Care Home: High Mount

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What the care home does well Staff have access to detailed support plans so people can be assured staff will know how to meet their needs. People are involved in their care planning so they can be confident they will receive the support needed in a way they prefer. Detailed risk assessments ensure staff know how to support people`s independence and ensure their safety. Consultation meetings with the individual enables them to have a say in how they wish to live their life, reflecting their choice and individuality. People have access to leisure services within their local community so they are able to live an interesting lifestyle. Menus provide a variety of meals to reflect people`s likes, dislikes and ensure their nutritional needs are met. People are able to maintain contact with family and friends so they can have meaningful relationships. People live in a home that is clean and tidy so their comfort can be assured. The home`s recruitment and selection procedure ensures staff are suitable to work with vulnerable people. A survey received from a staff member said, "We always give service users a choice in every aspect of their life`s." One person who lived there told us, "I like the food here." Another person who used the service said, "The staff are nice." What has improved since the last inspection? The home has secured funding for additional night staff, so people can be assured they will be provided with the support needed to meet their needs. What the care home could do better: The Statement of Purpose, Service User Guide and Complaints procedure should be in a format people can understand so they know what service to expect and how to share any concerns. People`s choice of what staff assist them with their personal care needs should be written in their support plan so their wishes are assured. To ensure the medicine cupboard is appropriately secured to the wall so the security of medicines can be assured.To ensure fire safety systems are not compromised by wedging fire doors open and place people at risk of harm. To ensure necessary repairs to the property are undertaken in a timely manner so the home is well maintained and safe to live in. A survey received from a staff member said, "The home could do better in sorting out the maintenance with the Primary Care Trust, who owns the property." Key inspection report Care homes for adults (18-65 years) Name: Address: High Mount 13/14 High Mount Donnington TF2 7NL     The quality rating for this care home is:   one star adequate 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: Dawn Evans     Date: 1 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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: High Mount 13/14 High Mount Donnington TF2 7NL 01952417713 01952608764 highmount@accordha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Accord Housing Association Ltd care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 8 Date of last inspection Brief description of the care home The date of the last inspection was 31 July 2007. High Mount is located in a quite residential area and is within walking distance of local shops and a supermarket. The bus route is also nearby, making travel to Telford Town Centre easy. The home provides a service for eight people who have a learning disability some of whom have a physical disability. The property consists of two bungalows, one of which offfers three single bedrooms. The other bungalow provides three single and one shared bedroom. En suite facilities are not provided but some rooms are fitted with a washbasin. Bathrooms and toilets are near to bedrooms and communal areas. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 8 Brief description of the care home Each bungalow has a lounge, dining room, bathroom, kitchen and laundry. One bungalow has a conservatory. All areas of the home are equipped with essential furnishings so peoples comfort can be assured. People have access to a well maintained garden; ramp access is available at the front of the building so it is accessible to people with restricted mobility. Equipment and adaptations are in place to support peoples independence and safety. These consisted of an assisted bath and grab rails. Off road car parking is available. Staffing is provided throughout the day and night so people receive the necessary support when needed. People also have access to relevant healthcare services so they can be assured their healthcare needs will be met. People have access to previous inspection reports enabling them to find out about the quality of the service provided and peoples experience of living there. The fees charged for the service provided at High Mount is £930.22p per week. This information was correct at the time of this inspection. The reader may wish to contact the service for more up to date information. 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: one star adequate 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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection . This included notifications received from the home. These are reports about things that have happened in the home that they have Care Homes for Adults (18-65 years) Page 6 of 33 to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. We spoke to two people who lived there and three staff members. Where people who use the service were able to comment on the care they receive their views have been included in this report. Due to the communication needs of some people living here it was not possible to ask them for their views on the home, so time was spent observing care practices and staff interaction. We sent eight of Have your Say surveys to people who use the service and six to staff members. We received four from people who live there and six from staff members and their views have been included in this report. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose, Service User Guide and Complaints procedure should be in a format people can understand so they know what service to expect and how to share any concerns. Peoples choice of what staff assist them with their personal care needs should be written in their support plan so their wishes are assured. To ensure the medicine cupboard is appropriately secured to the wall so the security of medicines can be assured. Care Homes for Adults (18-65 years) Page 8 of 33 To ensure fire safety systems are not compromised by wedging fire doors open and place people at risk of harm. To ensure necessary repairs to the property are undertaken in a timely manner so the home is well maintained and safe to live in. A survey received from a staff member said, The home could do better in sorting out the maintenance with the Primary Care Trust, who owns the property. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. People have access to relevant information so they know what to expect from the service and the undertaking of appropriate assessments should ensure their needs are met on admission. Evidence: We saw that a Statement of Purpose was accessible to people who lived in the home. This document provided information about the service and facilities available. The manager said the Statement of Purpose would be given to people before they move into the home. This would enable people to find out if the service would be suitable to meet their assessed needs. The manager told us the Statement of Purpose was not in a format people could understand. Discussions with the manager confirm the service was considering providing this document in a pictorial format so people can understand it better. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: The home has not had any new admissions in recent years. The manager said any future admissions to the home; a needs assessment would be undertaken before the person moves in. A needs assessment enables the home to find out about the persons care needs and the level of support required to support their health and independence. The manager said people would be given the opportunity to visit the home and have an overnight stay if they wish before they make a decision to move in. Care Homes for Adults (18-65 years) Page 12 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. People can be confident they will receive the necessary support to ensure their care needs are met. Evidence: We case tracked three people and looked at their support plan. A support plan tells staff about peoples needs and the support required so their health and wellbeing can be assured. Support plans provided detailed information. For example, one plan told staff about the persons morning routine and the assistance required to ensure their individual preferences. The support plans also told staff what the person could do independently, such as taking their clothes to the laundry in the morning and cooking their own breakfast so their daily routine is specific to their individual needs. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: We spoke to this person who confirmed their morning routine was as stated in their support plan. They also told us they were involved in planning and reviewing their support plan. The care records we looked at contained peoples signature to show the care they will receive has been discussed with them. This should ensure people receive the care and support in a way they prefer. Care records showed and discussions with staff confirmed support plans were reviewed monthly, so the service provided reflected the persons current needs. The support plans we looked at showed they were regularly reviewed to ensure the person received the appropriate support. Support plans were provided in written and pictorial format so people can understand them. We spoke to one care staff who had been in post for three days, they told us the support plans were very informative and provided them with the knowledge to meet peoples needs. A survey received from a staff member said, We provide good support and quality care to all service users. Staff told us people are supported to make decisions about their lifestyle. The home had regular consultation meetings with people who live there. These meetings are undertaken with the individual to find out about things they would like to do, to ensure they are able to live a stimulating a fulfilled lifestyle. We looked at the minutes of one of these meetings, which showed the person had asked to go to the cinema. Records told us the person was given a choice of films to see. This person was taken to see Terminator Salvation and chose to take two people with them who also lived at the home. These practices not only reflected peoples social interests but supported their choice and rights. This person had no verbal skills and was not able to tell us about this event. The manager told us people have access to a self advocacy service. This is a service that provides independent support to people to ensure their choice and rights are respected. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: Although people were not able to tell us about the advocacy service, care staff and information contained within the AQAA confirmed peoples access to this service. Each person had a risk assessment, this supported peoples independence and ensured their safety. Information on how to reduce or eliminate the risk to people was shown in the persons support plan where it related to their daily activities. Discussions with one person who lived there, told us they enjoyed cooking and staff supported them whilst doing this. We saw a risk assessment was in place telling staff how to support this persons independence and safety whilst cooking. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to enable them to pursue their social interests so they can live a stimulating a fulfilled lifestyle. Evidence: People were involved in various social activities, these consisted of exercise classes, swimming, pub lunch, bowling, shopping trips, cinemas amongst others. Support plans showed people had access to these social activities and told staff what support was needed to enable them to take part. All four surveys received from people who live there, told us they were able to access leisure services within their local community. One person spoken to also confirmed this. The home had a full time activities Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: coordinator and records were maintained of social activities people are involved in. One person told us they use to attend day care services. They said, I dont like it there. I dont go anymore. I want a job. The manager told us this persons choice was respected and they were currently in the process of assisting them to find a job and were working with Employment Link. This is an organisation that supports people with a disability to find paid employment. A survey received from a member of staff said, We always give service users a choice in every aspect of their lifes. Support plans showed people were able to maintain contact with family and friends. One person said, I am going to see my sister soon. They also told us their sisters were able to visit them. This means people are able to maintain contact with people important to them. We observed the daily routine to be relaxed with one person watching the television, another person was assisting staff to make drinks and the other people were at day care services. All bedrooms were fitted with a security lock so peoples privacy can be assured. One person told us they had a key to their bedroom door, they said staff always knocked on their door before entering. We also observed staff doing this. We saw staff communicating with people in a way they understand, this consisted of gestures and verbally. The manager said consideration was being given to provide staff with Makaton training. This is a form of sign language and would enhance staffs skills to communication with some people more effectively who use Makaton. Support plans told us about peoples religion and showed whether they wish to attend a place of worship. Records showed one person had requested to go to church and staff supported them to do so. People can be assured they will be assisted to continue to practice their religious faith, if they so wish. We looked at the homes menus it showed people were able to choose what they wanted. Menus also showed people were offered variety of meals. A pictorial menu supported people to choose what they like. Two people were on Why Weight Diet. These people were referred to this scheme by Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: their doctor. This scheme is run by the National Health Trust and supports people to eat healthily and reduce their weight. One person told us about this scheme and said, I get weighed every week. I like the food here. There was a variety of food provisions in storage to meet peoples nutritional needs. Staff told us no one required a special diet due to religion or culture. One person was provided with special equipment to assist them with eating and drinking supporting their independence and dignity. Care Homes for Adults (18-65 years) Page 18 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. People can be confident their personal and healthcare needs will be met. Evidence: Support plans told staff how to meet peoples personal needs. This included the support required to assist them with washing and dressing. We saw people were smartly dressed relating the age and gender. One person said, I enjoy going clothes shopping, I choose my own clothes. People can therefore, be assured they will be supported to dress in way that reflects their style and preference. One support plan showed that jewellary and having a handbag was important to this person. We observed this person was wearing these items and had her handbag with her. This reflected the persons individuality and choice. The manager said people can choose what staff assist them with their personal care needs. This information was not written in peoples support plan to ensure their choice is respected. However, we heard one person asking for a particular staff to assist them and this was respected. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: The AQAA told us people have access to relevant healthcare support. The support plans we looked at also confirmed this, showing people had access to a dentist, chiropodist, doctor and opticians. One person said, If I am not well, the staff will take me to the doctors. Access to relevant healthcare services should ensure peoples physical and mental health needs are met. We looked at the homes management of peoples prescribed medicines. All medicines were stored in an appropriate medicine cupboard. However, this was not securely bolted to the wall to ensure the security of medicines. The manager said he would ensure the cupboard is ragged bolted to the wall. The lid of one medicated gel was broken and the contents was left open. This may lead to the medicine being contaminated and place the person receiving this gel at risk of harm. The label on another medicated cream was not clear for staff to read so they would know how to apply this cream safely. The absence of relevant information may compromise the health and wellbeing of the person receiving this cream. The manager disposed of the medicated cream and gel and replaced them with new ones, during the inspection visit. The manager said staff who administer medicines have been trained to do so. Training records showed a number of staff members had received medication training. One staff member told us they had received this training. This should provide staff with the skills and knowledge to manage peoples medicines safely and so ensure their health. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have access to a complaints procedure they understand but can be confident staff will listen and act on their concerns. Evidence: The home has a complaints procedure but this was not in a format that all people can understand. The manager told us that pictures are sometimes used to assist with communicating with people. Consideration should be given to provide the complaints procedure in a pictorial format so people can understand it. One survey received from a person who uses the service told us if they were unhappy they would tell the manager. Discussions with one person who lived there said, I would go to X or X (manager or deputy manager) if I had a problem, they would sort it out. This means people can be confident their complaints will be listened to and acted on. There were no complaints recorded, the manager said they had only received minor concerns. It is recommended that all complaints are recorded and show what action has been taken to resolve the concern and ensure peoples best interests. The manager said theyve had one safeguarding referral since the last inspection visit. A safeguarding referral relates to an allegation of abuse or where care practices may compromise peoples health or safety. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Discussions with the manager and records showed the home had taken the necessary action to report this allegation to the appropriate agencies and to safeguard the person at risk. This was investigated by Social Services and there was no evidence of poor care practices within the home. The manager said some staff had received safeguarding training. We looked at staff training records, which showed seven out of 15 staff had received this training. One staff member confirmed receiving this training and said if they received an allegation of abuse they would report it to the manager or to us. This training should ensure staff have the skills to recognise various forms of abuse and protect people from potential harm. Due to peoples mental capacity the manager said they were not able to manage their financial affairs and this was done by the home. We looked at two financial account records. These showed a record of transactions and receipts were maintained for expenditures. Funds held in safekeeping tallied with the records. People can be assured their finances will be well managed. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live a clean and tidy home that is suitable to meet their needs. However, insufficient maintenance does not ensure the home is safe to live in. Evidence: The home is situated in a quiet residential area and is within walking distance to local shops and a supermarket. The local bus route is nearby making travel to Telford Town Centre easy. The property consists of two bungalows, one offering three single bedrooms and the other providing three single and one shared bedroom. Bedrooms were decorated to reflect the individuals style and interests. One person told us they chose the colour of their room reflecting individuality. Both bungalows provided a lounge, dining area, kitchen, bathroom and laundry. One bungalow had a conservatory. The size and layout of both properties was suitable for the number of people living there. Necessary repairs and maintenance were not undertaken to ensure the home was safe to live in. Discussions with the manager confirmed the roof needed to be repaired to ensure it was water tight and the metal structure on the conservatory roof was not Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: safe. People had access to a well maintained garden and adequate parking is available within the grounds. Equipment and adaptations were available to support peoples independence and safety. These consisted of an assisted bath, ramp at the front of the property and grab rails in the bathroom. People who live there helped to keep the home clean. We observed that all areas of the home was clean and tidy ensuring peoples health and comfort. Care Homes for Adults (18-65 years) Page 24 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. People are supported by suitably recruited skilled staff to ensure their assessed needs are met. Evidence: The AQAA told us 12 out of 15 staff members had obtained the National Vocational Qualification Level 2 or above. Two staff members spoken to said they had not yet done this training. One staff said they hope to start this training in September 2009. This should ensure staff have the skills and understanding of how to meet peoples assessed needs. We looked at the staff training matrix, which showed they had received the following training: Moving and Handling, Health and Safety, Fire Safety, Food Hygiene, Behaviours that Challenges, Medication, Adult Protection, Infection Control, amongst others. Two staff members spoken to said they had received this training, which gave them the skills to provide a good service to people. The manager was confident that adequate staffing levels were provided throughout the day to meet peoples needs. He told us there was a need to increase staffing Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: during the night time. On the day of our visit the home received confirmation that their request for additional funding, to increase staffing levels during the night had been agreed, so peoples needs will be met. We looked at the homes recruitment and selection procedure and selected three staff personnel files to look at. They showed appropriate safety checks were undertaking to ensure staffs suitability to work with vulnerable people. These checks included a Criminal Record Bureau clearance (CRB), Protection of Vulnerable Adults check (PoVA 1st) and two written references. Three staff spoken to confirmed they had these safety checks before they commenced working in the home. One person who lived there said, The staff are nice. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not be actively involved in how their home is managed and insufficient maintenance of the the building does not ensure it is safe to live in. Evidence: The manager said he had worked in social care for approximately 10 years and obtained the necessary qualifications relating to his role and responsibility. He continues to undertake training to enhance his skills and knowledge. If these learned skills are put into practice people can be assured their needs will be met. We looked at the homes quality assurance system. These are systems and practices put in place to ensure people receive good quality services, so their needs are met. Regular monthly quality assurance visits were undertaken by another manager within the company. During these visits care plans, risk assessments and staffing were looked at, to ensure standards were sufficient to meet peoples assessed needs. Quality audits were also carried out yearly looking at how peoples rights, care and Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: support provided, management of the home, staff training and the environment. These practices should identify any shortfalls and show what actions will be taken to improve the service. An annual quality assurance report is published but this is not given to people who use the service and is not available in a format they would understand. The manager said he would tell people about the information contained in this report. The manager said the organization sends out quality assurance surveys to people who use the service, enabling them to express their views and opinion on the service they receive. However, the manager told us that due to peoples mental capacity only two people were able to complete them. It is recommended that these surveys are produced in a way that it is easier to understand. The service sent their AQAA to us within the required timescale. The AQAA did not provide sufficient information to tell us about the service offered to people or how systems and practices would ensure their assessed needs will be met. We looked systems and procedures regarding health and safety and saw that electrical appliances were routinely serviced yearly to ensure they were safe. An up to date fire risk assessment was also in place so staff know how to ensure peoples safety in event of a fire. However, the property was not maintained to a standard to ensure peoples health and safety. For instance, the window catch within one bedroom was broken so the person was not able to open their window safely. The metal supporting structure on the conservatory roof was coming away with metal strips protruding from the roof. This compromised the health and safety of people who live there and visitors to the home. The main roof of the property was in need of repair. The manager told us one bedroom often leaked when it rained. This compromised the health, safety and comfort of the person using this room. We saw fire doors wedged open so they would not be effective in the event of a fire to ensure peoples safety. The manager said the door closures had broken. The manager said the property was owned by the Primary Care Trust (PCT), who were Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: aware of the repairs required but were slow to undertake the work to resolve the problem. This was also mentioned in the homes quality assurance report. The manager said it was anticipated that the necessary repairs will be undertaken in September 2009. One survey received from a staff member said, The home could do better in sorting out the maintenance with the Primary Care Trust. We contacted the Environmental Health Department on 15 July 2009, who undertook an inspection of the property on 16 July 2009. The Environmental Health Officer said they had instructed the home to find a competent person, to examine the roof and to undertake all works to make the roof structural sound and water tight. Care Homes for Adults (18-65 years) Page 29 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 30 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 20 13 The medicine cupboard was not appropriately secured to the wall and compromised the security of medicines. The necessary action must be taken to ensure medicines are securely stored. 14/09/2009 2 43 13 Fire doors were wedged open and compromised the fire safety standards within the home. Action must be taken to ensure fire safety standards and practices within the home will ensure peoples safety in the event of a fire. 18/08/2009 3 43 13 One bedroom ceiling leaked water when it rained and compromised the persons health and comfort. 31/08/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 Action must be taken to ensure the room is water tight so this person welfare can be assured. 4 43 13 The metal structure of the conservatory roof was protruding and placed people at risk of harm. The necessary action must be taken to ensure the roof is structural sound, so peoples safety can be assured. 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 31/08/2009 1 1 Consideration should be given to produce the Statement of Purpose, Service User Guide, Complaints procedure and Quality Assurance questionnaires in a format people can understand so they know what to expect from the service. To ensure all complaints are recorded and show what action has been taken to resolve the concern so people know their concerns are taken seriously. 2 22 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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