Care Home: Greenacres Cheshire Home

What the care home does well People have the information that they need to enable them to decide if they want to live at the home. People have access to a range of health and social care professionals and this ensures that the appropriate advice is sought to meet their health needs. There are lots of opportunities for people to do things for themselves, go out often, have a chance to develop new skills and stay as independent as possible. People can be confident that they are supported by people who have received training in order to meet their individual and collective needs. People benefit from being cared for by a staff team that are supported in their job roles. People are supported to keep in touch with their families and friends so that they maintain relationships that are important to them. The home is sensitive to people`s cultural and religious needs so that they are supported to live their lives pursuing what is important to them. People living at the home are offered a variety of healthy meals that meet any special dietary requirements. People can be confident that support is available to them during meal times. There are good procedures to listen to people, so that they have the opportunity to influence how the home is run. People can be confident that their concerns are taken seriously and their views are acted upon. People can be confident that there are systems in place to protect them from harm. There is a robust system for checking that people`s money is held at the home in a safe manner. Health and safety is well managed to keep people safe. People told us: "When we found out about this place they sent us a brochure". "My wife came to look around first and then I came with my parents. I then came again and had lunch here". "When I have an interest I ask staff to arrange for me to do this". "There is a fair lot going on. In the two weeks our son has been here he has been out with both the family and staff". "We can put suggestions forward for menu choice. Food is good". "We can choose to do what we want here". "The manager says if we have any problems to come and see him. I have not had any problems". "The quality of care is good. In my opinion the home is well run". What has improved since the last inspection? There is a rolling programme of redecoration and refurbishment in place, so that people are provided with a clean and comfortable place to live, that meets their assessed needs. Staff know the people who live at the home well and recognise when their needs change People can be confident that they receive healthcare and personal support in a timely fashion. Systems in place for communication between staff team have improved so that people can be confident that they receive care and support in a consistent manner. Wound care records include details of any treatments and interventions, so that the effectiveness of these can be monitored. People have the option of using multi sensory equipment in order to promote their well being. Quality monitoring systems have been further developed, so that shortfalls within the service provided have been identified and addressed for the benefit of the people living there. People told us: "The staff have started to respond quicker to the call system". "The sensory room is very relaxing". What the care home could do better: A written record of the outcome of trial visits undertaken prior to people coming to live at the home should be kept, as evidence that a person`s needs can be met by the home. Robust monitoring systems should be in place to ensure that people receive their medication at the prescribed times. Key inspection report Care homes for adults (18-65 years) Name: Address: Greenacres Cheshire Home 39 Vesey Road Sutton Coldfield West Midlands B73 5NR     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: Amanda Lyndon     Date: 1 3 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 34 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 34 Information about the care home Name of care home: Address: Greenacres Cheshire Home 39 Vesey Road Sutton Coldfield West Midlands B73 5NR 01213547753 01213546065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.LCDisability.org Leonard Cheshire Disability Name of registered manager (if applicable) Mr Stephen Patrick Plant Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 32 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: Physical disability (PD) 32 Date of last inspection Brief description of the care home Greenacres provides nursing and residential care and accommodation for up to thirty two younger adults who have a physical disability. The home is situated close to Sutton Coldfield Town Centre near to community facilities, leisure activities, and public transport links. There is off road car parking to the front of the building for several cars including reserved parking for vehicles belonging to people living at the home. There is a garden that is accessible to all Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 32 2 1 0 5 2 0 0 9 Brief description of the care home people living at the home. Peoples bedrooms are spread over two floors and offer single accommodation. Seventeen of these have an en suite toilet facility. Upper floor rooms are accessed via a passenger lift. A bungalow that is accessed via an enclosed walkway from the main building provides accommodation for four people with lower dependency care needs. There are four lounges, a dining room, bar area, cafe, and smaller seating areas around the home. Smoking is not permitted within the building and a shelter is provided in the garden for people to use when choosing to smoke. There are assisted bathing and toilet facilities which meet the assessed needs of the people who live at the home. