Care Home: Gladstone Road, 31

What the care home does well The people living at 31 Gladstone Road get lots of support to spend their time doing the things they enjoy. They can go out and about with support from staff. When they are at home they can spend their time how they choose. People are able to make decisions for themselves. They can decide everyday things like what to do each day. They are asked their opinion about bigger things, such as if someone new is moving into their home, or what is written in their care plan. People know who to talk to if they are unhappy or if they have a complaint. They have confidence that staff will listen to them and help them. The people living there like the staff team. They told us staff listen to them and give them the support they need. The house is an ordinary house in a family area. It is clean and comfortable and the people living there can choose how they want to decorate it. What has improved since the last inspection? There is now a manager called Margret Gallagher who runs the home on a day to day basis. She has helped to make things better and run things on behalf of the people living there so they can live better lives. She will soon apply to us [The Care Quality Commission] so that we can further check she is the right person to manage the home. People are assessed before they move into the home. This helps to ensure they are suitable and the home is the right one for them. Since the last inspection the home have improved the way they manage the medicines so that they are safe and people get their medicines properly. The staff are better trained and they are all now signed up to training in care called NVQ`s. This should help ensure that they are better equipped to carry out care. The managers from `Expect` visit regularly and carry out checks. This ensures that any problems are picked up and the home can improve and make it a better place to live. What the care home could do better: We have made a list at the end of the report of things the managers need to improve. The main things are: There is a good awareness of peoples ability to make decisions for themselves but we would recommend that this is also assessed before people come int the home so that we can see if they are making a positive choice to live at Gladstone Road. There is one person who needs to be assisted to move by staff sometimes. This person has not had their assessment record updated very often. Also staff have not had any training in how to move people safely. This can put residents and staff at risk. We would recommend that all staff are further observed by the manager following their training to make sure they are OK to give out medicines. This should be recorded on their file. We were worried that the windows upstairs could open wide. This may put people at risk as they might fall. We recommend that the windows are made safe by limiting their opening. Although training has improved we have made some recommendations around more training we think is needed. The manager needs to tell us what is going on in the home. She does this by writing and `notifying ` us. We have asked the manager to talk to her senior managers about the sort of things that should be reported such as accidents and other incidents that happen. This is so that we can keep in touch with what is happening. Key inspection report Care homes for adults (18-65 years) Name: Address: Gladstone Road, 31 31 Gladstone Road Bootle Liverpool Merseyside L21 1DG     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: Michael Perry     Date: 2 6 0 5 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Gladstone Road, 31 31 Gladstone Road Bootle Liverpool Merseyside L21 1DG 01514761964 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Expect Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Up to a maximum of 3 service users in categories MD or LD may be accommodated. Date of last inspection Brief description of the care home 31 Gladstone Road is a terraced house situated in a family area of Bootle. It provides support for three adults who either have a learning disability and or who need support with their mental health. It is run by Expect Ltd, a local organisation who provide support to people within the local area. The house provides 3 single bedrooms, two lounges, a small dining room and kitchen. In addition there is a sleep in room / office and enclosed back yard with seating. Parking is available on the street outside. Staff are available 24 hours a day to provide support. During the day there are one or two staff providing support and at night a member of staff sleeps in the house. The Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 3 3 1 2 0 6 2 0 0 9 Brief description of the care home Manager for the service is Margret Gallager. from 303 pounds to 353 pounds weekly. The current fees for the service range Care Homes for Adults (18-65 years) Page 5 of 29 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: Before we visited we sent a question form to the manager. This gave her with the chance to tell us about the areas the home are doing well in. Also any improvements they have made and plans they have for future improvements. It also told us about staff and how people are supported. Also how people are kept safe. We a looked at any information we have been given about the home since our last big inspection. This helped us to plan our site visit and in writing this report. We visited the home on 25th May 2010. During our visit we met the three people living there and members of staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 29 We spent time reading records, looking at the environment and observing the support provided to the people living there. After our site visit we talked to a nurse who visits the home on the phone to get more information. It costs between three hundred and three pounds [303] and three hundred and fifty three pounds [353] each week to live at 31 Gladstone Road. This may be more if the person needs more support from the home and staff. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: We have made a list at the end of the report of things the managers need to improve. The main things are: There is a good awareness of peoples ability to make decisions for themselves but we Care Homes for Adults (18-65 years) Page 8 of 29 would recommend that this is also assessed before people come int the home so that we can see if they are making a positive choice to live at Gladstone Road. There is one person who needs to be assisted to move by staff sometimes. This person has not had their assessment record updated very often. Also staff have not had any training in how to move people safely. This can put residents and staff at risk. We would recommend that all staff are further observed by the manager following their training to make sure they are OK to give out medicines. This should be recorded on their file. We were worried that the windows upstairs could open wide. This may put people at risk as they might fall. We recommend that the windows are made safe by limiting their opening. Although training has improved we have made some recommendations around more training we think is needed. The manager needs to tell us what is going on in the home. She does this by writing and notifying us. We have asked the manager to talk to her senior managers about the sort of things that should be reported such as accidents and other incidents that happen. This is so that we can keep in touch with what is happening. 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 29 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 29 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 are assessed and admitted appropriately so that there care needs can be met. Evidence: An information pack is available for people considering moving into the home, with a copy kept in the hallway for people living there to look at. This gives people information about how the home works and the support they can expect. There are also leaflets about how to raise a concern or complaint and information about Expect, the organisation who run the home. The information uses pictures and is written in a way that is easy for people to read. This helps people to understand as much as possible about their rights and the support they can expect to receive. We looked at how the home assesses people as suitable for admission. There have been no admissions since the last visit. We looked at the last admission and saw that appropriate assessments had been made and the social work team had been involved. When we spoke to the person they said that the move had been made with their full input and they were pleased with the way it had been managed. This process helps the person to settle and make sure they are suited to the home and staff understand Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: their care needs. The assessment seen was very detailed and personalised and indicated any immediate risks and needs so that a care plan could be drawn up. We discussed the new Mental Capacity Act and the need to formally assess peoples mental capacity as part of the admission. Although evident in other parts of the continuing care documentation we would recommend that this is included in the pre assessment documentation so that capacity around the decision to move into the home is established. Such assessments are important as they form the basis of decisions about ongoing care. Care Homes for Adults (18-65 years) Page 12 of 29 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. Peoples care needs are assessed and planned so that they are able to live as independent a life as possible. Evidence: Individual care files are in place for all of the people living at Gladstone Road. These files are full of information about each person and the care and support that they get. The files contain a care plan which has been drawn up with the person concerned following the various assessments. It tells us how the support is to be delivered. The care plans use an easy to understand format including the use of pictures and photographs. This is good practice as it helps to ensure people are as aware and involved as possible in the support they receive. We did have some conversation with the manager regarding the appropriateness of such easy read formats for people with no intellectual impairment and this should be considered on an individual basis. Plans are clearly sectioned and cover the things the person does and does not like, their chosen lifestyle and the support they need with their health and personal care as Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: well as the things they can do more independently. We looked at care plans and files for all of the people living at Gladstone Road. They contained sufficient information about the persons support needs and choices to guide staff. We also found that care plans contained risk assessments for people. These identified areas of risk to the person and gave guidelines to remove or minimise that risk. This helps to make sure that people are safe and their lives are not unduly restricted. For example one person has a physical disability and some mobility needs. These had been assessed and the plan included the support needed as well as the provision of extra aids such as a chair lift to get about the house. The person said that they were very comfortable in the house and could get a bath and move around freely. This shows that the home are careful to assess people with a diverse range of care needs and disability. We did did find some anomalies with a few of the records and it is important that the manager audits the care files to keep them up to date. For example the assessment mentioned above was not signed and the manager was not sure who had made the assessment. The assessment also said that it should be reviewed monthly but this had not been done since October 2009. It is important that assessments are kept up to date as care needs may change. We would also recommend that daily notes are signed by care staff with there full identity rather than just first name as this helps identify staff if notes have to be reviewed historically. The people living at Gladstone Road told us that they are able to make decisions for themselves. For example they can go out and about and can decide when to get up or go to bed. Their involvement in their care plan also enables them to have input into the support they receive. It was evident during our visits that people are supported to make their own choices and to be as independent as possible. People were seen to spend their time doing things they enjoyed as well as making full use of shared areas of the home. Information about local advocacy services, that help people to speak up for themselves is readily available in the home. In addition the organization have a service user forum that provides people with a formal way to give their views and influence the services they receive. