Care Home: Greenheys (52)

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What the care home does well The people using the service have a staff team that know their needs well. Observations of staff indicated that they are caring and respectful towards the people using the service. There is a low turnover of staff and a number of the staff have worked at the home for several years, which provides continuity of care. The home is well managed and the staff feel they are well supported by the manager. The people using the service benefit from the training and support provided to staff. Staff said they enjoy working at the home and that the people using the service are well looked after and get a good service. The manager has developed a very easy and clear system for people to raise comments or concerns. There are clear procedures at Greenheys for people to raise any concerns or complaints they may have. The home is safe. Maintenance certificates showed up to date checks including the electrical wiring and gas supply. There is a good system for ensuring the quality of the service through consultation with relatives and staff and checks carried out by the manager and other staff from within Alternative Futures. What has improved since the last inspection? The statement of purpose and the service user guide have been reviewed and are available to any people thinking about using the service, their families and professionals working with them. Since the last visit to the service the staff have received training to update their knowledge and skills in medication management, first aid, safeguarding and the management of challenging behaviour. One person has moved from Greenheys to a placement that better suits their needs. This has been a positive change for them but has also meant there is more staff time available for the people currently living at the home. This was reflected in interviews with staff who felt that a better service is now being provided at the home. Advocacy services are being used for a person who has little family contact which means there is someone available outside of the staff at Greenheys who can represent their views. Care plans have been reviewed since the last inspection of the service and provide better information on supporting people who have challenging behviour and supporting people who are at risk of poor nutrition. This ensures that staff have better information to guide them in their support of the people using the service. Policies and procedures have been reviewed. This is necessary to assist with good practice and ensures staff have up to date guidance. The home is currently being redecorated and new furnishings are being provided in some areas of the home. A new kitchen has been fitted and a wet room is being installed. This will provide a more comfortable home environement for the people using the service. What the care home could do better: The service is currently meeting the individual needs of the people living at the home, however their needs are not compatible in terms of age and ability. A clear plan needs to be put in place identifying the actions to be taken to address this. Given the differing levels of need of people living at the home in the past, it is of upmost importance that the needs of any new service users are fully assessed so that there are no further issues of incompatibility that may have a detrimental affect on the wellbeing of the people currently using the service. The care plan around the management of a service users diet needs to clearly state that staff are to offer alternative foods at each meal time. The food alternative offered needs to be clearly recorded. This will provide clearer guidance for staff to follow and will show that the service user is being offered a variety of foods. A record should be made of what activities are planned, what activities are offered and whether or not the activitiy takes place to demonstrate that the people using the service have access to a range of appropriate activities and access to the local community. Where medication is given as part of the procedure to support a person using the service with their behaviour, the time this is given and the time the behavioural difficulties began should be clearly recorded. This will provide further evidence that medication is being managed appropriately. The manager must be able to demonstrate that any students who undertake placements at the home are suitable to work with vulerable adults. This will ensure that the people who live at the home are adequately safeguarded. The organisation that a referee works for needs to be clearly stated on the reference. So that there is no confusion as to who supplied the reference. The visits by the representative of the organisation should include a broader range of checks being made of the service such as checks of medications, finances, support plans and staffing. This will provide evidence that the monthly visits offer a more comprehensive assessment. Key inspection report Care homes for adults (18-65 years) Name: Address: Greenheys (52) 52 Greenheys Road Wallasey Wirral CH44 5UP     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: Beate Field     Date: 0 3 0 2 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 33 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 33 Information about the care home Name of care home: Address: Greenheys (52) 52 Greenheys Road Wallasey Wirral CH44 5UP 01516388248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Alternative Futures Limited care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD. The maximum number of service users who can be accommodated is: 5. Date of last inspection Brief description of the care home 52 Greenheys Road is registered with the Care Quality Commission to provide personal care for 5 adults with a learning disability. Alternative Futures Limited, a registered charity operating in the North West, operates and manages the home, with the premises being owned by Alternative Housing Association. The home is a purpose built detached bungalow with a large garden, close to Central Park in Liscard, Wirral and is within walking distance of local shops. There