Care Home: Evergreen

What the care home does well The home has good admission procedures in place that ensure peoples needs are fully assessed before they move in so they know the home can meet their needs. Each person has a care plan so that staff know how to support them to meet their needs. There are lots of activities offered to people so that they can take part in things they enjoy doing. The people living there are helped to keep in touch with their family and friends and the people that are important to them. A choice of food is offered to people and they have a healthy diet to help them keep well. The health needs of the people living there are met and people get the care from other professionals they need to help them stay healthy. The staff at Evergreen are friendly and helpful. People are supported by staff they know, and who are familiar with their needs. There is enough staff employed so that the people living in the home can be supported to do the things they want to do. All the people living at Evergreen have a single bedroom. These are all very different, and each person`s room contains the things that are important to them. Staff ask people what they think about the home and if anything can be done to make their lives better. What has improved since the last inspection? Medication administration records are completed to a better standard and show that people usually get the medication they need to stay well. Some areas of the home have been repainted and new floor covering fitted so that the home is a nice environment for people to live in. Staff have the training they need in managing people`s behaviour so they and the people living there can be safe if someone is behaving in a way that they or others can get hurt. Bathing facilities have been reviewed to make sure they are suitable for people at the home so that they can have a choice of having a bath or a shower. The emergency lighting is being tested monthly to ensure it is working and people are not put at risk in the event of a fire. What the care home could do better: People should have a copy of the terms and conditions of their stay and these should be signed by them or their representative to ensure they are fully aware of the terms and conditions of their stay. Behaviour management strategies should be reviewed following any serious incident. The review should show that an evaluation of any incidents that have occurred has been done to show if the plan is still effective or needs changing. This will help ensure people`s behaviour is managed as safely as possible. The home should consult with the GP where people regularly miss out on having their medication because they are asleep. Guidance needs to be available about if the medication can be given at a later time so that people get the medication they need to stay healthy. Ensure that all staff are aware of the homes safeguarding reporting procedures. So that any incident is reported without delay and people can be confident they will be protected from abuse. Where water is identified as too hot for people staff should record on the temperature records what action has been taken to reduce the temperature. To show that the home is taking action to make sure people are safe. Key inspection report Care homes for adults (18-65 years) Name: Address: Evergreen 119 Wake Green Road Moseley Birmingham West Midlands B13 9UT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 2 1 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Evergreen 119 Wake Green Road Moseley Birmingham West Midlands B13 9UT 01214491016 F/P01214491016 evergreen@tracscare.co.uk suehullin@tracscare.co.uk Tracs Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Gillian Taylor Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Future admissions to the home are only considered for service users over the age of 45 years. That details regarding how the specific care and social needs of people over the age of 65 will be met must be included in the service users plan. That the home can continue to accommodate three named service users who are over 65. That TRACS Evergreen apply for variation on behalf of future service users who reach the age of 65. The home may accommodate a maximum of eight (8) service users with learning and physical disabilities, aged under 65 years. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 8 8 Brief description of the care home Evergreen is a large detached property, located in Moseley Birmingham. The home is close to a range of community facilities, which include shops, parks, places of worship, a library, leisure centre and public transport links. The home is set back off the main road in a small avenue that provides security and privacy from the road. The accommodation comprises of four bedrooms, an assisted bathroom, kitchen, lounge diner, office, laundry and conservatory on the ground floor. On the first floor are a further four single bedrooms, another bathroom, wc, and staff sleep in room. The home has off road parking, and at the rear of the home is a large deck area, and mature gardens. This home provides care and support for up to eight people with a Learning Disability or Acquired brain injury. The service user guide records that the fee levels range from 1200 to 1500 pounds per week. However the guide does record that this is dependent on peoples needs and so the reader is advised to contact the home for up to date fee information. Copies of our reports are available to read at the home on request from staff. Care Homes for Adults (18-65 years) Page 5 of 30 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 inspection was carried out over two days by one inspector. This was the homes key inspection for the inspection year 2009 to 2010. Our previous visit to the home was on 30th May 2007. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. Care Homes for Adults (18-65 years) Page 6 of 30 We received surveys from six people who live at the home, two care professionals and one relative. Information from the surveys has been used within this report. Three of the people living in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. During our visit we spoke with everyone who lives at the home. We looked at parts of the home. A sample of care, staff and health and safety records were looked at. The manager and staff on duty at the time were spoken with. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Medication administration records are completed to a better standard and show that people usually get the medication they need to stay well. Some areas of the home have been repainted and new floor covering fitted so that the home is a nice environment for people to live in. Staff have the training they need in managing peoples behaviour so they and the people living there can be safe if someone is behaving in a way that they or others can get hurt. Bathing facilities have been reviewed to make sure they are suitable for people at the home so that they can have a choice of having a bath or a shower. The emergency lighting is being tested monthly to ensure it is working and people are not put at risk in the event of a fire. Care Homes for Adults (18-65 years) Page 8 of 30 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 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to ensure they can make a choice about whether or not they want to live at the home. An assessment is undertaken prior to moving in, to ensure the home is able to meet the needs of the individual. Evidence: People are provided with a copy of the Service Users Guide that tells them all about the home. The manager showed us at this visit that the guide was in the process of being updated to include the new management arrangements for the home and photographs of the refurbished bathroom. The work undertaken to assess one individual prior to admission to the home was tracked. An initial assessment had been completed in consultation with other care professionals and the individual. The assessment covered all areas of need and possible risks had been assessed. Two files were sampled to check that people living at the home had a copy of their Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: terms and conditions. Both people had a copy of the document but it had not been signed by them or their representative. As recommended at our last inspection this needs to be done to ensure they are fully aware of the terms and conditions of their stay. We received surveys from six people who live at the home. Four people told us they were asked if they wanted to move to the home and were provided with enough information. One person who returned a survey told us they could not remember if they had enough information when they moved into the home. Care Homes for Adults (18-65 years) Page 12 of 30 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. Staff have most of the information they need to help them support each person in the way they prefer and need. People are supported to make decisions about their lives and are supported to take risks ensuring they are safe. Evidence: We looked at the care records for three people. Care plans were up to date and were detailed so that staff know how to support each person and they have the information they need to support individuals in a consistent manner. Peoples personal preferences are recorded in their plan. It is good that reviews are held with each person and people important to them are invited to attend. Objectives are agreed at the review. For one person this included staff to wear name badges as the individual forgets their names. Staff were observed wearing badges during the visit, this showed that objectives are acted on. We spoke with staff during our visit and found that they have good knowledge of the needs of the people they support. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Some people at the home may have behaviours that staff can find challenging. Care plans sampled included behaviour management strategies that included triggers for behaviour and distraction techniques. We saw that these plans are regularly reviewed. However for one person although their plan had been reviewed recently it should have been reviewed again. This is because an incident occurred where their behaviour impacted on another person at the home. It is also recommended that the review of the plan shows that an evaluation of any incidents that have occurred has been done to show if the plan is still effective or needs changing. Choice was observed to be offered to people throughout the visit. People have their own notice board to inform them of what is happening, activities or educational information. Meetings with people who live at the home are held regularly. Topics discussed include where people would like to go on holiday, activities, food, the environment and things they like and dont like about the home. A Focus day is also held annually for people who live in Tracs homes where they can meet people from other Tracs homes and comment on the service they receive. The majority of people who returned a survey to us indicated their needs are met and they can make their own decisions. People told us that staff always or usually act on what they say but three people said this was only sometimes. One person who lives at the home has said they would prefer to move to another home. Discussion with their keyworker and records indicate that the home has respected this decision and has made contact with social workers to try and facilitate this. Records included individual risk assessments for each person. These stated how staff are to support each person to reduce the risks of there being a fire, when accessing the community, having a seizure due to epilepsy, vehicles, undertaking household activities, peoples vulnerability, money handling skills and manual handling. All risk assessments had been regularly reviewed. Care Homes for Adults (18-65 years) Page 14 of 30 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. Arrangements are in place so that people living in the home experience a meaningful lifestyle. Evidence: Sampled records and discussions with staff and people who live at the home show that a variety of activities are on offer consistent with any person of the same age, culture and gender. Activity charts and the annual quality assurance assessment show that activities on offer include independence skills, contact with family, college, car booting, shopping, walks, playing darts or pool, going to church and cooking. Some people had recently been on holiday. During the visit people were observed being supported by staff to play dominoes, one person was drawing and another was doing a woodwork activity in the garden. Some people later went out shopping to buy food and another went to church. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Information from surveys indicated people can do the things they want to, although one person commented they would like staff to take them out more. During our visit to the home people told us: Im happy here, do not get bored, theres lots of activities, I choose where to go on holiday and meals, they are nice, theres nothing I would change. Its an okay home, I do my own cooking. People living at the home and staff reported, and it was evident from care records that contact with people important to them is encouraged. This included people coming to visit at Evergreen, phone calls and people making visits to their family and friends. Care plans record a full list of birthdays of family so that staff can support people to send out cards. In February the home held a Valentines party and peoples friends from other homes were invited to attend. Minutes of peoples meetings show they are consulted on the foods they would like on the menu. One person at the home told us they like to do their own shopping and cooking. We looked at the menus, these showed that there is a choice of varied and nutritious meals on offer. Fresh fruit and vegetables were observed to be available in the kitchen. We observed that at lunchtime staff sat and ate with people, giving them appropriate support in a friendly manner. Care Homes for Adults (18-65 years) Page 16 of 30 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. People receive personal support in the way they prefer and require and their health needs are met. The management of the medication generally protects people and ensures their well-being. Evidence: Care plans contain detailed information about individual personal care needs so that staff know how people like to be supported. People living in the home were dressed appropriately to their age, gender, the weather and the activities they were doing. Care records show that people are supported by staff to go out and purchase their own personal toiletries. Records showed that the people living in the home had their medication regularly reviewed and they have regular health check ups with the dentist and optician. Where appropriate the advice of other health professionals is sought, for example the GP or psychiatrist. When people attend health appointments a detailed record is made of the reason for the appointment and the outcome. Surveys from health professionals indicate that they think the home meets peoples healthcare needs. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Prior to our visit to the home we received a concern about the monitoring of one persons epilepsy. There was a concern that the audio monitor in use at night did not work properly and that this had been raised with the manager previously but not acted on. Therefore at this visit we looked at the care provided to one person who had epilepsy. We saw that there was a detailed plan in place re the support they needed regarding their epilepsy. Discussions with the manager and several staff indicate that the audio monitor had been in working order. Review meetings show that a bed alarm has been under consideration for several months. This was seen to be in place when we visited. Discussions with staff and records show that monitoring of the persons well being is now done via a combination of visual checks, and both the audio and bed monitor. The person had recently had more seizures than usual and there was evidence to show they had been referred to a specialist for this. Medication systems are generally satisfactory. Storage of medication is in a locked cabinet. A weekly check of medication is done to ensure the cupboard is clean and medication is within its use by date. Copies of prescriptions are retained so that staff can check the correct medication has been received from the chemist. At our last inspection we found that there were some gaps on medication administration records and prior to our visit a concern was received about staff not signing the records. At this visit we found that practice had improved and that the records had usually been signed. Where staff had on limited occasions forgot to sign the record there was evidence that appropriate action had been taken by the home to address this. Where individuals are prescribed PRN (As required) medication a protocol is in place stating when, why and how this should be given so that people should get the medication they need when they need it. Medication administration records show that sometimes people do not get the medication they need because they are asleep at the time it should be given. We discussed with the manager that the home should consult with the GP about this and seek guidance about if the medication can be given at a later time. Care Homes for Adults (18-65 years) Page 18 of 30 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 who live at the home know how to make a complaint and that their views will be listened to and acted on. Arrangements are sufficient to ensure that people are protected from abuse, neglect and self harm. Evidence: The home has a complaint procedure that is in an easy read format and is on display in the home. Surveys we received from people at the home told us they are aware of the procedure and know who to speak to if they are unhappy. We looked at the complaint log in the home, this showed that the home had received one complaint from a relative and three from someone who lives at the home. Records show that action was taken to respond to the concerns and generally indicated that the complainants were happy with the response. The home has also received some concerns made under their own whistle blowing procedures. Tracs had responded to the whistleblower in writing with regard to their concerns. However information suggests that the whistleblower is not satisfied with the response to their concerns. We have requested information from Tracs regarding their investigations so that we can be sure the concerns have been looked at properly. Training records and discussions with staff show they have received training in safeguarding people from abuse. Discussions with staff show they generally know Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: what to do to keep people safe from abuse. One member of staff was not so confident on the procedures to follow if the abuse was from another person at the home. However all staff said that they would report any suspected abuse immediately to the senior staff on duty. Since our