Care Home: Highfield House

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What the care home does well Highfield House provides good accommodation where people have a shower and toilet they can access from their bedroom. A person centred approach to care is in place and some people are involved in reviewing their care plans. People told us they enjoy going out to clubs, drop in centres, trips to Stroud and holidays. People were observed helping around the home, cooking and cleaning. People said, `I like living here`, ` the staff are good` `we have meetings every two weeks where we can make comments`, `I go through my care plan with my keyworker we are looking for a new job for me` and ` I can do what I like`. Staff have the skills and knowledge needed to support people. They have access to training and have regular support from their manager. What has improved since the last inspection? The decor of the home has been maintained and there are new carpets. There is an additional small quiet lounge with a patio door out onto the rear courtyard. The home has a new payphone people can use in the office if they wish. What the care home could do better: People must always have adequate support to make important decisions, which may include an advocate or Independent Mental Capacity Advocate (IMCA). The rear garden steps must be safe to help make sure people do not have an accident. Key inspection report Care homes for adults (18-65 years) Name: Address: Highfield House London Road Stroud Gloucestershire GL5 2AJ     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: Kathryn Silvey     Date: 0 5 0 1 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 30 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 30 Information about the care home Name of care home: Address: Highfield House London Road Stroud Gloucestershire GL5 2AJ 01453758618 01453767911 stroudcarehomes@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Stroud Care Services Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Highfield House is a detached house with accommodation for seven adults with a learning disability who may display behaviour that challenges the service as well as people diagnosed with mental health concerns. The home is situated close to the centre of Stroud and people are able to access public transport easily. They also have access to a car. Highfield House is one of three homes owned and managed by Stroud Care Services Limited. People living there have single rooms with access to their own shower and toilet from their bedroom. There are two lounges and a kitchendiner. The gardens at the rear are on several levels. Each person is given a personal copy of the Statement of Purpose and Service User Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 7 3 Brief description of the care home Guide. Further copies of these documents are available from the office in the home. The last inspection report is also kept in the office. Care Homes for Adults (18-65 years) Page 5 of 30 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 last inspection for this home was completed in January 2008. This inspection took place on two visits to the home on 31 December 2009 and 5 January 2010 by one inspector. A registered manager was present at both visits. The registered manager completed an Annual Quality Assurance Assessment (AQAA) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these 3 people. This is called case tracking. We spent time talking to other people and the support staff, also observing the care people receive. We looked at a range of records including procedures, medication records, staff files and training information. Care Homes for Adults (18-65 years) Page 6 of 30 We walked around the home with the registered manager and some people showed us their individual rooms. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 of 30 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 9 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that want to live in the home have a detailed assessment before they move in to help ensure their needs can be met and that the correct care and support is planned. Not all people transferring between homes within the group had the correct support, to help ensure that the move was the right one for them. Evidence: The AQAA told us that in the last twelve months the homes Statement of Purpose had improved, and we looked at the document. This was a previous requirement which is complete. We looked at the pre-admission assessment of a new person admitted from hospital to the home, which included assessments of strengths, needs and aspirations. There were detailed records about the persons history both medical and psychological. Information regarding eating and personal hygiene was clear, and the plans required on admission to meet this persons needs. Healthcare professionals had been involved and continue to be closely involved to help ensure that the persons needs are well met. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: Four people had recently transferred to the home from another service within the group where the home is now dormant. The manager from the dormant home has transferred with the people, and provided us with information about their planned move to Highfields. The providers had informed all placing authorities of the imminent move of people to Highfields when the closing of Westend was planned. One person had an Independent Mental Capacity Advocate (IMCA) to help him decide about where to move to. Another person had parents to help him decide and the social worker visited after the move to help ensure that the move was appropriate. A third person had support from the social worker and the move was seen as a positive step for her, and the fourth person had no support from the placing authority or an IMCA to help ensure that her needs would be met at Highfields. