Care Home: Forest Road

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What the care home does well Information about what the service provides is available in “easy read” format. People’s needs are properly assessed, so that their care can be planned appropriately. People can visit the home before they move in to see what the service offers and help them make a choice about whether or not the home is right for them. Staff know the people living there well and understand how they need to support them.Forest RoadDS0000072794.V377567.R01.S.docVersion 5.3People’s care plans are up to date and reviewed regularly, so that they can get the support they need in the way that they want. Staff try hard to ask the people living there what they want, recognising their communication support needs. Staff encourage the people living there to be as independent as possible, to be part of the community they live in, and to keep in touch with the people who are important to them. The people living there enjoy their food. They can choose what they want; so that they are able to have the things they like to eat. Staff support people to go on holiday to the places they want to go to. This gives people a chance to see different places and experience new things. The house is kept clean and tidy, so that people can be comfortable in their home. One person said, “I like my bedroom, I have the things I like in it.” Proper checks are carried out on staff before they start work at the home. This is to ensure that they are fit for the job. Staff are well supported, so they can do their jobs well. One person said, “The staff are nice, all of them.” Checks on essential equipment are carried out regularly, to help make sure that everyone in the house stays safe. What has improved since the last inspection? More work has been done on setting individual’s goals so it is clear whether or not they have been achieved. Planning of activities has continued to improve, so that these are now more clearly linked to people’s individual goals. Staff have got better at recording the activities that people do. This helps to make sure that activities have a clear purpose. New furniture had been bought for the dining room to make it more comfortable. Some people had new furniture and personal items in their bedroom so they are more comfortable.Forest RoadDS0000072794.V377567.R01.S.docVersion 5.3 What the care home could do better: People should have their health monitored more so that if they are unwell their health needs can be met. All risks should be assessed to ensure that people are as safe as possible. The home should be redecorated and repairs needed made so it is more comfortable for people to live in. Staff should have more training so they know more about how to help the people living there and keep them safe from harm. The home should be regularly audited to ensure it is meeting the needs of the people living there. Key inspection report CARE HOME ADULTS 18-65 Forest Road 4 Forest Road Moseley Birmingham West Midlands B13 9DL Lead Inspector Sarah Bennett Key Unannounced Inspection 7th September 2009 09:25 Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. 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 home adults 18-65 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. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 2 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 Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Forest Road Address 4 Forest Road Moseley Birmingham West Midlands B13 9DL 0121 442 2246 0121 442 2246 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Midland Heart Limited Robert Timmins Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 Disabilities (LD) 5 The maximum number of service users to be accommodated is 5. New registration as provider re- registered as Midland Heart. 2. Date of last inspection Brief Description of the Service: 4 Forest Road is registered to provide accommodation, care and support for up to five people who have a learning disability. The house is a large detached property, located in a residential area of Moseley, on the south side of Birmingham. The current group of residents are all male: they all have complex and high-level support needs. Communal areas on the ground floor of the house include a kitchen, separate dining room, and a spacious lounge. Also on this level are the office, laundry room, a spare room with en-suite facilities (formerly used as a staff sleep-in room) and a separate W.C. On the first floor are five single bedrooms, an assisted bathroom, a separate walk in shower room with W.C., and a staff sleep-in room. There is an enclosed private garden to the rear of the property. At the front of the house is a drive that can provide limited off-road parking. The service users guide stated that the fees charged to live there are £317.09 weekly to Midland Heart, £255.74 of this is paid by Birmingham East and North Primary Care Trust. The person contributes £62.50 per week and also needs to contribute £9.00 per week towards the use of the vehicle. This information was correct at the time of the inspection and the reader is advised to contact the home for updated information regarding fees. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. 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 an Annual Quality Assurance Assessment completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by two people living there. This involved establishing individual’s experience of living in the care home by meeting and talking with 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. We looked at parts of the home and a sample of care, staff and health and safety records were looked at. The manager and staff were spoken with. The people living there have limited verbal communication skills due to their learning disability. Time was spent observing how staff interacted with them and the support that staff gave. What the service does well: Information about what the service provides is available in “easy read” format. People’s needs are properly assessed, so that their care can be planned appropriately. People can visit the home before they move in to see what the service offers and help them make a choice about whether or not the home is right for them. Staff know the people living there well and understand how they need to support them. