Care Home: Gorstyfield Nursing Home

What the care home does well There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. Prior to coming to stay at the home pre-admission assessments are completed, so that staff and people considering using the service can be sure individual needs can be met appropriately. There were adequate numbers of staff on duty at the time of inspection to ensure people`s needs were met. The home was clean and generally well maintained providing people with a pleasant place to live. Recruitment of staff is robust ensuring people are protected by the employment of new staff. The care plans and records in respect of peoples follow up were of a good standard, so staff had the information they required to support people. The arrangements for health care were good, ensuring that peoples health needs were being met. An activity worker is employed and supports people with a range of activities. What has improved since the last inspection? Staff are in the process of developing the care planning systems to provide a more person centred approach. The service user guide has been updated to provide people with information to assist them with making a decision about moving into the home. The dining room has been re-decorated and one of the lounges was being redecorated at the time of inspection, so enhancing the environment for people who live in the home. Staff are developing systems to assist people with their independence in respect of managing their own medication and money. An activity kitchen has been developed in the home in order to support peoples independent living skills and a new smoke room has been constructed to the rear of the building. What the care home could do better: Where staff support people with purchases or purchase items on their behalf receipts must be available to demonstrate a robust system and people`s money is protected. Suitable locks must be fitted to the homes external doors and adequate lighting in the road leading to the home to ensure the safety and security of people in the home. The menus should be reviewed with people living in the home with a view to providing a greater variety of foods/meals and systems put in place to ensure they are given a choice at each meal time. A letter should be forwarded to people confirming admission, so they can be assured their needs can be met on moving into the home. In addition, it is recommended records of pre admission visits are retained to demonstrate areas of need. Where challenging behavior is identified care plans should be in place to indicate any triggers, presentation and action to be taken to ensure peoples needs are met. A review of activities for people who need one to one support accessing the community should be undertaken with a view to developing this area further to ensure people have a fulfilling life. Staff training should be provided in areas such as the Mental Capacity Act, the Deprivation of Liberty Safeguards, challenging behavior and mental illness to ensure they have the skills and knowledge to support and safeguard people effectively. Ensure damaged carpets are replaced to enhance the environment for people who live in the home. Take action to make sure the fire and emergency lighting systems are serviced annually to ensure people are safe in the event of a fire. Key inspection report Care homes for adults (18-65 years) Name: Address: Gorstyfield Nursing Home Ridge Hill Brierley Hill Stourbridge West Midlands DY8 5ST     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: Ann Farrell     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Gorstyfield Nursing Home Ridge Hill Brierley Hill Stourbridge West Midlands DY8 5ST 01384401018 01384404617 gorstyfield@shaw-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw healthcare Ltd care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 16 Date of last inspection Brief description of the care home Gorstyfield Nursing Home is privately owned by Shaw Homes. The home provides accommodation for up to 16 people who have a mental illness and require nursing care. The aim of the home is for people to be as independent as possible whilst living in a supported environment, which enables them to develop life and social skills. The home is a three storey building that consists of four flats over the first and second Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 16 Brief description of the care home floor, each flat consisting of four single bedrooms, a kitchen and a bathroom. The communal rooms are situated on the ground floor and consist of two lounges, a dining room and activity kitchen. Smoking facilities are available to the rear of the building. Laundry and catering facilities are available on site. Information about the fees should be sought at the time of making inquiries. Care Homes for Adults (18-65 years) Page 5 of 32 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) 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 peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken during 2007/2008 when they were given a three star rating. This inspection found some areas that need to be addressed and they can be found in the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken by 14th December 2012. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Care Homes for Adults (18-65 years) Page 6 of 32 Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies plus concerns raised. An Annual Quality Assurance Assessment (AQAA), which is a questionnaire that is completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. The inspection was undertaken over two days by one inspector. The Manager was not available for the inspection, so senior staff assisted with the process. The home did not know that we were visiting. At the time of inspection information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involved discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection four people who live in the home and six staff were spoken with. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Where staff support people with purchases or purchase items on their behalf receipts must be available to demonstrate a robust system and peoples money is protected. Suitable locks must be fitted to the homes external doors and adequate lighting in the Care Homes for Adults (18-65 years) Page 8 of 32 road leading to the home to ensure the safety and security of people in the home. The menus should be reviewed with people living in the home with a view to providing a greater variety of foods/meals and systems put in place to ensure they are given a choice at each meal time. A letter should be forwarded to people confirming admission, so they can be assured their needs can be met on moving into the home. In addition, it is recommended records of pre admission visits are retained to demonstrate areas of need. Where challenging behavior is identified care plans should be in place to indicate any triggers, presentation and action to be taken to ensure peoples needs are met. A review of activities for people who need one to one support accessing the community should be undertaken with a view to developing this area further to ensure people have a fulfilling life. Staff training should be provided in areas such as the Mental Capacity Act, the Deprivation of Liberty Safeguards, challenging behavior and mental illness to ensure they have the skills and knowledge to support and safeguard people effectively. Ensure damaged carpets are replaced to enhance the environment for people who live in the home. Take action to make sure the fire and emergency lighting systems are serviced annually to ensure people are safe in the event of a fire. 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 32 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 32 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. Information is available to assist people with making a decision about moving into the home. Peoples needs are assessed before they move in to the home, so their needs are known and can be met on moving in. Evidence: The home provides care to sixteen people with mental illness in four flats each accommodating four people. The home provides a service user guide, which is given to each individual on admission to the home. It provides information about the aims and objectives of the home plus the general arrangements. This document provides people with some information about the home in order to assist them in making a decision about moving in. A pre admission assessment is completed for each person by the Community Psychiatric nurse, which is forwarded to the home for staff to consider their needs and admission to the home. If staff feel they can meet peoples needs they are invited to visit the home for a day, overnight and a weeks stay before admission to the home. This enables people to sample the home, meet staff and other people living in the Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: home to determine if they wish to use the service. On inspection of records for one person who had recently been admitted to the home there was evidence of a pre admission assessment and report outlining the persons needs. However, there was no record of visits to the home before admission or a letter confirming the home could meet peoples needs. It is recommended a letter confirming the outcome of the assessment is sent to people and records of pre admission visits are kept The first four weeks of living in the home are considered as a trial period where the person moving into the home can decide whether they would like to remain. A review is held at the end of the trial period with the social worker to determine if people are satisfied or any changes are needed. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are involved in making decisions about their lives and planning the care they receive with the support of staff. Evidence: Three peoples care files were looked at in detail. Following admission to the home staff develop an initial assessment care plan. This document outlines the support people require to maintain their well being in the short term, so staff have the relevant information to support them. Over a period of time a care plan is developed, which provides more detailed information about the support people require and demonstrated people were involved in the process. The staff were in the process of developing a new system and had completed one persons plan of care, which included information about their past life experiences, preferred lifestyle, relationships, hopes and dreams, goals and the support required to achieve them. This was of a good standard, included photographs and the person was obviously involved with the process and proud of the document. This is a very positive development. However, it Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: had not been dated and there was no indication who had drawn up the plan. There was evidence that risk assessments had been completed. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. They were reviewed and evaluated on a monthly basis, so that any changes could be identified and care plans changed to address them. Daily records and monthly evaluations were completed by staff and were of a good standard, so that peoples care could be followed. On one persons file it was noted that they could be challenging at times, but there was no evidence of a care plan for this area to advise staff of the type of behavior, any triggers and how to manage it. The nurse showed us an example of such a care plan that had been completed for someone else and stated they had commenced these, but then commenced the new care planning system. Staff must ensure such information is recorded and staff are made aware of it, to ensure peoples well being. People were supported with developing life skills such as washing cleaning, cooking etc. The staff spoken to underlined the importance of people being supported to take control of their own lives and it was observed that people were treated with respect and consulted about things. There was evidence that meetings were held with people in the home approximately every two months from the minutes available. Survey forms were distributed on a regular basis to obtain feedback about the service from people who live in the home and there relatives. Comments were positive and included; X seems much happier and settled since she has been at Gorstyfield. She is cooking, washing and taking more interest and has more confidence. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are able to make choices about their lifestyle and are supported to develop their life skills. Evidence: A senior member of staff stated they had moved to a rehabilitation model of care now. They encouraged people to develop life skills and opportunities were provided to develop and maintain social and and independent living skills where possible. Staff were observed to be respectful towards people and used their preferred name. People are supported to maintain existing links within the community if they wish to and develop new ones outside the home. People were seen to wander freely around the home, from one area to another and were observed freely going out into the community to do shopping. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: People living at the home told us of the range of activities they were involved in such as visiting day centers where they were involved in art, craft, pottery, gardening, visiting the gym, going swimming, visiting family. The home has its own activity kitchen where people are supported with cooking. On the day of inspection it was stated one person was cooking a meal for the area manager and member of staff from the human resources department of the company. A cooking club has commenced where a small group of people meet on a monthly basis taking it in turns to cook meals for the group. They have a range of cook books, so they can choose the meal and it is often based on a different country, giving them the opportunity to discuss aspects about the country etc. The home had been decorated very nicely for Christmas and there was a program of activities for the Christmas period that included a visit to a craft centre, shopping, a party, lunch at a local pub, bingo and visit by a choir on Christmas Eve. A senior member of staff also stated some people had expressed an interest in attending a carol service and one wanted to attend church, which they were organizing. People also have the opportunity to go on holiday and people told us they had been to Tenby for a holiday and Blackpool for an overnight stay, which they enjoyed. Some people do not wish to go on group holidays and stay at home. Staff stated they would be supported with going out or other activities during this period, but they did not organise holidays on an individual basis. There were separate facilities outside the main home for people who wished to smoke and the senior member of staff stated the Environmental Health Department had been consulted about it in the planning stage. Some people appeared to be undertaking a range of activities, whilst some appeared to engage in few activities. On discussion with staff they stated they were offered opportunities, but often refused although it was not always recorded. A senior member of staff they would go out on a one to one basis sometimes, but it was on an ad hoc basis. There was no evidence of training in respect of employment skills or attendance at college etc. One comment received in feedback forms indicated one person spent a lot of time watching television. It is recommended that this area be reviewed with people. There were two communal lounges with a television in each and one had free view which increased the number of programmes they could watch. Some people in the Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: home expressed a wish for sky television and this was passed on to a senior member of staff for discussion with them. There was a computer in the large lounge and it was stated there was internet access if people wished to use it. In addition, there was a small kitchen/dining areas in each flat with a television and radio, so providing people with a choice of areas to sit. People living in the home can have keys to their own rooms if they wish. Staff were observed to enter peoples bedrooms after seeking permission. There was a four week rotating menu. Breakfast consisted of a choice of two cereals (weetabix and cornflakes) plus toast. People living in the home stated they would appreciate a greater choice of cereals for breakfast. The main meal was served at lunch time and a light meal in the evening which included sandwiches or something on toast. On discussion with people they stated the meals were ok, but they were only offered a choice of meals sometimes and they would like more variety to include Chinese, Italian and burger meals. Also it was noted no consideration had been given to providing cultural options for people who were of ethnic minority origin. The home employs separate kitchen staff during the day and care staff take responsibility for the evening meal. Care Homes for Adults (18-65 years) Page 17 of 32 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. Peoples health and personal care needs are met appropriately and people are treated with respect. Evidence: There is a mixed group of people living in the home in respect of age, gender and ability. Care plans provided information about the support people required with personal care and they were dressed appropriately for their age, culture, gender and weather according to their own personal choice. Everyone living in the home was registered with a local General Practitioner (GP). There was evidence of visits to/from health and social care professionals such as chiropodist, dentist, optician, GP and psychiatrist. There was also evidence that people were given the opportunity of annual health screening and other health promotion interventions. Such follow up ensures peoples health and well-being is maintained to optimum levels. Peoples weight and body mass index was being monitored on a regular basis, which Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: can be an important indicator of health care concerns. When looking at records for one person it stated they should have regular observations, but they had not been completed and the nurse was unable give an explanation. Also the records for one person stated a referral to the chiropodist was needed, but there was record of this occurring. Staff had received training in respect of moving and handling, but people in the home did not require assistance in this area. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. Stock medication was stored in locked cupboards in the office. Recently medication for each person had been stored in lockable facilities in their bedrooms. This is so staff can work with people and support them in developing independent skills to manage their own medication where appropriate. On inspection of the medication for the current month it was found that all audits were correct. Homely remedies are given following agreement by the GP. The home did not have any controlled drugs at the time of inspection. A medication fridge was available, but was not in use at the time of inspection. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were suitable systems in place to listen to people and protect people from the risk of harm. Evidence: A copy of the complaints procedure is included in the service user guide. On discussion with people they stated they were not aware of the complaints procedure, but would speak to the senior team leader if there were any concerns. The home had a complaints book to record the details of any complaints and none had been recorded for the past year. We have not received any complaints about the home. Records indicated staff had received training in respect of safeguarding, so they were aware of what to do in the event of an allegation of abuse. On discussion with some staff they were aware of the procedure. The home had a policy in respect of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). Records indicated the manager and senior team leader were the only people who had undertaken training in respect of DOLS. It is recommended all staff undertake training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with their position in the home, so they are aware of their responsibility in safeguarding people. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Staff in the home do support people with managing their money. The home does not act as appointee/agent for people in the home. The money is held in individual lockable facilities and individual records are maintained. On inspection of records they were of a good standard, they could be audited and people signed for money they were given for personal shopping. However, receipts were not consistently available for items where staff provided support with shopping. Staff recruitment was of a good standard ensuring people were safeguarded with the employment of new staff. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home, which promotes their well being. Evidence: The Home is a three storey building set in the grounds of Ridge Hill in Stourbridge, on its own. There was adequate parking in the vicinity, but lighting on the road leading to the home was not adequate. The senior member of staff stated it had been damaged some time ago. Action will need to be taken to ensure adequate lighting in the road leading to the home, to ensure the safety of people who use it. There is a small fenced garden to one side of the property with patio and seating for use by people who live in the home. There is also a smoking shelter plus a lawned area and it was stated there were plans to convert it into a vegetable patch. Entry to the home is by a door from the garden or a door to the rear of the home. On arrival the doors were not locked and entry was gained without anyone knowing. This was concerning as it could pose a risk to people who live in the home. A senior member of staff stated they had requested key pad locks to be fitted to both doors, so the people living in the home could move in and out freely as they wished. An immediate requirement was made for action to be taken urgently. We have been informed that a workman visited the home to assess the doors and he has submitting a quote to the organization for the work. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The interior and exterior of the home were fairly well maintained, clean and odour free with a relaxed atmosphere. The first and second floor of the home is divided into four flats, each accommodating four people. Each person has their own bedroom and share a toilet, bathroom and kitchen/dining room, which were domestic in nature. They were pleasantly decorated and bedrooms were personalized according to peoples wishes. Each bedroom had a wash hand basin and call bell to summon assistance if required. Bedroom doors had locks and people could have keys if they wished. In addition, lockable facilities were available in each bedroom for storage of medication etc, so enhancing arrangements for privacy. Some of the carpets required replacement and the senior member of staff stated they were in the process of changing five bedroom carpets and the carpets on the stairs. There is a choice of two communal lounges and a dining room on the ground floor for people to use. One of the lounges was in the process of being re-decorated at the time of inspection. The other areas were pleasantly decorated providing pleasant areas for people to sit or take meals. In addition, a range of Christmas decorations had been put up making the home very inviting to people who live there and visitors. There was one main kitchen that produced meals for people living in the home, which was clean and orderly. In addition, there was an activity kitchen with a dining area that was used by people living in the home to cook meals etc. and so develop their skills. The kitchen in each flat had a washing machine and people were supported with undertaking their own washing and ironing. Systems were in place to support infection control including the provision of staff training and the provision of protective equipment. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient staff on duty to meet peoples needs. The recruitment procedures protect people from the risk of harm. Staff would benefit from further training to ensure they have the skills to meet peoples needs. Evidence: The staffing rotas for the week of the visit and a further three weeks were inspected and indicated there were two support workers plus one nurse on duty during the day and one support worker and one nurse overnight. In addition, there was a senior team leader who worked a combination of supernumerary shifts and nursing shifts on the floor plus the manager who was supernumerary. Staff were supported by an activity worker, administrator, domestic, catering and maintenance staff. The duty rota did not indicate the hours the manager worked and it is recommended they should be recorded on the rota, so it can been seen when she is working. The staffing levels appeared adequate to meet peoples needs in the home. Staff appeared to interact well with people living in the home, which indicated that good relationships exist between people living there and the staff supporting them. Feedback from one of the ones surveys included a comment; Gorstyfields have in my opinion succeeded in bringing together a really good Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: standard of care with stable staff acting in the clients interests Recruitment records were sampled for two new members of staff and they showed appropriate checks had been made to make sure staff were suitably experienced and qualified to work in the home. Protection of Vulnerable Adult checks and written references had been