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are regularly reviewed and risks are identified and managed well to promote independence and keep people safe. People have choice and control over their lives and are supported to achieve their lifestyle plans. Evidence: Since we last inspected the home a year ago all the people living there have moved on and there were seven different people living there. We spoke to all but one person living in the home, the one person did not wish to speak to us. One person was unable to communicate with us, however, he was responding in a different way which indicated he was not anxious at that time. We asked people about making choices about their life in the home. The following are comments we received: The staff are good, I can do what I want, and i like being alone and not doing organised activities. I go out on my own, shopping and the bookies and I cook for myself, we have meetings every two weeks where we can Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: make comments, I do household chores, go bowling and visit my mun sometimes, I have had jobs but nothing at the moment. I go through my care plan with my keyworker we are looking for a new job for me, I dont go into Stroud alone, I like my bedroom and am still unpacking, the food is good, I have everything I need and I will be going home sometime. The Essential Lifestyle Plans identified in detail the care needs and support for people to promote independence and develop existing skills. We spoke to keyworkers and they knew peoples strengths and weaknesses and where they may need to gradually support people with new skills. The people recently transferred from another home were supported by staff that had moved with them. This helped to ensure continuity of care and most people seemed to be adjusting well to the move. We looked at the individual care plans and there were good risk assessments and management strategies where people were at risk, particularly when in the community. One person was to be enrolled on a course to help her with coping strategies as she was vulnerable when going out. There were also very detailed monthly care reviews completed by the manager that clearly identified what had been happening and any further support that may be needed, including risk assessments. During the inspection the staff took people out for lunch and shopping. There were currently no active Care Programme Approach plans, however, people had support from the psychiatrist when required. One person was on the Gloucestershire County Council Multi Agency Risk Management and Assessment Process (MARMAP) register and required one to one support at times. Three monthly reviews and pre-annual reviews were completed to ensure that all the information was available at the annual review with the placing authority and the Community Learning Disability Team (CLDT)when required. Communication records seen had good information about how people usually communicate and what the staff need to know to promote clear communication. The staff were seen communicating with people in a relaxed and meaningful way. There were good daily records that recorded what mood people were in, their activities and food they had each day. A recent Deprivation Of Liberty Safeguard referral had been made that subsequently Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: was not upheld as the home was managing the situation appropriately for all concerned. Care Homes for Adults (18-65 years) Page 14 of 30 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 have access and support to join in with a variety of activities and outings, and are encouraged to become more independent by completing household tasks. Evidence: On the first day of the inspection a New Years Eve party had been arranged and friends had been invited. People were looking forward to enjoying the buffet supper at the party and seeing their visitors later in the day. Each person had an activity plan and it was recorded whether the plan had been achieved. One person told us that she goes through her plan with the staff. This may mean completing their own household chores and cooking food. The staff support people with chores but people are encouraged to be independent. We saw people cooking and cleaning, and going out shopping for food. One person we spoke Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: to was concerned that she could no longer go line dancing as there was insufficient staff to accompany her there in the evenings. There was also concerns about one person having a key to the front door and having sufficient money to go out. With the persons permission we discussed the concerns shared with us with the manager who resolved most of them during the inspection. The need for more one to one time had been identified for one person, and an advocate may be required for this person to enable them to express this wish, and for the placing authority to agree more time. People do a variety of activities to include going to Guidepost club, visiting the pub, bowling, the cinema, accessing the Drop in centre, going to church. The aim is for everyone to have five holidays days or trips out every year, for example one person had been to Tenerife, a safari park, Burnham-on-Sea twice and Longleat lion safari park. Shopping trips to buy clothes in Gloucester and pampering sessions organised by the staff were also recorded. The staff often take people out for lunch or a coffee in Stroud town centre a short walk away, which they did during the inspection. People are taken to meet family that live far away and contact is maintained as far as possible. People also had mobile phones to keep in contact with their family and friends. The home has recently installed a payphone in the hall, which can be moved to another room for privacy when required. Care Homes for Adults (18-65 years) Page 16 of 30 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 have support from healthcare professionals to help ensure they remain healthy and that all their needs are well met. Medication is well managed by appropriately trained staff. Evidence: The health action plans were detailed and there was support from appropriate healthcare professionals to meet peoples individual needs. Where required people had their mental