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has specialist equipment to meet the assessed needs of individual people. Facilities provided include an art studio, internet cafe and hair salon. In the reception area of the home there is a range of information which may be of interest along with details of forthcoming events. A copy of our last inspection report, statement of purpose and service user guide are displayed so that people can read them if they choose. In addition people told us that they obtain their own copies of our reports directly from us. The service user guide includes details of current fee rates. Further details about fees charged are available from the home on request. Care Homes for Adults (18-65 years) Page 5 of 34 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 focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on areas that need further development. The inspection was carried out over one day by two inspectors. The home did not know we were going to visit. There were thirty people living at the home and two of these people were in hospital. Prior to the visit taking place we looked at all of the information we had received, or asked for. This included any complaints made or notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. Care Homes for Adults (18-65 years) Page 6 of 34 We received an Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of the people living there. It also gives us some numerical information about staff and people living at the home. This was completed by the manager in good detail and returned to us within the deadline. We sent out surveys to ten people who live at the home and ten staff members, in order to obtain their views about the service provided. Prior to our visit six people who live at the home and five staff members returned surveys to us. Three people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to eight staff members about the care and support they provided to these people. We sampled care, staffing and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean and comfortable for them. We gave all people living at the home the opportunity to be involved in the inspection. We spoke with seven of these people. We also spoke with three relatives that were visiting the home. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: People have the information that they need to enable them to decide if they want to live at the home. People have access to a range of health and social care professionals and this ensures that the appropriate advice is sought to meet their health needs. There are lots of opportunities for people to do things for themselves, go out often, have a chance to develop new skills and stay as independent as possible. People can be confident that they are supported by people who have received training in order to meet their individual and collective needs. People benefit from being cared for by a staff team that are supported in their job roles. People are supported to keep in touch with their families and friends so that they maintain relationships that are important to them. The home is sensitive to peoples cultural and religious needs so that they are supported to live their lives pursuing what is important to them. People living at the home are offered a variety of healthy meals that meet any special dietary requirements. People can be confident that support is available to them during meal times. There are good procedures to listen to people, so that they have the opportunity to influence how the home is run. People can be confident that their concerns are taken seriously and their views are acted upon. People can be confident that there are systems in place to protect them from harm. There is a robust system for checking that peoples money is held at the home in a safe manner. Health and safety is well managed to keep people safe. People told us: When we found out about this place they sent us a brochure. My wife came to look around first and then I came with my parents. I then came again and had lunch here. When I have an interest I ask staff to arrange for me to do this. There is a fair lot going on. In the two weeks our son has been here he has been out with both the family and staff. We can put suggestions forward for menu choice. Food is good. Care Homes for Adults (18-65 years) Page 8 of 34 We can choose to do what we want here. The manager says if we have any problems to come and see him. I have not had any problems. The quality of care is good. In my opinion the home is well run. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 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 11 of 34 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. Admission processes are thorough and people living there can be confident that their care needs will be met. Evidence: The statement of purpose and service user guide had recently been updated. These included information about the majority of services and facilities provided at the home. The range of fees charged to live at the home is included in these documents, so that people are aware of this information. We saw that they are produced in large print formats and are available in other languages and formats on request. This is so that more people can access the information. The relatives of a person who had recently come to live at the home told us When we found out about this place they sent us a brochure. We sampled the pre admission assessment of a person who had recently come to live at the home. We saw that senior staff undertake comprehensive pre admission assessments. This is in order to determine whether peoples assessed care needs could be met whilst living there. People told us that they had been involved in this Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: process. This means that they should receive care and support in the way they require and prefer. One person told us I was involved in the assessment. The staff read my notes but also did their own assessment as well. People told us that they had spent time at the home prior to admission. This is in order to sample what life would be like to live there. One person who had recently