, although staff said it has never been needed. Management want to utilise health action plans to greater effect. Since the AQAA , well mens clinics were attended but we were told that doctors have not always followed up findings. Doctors are to be trained about learning disabilities by the Care Trust to improve this. The home attends appointments to support people. One person had an operation and staff stayed with them in hospital during waking hours. The person returned to the home after staff had training from health. The communication book was used confidentially to share information about bathing until the wound healed, and advised staff to view the medical notes. People have annual health checks, including diabetes blood sugar level monitoring, and one person had a flu jab. Regular medication reviews take place, and medication side effects are queried with appropriate clinicians. Regular checks with dentists and opticians are kept, although we did not see use of chiropody for people with diabetes. There was good liaison with a GP when full eye screening could not be undertaken for someone because the test is not adapted to their needs. People are well supported for Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: hospital admission and discharge, health and healing is promoted and management know what they need to improve. There is no screening system or policies about malnutrition or pressure sore prevention / management. Management told us that no one is at risk, but there are wheelchair users and people with degenerative conditions or decreasing mobility and swallowing problems, and barrier creams are prescribed for occasional use. Best practice guidance and validated tools are available. As the home are also planning for peoples later life, these policies are essential. Management intend to contact a dietician for advice. Everyone has nutrition assessed so that cultural and dietary needs are met, and staff are trained in nutrition and health. Food intake and output is monitored and people are regularly weighed, so changes are identified. Nutritional practice is high quality, except that risks are not screened and training about this is not planned so that people have access to specialist help at early points. There are on-line government learning tools about nutrition and healthy eating that would be of benefit for peoples outcomes. When we sampled 4 weeks menus we did not see that people are provided with any oily fish. Medication records help staff ensure the right person has medication, diet and protection from the sun by noting allergies, photos of people and guidance. No one self manages medication. Some people have it in liquid form, or tablets taken in food or hot drinks, which we queried this with staff. There are multi-professional best interest decisions about covert medication, which the person cannot refuse, but one was not agreed by a doctor. A pharmacist had been consulted about another having trouble taking tablets. Management confirmed with us immediately following the inspection that a GP provided written agreement. We saw more good practice and good outcomes. For instance, one person is having a trial overseen by a nurse about pain control from arthritis, and challenging behaviour has ceased. Medication administration records have an excellent chart for staff about conditions that drugs treat, signs to watch for, and who to contact. There are best interest guidelines as some people are unable to consent but are compliant. Audits and professional advice has been followed to improve for instance, occasional use medication guidelines for psychiatric drugs. An audit by the PCT in 2008 scored 96 per cent compliance with Trust policy. Medication administration procedures have since been updated All staff complete medication training to their role and update training is scheduled. Competence is tested, observed and reviewed 6 monthly by a Trust nurse, who Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: provides a report and advice. There is a monitored dose system and pre-printed medication records from the pharmacist, who also audits the homes system, and there are weekly management checks. There is good key security and a system to check medication when it is received and disposed of. There was one recorded incident of essential medication going missing, and an audit found two medication errors. These resulted in immediate action for peoples health, and a system change so that a second worker acts as a witness. Occasional use medication carried over from a previous delivery is not always added to new medication checked into the home in the records, which hampers auditing. Medication is stored in appropriate cabinets in a room where temperature control can be problematic, however daily temperature checks are in the safe range. We saw containers and records for medication transferred with people attending day services or for holidays. No one needed medication stored in a fridge, or controlled drugs and there is no cabinet or controlled drugs register. Two peoples summary of medication needed updating as some had been discontinued. There were a few minor gaps in medication administration records and on witness records which were discussed with management, so that action taken following weekly audits is clear in the homes records. Medication is generally well managed and recorded so people have medication as their doctor intends for their health and wellbeing. Care Homes for Adults (18-65 years) Page 22 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 know who they can report a concern to inside and outside of the service, and staff are trained to recognise and report distress or abuse in line with national guidance and local protocols. People can have confidence it will be taken seriously and acted upon. Evidence: People told us in surveys who they would turn to if they were unhappy, and some would choose staff, their advocate, social worker or tenancy group. This demonstrates how