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with daily activities and chosen lifestyles so that they can experience a good quality of life. Evidence: Discussions with the people living at Gladstone Road and with staff evidenced that people receive support to do the things they enjoy and spend their time how they choose. The level of activities for people has gradually been developed over a period of time. One person commented that the new staff are very good and are always helping us to do things. The staff team at the home is new in the sense that most have been employed in the home for under a year. There is also a new manager. People spoken with seemed to appreciate that staff are now settled and there is continuity. One person explained about her course work at a local college and how staff had Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: supported her through this. We were shown photographs of the ceremony where the certificate had been presented. The person also talked about support with holidays and also visits to see a relative on a weekly basis. Records showed that people receive plenty of support to go out and about if they wish to do so. These activities varied from going out for lunch, shopping,, for walks and to visit family. Any particular interests were noted in the care planning documentation. During our visit people were spending their time in different ways as they choose. One person attended a local gym with staff to support, while others were sat chatting to staff and watching TV. Staff were seen to spend time at the home socialising with the people living there as well as supporting and meeting their everyday needs. Records showed that people are engaged in household tasks such as cleaning and shopping for food and this was confirmed in discussions with one person who explained, I clean around my room when I can and do a bit of hovering. Individual records of menus are kept for each person. These are completed daily. This is an improvement from the last inspection. This shows that people are being supported to eat a healthy meal. People told us that the diet is good and varied and that there is always fruit available. We saw a fruit bowl in the kitchen. One person said I like bananas and Ive had a tangerine this morning. Routines in the home are flexible and people told us they can choose how they spend their time. They are able to have a key for their front door or bedroom if they wish and can spend time in communal areas or their bedrooms as they prefer. Care Homes for Adults (18-65 years) Page 16 of 29 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. The people living at Gladstone Road receive individual support with their personal and health care so they are supported to be as independent as possible and seek medical advice if needed and to live healthy lifestyles. Evidence: We saw that people were supported with their personal care. One person told us that staff were giving more assistance at the moment due to an acute infection which meant they could not do as much for themselves; the staff are very good and help me when I need it. Another person needs a lot of support regarding personal care and staff were very alert at maintaining this through out the day in a sensitive manner. Everybody was appropriately dressed and had good standards of personal hygiene. This means that people are supported with the personal care appropriately. All of the people living at Gladstone Road have particular health care needs. We found these to be very well monitored. Care records clearly showed when medical appointments had been made and followed through. People were very clear about there medical support and could tell us when they had there next review and spoke about how staff ensured these were maintained. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: We spoke with a health care professional who visits the home who told us that staff are excellent and they give above and beyond the support needed. The manager is also very proactive and links in with us well so that any issues are dealt with quickly. We spoke with care staff and found them very knowledgeable about the health care needs of the people. They understood about particular health issues such as diabetes and were able to explain key things to observe and report on so that peoples health is maintained. The people living in the home do have particular mental health needs and it would be a strong advantage if staff had some training in these to increase there background knowledge. This was a requirement on the last inspection and still needs addressing to some degree although staff did tell us [for example] that there is some planned training around diabetes. We looked at the way medicines are managed. We found that people are supported appropriately. One person self medicates to some degree and this is appropriately supported in a safe manner following assessment. People told us that staff always give medications on time and the medication records supported this.The records are audited by the manager on a regular basis and this means that any errors can be picked up and corrected quickly. We spoke to staff and the manager about the training staff receive and this was up to date. Staff spoken with had all completed the company training course around medication administration. There was no record of the manager having observed staff giving medicines and checking for competency. This an important part of the medication training so that the manager can be sure that staff not only have a sound knowledge base but also are practically competent and safe to administer medications. We would recommend that this is completed and each staff