Care Home: Downing Close

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What the care home does well People have information about the home and opportunities to visit, before moving in, so that they can be confident their needs will be met there. The home is good at supporting people to keep in touch with their friends and relatives so that they do not lose relationships that are important to them. Records that describe people`s personal care needs are well written and staff understand how to offer care to people in a way they they need and like. Staff have made effort to present information to people in an accessible way so that they can make choices and decisions. There are good systems to recruit staff so that people are protected from possible harm. Complaints are taken seriously and people are confident that staff will listen to them should they have any concerns. Staff understand how to recognise changes in people`s behaviour as an indication that they are not happy and take action to investigate why this may be. Staff have regular training to help them care for people more effectively. Health and safety is promoted to protect people from possible risk of harm. What has improved since the last inspection? This was the home`s first inspection since becoming newly registered with the commission. This means that although the details for the responsible individual have changed, the service at Downing Close remains the same as at our last visit in July 2008. What the care home could do better: The home is meeting national minimum standards. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Downing Close 7-9 Downing Close Knowle Solihull West Midlands B93 0QA     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: Julie Preston     Date: 2 0 0 2 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 27 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 27 Information about the care home Name of care home: Address: Downing Close 7-9 Downing Close Knowle Solihull West Midlands B93 0QA 01564732840 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) : Solihull Care Trust care home 12 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability physical disability sensory impairment Additional conditions: 12 5 2 The maximum number of service users to be accommodated 12. 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) 12 Physical Disability (PD) 5 Sensory Impairment (SI) 2 Date of last inspection Brief description of the care home Downing Close provides care and support to up to twelve people with a learning disability. The home consists of three separate houses. One house is currently empty and there are no plans for anyone to move in. Bedrooms are single and all ground floor. Each house has a kitchen with dining area, lounge, laundry room, bathrooms and smaller lounge used for relaxation and private meetings. There are adapted bathing facilities in house 9 and ramps fitted to the rear gardens. Fees are variable. The home can provide further information. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 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: We spent a day at the home. The people who live there and the staff did not know that we were coming. Before our visit we looked at information that the home had sent to us including notifications of events that impacted on the health and well being of people who live there and details of any complaints or safeguarding issues. We case tracked three people who live in the home. Case tracking includes meeting people and talking about the care they receive or watching staff supporting them, looking at their care records and medicines and the way that they are helped to make choices and decisions. This assists us to understand the experiences of people who live Care Homes for Adults (18-65 years) Page 6 of 27 in the home. We looked at records of staff training and recruitment, health and safety records and the food people are offered. Time was spent talking to the management team and three members of staff as well as two people who live at Downing Close. Some people who live at the home have complex communication needs so were not able to provide us with their views about the service they receive. Instead, we observed staff working with them and talked to staff who support them. We looked around the building to make sure that it was clean, warm and comfortable. There were no immediate requirements made as a result of our visit. This means that there was nothing urgent that needed to be done to protect people who live in the home. What the care home does well: What has improved since the last inspection? 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 8 of 27 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 9 of 27 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. Peoples individual needs are assessed before they move into the home so that they can be confident their needs can be met there. Evidence: There have been no new people move into the home since we last visited in July 2008. During our last visit, we saw that there was a procedure in place for assessing the needs of people so that they could be confident that the home would be suitable for them. Trial visits are encouraged and the information gathered from them are used to write a care plan so that staff can understand how to meet peoples needs. We were advised by the manager that this procedure remained the same so we did not look at it again. Care Homes for Adults (18-65 years) Page 10 of 27 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. There are effective systems of care planning and risk assessment in place, which should ensure that peoples needs are understood and met. People receive good support to make choices and decisions about their lifestyles. Evidence: We looked at care plans and risk assessments for two people who live in the home. These records give information about the type of support that people need to carry on with their day to day lives and identify measures in place to reduce any risks to their health and well being. The records were clearly written and explained how the person should be supported with regard to personal and health care, spiritual and cultural needs, communication, mobility, social and leisure needs and day to day living. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: There was evidence that the records had been reviewed on a regular basis so that they remained relevant to peoples current needs. The three members of staff that we spoke to demonstrated knowledge of each persons individual needs, which indicates that care records had been read and understood. Risk assessments were comprehensively written so that known hazards were identified and an action plan developed to reduce the risk of potential harm to people. For example, people at risk of falls were offered one to one support when moving around to minimise the risk of injury to them. We saw that one persons care plan was not dated, which made it difficult to establish that it was relevant to their current needs. Dating care plans aids the system of review so that staff have accurate and up to date information about the support people need within their day to day lives. We looked at daily records, which described the choices that people had made as part of their day to day routines, such as getting a haircut, planning activities and holidays and menus. People who live at Downing Close have complex communication needs. We saw records within care plan files that Speech and Language Therapists had worked with the staff team to promote choice and decision making for the people who live there. A member of staff told us that they had learned to recognise peoples gestures and body language as a valuable means of communication and were able to use this understanding to help people make choices and decisions. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home experience a meaningful lifestyle that promotes their independence and reflects their personal choices. Evidence: We looked at activity plans and daily records for two people to see if they had regular opportunities to do things that they enjoy. Each person had a record of the activities they like and those that they dont like. Planning meetings take place each week so that people can decide what they would like to do. Peoples choices had been recorded and each activity evaluated to determine that the person had enjoyed the activity. Some people living at Downing Close have complex communication needs and need support to make choices about their social and leisure time. Staff showed us tools that they use to assist people such Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: as pictures and photographs. We were told that Speech and Language Therapists had guided this process to enable people to make realistic choices as part of their daily routines. People made good use of their local community and daily records described a range of activities such as food shopping, trips to cafes and pubs, walks, bingo sessions and social clubs. The home supports people to keep in touch with their friends. Care plans that we looked at described how people should be supported to maintain this contact. Transport is provided to people so that they can visit friends and family who do not live locally. We looked at menus and the records of food that people eat to make sure that a varied and healthy diet is offered that meets peoples needs and preferences. It was evident from looking at records that people have a choice of meal and that they are included in shopping for food each week. Menus were presented by use of photographs so that people could see what was available each day. The home offers traditional English meals, which is in keeping with the cultural needs of the people who live there. One person told us that the staff cook well and that the food is always good. Care Homes for Adults (18-65 years) Page 14 of 27 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. There are effective systems in place to meet peoples personal and health care needs. Medicines are well managed so that people receive their medication in a planned and safe manner. Evidence: We looked at personal and health care records for two people. They contained clear information about peoples needs and had been recently reviewed to make sure that they were accurate and up to date. We met all of the people who live at Downing Close during our visit. It was evident that they had been supported with personal care; people were well dressed and some of the women had had their hair and make up done by staff. One person was looking forward to a massage by a beauty therapist that visits the home. The two members of staff that we spoke to were able to describe how they supported people with their personal and health care, which indicates that they had read and understood individuals care plans. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: The health records we looked at showed that people had regular appointments with health care staff and that the outcome of the contact had been recorded so that staff had up to date information about peoples well being. Moving and handling risk assessments were in place for those people who need support to move around. Records showed that professional advice had been sought for people with specific health care needs such as epilepsy and swallowing difficulties. There were guidelines that described how staff should support people with specific health care needs. We looked at the way medicines are managed in the home to check that this was being done safely. Medicines had been securely stored and we were told that all medicines were checked by staff at the end of each shift. This should ensure that errors are spotted quickly and investigated promptly. We were told that there had been no mistakes in handling medicines within the last twelve months. Staff have had accredited training in the safe handling of medicines and their competence is assessed by a registered nurse every six months. This should ensure that people receive their medication by a trained and knowledgeable team of staff. From looking at the medication records of two people it was evident that medicines had been given as prescribed. Care Homes for Adults (18-65 years) Page 16 of 27 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. There are effective procedures in place to listen to peoples complaints and safeguard them from possible harm. Evidence: The home has a complaints procedure, which is made available to people and to their relatives. There have been no complaints about the service in the last twelve months. Due to peoples complex communication needs it was difficult to establish that they were aware of the process of making complaints. Staff did however comment that they were alert to changes in peoples behaviour as an indication they may be unhappy and would take action to discover the cause. There have been three safeguarding issues referred to Solihull Care Trust since our last visit. The home have kept us up to date about the action they have taken to maintain peoples safety in light of the referrals