come to live at the home told us My wife came to look around first and then I came with my parents. I then came again and had lunch here. When we came to look around there were not many spare places. My room is accessible to me. Prior to admission people and their families are introduced to people living at the home and are shown around. This helps them to settle in and to get a feel for the home from the people who live there. One person who lives at the home told us that he accompanies people who have come to view the home. He told us I do the show arounds. As the home provides a specialist service people come to live there from around the country. Whilst people told us that trial visits take place written records about these were not available. This means that it would not always be possible to determine the success of the visit as an assurance that a persons needs could be met there. Care Homes for Adults (18-65 years) Page 13 of 34 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 that live in the home receive good support to make choices and decisions about their day to day lives, so that they lead lifestyles that meet their needs and expectations. Evidence: On coming to live at the home comprehensive assessments of peoples individual care needs are undertaken. These include details of their preferences, so that their preferred routines can be maintained whilst living at the home. Care plans are written from this information. These are individualised plans about what the person is able to do independently. They also identify what support is required from staff in order to meet the persons needs. Care plans were sampled for three people living at the home. It was evident from the records that people and their families were involved in the development and review of their care plans. People met with during the visit confirmed that they had been involved in writing and reviewing these. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: A key worker system was in place so that a designated staff member works alongside each person living at the home. This is in order to understand peoples specific needs better. From discussions with staff it was evident that they had a good understanding of these needs. One staff member told us We are encouraged to read the care plans when we have time. One person who completed a survey told us The home caters and cares for each individual to the best of its ability. From discussions with staff and people who live in the home, it was evident that people are encouraged to maintain and develop their independence. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks and promote their independence. These include comprehensive assessments about the risk of people choking, moving and handling, nutrition and the use of bed rails. We saw that risk assessments had been completed about the risks involved in people wearing wheelchair lap belts. From the documentation sampled it was not clear whether all of the people who were wearing lap belts actually needed to do so. This was brought to the attention of the manager who advised that he would look at the risk assessment being used for this. He stated that no one living at the home wore lap belts against their wishes. We saw evidence that a person who had chosen not to wear a lap belt was aware of the risks involved in not doing this. Care records identified that people living at the home and their representatives are invited to care reviews with the homes staff and social workers. This is in order to discuss their care and put forward any suggestions for improvements. From discussions with people living at the home, staff and sampling of records we evidenced that people have choices and make their own decisions about their daily lives. This includes the times they get up, go to bed and what they spend their money on. Peoples preferred names were recorded within their care plans and we heard staff greeting them by these names. People are given a choice about the gender of staff member assisting them with their personal care needs. People confirmed that they are supported to buy and wear clothing that is appropriate for their age, gender, culture and lifestyles. Regular group meetings are arranged for people living at the home and their relatives. This means that they have the opportunity to discuss the services provided at the home. The minutes of recent meetings and dates of forthcoming meetings were on Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: display, so that people could access this information. One person told us I go to the group meetings. The room is full. People told us that actions are taken in response to suggestions that they put forward. During our visit we saw that people are kept up to date about other issues regarding the home. For example we saw that a memo was on display to inform people that a bedroom was vacant in the bungalow, should anyone be interested in moving into this. A number of people told us that the homes staff had supported them to vote in the recent general election. One person living at the home met with during the visit told us We can choose to do what we want here. Care Homes for Adults (18-65 years) Page 16 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home experience a meaningful lifestyle that promotes their independence and is reflective of their individual needs and interests. Evidence: There are two activity co ordinators working at the home and a team of volunteers. From discussions with people living there, staff and our observations during the visit, it was evident that people are encouraged to pursue any interests that they had prior to coming to live at the home. People told us that staff also provide support for people to pursue new interests and develop new skills. One person told us When I have an interest I ask staff to arrange for me to do this. People are encouraged to pursue their talents for example one person living at the home is very artistic and an art studio had been created to meet his assessed needs. People are consulted and staff arrange activities both within and outside of the home. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Since our last visit two additional vehicles and newly recruited drivers are available for people living at the home to use for trips out. One person who completed a survey told us Trips out and activities have improved recently. The parents of a person who had recently come to live at the home told us There is a fair lot going on. In the two weeks our son has been here he has been out with both the family and staff. One person told us I go out with my friend and with a carer to town. People told us that recent trips had been arranged to the motorcycle museum, Thinktank and local pubs and shops. Leisure activities are also provided at the home, for example, Pets for Therapy and music therapy. One person told us The music this morning was fantastic. Another person said The donkey sanctuary came yesterday. It was brilliant. A gardening club has been formed and plans are in place for a greenhouse to be purchased that is accessible to wheelchair users. People are informed about forthcoming events via notice boards in the home, meetings and newsletters. We saw that people are consulted about which forthcoming events they would be interested in participating in. People living at the home told us that they also enjoyed being actively involved in fundraising projects for the organisation. The latest edition of the homes newsletter was on display. This included information about life at the home, the events programme and both local and national news. This means that people are kept updated about current issues. It also included a request for people to feedback their views and experiences of the recently completed multi sensory room. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. Arrangements are in place so people can follow their religious beliefs if they wish. People are supported to maintain links with the community. People attend local colleges and work shops. We also saw that children from local schools regularly visit the home and join in with activities.. People are encouraged to maintain relationships with the people important to them. There is an open visiting policy and people can choose where they meet with their visitors. The home has a pub staffed by volunteers that people can go to with their friends and families if they wish. People have a choice of where they are served their meals. Menus identified a variety of nutritious meals. A choice of meals is always available and in addition people have Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: the option of choosing snacks at other times. Special diets are prepared for reasons of health, culture and religion. Catering staff met during the visit had a good understanding of this. One person who completed a survey told us They give me very good meals with a wide choice. Another person said We can put suggestions forward for menu choice. Food is good. During the visit people told us that they were enjoying their meal. Dining tables were laid attractively, drinks were served and seating was arranged to promote social interactions between the people living there. We saw that staff were supporting people in a sensitive manner during lunch time. An environmental health inspection had been undertaken in 2009. The home was awarded five stars. Catering staff had recently achieved enhanced food hygiene qualifications. This should mean that food is prepared in a hygienic manner. Care Homes for Adults (18-65 years) Page 19 of 34 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. Systems in place ensure that the health and personal care needs of people living at the home are met. Evidence: We looked at three peoples care plans. These are individual plans written with the involvement of people living at the home and their families. They included information about what people can do for themselves and in what areas they require support. Information was available about the health conditions of people living at the home and any associated risks involved with these. Since our last visit staff had undertaken training about care planning. We found that improvements had been made regarding the content of these. We saw that care plans now included peoples preferences regarding their daily lives and specific instructions for staff to follow in order to meet peoples needs. This included peoples short term needs, for example if they had an infection or sore skin. This means that people should receive care and support in the way they require and prefer. From discussions with the staff team, it was evident that they had a good understanding of peoples individual care needs. People living at the home spoke with during the visit confirmed Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: that the care being provided to them reflected the information included within the care plans. We saw that since our last visit a quality monitoring system had been introduced, so that shortfalls regarding the content of care plans could be identified. This means that care plans should reflect peoples current care needs. Since our last visit the systems in place for communication between the staff team had improved. For example, the system used for staff to handover information to the next shift team had been further developed. We saw that senior managers are monitoring the effectiveness of this system. A member of the care staff team told us We pass on information to the nurses and they are approachable. We saw that people can retain their own doctor on admission to the home, if the doctor is in agreement. Advice can also be sought from a range other health and social care professionals as needed. A number of people are supported by external specialists to obtain equipment in order to improve the quality of their live. For example to assist with communication and mobility needs. Physiotherapy