Care Home: Ingleby House

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What the care home does well People are given information about the home, before they move in so that they can decide whether they want to live there. People have lots of opportunities to make choices and decisions about their lives. Comment cards received by us show that people "always" are able to make a decision about what they do each day. One person has stated "I have a timetable". The home is good at helping people stay in touch with friends and relatives so that people do not lose contact with those who are important to them. People were observed to be at ease with staff and said they liked living in the home. Staff comments about the home included "It is well run, good team work, very clean". "residents always happy, updated with whats going on daily". "Very supportive to staff and residents". Staff have a good understanding of people`s needs and access training where necessary to help them meet people`s needs effectively. Four out of the five comment cards we received from people stated that staff "always" treated them well, one person stated they "sometimes" did. There are good facilities available within the home including a games room and the environment is homely, clean and well maintained. What has improved since the last inspection? The procedure used to assess people`s needs before they move into the home now includes information about their health care needs as well as their personal care needs to help ensure staff support is arranged to meet these needs. All people living in the home have now had the opportunity to participate in a fire drill so that they know what to do in the event that the fire alarm sounds. There has been some consultation with people living in the home about the use of the games room so that any proposed changes are made to their advantage and this increases the possibility of it being used more frequently. What the care home could do better: The procedures for employing new staff need to be reviewed to ensure they are suitably robust to protect people that live in the home from having unsuitable staff work with them. Some attention is needed to updating health and safety policies and procedures to make sure the people`s health and safety is protected. Some of the records that explain how people should be cared for need to be updated to reflect advice given by professionals to make sure that people`s needs are met. Care plans need to be developed for any person who may display challenging behaviour so that is it clear to staff how this is to be managed and a consistent approach can be adopted in supporting the person. A review is required on how medicines are managed to make sure that the service can demonstrate people are receiving their medicine as prescribed to maintain their health. People who live in the home need to be clear about who they can report any concerns or complaints to and records available in the home need to clearly show who they can contact. The service needs to make sure a suitable manager is appointed and registered with the Care Quality Commission so that people can be confident there are suitable management arrangements in place for the home to operate effectively. Key inspection report Care homes for adults (18-65 years) Name: Address: Ingleby House Leicester Road Bedworth Warwickshire CV12 8BU     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: Sandra Wade     Date: 1 1 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 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 34 Information about the care home Name of care home: Address: Ingleby House Leicester Road Bedworth Warwickshire CV12 8BU 02476319909 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ingleby House Ltd care home 6 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 6. The registered person may provide the following category of service only: Care home only to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability (LD) 6 Date of last inspection Brief description of the care home Ingleby House is situated on a main road near to Bedworth Town centre, close to places of worship, shops, pubs, cafes and public transport services. The home provides care for up to six people with a learning disability. Each person has their own bedroom with either en suite facilities or use of a private bathroom. Shared space consists of a large dining room, lounge, kitchen, utility room and sensory area on the ground floor with an additional smaller lounge on the first floor. There is a large, well-maintained garden with space for people to house their caged pets. The cost of living at the home was not published at the time of this inspection, people would therefore need to make direct contact with the service for this information. People make a contribution to the cost of their care based on the amount they receive in welfare benefit. There are no Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 6 1 0 0 3 2 0 0 9 Brief description of the care home extra charges made. Information is shared with people at house meetings which are scheduled to take place each month. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This key inspection visit to this home took place over one day from 9.25am until 6.35pm. People who live there and the staff team did not know that we were coming. Two people using the service were identified for case tracking. Case tracking means that we meet and talk to people and the staff that support them, look at records about their care, the way their medicines are looked after and look at the home they live in to make sure that it meets their needs. Case tracking helps us understand the experiences of people who live in the home. Notifications that the home send us about events that may affect the wellbeing of people who live there were also looked at as well as information about complaints. This helps us understand how people are being listened to and how their health and safety is protected. We spoke to staff and the manager about the support they give to people and looked at records that explain how to help people stay safe and well. We spoke to Care Homes for Adults (18-65 years) Page 6 of 34 people who live in the home who told us about the staff support and activities they take part in as part of their daily routines. We looked around the home to make sure that it was clean, warm and a pleasant place for people to live. A range of records including health and safety, staff training and recruitment and policies and procedures were sampled so that we could form an opinion about the arrangements in place to promote peoples well being and protect them from possible harm. Our assessment of the quality of the service is based on all this information plus our own observations during the visit. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The procedures for employing new staff need to be reviewed to ensure they are suitably robust to protect people that live in the home from having unsuitable staff work with them. Some attention is needed to updating health and safety policies and procedures to make sure the peoples health and safety is protected. Some of the records that explain how people should be cared for need to be updated to reflect advice given by professionals to make sure that peoples needs are met. Care plans need to be developed for any person who may display challenging Care Homes for Adults (18-65 years) Page 8 of 34 behaviour so that is it clear to staff how this is to be managed and a consistent approach can be adopted in supporting the person. A review is required on how medicines are managed to make sure that the service can demonstrate people are receiving their medicine as prescribed to maintain their health. People who live in the home need to be clear about who they can report any concerns or complaints to and records available in the home need to clearly show who they can contact. The service needs to make sure a suitable manager is appointed and registered with the Care Quality Commission so that people can be confident there are suitable management arrangements in place for the home to operate effectively. 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 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the care and services provided prior to accepting a placement at the home and can be confident that their health and personal care needs will be assessed prior to moving into the home. Evidence: The home has a Statement of Purpose and Service User Guide. These documents provide people with some information about the services and facilities provided at the home to enable them to make an informed decision on whether or not to move in. The Service User Guide was viewed and this had been produced in two formats one of these being an easy read format with a supporting DVD. The easy read format had been completed in large print and plain English and had supporting pictures alongside the information provided. The manager explained that information in this document was explained in the accompanying DVD. The manager said that all people who come into the home had received a Service User Guide before they had moved in. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Comment cards received from people living in the home indicated they all felt they had received enough information about the home before they moved in. People spoken to confirmed they had visited the home before they decided to stay. A comment card stated I came to visit and had lunch at the house then they want me to live here. Since the last inspection there have been new people move into the home. We looked at the records for two of the people to establish that their needs had been assessed before a service was offered to them. The records showed that an assessment had been carried out both by staff at the home and a social worker. The assessments that we looked at also contained their health care needs so that staff could support them in meeting these needs. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of peoples needs but care plans are not always developed to make sure peoples needs are fully understood and can be met effectively. Evidence: We looked at care plans and risk assessments for two people who live in the home. These records gave information about the type of support that people needed to carry on with their day-to-day lives. Generally the records were clearly written and explained how the person should be supported with regard to personal care, health care, spiritual and cultural needs, communication, mobility, social and leisure needs and day to day living. It was evident that the homes approach to care planning is person centred in that the plans focused on the preferences, skills and goals of each person. Particular care staff had been allocated to each person as their key worker. We were told the keyworkers take specific responsibility for some of the care required by the person they are supporting. They can provide some one-to-one support and have a role in attending care reviews and supporting the person when they go out. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: This offers the person some individual attention and means key workers can get to know the person and their likes and dislikes. One care file viewed clearly indicated what the person could do for themselves and how staff were to support them. For example the records stated the person could make their drinks and prepare their own basic meals. Staff confirmed that the person was able to prepare their own meals and had made their own lunch on the day of inspection. Relevant risk assessments were seen in one of the care records sampled which were linked to the persons needs. These explained the risks of falling when mobilizing and how staff could support the person to reduce these risks. In a second care file viewed there was no risk assessment for the persons challenging behaviour. There was also no care plan in place explaining the behaviours of this person, the triggers and how staff should manage these to make sure they remained safe whilst also promoting their independence. Risk Assessments and care plans must be available for challenging behaviour so there are clear guidelines to staff on how to provide a consistent approach in