Care Home: Kenrick House

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What the care home does well Interactions between people and staff were friendly and relaxed. Staff treated people with respect and maintained their dignity. People are helped to keep in contact with their family and friends so they can maintain relationships that are important to them. Staff support people well with their personal care to help them to feel comfortable and good about themselves. Staff work well with other health professionals to benefit the people living there and help to meet their health needs. Bedrooms are personalised and reflect the tastes and interests of the individual. What has improved since the last inspection? We last visited the home in March 2009. However due to the inspector being poorly after the visit the home did not receive their report. The following improvements have been made since the home`s last report which was dated November 2007. Health action plans have been introduced to improve health care planning to help people to stay healthy. Staff have had more training in giving medication to help them do this safely. The kitchen has been improved so that it is now clean and modern. A stair lift has been fitted to make it easier for people to get to the first floor of the home. Equipment in the home is regularly checked so that it is safe to use. What the care home could do better: Information about how much it costs to live there should be included in the Service User Guide. Improve the policy and procedure for washing dirty laundry in the kitchen to reduce the risk of infection. Care plans and risk assessments need further development to make sure staff know how to support people. People`s weight should be monitored to ensure that they can get help if they have any health needs. People need to be provided with meals that meet their assessed needs to help them to stay healthy. Medication procedures need to be reviewed to help reduce the risk of staff giving people the wrong medication. Staff must have the training they need so they know how to meet people`s needs. Staff recruitment records need to be available to show that suitable people are employed to work with the people living there. Quality assurance systems need to be improved so that the home is run in the best interests of the people who live there. Key inspection report Care homes for adults (18-65 years) Name: Address: Kenrick House 1777 Pershore Road Cotteridge Birmingham West Midlands B30 3DP     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: Kerry Coulter     Date: 2 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: Kenrick House 1777 Pershore Road Cotteridge Birmingham West Midlands B30 3DP 01214512511 01212466833 charmaine_doherty@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Charmaine Doherty,Ms Rosemarie Brown care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Date of last inspection Brief description of the care home Kenrick House is registered to provide care for up to three people with learning disabilities. The house is a small terraced property on a main road in Cotteridge. On the ground floor there is a lounge, separate dining room, kitchen, toilet and single bedroom. Upstairs are two single bedrooms, office, bathroom and a separate shower. The front door gives access directly onto the pavement outside the house, and there is limited parking on the road outside. There is some parking in nearby side roads. To the Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home rear of the house is a small garden. There are local shops within walking distance of the house, at either Cotteridge or Stirchley. The home is also close to local bus routes. The service user guide did not record how much it costs to live at the home, so people would need to ask the manager about the fees. Copies of the homes previous reports are available in the office on request. Care Homes for Adults (18-65 years) Page 5 of 31 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 inspection was carried out by one inspector in one day. The home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We met with people who live at the home and they told us what they thought of the home. We also asked staff about peoples needs. We looked at the care plans, health records and daily notes for two people. This is called case tracking. We also looked at all parts of the home, staff and health and safety records. We spoke with a health professional to seek their views on how the home meets Care Homes for Adults (18-65 years) Page 6 of 31 peoples health care needs. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Information about how much it costs to live there should be included in the Service User Guide. Improve the policy and procedure for washing dirty laundry in the kitchen to reduce the risk of infection. Care plans and risk assessments need further development to make sure staff know how to support people. Peoples weight should be monitored to ensure that they can get help if they have any health needs. People need to be provided with meals that meet their assessed needs to help them to stay healthy. Medication procedures need to be reviewed to help reduce the risk of staff giving people the wrong medication. Care Homes for Adults (18-65 years) Page 8 of 31 Staff must have the training they need so they know how to meet peoples needs. Staff recruitment records need to be available to show that suitable people are employed to work with the people living there. Quality assurance systems need to be improved so that the home is run in the best interests of the people who live there. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need and their needs would be assessed so they can be sure that the home is right for them. Evidence: The home has a service user guide in place that tells people about the home. We saw that it did not include information about the range of fees. This should be included so that people know how much it costs to live there. The guide is available in a format that includes pictures, this helps to make it easier for people to understand. There are currently two people living at the home, both have lived there for several years. The home has one vacancy but the manager told us that there had been no referrals for this. The manager said that before anyone new moved in a full assessment of their needs would be completed. People would also be offered a trial visit that would include an overnight stay to see if they liked the home. Care Homes for Adults (18-65 years) Page 11 of 31 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 may not have all the information they need to be able to support individuals to meet their needs and reduce the risks to their safety, which could impact on their well being. People are able to make choices and decisions about their lives so that they can do the things they want to do. Evidence: We looked at the care files for both people who live at the home. Each person had a care plan that generally told staff the support people needed. Records included a person centred plan that included pictures, making it easier to understand so the person could be more involved. Care plans covered needs such as mobility, health, behaviour, relationships, personal care, activities and eating and drinking. There was some good information about peoples preferences and routines. Some improvements were needed. One persons care plan recorded that they had Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: epilepsy that was well controlled. However the plan was unclear about when the person was last known to have had a seizure and the support they would need should they have a seizure. It was good that people had guidelines in place to help manage behaviours that others may find challenging. However one persons guidelines referred to the use of medication to manage the behaviour. We were told by the manager that the person is no longer prescribed this medication. Their care plan needs to be updated to make sure it reflects this change. During our visit people were observed to be consulted, for example about what they wanted for