successfully staff have made people aware of their rights. The homes procedure has accurate contact details so a concern can be reported inside or outside of the home, which is good practice, and there is access to independent advocates. A pictoral complaints procedure is displayed prominently in the home. Complaints and protection policies are robust, linked to council and trust processes, and they are in keeping with national guidance. The home want to make the complaints procedure even more user friendly, especially for people with no communication. We saw two versions of the formal Trust procedure about the council and NHS processes, and the one in the complaints folder is not the latest version. Safeguarding is taken seriously and there is a whistle blowing policy. There have been no complaints and no adult protection concerns. Staff have training to recognize and Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: report abuse, and they have detailed guidance to recognize when people without communication express dislike or distress so that they can enquire further. Most staff surveys showed that staff know how to respond to a concern, but one did not know. The home has other protective policies in keeping with the law, national guidance and best practice. This includes restraint and managing challenging behaviour, money and belongings. Peoples financial interests are protected, and their property so that it wont go missing or be disposed of without their involvement. We saw care plans to manage behaviour including self harm that avoid the need for restraint, which is good practice. Staff are not trained to British Institute of Learning Disability (BILD) standards to use physical restraint, but no one in the home has such needs. Multi-professional decisions are usually made about covert medication, which is chemical restraint. People who need a staff escort have assessments and best interests decisions recorded about this, with consultation in keeping with the Mental Capacity Act and peoples rights. The home needs to prepare for new statutory duties in force in April 2009, as paid professionals make most best interest decisions about a number of peoples lives daily. Care Homes for Adults (18-65 years) Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and safe environment, personalize their room and have the equipment they need maintained. There are infection control measures, checks and timely repairs to ensure health and safety . Evidence: The location is pleasant, in a leafy suburb. The home is comfortable with a good standard of decor and furnishing. Bromford Housing Association maintains the premises through contractors and safety checks, and repairs are timely. There is a homely and welcoming atmosphere. The home and enclosed garden are accessible by ramps for wheelchair users, and the home is secure so people do not wander into the road. Since the AQAA, windows were replaced and a window lock is needed for a bedroom at the front of the home as a precaution against intruders. The storage of mops and bins could improve so that the laundry is more accessible and safe for people. Presently staff need to remember to keep the door locked if they leave the kitchen. On our visit the conservatory was used as a smoking room by one person when others were not using the room, and ventilation was provided by opening the garden door, which can blow smoke into the room. By law care homes must be smoke free or have Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: a designated smoking room and precautions for the health of others. We were told that this has been discussed with the housing association without resolution. We recommend the home checks local government guidelines to ensure their facilities fully protect the health of others. We looked around the building including bedrooms with people and found that rooms suit their age, culture and lifestyle. Each room is individual and people help to choose the colour scheme and bedding. There is sufficient storage space for personal belongings, such as music collections. Photographs of family and friends are on display, and older communication diaries. Each person has lockable space for their valuables. There is no emergency call system, but staff conduct night checks. One person likes their bedroom door closed at night, and people have privacy when they want. Equipment meets peoples needs and maintains their independence and mobility. There are manual handling assessments so that staff help people safely. Two cars are adapted to use hoists. One person needing protection from falls out of bed has a high/low bed with integral rails, and an additional crash mat, which matches their needs. Two people use wheelchairs. This equipment and hoists are regularly checked and maintained. Toilets and bathing facilities suit peoples needs and have door locks. One person has a multi-sensory bath provided daily and another has a multi-sensory chair. Contractor certificates and safety checks were sampled and were satisfactory. There are low-surface radiators and the water is tested to prevent bacteria and scalds. There are fire drills twice a year, and the fire officer is visiting to advise on a phased fire evacuation plan. The home is generally clean and smells fresh, and surveys told us it is always this way. There are best practice infection control and food safety measures in place. We discussed open, undated food in the freezer and sauces in the fridge with management who intended to take immediate action. An Environmental Health Report in 2008 made only one recommendation, that staff are clear about the cleaning schedules. On our visit we advised that tiles in the shower room needs deeper occasional cleansing, which management said they would act on . Staff are all inducted and trained in safe working practices, have food safety and infection control training. We saw staff reminded to probe food in the communications diary, which shows us that management conduct effective spot