is provided at the home five times a week. Positive feedback was obtained from people living at the home and their families about the service provided by this team. We saw that the safe handling plans written by the physiotherapist gave staff detailed and clear instructions about how peoples needs were be met in this area. The training matrix identified that staff including volunteers had undertaken moving and handling training. This should mean that people are supported to move safely. During our last visit to the home we identified that people were waiting for long periods of time for staff to respond to call bells. In order to address, this a new call bell system had been installed. This included two additional alarm points close to the offices so that the management team could monitor the time taken for staff to respond. One person who completed a survey told us The staff have started to respond quicker to the call system. We saw that the importance of this had been discussed during staff team meetings. Audits of response times are undertaken regularly. These identified that staff respond to the vast majority of calls within three minutes. We saw that improvements had been made regarding the management of medication. Staff had recently undertaken training in this area and further training was planned. During our visit we saw staff organising medication within a newly built spacious Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: medication store room. This should improve the system in place for the storage and stock rotation of medication. We saw that systems had been introduced that should ensure that people received their medication as prescribed. The stock balances of medication issued in blister packs were correct. However we identified that a couple of the stock balances of boxed medication sampled were incorrect. This was brought to the attention of the manager for investigation. Shortly after the visit he confirmed that the stock balance of one persons medication was incorrect due to a recent hospital admission. He also sent us a copy of a revised auditing system and assured us that the appropriate actions would be taken if errors of a similar nature occurred again. This should ensure that any shortfalls in this area are identified and corrective action taken to maintain the health and well being of people living at the home. We saw that people are encouraged to self administer their own medication if able. We saw that staff assess and monitor peoples competency to do this in order to ensure their health and safety. Care Homes for Adults (18-65 years) Page 22 of 34 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. Arrangements ensure that the views of people living at the home are listened to and that they are safeguarded from harm. Evidence: The complaints procedure was included within the service user guide and leaflets were available in the home. It was produced in a large print colour format making it easy to read. It included easy to understand information. People living at the home told us where these leaflets could be found and that they are aware of how to make a complaint. One person told us If I was not happy I would speak to the management. Since our last visit to the home we have not received any complaints about the service provided at the home. Information on the AQAA identified that the home had received six complaints in the last twelve months. We looked at the complaints register held at the home and found that details about these were included. Issues raised included the time that a person had got out of bed on one occasion and that the kitchen had been closed without authorisation from the management team on one occasion. We saw that the home had investigated these in an appropriate and timely manner and that the complaints had been upheld. From records held at the home it was evident that complaints are taken seriously and that the outcomes are feedback to all concerned. There was evidence that actions had been taken in order to address issues raised for the benefit of people Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: living at the home. Since our last visit there have been six incidents regarding people who have lived at the home that have been raised as safeguarding. Three of these occurred whilst people were temporarily away from the home. The three incidents that occurred at the home were of a similar nature. We saw that the home reported these to the relevant external people responsible for overseeing safeguarding matters. This is in order to protect the people living at the home and minimise the potential for a similar incident to happen again. These were investigated by the home, following advice given by social services. The outcomes of these were found to be not upheld and the cases are now closed. We identified that the home had taken the appropriate actions in response to these for the benefit of the people living there. This has included further staff training. Prior to our visit the manager told us that an incident had occurred at the home. He advised that there was an agreement between Greenacres and another home within the organisation to provide drop in nursing care support to a named person who was attending a local event. On one occasion the identity of the person attending the home did not match that of the person for whom support had been agreed. This resulted in the wrong person receiving nursing care support at the home. The person involved did not experience ill effects on this occasion. Details about the drop in service were not identified within the homes statement of purpose. We discussed this with the manager who stated that it was unlikely that this service would be provided in the future. He agreed that further consideration was required before deciding whether to continue with this service. This is in order to ensure that all safety measures are in place. This will prevent an incident of a similar nature from occurring again. The