is car parking at the front of the home. Communal areas comprise a large lounge, with doors to the garden, and folding doors to the adjacent dining room. A domestic style kitchen and separate laundry facilities are provided. The home has a bathroom with W.C and separate shower room with W.C on the main corridor leading to the bedrooms. There is a separate toilet next to the Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 5 1 9 0 2 2 0 0 9 Brief description of the care home lounge. There are five single bedrooms each with a wash hand basin. The fees for the home are 1085.09 pounds per week. Items not covered by this fee include chiropody, haircuts, presents, toiletries and confectionary and some activities. A service user guide and a statement of purpose, which describe the services offered at 52 Greenheys Road, are available from the manager. The manager can also supply a copy of the report of the most recent inspection undertaken by CQC. Care Homes for Adults (18-65 years) Page 5 of 33 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 two star. This means the people who use the service experience good quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced visit to the home on 3rd February 2010. This took place over seven hours and included reading records, meeting people and looking at the building. A second Inspector was at the service for three hours. We spent time looking at the support the people living at Greenheys receive. This included looking at the support they get with their daily lives, care plans, medication, activities and environment. We met the three people who live at Greenheys and two members of staff. We also spoke throughout the visit to the manager and briefly spoke with the area manager. Care Homes for Adults (18-65 years) Page 6 of 33 We reviewed any information we had received about Greenheys following our last key inspection. The manager completed a self assessment form called an AQAA which we sent to her before our visit. We used the information in this form and the other information we had to help plan our inspection and write this report. We sent out a collection of surveys to the staff and people who live at the home and we received eight surveys back from members of staff. An expert by experience came with us for part of this visit. An expert by experience is someone who has experience of services for people with a learning disability and who is not employed by the Care Quality Commission. The expert by experience spoke to a person using the service, made observations of people using the service, spoke with the manager, looked at menus and records of activities and looked around the home. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? The statement of purpose and the service user guide have been reviewed and are available to any people thinking about using the service, their families and professionals working with them. Since the last visit to the service the staff have received training to update their knowledge and skills in medication management, first aid, safeguarding and the management of challenging behaviour. One person has moved from Greenheys to a placement that better suits their needs. This has been a positive change for them but has also meant there is more staff time available for the people currently living at the home. This was reflected in interviews with staff who felt that a better service is now being provided at the home. Advocacy services are being used for a person who has little family contact which means there is someone available outside of the staff at Greenheys who can represent their views. Care plans have been reviewed since the last inspection of the service and provide better information on supporting people who have challenging behviour and supporting people who are at risk of poor nutrition. This ensures that staff have better information to guide them in their support of the people using the service. Policies and procedures have been reviewed. This is necessary to assist with good practice and ensures staff have up to date guidance. Care Homes for Adults (18-65 years) Page 8 of 33 The home is currently being redecorated and new furnishings are being provided in some areas of the home. A new kitchen has been fitted and a wet room is being installed. This will provide a more comfortable home environement for the people using the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Adults (18-65 years) Page 9 of 33 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 33 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 33 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. The assessment process would ensure that the needs of a person interested in living at the service can be met. Evidence: A service user guide and a statement of purpose which descibe the services on offer at 52 Greenheys Road are available to people interested in moving to the service, their families and health and social care professionals. The guides provide good levels of information on the purpose of the home and the facilities available. Some information was missing from the service user guide and the statement of purpose which needs to be included. The manager was advised to ensure that details of her qualifications and experience, a contract and the fees are included. The home was being refurbished at the time of our inspection. The manager plans to update the service users guide with pictures of the interior of the home once the works are completed. Since our last visit to the home one person has moved to more suitable accommodation. There are now three people living at the service who have been there for many years. We discussed the process of assessing any new person thinking of Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: using the service with the manager and looked at documentation around the assessment process. The assessment process that would be used for new service users would ensure a thorough assessment of an individuals needs. Opportunities to visit the home to see if it is right for them would be made available to any person thinking of using the service. The manager also said that introductions to the service would be made