health needs meet, and we looked at communication from a psychiatrist and the Community Learning Disability Team to support this. Every aspect of peoples health was recorded and this included for example visits to the dentist and how this was managed when people were very anxious or refused treatment. There was a visit by the orthotic technician recorded concerning a persons footwear, and also regular visits by the local epilepsy nurse. The outcome of all healthcare professional visits were recorded and it was clear where progress had been made and when additional visits had been arranged. One person with diabetes controlled by oral medication and diet is helped by the support staff to Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: plan a menu and cook meals. The Regulation 26 visits completed by the operations manager states that all people are supported to regular health clinics. There were excellent records of the annual review of peoples Essential Lifestyle Plans and where support was needed for healthcare needs. We made an immediate requirement for one person who may have been at risk during the night with regard to her epilepsy. Frequent reviews of her medication had been made and there were protocols in place when seizures occurred. However, the records indicated that this person had many seizures during the day and disturbed nights when the sleep-in night staff may not be aware of seizures. Night staff were required to be awake until the immediate requirement was addressed. The placing authority agreed that assistive technology could be used to reduce the risk of identifying when this person was up and about during the night. There must be an agreement with the placing authority regarding the risk assessment and the review process to help ensure the persons safety at night. We looked at how medication administration was managed in the home. There were currently no self administration for people, however, staff would support people appropriately should this be required. The home uses a monitored dosage administration system. The storage was secure and the stock levels were appropriate. The use of homely remedies had been approved with the doctor. Administration records were complete and there were protocols for as required medication. We recommend that start dates are recorded on boxes when they are opened to help ensure that a correct audit can be completed. Quantities should be carried forward each month where necessary and recorded on the Medication Administration Record (MAR) sheet to help with auditing safe practice. The manager told us a visual audit is completed monthly, however, we recommend that a written audit is completed. The homes medication procedure was not available with the medication for reference, we recommend that it is, and an up to date medication reference book, for example, a British National Formulary. Care Homes for Adults (18-65 years) Page 18 of 30 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. People are able to tell staff about their concerns and plans for this year will help ensure that there is a new system for highlighting improvements and minimising complaints. People are safeguarded from possible harm or abuse. Evidence: People living in the home told us that they would share their concerns with the staff and the manager. One person had several concerns that they shared with us during the inspection, which we discussed with their keyworker and the manager. The concerns were mainly about the changes for existing people since people had transferred from Westend, and the manager gave the person reassurance that current independence would not be altered. The person was having a visit from her social worker soon, and we advised that an independent advocate may be necessary should this person want to move to another home. There were no formal complaints recorded since the last inspection or indicated on the monthly Regulation 26 visits by the operations manager. However, the operations manager did record that people are reluctant to attend their regular meetings. One person told us he did go to the meetings every fortnight. As the home has so many new people accommodated now this may change. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: The AQAA told us that during the next twelve months there are plans to produce an outcome based reviewing system to highlight improvements and minimise complaints. Verbal concerns are dealt with daily by the staff and may be recorded in the daily records. The recent referral to the local Deprivation Of Liberty Safeguard (DOLS)team was evidence that peoples rights are safeguarded. The staff attend safeguarding training and it is included in the induction and NVQ training. The managers we spoke to both had awareness of the Mental Capacity Act 2005 and when to use an Independent Mental Capacity Advocate(IMCA). Care staff told us they had received Safeguarding of Vulnerable Adults training and the training matrix provided also indicated staff had completed the training. We checked how the home handles two peoples monies, and two staff check and sign they are correct at every shift change, at least twice a day. The manager trains staff in positive behaviour management so that any challenging behaviour is well supported to protect people without physical intervention. All incidents are well reported and the action taken is recorded. Care Homes for Adults (18-65 years) Page 20 of 30 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. The home is generally well maintained, however, we had to inform the provider to improve the heating and access to the home to improve safety. The home was clean and free from offensive odours. Evidence: The requirement from the last inspection to make the grounds to the front of the home safe had been completed, as the five supported living flats were now complete and people from the home were living there. There was some litter in the front garden that looked unsightly. However, since the last inspection all the people accommodated in the home were new. One person with a physical disability was