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 6 People’s care plans are up to date and reviewed regularly, so that they can get the support they need in the way that they want. Staff try hard to ask the people living there what they want, recognising their communication support needs. Staff encourage the people living there to be as independent as possible, to be part of the community they live in, and to keep in touch with the people who are important to them. The people living there enjoy their food. They can choose what they want; so that they are able to have the things they like to eat. Staff support people to go on holiday to the places they want to go to. This gives people a chance to see different places and experience new things. The house is kept clean and tidy, so that people can be comfortable in their home. One person said, “I like my bedroom, I have the things I like in it.” Proper checks are carried out on staff before they start work at the home. This is to ensure that they are fit for the job. Staff are well supported, so they can do their jobs well. One person said, “The staff are nice, all of them.” Checks on essential equipment are carried out regularly, to help make sure that everyone in the house stays safe. What has improved since the last inspection? More work has been done on setting individual’s goals so it is clear whether or not they have been achieved. Planning of activities has continued to improve, so that these are now more clearly linked to people’s individual goals. Staff have got better at recording the activities that people do. This helps to make sure that activities have a clear purpose. New furniture had been bought for the dining room to make it more comfortable. Some people had new furniture and personal items in their bedroom so they are more comfortable. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 7 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. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 People using the 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 make a choice as to whether or not they want to live there and know that their needs will be assessed before they move in. EVIDENCE: The service user’s guide was included in people’s records that were sampled. It included the relevant and required information so that people would know what the home provides including the fees charged to live there. The service user’s guide was produced using pictures, photographs and in an easy read language making it easier to understand. The statement of purpose included most of the relevant and required information so that people would have the information they needed to make a choice as to whether or not they wanted to live there. Our contact details needed updating so that people would be able to contact us about the home if they wanted to. It included pictures making it easier to understand. Since we last visited one person had moved into the home. We looked at their records, which included an assessment of their needs before they moved in. This was detailed and following the assessment the person had the opportunity Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 10 to visit the home. This included meeting the other people living there and staff. After a day visit they had some visits to the home where they stayed overnight. This gave them an opportunity to get to know the staff and the other people living there to make a choice as to whether they wanted to live there. Professionals working with the person and the person’s relatives also visited to ensure the person’s needs could be met there. The views of the other people living there were considered with staff observing how this person living there may affect them, as they had all lived together for several years. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People using the 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 the information they need so they can support people to meet their needs, make choices and keep them safe from harm so ensuring their well being. EVIDENCE: The records of two of the people who live there were looked at. These included an individual care plan that detailed how staff need to support the individual to meet their needs and achieve their goals. This was written in a way that centred on the person and how they wanted to be supported. It included photographs and pictures making it easier to understand. Some parts of one person centred plan had not been completed but this information was available in another part of the person’s records. For example, it stated ‘Important people in my life’, this was blank but this information was available in other Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 12 care plans that the person had but had not yet been transferred to this format. The manager said that there had been a change to the person’s key worker and this information would soon be available in this format. Care plans had been reviewed monthly and updated where the person’s needs had changed. Staff had signed to say they had read individual’s care plans so they knew how to support the person. Since we last visited the goals that individuals’ had set to achieve had been reviewed regularly to ensure that they were appropriate and achievable to the person. A monthly goal review sheet had been put in place. This recorded whether or not the goal had been achieved, what were any barriers to achieving it and the person’s reaction to meeting this goal. Some records stated that the goal had not been achieved due to shortage of staff, although the last recording of this was in July this year and since then more staff had been recruited. Care plans stated how the person communicates. This was detailed so that staff know how to interpret people’s facial expressions, gestures and nonverbal signs to understand what they are communicating. Staff use pictures to help people make choices about what they want to do, what they want to eat, what they want to buy and where they want to go on holiday. Regular meetings are held with the people living there to discuss what activities they want to do. Minutes of these meetings are produced using pictures and photographs so making them easier to understand. They stated that staff used pictures to help people make choices about the activities they wanted to do. Staff were observed during the day supporting people to make choices about what they wanted to do, what they wanted to eat and where they wanted top spend their time. Records included risk assessments that stated how staff are to support the individual to take risks whilst being as safe as possible. These included travelling by public transport, the person’s behaviour, their risk of being hurt by other people living there, going out in the community, fire, using the kitchen, health needs, eating and drinking and activities inside and outside the home. Risk assessments were regularly reviewed and updated where the person’s needs and risks to their safety had changed. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home experience a meaningful lifestyle so ensuring their well being. EVIDENCE: The manager said that the activity system is now linked to people’s personal goals and records sampled showed this. Staff use pictures to help people choose what activities they want to do. One person was starting a weekly social and development course the next week, which was to run for twelve weeks. Staff needed to support the person to attend this course. The person had previously completed a college course and has applied for a voluntary job. One person had been working at a Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 14 gardening project two days a week but this was due to close at the end of the month. Staff said that they would be looking for alternative occupation for this person. This person also has a greenhouse in the garden where they have grown tomatoes and does some of the gardening for the home. Daily records sampled showed and it was observed that people went out of the home most days at least once. People went for walks, drives, to pubs, shopping, to parks, restaurants, to the library and to the barbers. One person’s goal was to go to a retail park once a week. Their records showed that this had been achieved and they were now able to go with staff to the city centre to do shopping without being too anxious. People travelled on public transport or by using the car that belongs to the home to enable people to access the community. Inside the home people did baking with staff, did household chores helping them to develop their independence skills, watched DVD’s and TV, spent time in the garden, listened to music, arts and crafts and reading books. Records sampled included an individual folder titled ‘My holiday’. This included pictures, photographs and was written in an easy read format. It included the process the person had worked through with staff in choosing their holiday, where they wanted to go, when, which staff they wanted to go with them, whether or not they wanted other people living there to go with them, how much it would cost and how they are going to get there. People had chosen their holiday by looking at brochures with their key worker. Where people were able to they had signed to say they agreed to the choices made. Two people were going on a barge holiday that day with staff, one of these people were also going with staff later in the month for a short break in Wales. One person had been to Gran Canaria earlier in the year with staff and another person was planning to go to Morocco. Another person said they were going to Devon with staff soon and were looking forward to this. Records sampled showed that where appropriate people are supported to keep in contact with their family and friends. This may be through visits to the home, telephone calls and visit to their family and friends. Staff were planning how they would support one person to attend a reunion with people the person used to live with, as they knew it would be important for the person to go. Food records sampled showed that people had a varied diet that included fruit and vegetables. However, it was not always clear that people had the recommended five portions of fruit and vegetables each day for a healthy diet as records did not detail how many portions the person had. Food records showed that people’s diet reflected their cultural background and that people had regular meals. Records showed people’s food likes and dislikes and food records showed that these had been considered. One person said they liked the food and had what they wanted. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 15 Staff said that they do shopping once a week. Adequate and varied stocks of food were available in the home so that people would have a choice of what to eat. A bowl of fresh fruit was available in the kitchen. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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 health and personal care needs of the people living there are met so ensuring their well being. EVIDENCE: Records sampled included information about how the person would like to be supported with their personal care. This was detailed and used pictures making it easier to understand. It included how much help the person needed and what they were able to do so encouraging them to be as independent as possible. People were well dressed in individual styles that were appropriate to their age, gender, cultural background, the weather and the activities they were doing. People had individual hair styles and records showed that they regularly visited a local barber to get their hair cut. It was evident that attention had been given to individual’s personal care so helping to raise their self esteem. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 17 Records included a health action plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. These showed that people have regular health check ups and where needed referrals are made to health professionals. Staff support people to attend health appointments. Plans included pictures making them easier to understand. One person’s health assessment stated that staff needed to regularly monitor the person’s weight. Their weight chart showed that they were weighed in December 2008 but this was not checked again until August 2009. However, records of a health appointment recorded that the person’s weight had increased in July 2009. The chart in August confirmed this. It is important that it is clear that people’s weight is being monitored as losing or gaining a significant amount of weight can be an indicator of an underlying health need. The people living there may be unable to communicate that they have a health need due to their communication needs. Most of the staff are assessed as competent to administer medication to the people living there. Two staff are currently being assessed for this so there are always staff on duty who can give medication safely. Boots supply the medication using the monitored dosage system in blister packs pre packed by the pharmacist. This makes it easier for staff to know how much and when to give each medication to the person. At the front of each person’s Medication Administration Record (MAR) there was a photograph of the person so that unfamiliar staff would know who to give the medication to. It also stated details of how the individual likes to take their medication. Records sampled showed that people regularly had their medication reviewed to ensure it is effective in meeting their health needs. Staff had signed MAR appropriately and these cross referenced with the medication in each pack indicating that it had been given as prescribed. Some people are prescribed as required (PRN) medication. For each PRN medication prescribed there was a care plan. This stated when, why and how much of the medication should be given. Where PRN medication was prescribed for the person being agitated it clearly stated that things such as diverting the person’s attention to other activities should be tried first. This ensures that medication is only used as a last resort. Records showed that staff had followed these guidelines so that medication was not over used which could have a detrimental effect on the person’s health. In the medication cabinet there was a blister pack containing PRN medication for one person. This medication was no longer stated on the person’s MAR so if it is not prescribed for the person it needs to be returned to the pharmacy. This will reduce the risk of people being given medication that they are not Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 18 prescribed. The senior was made aware of this the day after the inspection and agreed to return these. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 ensure that the views of the people living there are listened to and acted on and that people are generally safeguarded from harm. EVIDENCE: The complaints procedure was available in the home and in people’s records so that people were aware of how to complain. It included pictures making it easier to understand. It needed updating with our current contact details so that people would know how to contact us if they want to. The home had not received any complaints about the service provided and we have not received any complaints since we last visited. The people who live there can sometimes behave in a way that can challenge staff and disrupt the other people living there. Care plans included ‘What to do when I have a bad day.’ This stated how staff are to respond to the person’s behaviour as well as how to support the person so that they may not be agitated or distressed. The person’s community nurse was involved in developing the strategies that staff use to support people. It stated that all staff should receive training in minimising confrontation and Studio III (an accredited type of physical intervention techniques). Staff records showed that staff had received this training but it now needed updating. The manager said that all staff are booked to receive this updated training. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 20 One person was noted to have a bruised eye, which they stated another person living there had done. Staff did not witness this but said that sometimes there has been rivalry between the two people but these have not resulted in injury before. Records sampled confirmed this and risk assessments were in place that stated how staff were to ensure that the risks of either person getting hurt were reduced. Following this incident these should be reviewed to ensure that appropriate action is taken to reduce these risks. Records sampled did not indicate that a disagreement had occurred between the two people the day before and there was no indication that staff had not supported either person appropriately. This injury was reported to social services as safeguarding as is required to ensure people are safeguarded from harm. Staff were observed throughout the day supporting individual’s so that their difficult behaviours were minimised as much as possible. People were distracted to other activities when appropriate so that others were safeguarded from harm. Staff records sampled showed that staff had received training in how to safeguard vulnerable adults from abuse. However, most staff had not received this training recently. The manager said that all staff would be receiving updated training in this. This had been delayed as a new provider was to take over the ownership of the home and management of the staff. Decisions as to who the provider will be have not been reached so the current provider will now provide updated training to staff. The people living there are unable to manage their own money. Each person has a bank account that their benefits are paid into. Money is withdrawn from these accounts when the person needs it. The money is held securely in the home and checked by staff at the handover of each shift. For items over £50 a senior manager has to authorise expenditure and staff need to clearly show that the person has been involved in decisions made to purchase this. Clear records are kept of what each person spends their money on and receipts are kept of all money the person spends. A record of what each person owns is kept and regularly updated so that it is clear what belongs to each person. The manager said that a Deprivation of Liberty Safeguard referral had been made to the local authority for one person as the kitchen is locked when the person is at home. This is due to hygiene reasons and some of the person’s behaviours. The local authority will assess whether or not this deprives the person of their liberty or if a less restrictive approach can be used to manage this. The manager said that a referral will also be made for the front door as this is locked so that people do not leave without staff support which could put them at risk of harm. The manager demonstrated good understanding of the legislation and the Mental Capacity Act. He was aware of his responsibilities to Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 21 make referrals where needed to ensure that people are safeguarded from harm but not deprived of their liberty. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that people live in a comfortable and safe environment that meets their individual needs. EVIDENCE: Since we last visited new furniture had been bought for the dining room making it more comfortable and homely. The kitchen had been refurbished with new worktops, cupboards and cooker. This made it more hygienic and comfortable. The internal decoration had not been completed for four years but Midland Heart should do this every three years. The manager said that it has been agreed that the home is a priority for internal redecoration. This will make it more homely and comfortable as the decoration in several rooms was showing signs of wear and tear. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 23 There was a small bolt at the top and a chain in the middle of the front door. This is to stop the people living there going out without staff support which could put them at risk of harm. The manager has referred this to the local authority for a Deprivation of Liberty Safeguards assessment to ensure that people are not being deprived. A risk assessment was not seen to ensure that action is taken so that if people needed to get out of the home quickly they would not be prevented from doing so. The manager said they hoped to get funding to get a coded lock, which would make it safer. The manager said that they were hoping to change the office into a sensory room, which would benefit the people living there. Another room on the ground floor which used to be the sleep-in room would then be the office. The manager has applied for funding from charitable trusts to enable this to happen but was not successful. The manager said they are now looking at other funding options for this to happen. The radiators were not covered in any of the rooms seen which could put people at risk of scalding. A risk assessment for this was not available. This should be in place to show that the risks of people being scalded have been considered so that action is taken to reduce this if covers are not to be provided. It was a warm day so the radiators were not on. Therefore, there was no immediate risk to people. Bedrooms seen were personalised to individual tastes and interests. One person said they liked their bedroom and their bed was comfortable. Some people had a double bed so they could be more comfortable and have more space. Some people do not like to have curtains in their room but blinds had been put in or the window was coated so to maintain the person’s privacy. In the bathroom there is an assisted bath making it easier for people to get in and out. The side of the bath was coming off, which could put people at risk of injury when using it. Staff said that the bath worked and records showed that it was serviced in June this year. From the lounge there are patio doors leading to the garden. These did not have anything, such as transfers on them, which would make it easier to identify whether they are open or closed. The garden was well maintained with grassed areas, shrubs, trees, baskets and pots. There were tables and chairs so that people could relax there. People were observed to enjoy spending time in the garden. Staff said that one person had been involved in planting the hanging baskets and growing tomatoes in the green house. The home was clean and free from offensive odours making it pleasant for people to spend time in. The laundry is on the ground floor but dirty laundry Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 24 does not have to be carried through areas where food is prepared, served or eaten. This helps to reduce the risk of cross infection. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the 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 arrangements for staffing, their support and development ensure that the needs of the people living there are met so ensuring their well being. EVIDENCE: The AQAA stated that all staff have completed or were working towards the minimum of National Vocational Qualification (NVQ) at level 2. The manager said and records showed that senior care workers have NVQ 3 and were now doing NVQ 4. Some care staff have NVQ level 3 and others were working towards achieving this. This ensures that staff have the qualifications and skills to meet the needs of the people living there. The manager said that there were no staff vacancies. Rotas showed and staff said that occasionally bank staff are used to cover sickness and holidays but these are usually permanent staff who do ‘bank’ shifts as extra. Agency staff are not used. This ensures that the people living there are supported by staff that know them well. Staff rotas showed and it was observed that there are Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 26 three staff on each shift during the day and at night there is one waking night staff and one sleep in. The manager does not work as part of the rota but is in addition to it. Records indicated and the manager said that some staff do not think there are enough staff to be able to support people in all the activities they do. This is being looked at by the manager and senior to assess whether changes need to be made. Records showed that regular staff meetings are held. Staff said that they can raise issues at staff meetings. Minutes showed that this was so and the manager took action to address issues raised where he was able to. The records of three of the staff that work there were looked at. These included the required recruitment records to ensure that ‘suitable’ people are employed to work with the people living there. These included evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. The AQAA stated that these were going to be reviewed to ensure that all staff employed continued to be ‘suitable’. Staff said and records sampled showed that they had an induction when they first started working there. This included reading people’s care plans and talking to other staff so they knew how to support the people living there. The manager said that staff training was not up to date as this was delayed as a new provider was to take over the ownership of the home and management of the staff. Decisions as to who the provider will be have not been reached so the current provider will now provide updated training to staff. Records seen confirmed and staff said that training had been booked. Records showed that staff had received training in epilepsy, first aid and fire safety this year but staff needed updated training in other areas. Staff records sampled showed that staff had regular supervision where the needs of the people living there were discussed as were the staff training and development needs. Records showed that the supervision was of good quality and staff were given opportunities to develop in their role where it was of benefit to the people living there. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the 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 ensure that the people living there benefit from a safe and well run home. EVIDENCE: The manager is registered with us and has completed NVQ level 4 in care and the Registered Managers Award. Staff said and records showed that the manager supports them to ensure that the people living there benefit from a well run home. The manager said that for the past three months they had also had responsibility for a supported living service that was managed by the Primary Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 28 Care Trust (PCT). The manager said it was difficult to manage their time between the two services although they were confident that the senior care staff could manage the home. The PCT have not informed us that the registered manager would be responsible for another service and this situation needs to be reviewed to ensure that the people living there are not affected by this. Since we last visited the provider Focus Futures had re registered as Midland Heart. South Birmingham PCT continue to manage and staff the home however, this arrangement has been put out to tender. The manager said there was no further news on who was taking over responsibility for this and this had impacted on staff morale. The manager had informed the people living there and their relatives of information about the changes and would continue to keep them updated. The manager said and records showed that the PCT area manager visits the home at least every fortnight. Monthly audits by the PCT had been completed up until March this year but there were no reports of this being done since. A representative from Midland Heart had also visited monthly up until June this year but no reports were available since. This seems to have been affected by the uncertainty of the new provider. A representative of the provider should visit the home monthly to audit how it is meeting the needs of the people living there and a report of this should be available. This will ensure that the manager knows where improvements need to be made. Fire records included a risk assessment that stated how the risks of there being a fire were to be minimised as much as possible. Fire records showed that staff tested the alarm weekly to ensure it was working. Staff had tested the emergency lighting every month, sometimes more often until July this year but had not tested it since. Senior staff said they would ensure this was done. Fire drills are held every six months and staff have regular fire safety training so they would know what to do if there was a fire. An engineer had regularly serviced the fire equipment to ensure it was well maintained and would work if needed. Staff test the temperatures of the fridge and freezers daily to ensure that food is stored safely to minimise the risks of food poisoning. Staff record that they have checked daily the use by dates of food in the fridge to minimise the risk of people eating food that is out of date. Staff test the water temperatures weekly to make sure that they are within the correct limits so that people are not at risk of being scalded. Records showed that these were within safe limits. Records showed that gas and electrical equipment are regularly serviced and checked to ensure they are safe to use. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 3 X Version 5.3 Page 30 Forest Road DS0000072794.V377567.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA17 YA19 YA20 Good Practice Recommendations Food records should state how many portions of fruit and vegetables the person has eaten to evidence that people are having a healthy diet. People’s weight should be regularly monitored to ensure that their health needs are met. Medication that is no longer prescribed for a person should be returned to the pharmacy. This will ensure that people are not at risk of being given medication they are no longer prescribed, which could impact on their health. Risk assessments for people being at risk of hurting each other should be reviewed and updated following the incident where one person sustained an injury. This will help to ensure that the risks of this are reduced as much as possible. All staff should have updated training in safeguarding, minimising confrontation and Studio III techniques to ensure they know how to safeguard the people living there from harm. DS0000072794.V377567.R01.S.doc Version 5.3 Page 31 4. YA23 5. YA23 Forest Road 6. 7. 8. 9. 10. 11. 12. YA24 YA24 YA24 YA24 YA27 YA37 YA39 The home should be redecorated to make it more comfortable for people to live in. Action should be taken to ensure that people are not at risk of being scalded by the radiators. Arrangements should ensure that people can get out of the front door in an emergency if needed to ensure their safety and well being. Arrangements should be in place to ensure that the people living there and staff are not at risk of harm when using the patio doors. The side of the bath should be repaired so that people are not at risk of hurting themselves when using it. The manager also managing another service needs to be reviewed to ensure that the people living at the home are not affected by this. A representative of the provider should visit the home monthly to audit how it is meeting the needs of the people living there and a report of this should be available. This will ensure that the manager knows where improvements need to be made. Forest Road DS0000072794.V377567.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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