over a two to three month period to ensure that the new service users needs could be met at the home alongside the needs of the current service users. We spoke to the manager and the area manager during this visit. Both acknowledged that given issues around the differing levels of need of service users living at the home in the past. It is of upmost importance that the needs of any new service users can be met without this having a detrimental affect on the wellbeing of the people currently using the service. The AQAA indicated and the manager confirmed that they have access to a local advocacy group who can act in the best interests of people. The manager advised that before any new service users come to live at the home the views of the current service users will be sought with support from their family and advocates where appropriate. Care Homes for Adults (18-65 years) Page 13 of 33 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. Support plans are detailed enough to show how people using the service will have their needs and choices met and supported. Evidence: Individual support plans were available for each person, we looked at two of them during our visit. The support plans show regular reviews carried out by staff to give updated information describing how they support people living at Greenheys. The plans gave information to show how their personal care and support would be met. They also included details on how to support each person with specific risks and needs including, support with medication, road safety, agitation and risk of scalding. The records and a discussion with staff indicated that people using the service are assisted to make decisions about their lives in accordance with their abilities. Communication guidelines assist in this process. Records of the likes and dislikes of the people using the service, their routines and preferences around daily living, such as what time they like to get up and the activities they enjoy also ensures their Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: choices are respected. Staff had worked hard in developing and producing the use of a picture dictionary to describe words and signs that each person uses to communicate. This helps people to be supported in choosing what they want to do in their home. The needs of everyone using the service are met at the home, however, their needs are not all compatible due to differences in age and abilities. This was identified in 2004 and attempts to find a more suitable placement for one person have been unsuccessful. The area manager advised that work is currently taking place to find a placement that better meets this persons needs. In the interim the current staffing levels ensure that all the people using the service are receiving the attention and care they need. The lack of compatibility around age and abilities of people using the service can mean that relationships between people using the service do not have the chance to develop which can make a more homely atmosphere. The expert by experience noted that the abilities and age of one person at the home are different to the other people using the service. They said, they were not sure about how well it works with one resident having very different needs and abilities. It will be of great importance that when assessments take place for any new residents, the compatibility of the current residents is fully assessed and that there are sufficient staffing levels to ensure that that the needs of all residents are fully met at the home. There are currently two females and one male using the service. There are more male staff employed at the home than female staff. This gives the females using the service less choice and can restrict their privacy and dignity on occasions. The manager has been taking steps to address this imbalance. The two staff spoken with were very knowledgeable about the needs of the people living at the home. They said they enjoy working at the service and feel that the people using the service receive a good quality of care. They said the home is calmer since the changes to the resident group and that there are currently sufficient staff to ensure all three people using the service have their needs met equally. Care Homes for Adults (18-65 years) Page 15 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have a lifestyle that in general meets their needs and provides opportunities for their social and personal development. Evidence: The people who live at Greenheys have different needs and abilities. The support plans showed very big differences in how each person communicates their needs and choices. Some people are very able to get involved in the community with support for things such as swimming, gardening, doing house work, shopping, choosing what meals they would like and they are very able to get their opinion across in what they want to do each day. Others at the service have to rely on the staff to interpret their needs and requests. Most staff have been at the service a long time and have built up a good rapport with the people using the service and are knowledgeable in how they express their needs. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: During our visit to the service one person was listening to music and stayed at home, one person watched television and went out for a trip on the mini bus and another person took part in a community gardening project. The expert by experience felt that some people could be offered more variety of activities during the day. A discussion with the staff indicated that they feel the people using the service have enough to do and that there are suficient staff to engage people in different activities but that some people using the service do not wish to participate in a wide variety of activities. There was no planned activity programme available for some people using the service. A record should be made of what is planned and what is offered and whether or not the activitiy takes place to demonstrate that the people using the service have access to a range of appropriate activities and access to the local community. Records and a discussion with staff showed that people