checks. We also saw good practice as environmental hazards, such as metal strips on kitchen work surfaces are reported and quickly replaced. A light bulb needed replacing in the lounge, which had been reported to the housing association. This confirms that the home, staff and service users have a health and safety culture. Care Homes for Adults (18-65 years) Page 26 of 36 Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are competent and consistent staff and clear roles. Robust recruitment checks ensure staff are safe to start work in the home. Qualifications and supervision, training opportunities and the appraisal system exceed national minimum standards. Evidence: Some staff have worked in the home many years, and two staff left since registration. Staffing hours are kept under continuous review and these match peoples needs. Temporary staff when necessary, are consistent and have the same training and induction as permanent staff so that peoples needs are known. There are staff trained in first aid on each shift. Staff told us that recruitment to vacancies is slow. There is a diverse workforce, so people in the home can have choice of who helps them with personal care. Cooking, laundry, domestic tasks and activities are done by all staff alongside people. Staff and management pass information to each other well about people and the home. There are regular staff meetings that seek staff views on the running of the home, discuss care of people and standards, or learn together as a team. We sampled staff files showing robust recruitment checks are made with police, Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: government list, and references returned before staff start work so that people are protected. There is a four day induction to safe working practices and code of conduct expected by the home, their policies and procedures. This is followed by a longer induction and a training programme that meets Skills for Care standards. There are excellent training opportunities. Various training providers are used, including the homes management, the council and NHS, and Coventry University for a leadership course that can lead to a management degree. Staff qualifications exceed minimum standards as all staff have or are completing NVQ 2 training. Some staff have qualifications specific to learning disabilities. Staff can gain further qualifications and have specialist training to meet peoples needs. There is in-house learning on the mental capacity act about consent and decision-making, and physical intervention and this will soon include a new law about Deprivation of Liberty safeguards. Management are considering Trust equality and diversity training for staff. There are clear roles. Staff work with more experienced staff until they are confirmed as competent. Mandatory training and refreshers are up to date. This includes: fire safety, infection control, safety and chemicals, food safety, moving and handling, challenging behaviour, abuse, care planning and risk assessment. Formal supervision exceeds the standard. Quality audits check that performance is sustained and improved. Performance and learning needs are appraised annually so that a staff development plan can be reviewed. The managed learning programme and detailed care plans ensure that staff can effectively monitor peoples health and wellbeing and recognise when to seek specialist advice. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can have confidence that the home is well run by an experienced management team and up to date ways of working. Views of people and others are used to develop the service. There are appropriate ways they check and continue to get things right. A safe environment is maintained in partnership by the Trust and housing association. Policies and systems could further address peoples needs and rights at all stages of adult life. Evidence: The home has an experienced manager who oversees more than one home and is based elsewhere but visits regularly. Since registration no application has been made for the Commission to register a manager, but this is intended. The manager is undertaking a leadership course. They have kept up to date with new laws and ways of working, for instance about mental capacity and person-centred care and provide inhouse learning opportunities for staff along with a Trust nurse. We met with the manager on our visit, and the acting house leader covering for Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: maternity leave who provides day to day oversight of the home kindly came in from leave to assist at the inspection. The home has good systems and is smoothly run smoothly for peoples benefit. There is a health and safety culture that also promotes peoples independence and risk taking, so that there is balance for peoples development as well as service development. Management and staff are approachable and respond quickly and effectively to requests and any concerns noticed or reported. This was evident from surveys, our observations and records seen on our visit. The AQAA was returned on time. It had all the information we requested and provided a critical and forward looking self assessment. The homes certificates are on display. We queried an out of date legal liability insurance certificate, and the home confirmed with the Trust that a certificate was received but was mistakenly not sent to the home. New things are tried to benefit people, such as the total communication strategy. People and their families influence facilities, how the home is run and care is provided. The home are beginning to anticipate changes, such as people growing older, and want to plan ahead. Some policies and screening systems need development and will provide impetus about malnutrition and pressure areas. We recommend that end of life care planning and advance decisions are considered where appropriate, in addition to funeral planning the home are in the process of consulting people about. Human resource processes are