last visit to the home these has been an incident where one person has had some money go missing. Discussions with the manager and evidence provided after our inspection indicates that this was appropriately notified to the persons social worker and the police. Tracs reimbursed the missing money and have changed the financial procedures to reduce the risk of this happening again. We looked at the financial records for two people. Receipts were available for all expenditure and people were not being expected to pay for things that should be purchased by the home. Recently there was an incident in the home where one person was hit by another person who lives there. Social services were informed by the home about this as they are the lead agency for safeguarding people. However there was a delay in reporting this as the manager and deputy were not on duty the day it happened. We discussed this with the manager who assured us that reporting procedures would be reinforced with staff. Care plans sampled included behaviour management strategies that included triggers for behaviour, distraction techniques and the use of Studio III (a form of physical intervention). Staff spoken with had good understanding about the use of Studio III and that it is used only as a last resort. Staff described using other techniques to calm the situation before using physical intervention. Training records show that staff receive training in Studio III and have regular refreshers so that they have the knowledge they need to manage behaviour. Care Homes for Adults (18-65 years) Page 20 of 30 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, comfortable, safe and clean environment that generally meets their individual needs. Evidence: Evergreen is an adapted domestic property, and from the outside is not distinguishable as a care home. The premises are homely in style and generally well maintained. At the last key inspection we reported that bathing facilities in the home needed review to make sure they were suitable for people in the home. Recently a new bath had been fitted. At the time of our visit repairs were being undertaken to the newly refurbished bathroom due to problems with water not draining correctly from the shower and so we were unable to look at the new bathing facilities. One ground floor bedroom has had an ensuite bathroom fitted since our last key. Ground floor hallway carpets were observed to be quite stained at our last key inspection but new flooring has now been fitted so that the hallway downstairs looks nice and is clean. First floor hallway carpets were a little stained at this visit but the manager told us these are due to be replaced soon. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The lounge has been repainted since our last visit and is now a nicer place to spend time in. The home has the facilities of a conservatory but this is currently used as a smoking room and an extractor fan is fitted to help remove the smoke. People at the home have their own bedroom. One person showed us their room and said that they had everything they needed. They told us that they had the opportunity to choose the decor of their room. We saw it was well maintained and personalised. We saw that one person who is hard of hearing had a doorbell fitted to their bedroom door. The manager told us that staff press the doorbell when they want to enter the room. This makes a light flash inside the room so that the person knows staff are at the door. We saw that one persons bedroom carpet was very stained. Discussions with the manager indicate that this carpet is not yet on the schedule to be replaced. This will need to be done so that the persons bedroom is well maintained. Part of the concern raised by the whistle blower was about the lighting in the home. They said that there had been some occasions when light bulbs were not working and had not been replaced quickly. We looked at the homes maintenance records and did see some instances last year when light bulbs were not replaced quickly. However there were no recent reports of this and when we visited we sampled lights and found them all to be working. We also found that the home had a good stock of light bulbs so that ones that were not working could be replaced. Satisfactory infection control procedures are in place. The laundry is sited away from the kitchen and dining room. Hand washing facilities are available with liquid soap and paper towels. The home was observed to be clean. In the annual quality assurance assessment the manager told us that the home has been awarded a five star excellent rating by the environmental health officer for their hygiene arrangements in the kitchen. People who returned surveys to us said the home is usually fresh and clean. Care Homes for Adults (18-65 years) Page 22 of 30 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 who live at the home benefit from a generally well trained and supported staff team that can support them to meet their individual needs and achieve their goals. People are protected by the homes recruitment practices. Evidence: Support to people was observed to be given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Staff spoken with showed a good understanding of the needs of the people who lived at the home. Surveys from people indicate staff usually treat them well. One person told us the staff are okay. One relative told us staff do everything well. Just under half of the staff have completed a National Vocational Qualification in care, some at level three. Staff who do not have this are undertaking it so helping to ensure that staff have the skills and knowledge to meet individuals needs. The number of staff on duty at the time of inspection was satisfactory to enable people to access the community, and to receive the level of support and supervision required. The staff rota for May was observed and showed that generally four staff are on duty during the day. Staff spoken with felt that staffing levels in the home were appropriate to meet the needs of the people who lived there. However some staff Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: spoken with were not happy with recent changes to the working time of the staff sleeping at the home at night. Staff said that often people had gone to bed, or not got up during the times they were expected to work. One said it was not a good use of their time. We discussed this with the manager who