and had clearly followed their own safeguarding procedures for peoples ongoing protection. The home has a procedure for safeguarding vulnerable adults, which is available to staff and also covered during the induction procedure for new staff. Some staff have not completed training in safeguarding vulnerable people, however the staff that we spoke to were able to describe their role within the safeguarding process. We also saw Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: evidence that training had been booked for staff later this year. Care Homes for Adults (18-65 years) Page 18 of 27 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 clean, warm and well furnished home which meets their individual needs and promotes their independence. Evidence: Downing Close is situated in the Knowle area of Solihull, close to local amenities such as shops, pubs and restaurants and places of worship. This is important to people who live there as they make regular use of these facilities. The home consists of three separate houses, however no one is living in one of them and there are no plans for anyone else to move in. People have their own bedrooms, which are all on the ground floor. The bedrooms that we looked at were clean, warm and furnished according to peoples personal tastes. Effort has been made to provide sensory equipment such as lights and fibre optics. We were told that people find this relaxing. Shared space (in each house) consists of a lounge, kitchen with dining space, bathrooms and a smaller lounge that is used for private meetings of for people to relax in. There is ramped access to rear gardens, which are secure and well maintained. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: Adapted bathing facilities are provided in house 9, which meet the needs of the people who live there. We saw that equipment had been serviced on a regular basis to make sure it remained safe for people to use. All areas of the home were clean and warm. There were no unpleasant odours that may indicate poor cleansing routines. Separate laundry facilities are available with secure storage for cleaning products that may cause harm to people if they were not locked away. We looked at maintenance records and found that issues reported were dealt with promptly so that peoples health and safety was promoted. One exception was the cooker in house 8 which was not working properly, although we were told that this had been reported. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a trained team of well established staff who have good understanding of their needs. The home operates a robust system of recruiting staff for the ongoing protection of the people who live there. Evidence: People told us that the staff team were good and nice. We observed staff working with some people and saw that relationships appear relaxed and friendly. The staff that we spoke to at this visit were knowledgeable about peoples needs and clearly know them well. From observation of the homes rota it was evident that there are enough staff on duty each day to meet peoples needs. Daily records showed that people go out on a regular basis and there were sufficient staff available to meet peoples personal care needs during our visit. The home employs both waking night and sleep in staff. There is an on call system in place so that staff have access to senior colleagues for advice and guidance during the night. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: The home has a rolling programme of staff training that is provided by Solihull Care Trust. This should ensure that staff have access to regular training to assist them to meet peoples needs more effectively. Staff talked to us about the value of taking part in total communication training. This had enabled them to present information to people in an accessible format to help them make choices and decisions about their lives. The majority of staff have worked at the home for many years. One person has been employed since our last visit. We looked at this persons records which showed that checks had been made of the persons suitability to work within the home, prior to appointment. This contributes to the ongoing safety and protection of people that live at Downing Close. Care Homes for Adults (18-65 years) Page 22 of 27 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. The home is well managed and peoples health and safety is promoted and protected. There are systems in place to listen to the views of people who live in the home and to develop and improve the standards of care provided. Evidence: The home has a registered manager who is a learning disabilities nurse and has completed other training that is appropriate to her role. The manager is supported by house leaders who take responsibility for the day to day running of each house. There are systems in place to review the quality of care and service provided within the home. A representative of the registered provider visits the home on a regular basis and writes a report about the standard of care provided. We spoke to this person and were advised that the home continues to take action to address any recommendations made following her visits. We saw records that a range of regular audits had been completed such as health and safety and infection control. This indicates that the home are taking adequate steps to promote the health and safety of Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: people who live there. A number of other health and safety checks are made. We looked at some records that show this has happened. The fire alarm system had been tested and serviced on a regular basis to make sure that it was working properly. People had taken part in fire drills so that they had opportunities to practice leaving the building in the event of an emergency. Individual risk assessments had been completed so that staff had instruction about how to support people in the event that the fire alarm sounded at night and they had to evacuate the building. Training records showed that all staff have taken part in health and safety, fire safety, infection control and first aid training. This should contribute towards promoting peoples health and safety. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 6 Care plans should be dated to aid the system of review, so that staff have accurate and up to date information about peoples care and support needs. Care Homes for Adults (18-65 years) Page 26 of 27 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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