using the service have their relationships with their families promoted and supported. The home was in the process of being redecorated during our visit. The manager said there are plans to make the dining area more homely for the people using the service. The fridge and freezer were well stocked with a variety of foods and there were fresh fruit and vegetables available. The records of foods in general showed that a variety is offered to give people as much choice as possible. Staff explained how they support people in choosing what they would like for their meal and that they have lists of what people like and dont like including details for special diets. Better care planning information is needed around meal times for a person using the service and a record is needed of all food offered in order to demonstrate that a variety is being made available. The expert by experience spoke to a person using the service. They said they like living in the home and they are happy. They showed the expert their bedroom that had been newly decorated and had pictures of them on holiday. They said they do lots of different things at the home like watching football, going to the pub, karaoke, watching bands and going swimming. The manager told the expert by experience about the holidays that the people who use the service have. The expert by experience thought this was good. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and medication needs of people using the service are appropriately monitored and met. Evidence: Support plans were available for each person we looked at two of them. The plans had been recently updated and revised and gave enough information to show how the personal care and support needs of the people using the service would be met. Each person has a section on medical needs called, My health action plans. The care records showed the people using the service are supported in accessing health care services when needed. Each section gave details advising on what they had identified each person needed to help keep them healthy and safe. One person using the service has dietary needs that could pose a risk to their health and general well being. The care plan around the management of their diet needs to clearly state that staff are to offer alternative foods at each meal time. The food alternative offered needs to be clearly recorded. This will provide clearer guidance for staff to follow and will show that the service user is being offered a variety of foods. A dietician is called upon to give advice where this is needed. Records showed regular monitoring of weight is Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: taking place where necessary. Staff spoken with and those who returned surveys said they are given the training and information they need to support the people using the service with their health care needs. Since the last inspection of the home all staff apart from the newest member of staff have attended a four day first aid course. None of the current residents are able to self medicate. The home has a medication policy and procedure in place. Staff who administer medication have all received training around the safe handling of medication to update their knowledge and practice since the last inspection. The home receives advice and guidance from the local pharmacy as necessary. The medication administration records and corresponding medication were inspected and were found to be accurately maintained. Where medication is given as part of the procedure to support a person using the service with their behaviour, the time this is given and the time the behavioural difficulties began should be clearly recorded. This will provide further evidence that medication is being managed appropriately. General observations showed that staff are respectful towards the people who live there. Staff were aware of the support each person needed and they appeared to have a good rapport and knowledge base of each person. It was observed that staff did not always ask permission of the people using the service before they showed their bedrooms to the expert by experience. Staff should ensure that where possible they seek the views of the people using the service. Care Homes for Adults (18-65 years) Page 19 of 33 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. The staff have the necessary knowledge and skills to safeguard the people using the service from abuse. Evidence: Information about how to raise a concern or complaint is made available to the people living at 52 Greenheys in a pictorial format with the use of smiley faces. This is good practice as it helps to increase the opportunities for people using the service to have a better understanding of the ways in which they can raise comments and concerns. Relatives, advocates and health and social care professionals have access to a suitable complaints procedure, which gives them a clear picture of how to raise a concern or complaint on behalf of a person using the service. The records of complaints held at the home showed that none had been made since our last inspection. No concerns or complaints have been raised about the home with the Care Quality Commission since the last key inspection. The staff who returned surveys to CQC stated that they knew how to manage a complaint made to them about the home. Reports about specific incidents which occur at the home have been submitted to the Care Quality Commisson. These records show that there had been a few incidents of aggressive behaviour being displayed by a person using the service. Since the last inspection of the service all staff have undertaken a 4 day training course around the management of challenging behaviour. Records showed that were any physical intervention had been used, this has been used to protect a service user or prevent Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: further assault of a member of staff. Records show that any incidents have been appropriately documented. Records of staff training showed that all staff have attended training around safeguarding vulnerable adults from abuse since the last inspection of the home. The two staff spoken with demonstrated an awareness