finding it difficult to access the gradient of the drive when walking into town, and we saw one person jumping a small wall, that divided the new flats from the home, so they could use the steps and a handrail. We recommended that the access to the steps and handrail should be made safe, which may mean taking down the wall. The gardens at the rear of the property are terraced and require additional measures to ensure that this area is safe for people to use. One person accesses the shed on the top level, therefore this must be addressed. The safety of the smoking area at the rear of the home should also be reviewed to ensure that it is safe area for everyone living Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: in the home with regard to fire prevention. The large lounge, hallway and one bedroom and ensuite facility were very cold and we asked that the provider be informed immediately to enable this to be rectified. The thermostat to increase the heating was only accessible by the manager, which is not acceptable when the manager is not available. A portable temporary heater was installed in the lounge fireplace until a new pump could be fitted to the central heating system, and we were informed that the one bedroom and ensuite were both warm again a week later. We recommend that the heating is regularly reviewed and that temperatures are checked in all rooms to ensure that individual radiator thermostats are working. We also noticed that some bedding provided by the home looked worn and old. We recommend that an audit is completed of all bedding and that replacements are provided where required. One person told us that the quilt on the bed was not warm enough. We looked around the home and generally it was well maintained and some areas had been recently decorated and there were new carpets. All bedrooms have an ensuite facility that include a shower. We noticed that window restrictors were not on all upstairs windows and we recommend that an audit is completed of all windows and risk assessments are completed. The areas of damp in the lounge and bedroom identified at the last inspection still remain a problem and must be addressed. The windows in the home were very dirty and must be regularly cleaned. One ensuite facility had no blind as the previous person had taken it and we were told this will be rectified. The front door needed painting and looked unsightly it was also ill fitting and did not help to keep the home warm. The new small quiet lounge was warm and welcoming and there was access to the rear from a patio door in this room, and there was also a office on the ground floor. We looked in the laundry which was organised and clean and the manager agreed to post a laundry infection control procedure there to help ensure that staff and people living in the home knew what to do to help prevent cross infection. Care Homes for Adults (18-65 years) Page 22 of 30 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 staff team are knowledgeable about the people they support and some have completed NVQ training. Access to more specific training with regard to learning disability, autism and epilepsy will improve their understanding. Recruitment practices have improved, however, supervision and disciplinary procedures may need to be reviewed to help ensure that people are always protected. Evidence: We looked at the staff rota and since the transfer of people from Westend care home there are three support staff on duty all day from 8:00 until 22:00 hrs and one sleeping-in during the night. In addition the manager is on duty each weekday from 9:00 until 17:00 hrs. The team consists of a team leader, senior support staff and support workers. There was an even mix of male and female support staff available to help ensure that people had a choice for personal care. Support staff told us that there are two people that require more than one member of staff to help at peak times and that four staff available in the mornings would be beneficial. We recommend that there is a regular review of staffing levels to help ensure that people have all their needs well met ,and that the manager should have information about each persons contract with the placing authority and the financial Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: information to determine the staffing levels. The staff we spoke to during the inspection were knowledgeable about the people living in the home and two staff had completed NVQ level 3 in health and social care and one had commenced the training. The staff also told us that they have regular formal supervision. The company employ a training officer two days each week and training is planned quarterly. The training matrix provided was incomplete and did not include all the staff employed in the home as yet. We saw an example of one support workers training record, which included mandatory training, positive behaviour management, risk assessment, mental health, care planning, equality and diversity, report writing, communication and Protection Of Vulnerable Adults (POVA). One support worker would have liked more specific learning disability, autism and epilepsy training. The manager told us that training for staff about epilepsy was planned. The manager informed us that the Skills for Care induction standards are used for new staff. Only one new member of staff had been recruited since the last inspection and we looked at the records and the Criminal Records Bureau (CRB) check. POVAFirst is not used unless a risk assessment has been completed, staff start work when a full CRB check has been completed. Gaps are explored in the application form and the person is interviewed by two managers and a record of the interview is kept. We were told that in the past people living in the home had been involved in the interview process. The reason for leaving previous employment is on the new application form used. There were two references for the last person recruited who began working as a bank support worker initially. There was the start of a thorough induction record that was incomplete, as the person had been recruited more than six months ago this should have been completed, however, mandatory training had been completed. We discussed regular supervision of staff with the manager and the disciplinary procedures should staff fall short of the homes expectations. There may be a need to review this process to ensure that any information is handled appropriately to help safeguard people living in the home, and that additional supervision may be required temporarily in some circumstances. There is a separate rota for supporting people that live in the flats, however, the manager is on call should there be an emergency there. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed day to day by competent managers with sufficient provider support the home will be a safe place for everyone. Fire safety risk assessments have been updated and some health and safety measures need to be completed. Evidence: The registered manager sent us a well completed AQAA and was soon to take maternity leave. We were able to meet the manager from Westend who would be taking over temporarily. Both managers are competent, knowledgeable and well qualified. We also spoke to the area manager who provided us with additional information and had completed well recorded monthly regulation 26 reports. The area manager also told us that the quality assurance programme is ready to start and the compliance forms are linked to service review procedures. Some staff felt there was lack of continuity of care for people as there had been so many staff changes recently. This should be avoided when supporting vulnerable Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: people as it is not good management practice. Procedures in the home are in the process of being updated. The maintenance person is employed for 15 hours each week, and we were told that there are times when issues identified may have to wait until he is available. Fire safety training is completed internally and externally annually to ensure that every six months staff receive training, fire drills also take place regularly in the home. The fire safety evacuation procedures have been updated and new fire safety stickers were seen around the home. This was a requirement from the last inspection. The manager told us that when new people are admitted to the home the fire risk assessment is reviewed to include any changes that may be necessary. The meeting point for fire safety has been identified as a position across a busy road to enable any fire fighting vehicles to access the home. We recommend that this is reviewed with the fire safety officer as people may be at risk crossing the road. We also asked the manager to review fire detection and alerting procedures for the adjoining flats to help ensure that staff are aware should a fire spread to or from the flats. A health and safety check completed in September 2009 highlighted that the access to the home was unsafe due to the gradient and no handrails. This should have been completed before the people from Westend were admitted recently as some people are less independent. The steps at the back of the home also need to be made safe as mentioned in the environment section of this report. The manager from Westend has experience and relevant training in health and safety and was knowledgeable about safety matters in the home, which the providers must complete. The managers and staff had a good rapport with the people living in the home and the managers were available to help and advise them. There was a clear open door policy which people used constantly during the inspection. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 19 15 There must be an agreement with the placing authority regarding the risk assessment and the review process to help ensure the persons safety at night with regard to epilepsy. This will help to ensure that any changes are managed well and that the use of assistive technology is reviewed. 26/02/2010 2 24 23 The steps to access the rear terrace garden must be safe for people to use. This will reduce the risk of potential accidents, as one person uses the steps regularly for access to the shed. 26/02/2010 Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 We recommend that people transferring to another home in the group have the support and advice from the placing authority and an independent advocate where required, before they move. An advocate should be used when people need to be supported to express their wish for important changes that effect their life. We recommend that start dates are recorded on medication boxes when they are opened to help ensure that a correct audit can be completed. We recommend that the heating is regularly reviewed, and that temperatures are checked in all rooms to ensure that individual radiator thermostats are working. We recommed that the front door is painted as it looks unsightly, it was also ilfitting and did not help to keep the home warm. We recommend that an audit is completed of all windows with regard to constrictors and risk assessments are completed. We recommend that an audit is completed of all bedding and that replacements are provided where required. The safety of the smoking area at the rear of the home should be reviewed to ensure that it is safe area for everyone living in the home with regard to fire prevention. The areas of damp in the lounge and bedroom identified at the last inspection still remain a problem and should be addressed. We recommend that there is a regular review of staffing levels to help ensure that people have all their needs well met at all times. We recommend that the practice of crossing a busy road to a fire safety position be reviewed with the fire safety officer, as people may be at risk crossing the road. We recommend a review of fire detection and alerting procedures for the adjoining flats to help ensure that staff are aware should a fire spread to or from the flats 2 14 3 20 4 24 5 24 6 24 7 8 24 24 9 24 10 33 11 42 12 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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