managing these to safeguard the person. Staff spoken to were aware of the persons behaviours and were able to give examples of triggers. An example given was that if an activity was cancelled causing the person to become agitated, they would offer various alternatives to try and compensate for the persons disappointment. Some people in the home had communication difficulties making it hard for them to make their needs and wishes known in a verbal manner. It was apparent from watching them with staff members on duty that staff were able to interpret their needs to ensure they were met. Care records for one person showed that they did not mind repeating themselves to make sure staff understood what they were trying to say. We found that people living in the home had been encouraged to make daily life decisions. In one case it had been acknowledged that giving too many choices to one person confused them and staff explained that they therefore gave a few choices at a time and if the person didnt want to do any of the these things then more choices were offered. Comment cards received by us showed that people always felt they were able to make a decision about what they did each day. One person stated I have a timetable. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experience a meaningful lifestyle that promotes their independence and reflects their personal choices. Evidence: Each person had an Activity Planner showing their preferred activities for each day of the week. Staff told us how they supported people each week to complete these with their preferred activities. Some activity planners had been produced in a printed format with pictures. In one case the activity planner had been completed with Velcro pictures showing what activities the person would like to do. Staff told us that the completion of this persons activity planner formed a daily part of their routine and the use of the velcro pictures allowed them to complete this planner independently. This person told us that they planned their activities each day and showed us the velcro pictures in their bedroom. They told us about the activities they enjoy and Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: there were photographs in their room showing that they had participated in these activities. Care plan records contained details of the social activities that people enjoyed and showed how staff were to support them in completing these. One persons records showed they had expressed a wish to go to college. Staff had followed this up by arranging an interview at a local college and they confirmed a placement had been accepted for this person to attend. Another persons care plan indicated the person liked to collect certain toys. This person showed us the toys they had collected which were kept in their room. They also explained how they liked to go shopping and during the inspection staff were observed to accompany this person to the shops. The daily records that we looked at showed that people take part in a range of activities both at home and in the local community, either independently or with the support of staff. Activities included going food and clothes shopping, meals out, swimming, horse riding and completion of household tasks such as laundry and clearing the table. These activities should contribute towards people having a meaningful lifestyle. The home supports people to keep in touch with their friends and families. Care plans that we looked at described how people should be supported to maintain this contact. People spoken to confirmed that they visited their relatives on a regular basis. It was clear on speaking to them and viewing their care records that these regular visits were an important part of their lifestyle. Comment cards we received from people showed that they all felt they can do what they want during the day and evening. We looked at the records of food that people eat to make sure that a varied and healthy diet is offered that meets peoples needs and preferences. Care records showed that some people needed help with ensuring they ate a healthy diet and in some cases people wanted to lose weight. From observations made it was clear that people were given a choice of what they would like to eat. Staff confirmed that they went food shopping on a regular basis with people to make sure they could provide meals of their choice. We were told that meal times at the home are flexible as people have their own Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: routines that determine the time that they eat. Some people were able to prepare their own snacks with staff observing them. The evening meal on the day of inspection was faggots, chips and peas which looked appetising and people ate at the table with staff. The home is able to cater for people who require specific diets for healthcare reasons. One person was not able to eat a specific food ingredient and staff explained how they had a special cupboard where food items for this person were stored. The person was also very aware of what they could and could not eat. We found in one of the care files that a recommendation had been made by a health professional for the person to complete their own menu planner each week in the same way they completed their own activity planner. It was not evident that this had been addressed. Staff confirmed that the person chose what they wanted on a daily basis in accordance with what items had been purchased and what was available in the home. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will receive the personal support required to promote their independence but less confident that clear guidelines will be place to ensure staff meet their healthcare needs. Evidence: Care files were viewed for two people. Care plans were available for both personal and healthcare needs and they identified that the care is offered in a person centred way. For example in one file it stated to prompt bathing morning and evening. Staff spoken to said they would prompt the person in the morning by asking if they were ready to get up and have a shower which usually resulted in them getting up, washed and dressed. Records are kept in the form of a diary showing all support people receive from staff. The activity planners that people had in place identified their preferred times to get up and go to bed. When we arrived some people had already got up, dressed and left house to complete their preferred activity for the day. One person was still in their bedroom and one was sitting in the kitchen having breakfast. This demonstrates the varying times people had chosen to get up to complete their chosen activities. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: We observed that people had their own keys to their rooms which they chose to keep locked when they were in other parts of the home. Care records viewed provided information about past medical conditions and any current health issues. In some cases records were clear in detailing how these should be monitored and dealt with by staff and in others this information was less clear. For example one person had a skin condition and records indicated that staff were to monitor this and treat as necessary. It was not clear in what way this condition should be treated. A cream had been prescribed as directed for this skin condition but staff spoken to were not able to confirm how often and when this cream should be used. A record stated that the advice of the dietician should be followed but any advice given had not been clearly recorded in their care plan. This meant that staff did not have this information readily available to them to ensure the dietary and healthcare needs of the person were met. Staff explained that one person displayed specific behaviours if their daily routine was not carried out as planned. There was no care plan describing how any challenging behaviours should be managed by staff to ensure a consistent approach in managing this. Records did show that there had been many appointments with healthcare professionals where these behaviours had been discussed and guidance had been given on how to manage these. It was not clear from care plans in place that all recommendations made had been considered or actioned. The systems for the management of medicines in the home were examined to check that this was being done safely and to ensure that people were receiving their prescribed medication. Medicines had been securely stored in a locked cabinet. We were told that staff are trained in the safe handling and administration of medicines and that only those staff who are trained give medicines to people. Since the last inspection a monitored dosage system has been introduced whereby tablets or capsules are stored in sealed pockets on a card. These are then pushed out of the pockets when they are to be given to people. The medication records were viewed for two people. It was difficult to determine whether the amount of medication received, given and remaining was correct. There were gaps on the medication records where staff had not signed or entered a code to state if medicine had been given or not. It was therefore not clear that people had received their medicines as prescribed. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Medicine bottles indicated a medicine was to be given twice a day but this information had not been recorded on the medicine administration record to make sure staff were clear how often this should be given. A cream had been prescribed to be given when required, staff said that currently this was every day. The cream was not listed on the medication record to indicate how often this should be applied to the person and records had not been signed to confirm this was being done. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place to protect people are not always followed to make sure peoples health, safety and welfare is maintained. Evidence: We have not received any complaints since the last inspection and we were told that there have been no complaints received by the home. A copy of the homes records where they would record complaints was requested but staff explained they did not have one because no complaints had been received. A clear system for recording any complaints received should be in place so that staff are clear if they should receive a complaint how and where this should be recorded other than in daily records. A copy of the homes written complaints procedure was included in the Service User Guide. There is also a picture format version of the Service User Guide if people prefer but this version was less clear on how any complaints would be managed. There were no clear contact details in both guides such as names, telephone numbers and addresses of people to contact including independent advocates should people wish to make a complaint. We were told that there were two people living in the home who would be able to independently make contact with people if they had a concern. A copy of the procedure was not on display in the home. One person was asked who they would speak to if they were not happy about something and they responded dont know although on speaking to this persons Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: keyworker it was evident they were aware of the times when this person became unhappy. The keyworker explained how they had sought additional professional advice in making sure they could more easily identify the signs of unhappiness so this could be managed effectively for the person and to reduce any stress to them. Staff were seen to be attentive to the needs of people, using knowledge gained from other professionals, the homes care plans and their own experience of working with each person. We observed staff taking time to listen and observe people to understand their views. People seemed relaxed with staff and around the home indicating they may feel safe. Training records indicated that the majority of staff had completed training in protecting vulnerable adults but we found some recruitment checks had not been carried out on potential new care staff prior to them working at the home. The service had received these after the commencement dates. This means that the service did not take sufficient actions to secure the ongoing safety and protection of people living at Ingleby House. This was acknowledged by the service and assurances were given that changes in recruitment practices would be implemented. We have subsequently received an updated recruitment procedure and recruitment check list to help prevent this happening again. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be provided with a warm, clean, comfortable and well furnished environment to live in. Evidence: Ingleby house is situated in the Bedworth area of Warwickshire and is close to shops, pubs, cafes and public transport routes. This is important to the people who live there as they make regular use of these facilities. There is a garden at the rear of the house with a patio area and lawns and people usually access the home from a side gate into the garden area. There is a ramp to enable wheelchair access into the home from the lounge. We looked around the shared areas of the home, which include a kitchen, dining room, music/quiet room and lounge. All of the rooms were clean, tidy, warm, comfortable and well decorated. The games room has a large pool table and various art and craft materials as well as board games for people to use. We were told that this room continues not to be used very often. Since the last inspection a meeting has taken place with people living in the home to discuss the use of this room. Notes of the meeting indicated that no other suggestions were raised. We were told that it is planned that mood boards are Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: introduced into house meetings with options and ideas of what the space could be used for, for example Gym, Snug, Cinema room, sensory room, meeting room. This is so that any planned changes to the room are made in the best interests of people who use the service. The bedrooms were personalised to reflect peoples individual interests and needs including a computer, music systems, personal collectors items, pictures and photographs. Some of these had ensuite facilities. People told us that they were happy with their bedrooms. One person explained how their bedroom had been moved around to accommodate some extra furniture they had chosen. One person told us that they would like handrails to be fitted to support them when accessing the shower. We also found that the person was using the radiator in the shower room to lean on for support with their mobility. This was discussed with the home and we were told they were awaiting an occupational assessment to secure any appropriate equipment to help this person. This should be followed up as soon as possible. There is a laundry room situated off the kitchen. The laundry area was equipped with suitable washing and drying facilities and the flooring was easily cleanable. Suitable cleaning equipment was available to help maintain the environment in a clean condition for people. Activity planners showed that people are involved in completing their own laundry as part of their daily routines. Staff told us how they prompted people to do this to help maintain their independence. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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 be supported by a team of suitably trained staff who have a good understanding of their needs, but less confident, they will always be protected by robust recruitment procedures which are consistently followed to ensure staff are suitable to work with vulnerable adults. Evidence: The number of staff on duty was discussed with the manager. We were told there are two staff on duty during the day plus at least one floater member of staff and there is one member of waking night staff. Copies of duty rotas seen confirmed these numbers were being provided. We were told that each shift is led by a senior member of staff and there are both male and female staff available which reflects the gender of the people living in the home. Duty rotas did not indicate the staff designations to be able to identify the senior staff and team leaders. The manager was also not indicated on the rota to demonstrate sufficient management support was being provided to the home. The staff training records were viewed and of the ten care staff employed (not including the manager) there were four with an NVQ 2 or 3 in care. We were told that there were actually five staff who had attained this qualification although the training Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: chart did not show this. This should mean that people benefit from having their needs met by appropriately experienced and qualified staff. In addition to this training some staff had completed mandatory training such as medication, first aid, adult protection, food hygiene and fire. There were several staff still to complete manual handling training and some still to complete food hygiene. Other specialist training had also been accessed such as epilepsy and diabetes awareness. We looked at staff recruitment records for two new staff to confirm that procedures were followed to safeguard people in the home. The records showed that some of the checks had been made of peoples suitability to work within the home, prior to their appointment. The exception to this was that both people had commenced employment without a Criminal Records Bureau check being received. This means the service could not be confident these staff were suitably safe to work with people living in the home. This issue is detailed further in the complaints and protection section of this report. Staff present during this inspection were able to answer our questions about meeting the needs of people who live in the home and knew them well. Staff interacted with people in a positive, relaxed and calm manner, being attentive to needs, no matter how expressed, and responding in ways that upheld their dignity and wellbeing. Four out of the five comment cards we received from people stated that staff always treated them well, one person stated they sometimes did. Three people felt that staff always act on what they say and two people stated they sometimes did. People spoken to indicated they liked living in the home. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be consulted on the quality of care and services they receive but gaps in health and safety management do not promote the safety of people living in the home. Evidence: At the time of this inspection a temporary manager was in post who had previously worked in the home as a senior support worker. We were told that the temporary manager had been in post for approximately four to five months and that a new manager was in the process of being recruited. People living in the home were observed to be at ease in approaching the manager. Throughout our visit the office door remained open and people were able to freely access the office to be with staff or the manager. This indicates that the manager makes herself accessible to people who live at Ingleby House. Staff told us that when the manager was not at the home they could make contact with them at any time should they have any concerns. There are systems in place for monitoring the quality of the service and this includes consultation with people who use the service at regular meetings. Meetings had been Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: scheduled to take place monthly but notes of the meetings confirmed these did not always take place on the scheduled dates. Issues discussed at the meetings included the introduction of a new person to the home and if this was alright with everyone, asking if there was anything broken in peoples rooms and discussion around the games room and how this could be better used. Staff meetings had also taken place and notes confirmed issues discussed included the needs of people living in the home, maintenance, cleaning and budgets. Comment cards received from staff showed that they always felt they are given upto-date information about the needs of people they support. Comments about the home included: It is well run, good team work, very clean. Residents always happy, updated with whats going on daily. Very supportive to staff and residents. A number of health and safety records were checked. We found that a fire risk assessment was in place but this had not been updated since 2007. Although this was the case, some of the fire checks had recently been carried out such as the fire extinguishers, emergency lighting and fire alarm. There were also records detailing the names of people who had been involved in a recent fire evacuation test. Some of the health and safety documentation in place such as a first aid needs risk assessment, first aid provision review and the first aid kit checklist was dated 2007 and 2008 and it was not clear these had been reviewed to ensure they were up-todate and still relevant. The Employers Liability Certificate on display was noted to be out of date. We were told that it was most likely a new one had been issued but not put on display. It was agreed this would be followed up as appropriate. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must be 28/02/2010 developed for challenging behaviours and must include the actions to be taken by staff to manage these behaviours. This is to ensure any health and safety risks are identified and appropriately managed and people are not placed at risk of harm orinjury. 2 19 12 Care plans must include details of any professional advice sought in relation to peoples care needs. For example dietary advice and menu planning and include the action required by staff to ensure needs are met. This is so people can be confident their care needs will be met. 28/02/2010 3 20 13 Medicine Administration 31/01/2010 Records must be signed or a Page 31 of 34 Care Homes for Adults (18-65 years) 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 code entered to demonstrate whether the medicine has been administered as prescribed. This is so people can be confident their medicine is being appropriately managed and records reflect practice. 4 23 19 The outcome of a Criminal Records Bureau disclosure must be known before new staff begin working with people who use the service. This will ensure people who use the service are safeguarded from the risk of potential abuse and they can be confident that only suitable staff are employed by the service. 5 42 23 Health and safety records must be updated. This includes the Fire Risk Assessment and Employers Liability Certificate. This is so people can be confident there are up-todate health and safety policies and procedures in place for staff to implement to protect them. 28/02/2010 28/02/2010 Care Homes for Adults (18-65 years) Page 32 of 34 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 17 Menu planners should be developed where this is considered to be beneficial to the person in promoting their independence and meeting their care needs. There should be an identified system in place for recording any complaints or concerns received by the service. This is so people can feel confident their concerns will be taken seriously and will be appropriately acted upon to maintain the persons welfare. The complaints procedure needs to include named contacts, addresses and telephone numbers so that people living in the home know who to contact should they wish to raise a complaint. The procedure should also include details of external agencies such as the Local Authority. Arrangements should be made to ensure the shower room is easily accessible to all people who use this so that peoples safety can be maintained. Duty rotas need to include staff designations and include the manager so that is it clear there are both sufficient and suitable staff supporting people living in the home. The service needs to ensure that recruitment information is readily available, it is clear and all pre-employment checks are carried as appropriate to help ensure the safety and protection of people living in the home. Statutory training for all staff needs to be maintained within the required timescales. Training schedules should indicate required timescales as well as dates when staff have completed this training. 2 22 3 22 4 27 5 33 6 34 7 35 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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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