training matrix identified that the vast majority of staff had undertaken recent training about the protection of vulnerable adults. Staff met with during the visit told us that further training was also planned about this. It was evident that staff had a good understanding of safeguarding procedures. This should mean that people are protected from harm. The home do not manage the money of people living at the home. However there is a robust system in place for the safekeeping of small amounts of peoples money. Care Homes for Adults (18-65 years) Page 24 of 34 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 safe and comfortable environment that meets their needs. Evidence: The home is situated in a residential area of Sutton Coldfield. There are a range of shops, leisure activities and public transport links nearby. This is important to the people who live there as they make regular use of these amenities. There was a rolling programme of redecoration and refurbishment in place, so that people were provided with a clean and homely place to live. Bedrooms are located on both floors of the home and offer single accommodation. En suite facilities are provided in eighteen of the bedrooms on the ground floor. We looked at the bedrooms of people case tracked and saw that they had been personalised to reflect their age, gender, interests and culture. One person had recently moved bedrooms and he had been involved in refurbishing his new room. This had been adapted to meet his assessed needs. People have the option of having a key to their bedrooms so that they have independence and privacy in this area. Bedrooms were equipped with specialist equipment that met peoples assessed needs for example, ceiling hoists and profile beds. Staff told us that other equipment available such as showering and bathing facilities and pressure relieving equipment Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: met the needs of the people living there. Corridors and doorways are wide. Push buttons are provided at wheelchair height so that doors can be opened. This enables people to move independently around the home as they wish. There is a bungalow that is accessed via an enclosed walkway from the main building. This provides accommodation for up to four people. We saw that some areas of the bungalow are in need of redecoration. The kitchen had been taken out of use however plans are in place to refurbish this and create a therapy kitchen. This will promote peoples independence. One person who lives in the bungalow told us We have been consulted about all the alterations. There are four lounges, a dining room, bar area, cafe and smaller seating areas around the home. People told us that they can choose which of these they use. However from information on the AQAA and discussions with people living at the home, the manager had identified a need to increase dining facilities. One person who completed a survey told us We cannot all get in to eat at the same time in the dining room. In response to this two lounges had been redecorated and additional dining furniture had been ordered to create two additional lounge/dining facilities. This means that people will have more choice about where to eat their meals. People will have the option of using one of these quieter rooms. Facilities provided include an art studio and internet cafe. Since our last visit a multi sensory room has been created. Portable equipment had been ordered so that it would be suitable for all people living at the home to use. One person told us The sensory room is very relaxing. There is a garden that is accessible to and suitable for all people living at the home. Since our last visit the sensory garden has become well established and people told us that they enjoyed using this facility. The home is a non smoking environment and details about this are included in the service user guide. A covered shelter had recently been built in the garden. This facility is for the use of people that choose to smoke. There was an effective system for the cleaning of peoples personal clothing and bed linen. We found that the home was clean and fresh throughout. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are supported by the right number of staff, who have the skills and knowledge they need to meet their needs. Evidence: In addition to nursing and care staff, administration, cleaning, activities, maintenance, laundry and catering staff are employed. This means that people living at the home receive support in these areas. Positive comments were made about the staff team. We saw that they were spending time talking with people living at the home and their families. This promotes a homely and inclusive environment for the people living there. One staff member told us Its good here. I get on great with the residents. From discussions with people living at the home, staff and sampling of staffing rotas, we identified that continuity of care had improved since our last visit to the home. Staff vacancies had been filled, staff turnover was low and the use of agency staff had reduced. Since our last visit care staffing levels had increased during the busiest times of the day and night. People living at the home and staff met with during the visit told us that there were now enough staff on duty to meet peoples needs. One person told us There are very rare occasions when staff dont come quickly. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: The gender and cultural backgrounds of the staff team reflected that of the people living at the home. This means that support could be provided in an understanding manner. People living at the home told us that they take part in the selection of new staff. This means that they have a say in who supports them. Volunteers are employed and we saw that they go through the same recruitment process as permanent staff. This should mean that they are suitable to support people living at the home. We reviewed two staff files of people who had recently come to work at the home. These included all information required. At least two references had been obtained for each of the new workers. We saw that staff do not start working at the home until satisfactory criminal records checks have been completed. This should mean that people can be confident that staff are suitable to work with vulnerable people. We identified that new workers including volunteers complete an induction training programme. This should mean that they have the knowledge to provide care and support in a competent manner. The training matrix identified that there is a rolling programme of staff training in mandatory areas planned throughout 2010. From discussions with staff met during the visit and from records sampled it was evident that since our last visit staff had undertaken training in a number of mandatory areas. This included health and safety, fire awareness, food hygiene and infection control. This should mean that staff provide support in a safe manner. Nursing staff had undertaken recent training relevant to their job roles. This included male catheterisation, person centred care planning, continence, nutrition and tissue viability. We also saw that plans are in place for staff to undertake a variety of training provided by the local primary care trust. This includes supporting people with multiple sclerosis and diabetes. There are currently 78 of staff who have completed a National Vocational Qualification (NVQ level 2 in Care). This means that they should have the necessary skills and knowledge to provide a good standard of care. Records identified that staff meetings are held regularly. This means that staff are involved in the running of the home and are kept up to date with training and development opportunities. We sampled the minutes of the meetings and saw that ways in which to improve the service provided were discussed. We also saw that staff Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: had the opportunity to put forward their suggestions about the service provided. There was evidence that actions are taken in response to these for the benefit of the people living at the home. For example the development of the new medication storage room. Care Homes for Adults (18-65 years) Page 29 of 34 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. People living at the home can be confident that the home is being run in their best interests. Evidence: The home manager has been in post since 2006 and is registered with us. He is a registered nurse and has had previous management experience in both the NHS and the private sector. He works extra to the rota and this means that he has dedicated management time. From our discussions with the manager he appeared to have good knowledge of the care and support needs of the people living at the home. Positive comments were received about his management style. People told us The manager says if we have any problems to come and see him. I have not had any problems and The manager is approachable. He comes round the home and is a good bloke. The manager is supported by an experienced care supervisor who works alongside the care team three days a week. She has dedicated management time for two days a week. This means that she is able to provide support to both the manager and the rest of the staff team. This should ensure that people living at the home receive a Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: good standard of care. One person who completed a survey told us The quality of care is good. In my opinion the home is well run. Quality monitoring visits are undertaken by the external senior management team. There was evidence that people living at the home are involved in these visits. We saw that suggestions made by people using the service during these visits were acted upon. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This included comprehensive details about the home, staff and people who live there. It also included information about what the service hoped to achieve for the benefit of the people living there. We found that the information included within this was consistent with the findings of our visit. This means that it gave us a reliable picture of the service provided at the home. Throughout this report we have identified a number of the ways that the views of the people living at the home are sought. This includes group meetings and their involvement in the recruitment of staff. We saw that people living at the home are encouraged to cover the reception desk and meet and greet visitors. They are available to answer any questions that visitors may have. We were told that an external Company had recently distributed service satisfaction questionnaires to people living at the home on behalf of Greenacres. This is another way of finding out what people think about the home. Accident records were well maintained and regularly audited so that any trends or patterns in accidents occurring could be identified. This means that measures can be put in place to reduce the risk of further accidents of a similar nature. Health and safety and maintenance records sampled were up to date. This is in order to promote the health and safety of people within the home. People living at the home told us that they are part of the health and safety committee. This further endorses their involvement in the running of the home. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose should include all services provided at the home, so that people have this information when choosing whether to live there. A written record of the outcome of trial visits undertaken prior to people coming to live at the home should be kept as evidence that a persons needs can be met by the home. Robust monitoring systems should be in place to ensure that people receive their medication at the prescribed times. 2 4 3 20 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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