received before employees began work. These checks are to ensure people living in the home are protected from the risk of having unsuitable staff work in the home with them. Following employment new staff undertake the homes induction training plus a four day training course that covers mandatory training areas such as infection control, food hygiene, manual handling etc. and some staff were undertaking the training at the time of inspection. The training matrix indicated that only eight staff had completed the induction work book and six had completed the foundation work book and these areas will need to be followed up. There is a rolling programme of basic training that included manual handling, infection control, health and safety, food hygiene, fire prevention, risk assessments and the matrix indicated most staff had completed the training. There was evidence that only a small number of staff had completed training in respect of challenging behaviour or mental disorders and it is recommended that these areas be followed up to ensure support staff have the appropriate knowledge and skills to meet peoples needs. Records indicated that less that of 50 of support workers had completed National Vocational Level (NVQ) level 2 training or above. Training improves staff knowledge and skills and leads to improved outcomes for people living in the home. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people who live there. Evidence: The home continues to be managed well. The manager is supported in her work by a senior team leader and on discussion with some staff they stated they worked well as a team and felt support by senior staff. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home in order to gain information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home. The form was completed and returned on time, but was very brief and would have benefited from more detailed information. The quality assurance system includes quarterly audits and feedback from surveys that are distributed to people who live in the home and their relatives. The feedback from these was found to be generally very positive. Consideration should be given to Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: obtaining feedback from other stakeholders such as staff plus health and social care professionals who have contact with the home. Regular visits are undertaken by a senior manager and reports are written following the visits. Staff meetings were occurring regularly and the frequency had recently increased to once a month to enhance communication. Records of meetings with people living in the home indicated they were occurring approximately once every two months. A sample of health and safety records were checked including fire, emergency lighting, electrical equipment call bell etc. They were all found to be satisfactory with the exception of the fire alarm systems that had not been serviced since September 2008. The senior member of staff followed it up with the organization responsible for servicing the equipment and we have been informed it will be serviced next year. We did not see any evacuation plans for people living in the home in the event of a fire. It is recommended the home should have these in place , so people are safe in the event of a fire. Advices should be sought from the West Midland Fire service if needed. Care Homes for Adults (18-65 years) Page 27 of 32 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 28 of 32 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 1 24 13 Action must be taken to provide appropriate locks to external doors. To ensure the safety and security of people living in the home. 25/12/2009 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 24 13 Action must be taken to provide adequate lighting in the road leading up to the home. To ensure the safety of people living in the home and staff who work in the home 17/01/2010 2 42 23 The fire and emergency lighting systems must be serviced annually. To ensure it is effective and fit for purpose. 30/01/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 2 It is recommended staff confirm the outcome of the pre admission assessment in writing to people, so they can be assured their needs will be met when they move into the home. It is recommended records of pre admission visits are retained, to indicate the outcome of such visits. Consideration should be given to opportunities for people who cannot access community activities independently or need one to one support, to ensure they have a fulfilling life. The menu should be reviewed with a view to improving the range of choices available and consideration given to including cultural options, in order to meet peoples preferences. People should be offered a choice of food at each meal time. Staff must ensure all aspects of the care plan are followed up, to ensure peoples well being is maintained. Ensure robust systems are in place to inform people of the complaints procedure, so they are aware of how to raise concerns. All staff should undertake training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with their position in the home, so they are aware of their responsibility in safeguarding people. Receipts should be available for all purchases where people are supported with shopping by staff, to demonstrate a robust finance system. The managers hours of work should be recorded on the duty rota, so it is known when she is working in the home. Where staff have not completed the induction and foundation work books action should be taken to ensure they are completed. The number of staff undertaking and completing NVQ level 2 should be increased to provide at least 50 of staff with 2 2 3 13 4 17 5 6 7 17 18 22 8 23 9 23 10 11 32 35 12 35 Care Homes for Adults (18-65 years) Page 30 of 32 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 the training to improve outcomes for people. 13 35 Support staff should receive training in respect of challenging behaviour and mental illness, so they have the knowledge and skills to meet peoples needs. It is recommended that the quality assurance system be developed further to include feedback from staff plus health and social care professionals, so that continuous improvements can be achieved. It is recommended that individual evacuation plans are drawn up for people living in the home, to ensure their safety in the event of a fire. 14 39 15 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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