robust and safeguard people from abuse and inexperience. Management told us they will be recruiting staff for existing vacancies. There is an effective interim plan for consistent temporary and management ensure bank staff are trained to meet peoples needs, which is good practice. Management highly value staff and invest in their support, development and training, and appraise their performance and knowledge. Staff files contained all required documents. There is a staff development plan and staff are keeping up to date on mandatory training and refreshers. Qualifications are progressed and exceed national minimum standards along with formal supervision and appraisal of staff. There is a recruitment plan but staff were hard to find last year because public transport arrangements to the area keep reducing. The recruitment process was said to be slow. There are consistent bank staff used and recruitment to vacancies is underway. The staffing level and skill mix meets peoples needs, including at peak times and when people need individual escorts. There is a good quality assurance system, including unannounced spot checks by the manager and PCT as well as housing association checks, meetings and surveys with a variety of people, families and other stakeholders so that the service can continue to Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: develop and learn from all sources. Regulation 26 visits by the Care Trust are usually held but two were missing. These should be further developed in line with the Commissions updated guidance. We recommend there are periodic analyses of incidents and accidents, including medication incidents, and the progress of health action plans so that patterns needing environment or system changes, or learning can be acted upon. The Commission has not been notified about medication incidents. Policies and procedures are reviewed annually, along with the homes health and safety risk assessment and fire safety plan. It was decided, for instance that people did not want to go on long food shopping trips, and staff were struggling with wheelchairs and bags, so staff undertake this now. There are safe working practices that staff are inducted and trained to and kept up to date about, including fire drills and manual handling. The fire officer will be advising the home about their fire evacuation plan, and the home had a successful environmental health inspection in 2008. We sampled policies on medication, complaints, adult protection, sexuality and infection control and found they reflect current national guidance, but older versions should be removed so that staff use the correct one. Most systems are well organized. There are daily, weekly and monthly schedules for maintenance, safety checks and cleaning. There are regular audits of the medication and care planning system, money transactions. All records are up to date, secured and confidentiality is maintained. People have access to records that are put into an Easy Read Format or are explained. The Trust are streamlining and updating documentation. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide should accurately reflect current management arrangements for the home, qualifications and whether the manager is registered by the Commission. The homes information, terms and conditions should clarify any care management elements by staff not under the homes direct control, such as activities, and specify any charges that may apply. People unable to make care decisions, where best interests are decided solely by paid staff must have a statutory independent mental capacity advocate involved for serious care and treatment decisions, and may be entitled to one for care reviews. We recommend that diet is regularly reviewed to ensure that healthy eating is promoted, such as the inclusion of oily fish. Nutritional care plans of people with diabetes need to ensure that long gaps between meals are avoided, so blood sugar levels are maintained. A system to screen for risks of pressure areas and malnutrition should be introduced so that interlinked risks are known and acted upon to promote prevention and access to health specialists at early points. Page 34 of 36 2 5 3 7 4 17 5 19 Care Homes for Adults (18-65 years) 6 20 Multi-professional best interest decisions about medication to be disguised in food or drink, or in liquid form should include written agreement by an appropriate health clinician that they are necessary, least restrictive and safe. Occasional use medication carried over from a previous delivery should be added on the MAR to new medication checked into the home so that audits ensure that all medication in the home is accounted for, in date and available when it is needed. It is advised that the LACORS guidance is consulted about smoking rooms so that the arrangements in place meet smoke free legislation. We recommend security is reviewed to provide protection from intruders, including window locks. Date-labelling and sealing opened food stocks in the fridge and freezer could improve. Environmental Health guidance should be used to review this to protect peoples health. The Commissions website guidance on Regulation 26 visits should be used to develop this role in the quality monitoring system, including periodic incident and accident analyses so that any changes in the environment or systems can be acted on or lessons learned. Missing policies need to be proactively addressed, such as pressure area care and continence promotion. A DOLS policy and system will be needed from April 2009, using national forms. As policies and procedures are revised, older versions should be removed so that staff have ready access to the correct process. The Commission should be notified in line with our current guidance, including medication incidents, so that we work in partnership with the home to protect people. 7 20 8 24 9 10 24 30 11 39 12 40 13 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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