has such an assessment on record. Care Homes for Adults (18-65 years) Page 18 of 29 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. Peoples concerns are listened to so that any issues are managed appropiatly and people are kept safe. Evidence: Although no complaints or concerns have been made about the service provided at Gladstone Road, the people living there all said that they are confident any concerns they had would be listened to. One person said: I am happy here but if I was worried I would speak to Margaret [manager] and she would help. People were observed to be relaxed and open with staff and it was clear that they felt comfortable about approaching them. There are polices in place within the organisation to deal with any complaints or safeguarding or protection concerns that arise. This includes the local safeguarding procedures from social services. Staff have received training in how to recognise and report abuse which helps ensure that people are protected. When we spoke with staff they were very clear on the importance of immediately reporting any concerns through the organisation but where not clear about the way allegations of abuse would be investigated and the role of the local authority safeguarding team. This is important so that staff have a clear understanding of the wider picture and their role in any investigation. The complaints procedure is in easy read format so it is easy to understand and follow.This information helps ensure that people are aware of their rights and know what they can do about it. Care Homes for Adults (18-65 years) Page 19 of 29 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. The home is well maintained and homely so that people are comfortable. Evidence: 31 Gladstone Road is a terraced house located in a family area of Bootle. It has good links to local transport and facilities. Both inside and outside it has the appearance of a family home and has a welcoming atmosphere. The people living there all have their own bedroom, one of which is located downstairs. They share a large downstairs lounge, small dining room, kitchen, enclosed backyard with seating and a small upstairs craft room. The house has an upstairs bathroom, which has a bath and an accessible shower. A separate toilet and basin are also available upstairs. Downstairs there is a small toilet and sink. There are no bathing or showering facilities on the ground floor. A ramp to the front door provides easy access to the house for people who have difficulties with their mobility. In addition grab rails and a stair lift are available to support people. During our visit we noted that all area of the house were clean and tidy. The kitchen, which was mentioned on the last report as looking a bit tired is due for replacement. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The self assessment completed by the manager for the service tells us that since the last visit there have been major areas of upgrading and refurbishment and these were seen on the inspection. This means that the home is well maintained. The manager carries out regular audits of the environment to look for any hazards that may put people at risk. We saw on the inspection that the upstairs windows where not restricted in opening and this presents as risk to people who may fall. We strongly recommend that the windows are fitted with appropriate restrictors. Suitable equipment and facilities are provided to enable staff to prevent or quickly deal with any outbreak of infection.These include diposal laundry bags, gloves and aprons etc. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and and trained so that people in the home can be supported appropriately. Evidence: The people living at 31 Gladstone Road told us that they like the staff who work there. One person explained, the staff are very good. The new staff are very friendly and i like them. During our site visit it was clear that the people living there felt comfortable with the staff team. Staff we spoke with had a good understanding of the support people need and of how they like to spend their time. One member of staff is available in the home twenty four hours a day. During the night this member staff sleeps in. Most days there is a second member of staff working. This provides the opportunity for the people living there to get support to do the things they enjoy. For example during our visit one person was out and about with a member of staff in the afternoon. Another spent time in the lounge and there was good interaction with the staff member. There are clear systems in place within the organisation for recruiting new staff. This includes obtaining written references and a Criminal Records Bureau check. These checks help to ensure that staff are suitable to work with people who may be Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: vulnerable. One staff file seen stated on their application form that they had worked previously in a care situation but the references seen were from none care environments. It is a requirement that if a staff has worked previously in care [even some time ago] a reference must be obtained if possible as this provides a more appropriate check for the current post. A member of staff confirmed that they attended interviews with the organisation. There is also a long initial period where new staff are inducted by shadowing other staff members. This gives them sufficient time to get to know the service and feel comfortable working there. The organisation has a training department for staff that provides training throughout the year in a variety of areas. We saw a training calendar from the organisation that contained dates for training in a variety of areas including, protection of vulnerable adults, medication and health and safety. The previous inspection required more specific training for staff in areas around health and supporting peoples basic care needs. This has been addressed to some degree as staff told us they are all now signed up for national Vocational Qualifications [NVQs] in care and this will be ongoing [although currently only two of the six staff have any NVQ qualifications]. Some staff are to attend training around diabetes. There has still been no