acknowledged that some staff were not happy with the new arrangements. The manager said however that if all people were in bed sleep in staff could make use of the time by bringing paperwork up to date. Recruitment records for three new staff were sampled. These showed a robust procedure had been followed. These included a photograph of the person, the required recruitment records and evidence that a Criminal Records Bureau (CRB) check had been undertaken to help ensure suitable people are working there. We spoke with several staff who had started working in the home since our last key inspection. They told us that when they first start at the home they work shadow shifts and are extra to the other staff on duty. They are also allocated a member of staff called a buddy who helps them to settle in at the home. One person told us that their induction to the home had been interesting and intensive. We looked at staff training records and spoke with staff. Staff spoken with said they get the training they need. As required from the last key inspection staff now get up to date training in Studio III (managing behaviour and physical intervention). Staff have had training that includes food hygiene, first aid, moving and handling and first aid. Staff have also had training on the Mental Capacity Act and more recently Deprivation of Liberty Safeguards. As reported earlier one person at the home has epilepsy. Previously staff training in this has been in house via a booklet. Discussion with the manager indicates that the home has recently improved this training. Three staff have done epilepsy training via an external provider and the manager said more will be doing this. Other training scheduled for some staff includes nutrition and dementia. Sampled records show that staff meetings and supervision happen regularly. This means that staff can be kept up to date with best practice and discuss the well being of people at the home. Care Homes for Adults (18-65 years) Page 24 of 30 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. Management arrangements usually ensure the home is run in the best interests of people who live there so helping to ensure their safety and well being. Evidence: Since we last visited the home the registered manager has left to work at another Tracs home. The home is currently being managed by the previous deputy of the home who has applied to us to become the registered manager. The annual quality assurance assessment for the home indicates that the new manager has the necessary qualifications to manage the home. We spoke with four staff about the management arrangements in the home. Staff were all very complimentary about the manager. Their comments included : The home runs very well, previously we had a high turnover of staff and a change of manager but it has improved. I have confidence in the manager, she is very easy to talk to. Get great support from both the manager and deputy, cannot fault them. They are very approachable, can raise things. Manager is supportive. Home is generally well managed. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Systems to ensure quality are in place, these include the views of people who live at the home, staff and others. Monthly visits to the home are made by a service manager who completes a report. Other audits are carried out periodically for example for health and safety or care planning. Where improvements needed are identified a corrective action plan is formulated. An annual away day is arranged for staff where they can discuss areas that they feel the home could improve on in the coming year. The home also has systems in place to consult with people and their representatives, staff and external professionals. This includes holding client focus days and also sending out quality questionnaires. The results of the questionnaires are collated into a report. The last report for the home was generally positive but this was dated 2007. The manager told us that questionnaires had been sent since then and that the new report was currently being collated at head office. In house checks of the fire alarm and emergency lighting are undertaken regularly. It is good that in addition to fire training for staff people who live at the home also have the fire procedure explained to them. This is available in a pictorial format so that it is easier for them to understand. Staff check the water temperatures weekly to make sure they are not too hot and could put people at risk of scalding. Records from the day before our visit showed that two showers were too hot and could pose a risk to people. The record did not show if this had been reported or not. When we told the manager about this she arranged for the temperatures to be reduced, this was done during our visit. Evidence that the fire, electrical and gas equipment had been serviced as required was available to show that the systems were safe for people. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 1 23 13 Ensure that all staff are aware of the homes safeguarding reporting procedures. So that any incident is reported without delay and people can be confident they will be protected from abuse. 02/07/2009 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 5 People should have a copy of the terms and conditions of their stay and these should be signed by them or their representative to ensure they are fully aware of the terms and conditions of their stay. Behaviour management strategies should be reviewed following any serious incident. The review should show that an evaluation of any incidents that have occurred has been done to show if the plan is still effective or needs changing. This will help ensure peoples behaviour is managed as safely as possible. 2 6 Care Homes for Adults (18-65 years) Page 28 of 30 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 3 20 The home should consult with the GP where people regularly miss out on having their medication because they are asleep. Guidance needs to be available about if the medication can be given at a later time so that people get the medication they need to stay healthy. Where water is identified as too hot for people staff should record on the temperature records what action has been taken to reduce the temperature. To show that the home is taking action to make sure people are safe. 4 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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