of how to ensure the people using the service are protected from abuse. CQC have been notified of any safeguarding issues. Care Homes for Adults (18-65 years) Page 21 of 33 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. On completion of the refurbishment the home environment will appropriately support the needs of the people using the service. Evidence: Greenheys is a detached bungalow in a residential setting. The service is situated close to shops, pubs and other community facilities including public transport and a local park. Shared space consists of a domestic style kitchen, small dining room and lounge with small conservatory. Everyone has a single bedroom and there are no stairs with facilities all being on ground level. At the time of the inspection the home was in the process of being refurbished. One bedroom and one bathroom had been redecorated and the bathroom refitted. The kitchen had been refitted and the lounge and dining area had been redecorated. The manager reported that all bedrooms and communal areas are being redecorated. A wet room is being installed which the expert by experience thought was a good idea. The manager reported that all works are to be completed by 12th February 2010. At the time of our visit a further two bedrooms were being decorated. The expert by experience said that the home could be made more homely in appearance although he acknowledged that a refurbishment was taking place. The manager reported that new furniture is being purchased along with curtains, blinds and various accessories such Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: as photograph frames and pictures to make a more homely environment. It is planned that the garden will also recieve attention when the refurbishment is complete and the weather is milder. The bedrooms seen had been personalised where this has been possible. The bedrooms provide enough space. The furnishings in some bedrooms are being replaced as part of the refurbishment programme. The people using the service are being involved in choosing new furnishings and fittings and paint colours throughout the service as far as possible. Bathrooms and toilets are within easy reach of bedrooms and communal areas. The provision of a wet room will allow the people using the service more choice around how their personal care needs are met. Records show that the gas, electrical wiring and portable electrical appliances are safe. The fire alarm and emergency lighting are tested by staff at the home to make sure they are working properly. Staff take part in fire drills and fire safety training. Care Homes for Adults (18-65 years) Page 23 of 33 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. The people using the service are supported and safeguarded by the number of staff available and the training they have received. Evidence: The service provides a high level of staff support. There are three staff on duty during the day and in the evening, with two staff one waking and one sleeping during the night time periods. The two staff spoken with considered that there are currently sufficient numbers of staff available to meet the needs of the people using the service. One person has left the service since the last inspection. The staff commented that this means there is more staff time for the remaining residents. Staff recruitment records were seen for one new member of staff. In general these contained all the necessary information. There were two references available but they did not clearly indicate which organisations had supplied them. This information needs to be clear so that there is no confusion and the adequacy of references can be judged. Student nurses undertake short work placements at the service. There was no record to indicate what checks have been carried out by the their course provider to ensure they do not pose a risk to vulnerable people. Criminal records bureau checks are seen by the manager but are not held on staff Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: files. The manager was advised to sign to indicate that she has seen this information and that it is satisfactory. The 2 staff spoken with said that their training needs are met. 8 staff who returned surveys stated that they receive training that is relevant to their role, keeps them up to date with new ways of working, helps them understand the individual needs of the people they support and gives them enough knowledge about health care and medication. Staff training records showed that since the last inspection staff have had training to update their skills and knowledge in first aid, safeguarding vulnerable adults, medication management, fire safety and managing challenging behaviour. The 8 staff who returned surveys said that their induction covered everything they needed to know. A discussion with the manager and a record of what the induction covers shows that a comprehensive training is provided when a person begins their employment with the service. The records of individual staff inductions were not available. The manager explained that these records belong to staff and are not always kept at the home. A record to indicate that staff have completed an induction and what this included needs to be held within the service as evidence that each member of staff has had the necessary training. Ten of the eleven staff have an NVQ Level 2 and two have an NVQ Level 3. This shows a committment to ensuring staff have this training and helps to make sure staff are aware of current good practice in the area of care and how to support people safely and well. Staff spoken with and those who returned surveys all said that they are regularly supported by the manager. They said that they think the people living at the home receive a good quality of care. Most surveys contained comments about the staff team being caring and supportive towards the people using the service. Some comments made by staff regarding what the home does well were: We have a consistent staff team that helps people using the service feel safe and secure. The service users participate in a range of activities that they enjoy. There is a good set of staff who care about the clients. All the staff work for the benefit of the clients to give them the best possible care in a friendly and homely atmosphere. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Some comments about what the home could do better were: Look into assisted technology to aid individual needs. Make better use of different communication aids. A survey indicates that even though one person who needed a lot of staff attention has left the service care still needs to be taken to ensure the needs of the people who cannot express their views are not overshadowed by those that can. These comments have been brought to the attention of the manager Care Homes for Adults (18-65 years) Page 26 of 33 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 service is well managed for the benefit of the people living there and the staff. Evidence: The manager has been at the home for approximately twelve years and has appropriate qualifications for the role. During our visit the manager displayed a good awareness of the support needs of the people living at the service. Staff who returned surveys and the staff spoken with said that they receive regular support from the manager. There are a number of ways in which the quality of the service is monitored. The manager meets with staff on a regular basis and the minutes of some of these meetings were seen. This shows good communication keeping everyone up to date and included with things at the service. The manager reported that regular consultation takes place with relatives. An advocate is also working with a person who has little family contact. Surveys are sent out to relatives on an annual basis to find out their opinion of the home. The home is visited on a regular basis by a Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of quality checks. These monthly visits should include a broader range of checks being made of the service such as medications, finances, support plans and staffing. This will provide evidence that the monthly visits offer a more comprehensive assessment. Health and safety audits carried out by staff at head office. The manager carries out her own detailed monthly checks on various areas within the service including the, environment, windows, kitchen, vehicle, clinical waste, coshh, training, medication and accidents. Since the last visit to the service the policies and procedures have been revised. A sample were seen at this visit. This is important as it means staff have access to up to date guidance. The requirements made at the last visit to the service have been addressed. The majority of the good practice recommendations made at the last visit to the service have also been addressed. Records and certificates showed that regular checks are carried out on the building. This includes checking the electrical installation, fire alarms and equipment and the gas supply. These checks help to make sure that the environment is well managed and is a safe place to live and work in. Care Homes for Adults (18-65 years) Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 15 The care plan around the management of a service users diet needs to clearly state that staff are to offer alternative foods at each meal time. The food alternative offered needs to be clearly recorded. This will provide clearer guidance for staff to follow and will show that the service user is being offered a variety of foods. 03/03/2010 2 34 19 The manager must be able to demonstrate that any students who undertake placements at the home are suitable to work with vulerable adults. This will ensure that the people who live at the home are adequately safeguarded. 03/03/2010 Care Homes for Adults (18-65 years) Page 30 of 33 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 is to include information around the experience and qualifications of the manager. The Service Users Guide is to include a standard form of contract/statement of terms and conditions and the current fees for the service. The care plan is to be updated for a service user identified with the manager to ensure that their privacy and dignity is promoted at all times. Further female staff should be employed at the home. To enable a better ratio of female staff to females using the service. This will better promote the privacy and dignity of the females using the service. The needs of the people using the service should be compatible so that where possible more meaningful relationships can be established within the home. An action plan identifying how this is to be addressed is to be drawn up. A record should be made of what activities are planned, what activities are offered and whether or not the activity takes place to demonstrate that the people using the service have access to a range of appropriate activities and access to the local community. Where medication is given as part of the procedure to support a person using the service with their behaviour, the time this is given and the time the behavioural difficulties began should be clearly recorded. This will provide further evidence that medication is being managed appropriately. The manager is to sign to indicate that a criminal records bureau check has been seen for new staff. This is to provide evidence that the manager has seen this record and that it is satisfactory. The organisation that a referee works for needs to be clearly stated on the reference so that there is no confusion and the adequacy of references can be judged. A record to indicate that staff have completed an induction and what this included needs to be held within the service as evidence that each member of staff has had the necessary training. 2 6 3 6 4 6 5 11 6 20 7 34 8 34 9 35 Care Homes for Adults (18-65 years) Page 31 of 33 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 10 39 The visits by the representative of the organisation should include a broader range of checks being made of the service such as medications, finances, support plans and staffing. This will provide evidence that the monthly visits offer a more comprehensive assessment. Care Homes for Adults (18-65 years) Page 32 of 33 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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