training, however , for staff in moving and handling. This is particularly needed as one resident is in need of daily assessment and ongoing support regarding mobility. We would also strongly recommend staff are given training in mental health conditions and mental capacity and consent as well as person centered care PCP] as these form the basis of the ongoing care in the home and staff can feel more confident about supporting people. The manager did find some difficulty in being able to identify whether some staff had had basic training in some areas. This is due to the records in the home not being readily available. We would recommend that some form of training matrix is maintained so that he manager can be up to date with training needs in the home. Care Homes for Adults (18-65 years) Page 23 of 29 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. There are systems in place to monitor and develop the home so that Gladstone Road can be run in the best interests of the people living there. Evidence: Margret Gallagher is the appointed manager of 31 Gladstone Road. She has some experience working with adults who have learning disabilities and is currently working towards further qualifications in care and management. The people living there told us that they have confidence in Margret and that she is approachable and easy to talk to. Staff commented on her enthusiasm and felt that the team at Gladstone Road was developing well. There has been no registered manager at 31 Gladstone Road for some time.This was commented on the previous inspection and since then there has been a further change as Margret has been appointed. She informed us that she is currently i the process of applying for registration. The process of managers registering with ourselves (Care Quality Commission) helps to ensure that managers are suitable and experienced people to manage a care service. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: We checked our records prior to the visit and found that no notifications had been made to the Commission since the last visit a year ago. These notifications tell us about any untoward events in the home and ensure that we are kept up to date with happenings in the service. We spoke with the manager about this and she seemed unclear as to what should be reported through. We looked at the accidents recorded in the home where residents had attended hospital but none of these had been reported through to the commission. We also discussed some medication errors that had occurred which perhaps should have been incidents to notify the Commission about. We had some discussion with a senior manager about this and would recommend that there is some discussion and clarity around the need to report such events. We looked at the requirements made at the last inspection and saw that these have been met [although we had made more specific requirments and recommendations around training]. This shows that the service is responsive to statutory requirements and able to plan and meet these. There are several systems in place at 31 Gladstone Road for checking the quality of the service they provide. These include audits carried out by a senior managers and directors. Both of these audits look at a variety of services provided by the home, including health and safety, the support provided to people and records. They then identify areas for improvements needed within the home. This helps endure that standards are maintained and further developed. Records and certificates showed that regular checks are carried out on the environment and equipment in the home. This includes regular checking of the fire system, water, fridge and food temperatures and gas and electrical supplies. These checks help to ensure that 31 Gladstone Road is a safe place for people to live work and visit. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 34 19 As part of the recruitment 25/06/2010 process any staff who has worked previously in a care situation must have a written reference requested. This ensures a suitable reference too work with vulnerable people. 2 35 18 All staff must have some training in moving and handling. This will ensure they can assess and move people safely when needed. 27/08/2010 3 39 37 Any notifiable incident occurring in the home must be reported to the Commission using the appropriate procedure This ensure that the regulator is aware of significant events in the home. 01/07/2010 Care Homes for Adults (18-65 years) Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 All assessments and care records should be signed by the person making them. The signatures should be the full name rather than just first name so that staff can be clearly identified. All assessments should be reviewed as prescribed and kept up to date as care needs may change. 2 19 The people living in the home do have particular mental health needs and it would be a strong advantage if staff had some training in these to increase their background knowledge. The manager should ensure that all staff have competency assessment carried out as part of their training to administer medications. We would recommend that staff are updated around the local authority policy document on safeguarding and how allegations would be investigated and the role of the local authority safeguarding team. This is important so that staff have a clear understanding of the wider picture and their role in any investigation. We strongly recommend that windows above ground floor are fitted with devises to restrict the opening and reduce risk of any falls. At least 50 of staff should have and NVQ at level 2 or above to ensure that there is a solid base knowledge for staff to deliver care. We would recommend specific training for staff in the following to increase their knowledge base and provide care for people: *Person Centered Planning [PCP] *Mental Health issues [such as depression, psychosis] *The Mental capacity Act and Deprivation of Liberty Safeguarding [DOLs] 3 19 4 22 5 24 6 32 7 35 8 37 The application for registered manager should be made as soon as possible. Care Homes for Adults (18-65 years) Page 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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