their lunch and where they wanted to spend their time. Regular meetings are held with people to discuss things they would like, for example regarding activities, menus and daytrips. Records sampled included individual risk assessments, these included assessment of the use of the homes stair lift and bath chair. It was good that a falls prevention checklist had also been completed for each person. Each person also had a general risk assessment document but these were quite basic in content and were sometimes unclear about what the actual risk was. For example for one person the risk was described as being the front door. From the information in the assessment it was not clear how the front door was a risk and what the level of risk was. Care Homes for Adults (18-65 years) Page 13 of 31 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. Arrangements help people to experience a meaningful lifestyle to ensure their selfesteem and well being is promoted. People are offered a healthy diet and enjoy their meals. Evidence: People have an individual activity planner and it is good that this is in a pictorial format so that it is easier for them to understand. Information on the activities people enjoy is included in their care plan. Both people usually attend a day centre during the week but were at home when we visited. Both people confirmed they enjoy the day centre and wish to continue to go there. One person told us I like the centre. Records show that people participate in various in house activities such as singalongs, Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: knitting, colouring, watching television and having their nails polished. People sometimes help around the home doing things such as washing up and tidying their bedrooms. This is important as people need to maintain and develop daily living skills to enable them to be more independent. Records show that people do have some opportunities to participate in community activities but this is not always frequent. People are supported to maintain links with friends and family and to celebrate festivals that are important to them. When we visited, Christmas decorations had been put up in the lounge. People told us that they would be spending their Christmas day with relatives. The home has flexible visiting times and sampled records show that the home supports people to have contact with friends and family. One person said they wanted to telephone a relative and the manager immediately helped them to do this. The manager said that people usually decide on the day what they would like to eat. Food records show that meals are varied. When we visited the home had satisfactory food stocks that included fresh fruit and vegetables. People told us the food is nice and when asked about the food another said its lovely. Care Homes for Adults (18-65 years) Page 15 of 31 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. Arrangements do not always ensure that the health care needs of the people living there are met, which could impact on their well being. Evidence: We saw that people were well dressed in a style that was appropriate to their age, the weather and their cultural background. It was observed that they had been supported to pay attention to their personal care and hygiene so ensuring their self esteem. Staff were observed interacting with the people living there and responding to them in a positive way. Since the homes last inspection health action plans have been developed. This is an individual plan about what the person needs to be well and what health care services they need to access. Health records showed that people attend regular health checks for example with their GP, dentist and optician. Where needed people are also referred to other health professionals. One person had been assessed by a health professional as having swallowing difficulties and so needed to have a soft diet. Food records showed that sometimes Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: this person has toast which is a food that should be avoided. The manager said that the toast was only very lightly toasted and the crusts were removed to make it safer. We told the manager that this practice needed to be discussed with the health professional to make sure that the person was not being put at risk. One person has not been very well and was due to go to the hospital the next day for further tests. The person told us they were going and about the examination they needed to have. After our visit we were told by the manager that the examination did not go ahead as the doctor did not think the person had the capacity to understand the risks involved. The manager will need to make sure that account is taken of the Mental Capacity Act and that other care professionals are consulted about the next steps to ensure decisions are made in the persons best interests. For one person records showed that the home monitored their weight monthly but for the other person they had not been weighed for several months. Records showed that sometimes this person did not have a good appetite and has previously needed input from the dietician who had recommended they should be weighed monthly. It is important the home does this as unplanned weight loss or gain can be a sign of ill health. We spoke with one health professional about the home. They told us they did not have any concerns about the home and had found that they were usually willing to take on board any advice. Discussion with the manager and sampling of records indicates that staff who administer medication have been trained to do so. The homes annual quality assurance assessment told us that it is planned for staff to have more advanced medication training in the next twelve months. The medication is stored securely. Storage was observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescriptions so they were able to check the prescribed medication against the MAR chart when it entered the home. The home had previously notified us of a medication error that had occurred. One person had been given too much medication for several days. We were told this had happened because the person had been given medication by the hospital that had a different brand name to their usual medication. The home had given the new Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: medication in addition to their old medication. The error was spotted by another health professional and not the home. We asked the manager if medication procedures had been reviewed, the manager told us a review had not taken place. A review is needed to prevent the risk of similar errors occurring in future. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements help to ensure that the views of the people living there have been listened to and they are safeguarded from abuse. Evidence: We have not received any complaints about this home in the last twelve months and the home have not received any directly. Since the homes last inspection an easy read pictorial version of the complaints procedure has been developed. This should be updated to include our contact details. Minutes of meetings with people show they had been told about the homes complaint and safeguarding procedures. One person at the home told us I would tell the manager if I was not happy about something. The home had a procedure in respect of safeguarding and also a copy of the local guidance with contact details. This gives staff information about what to do if there were any concerns or allegations in respect of abuse or poor practice. Records showed that staff have received training on safeguarding people from abuse. The homes annual quality assurance assessment (AQAA) told us that more training is planned soon. The manager told us that she had attended about the Mental Capacity Act and Deprivation of Liberty Safeguard Legislation (DOLs). This legislation helps to ensure Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: that people who live in a care home are not being cared for in a way that deprives them of their liberty. Minutes of meetings show that people who live at the home and staff have been told about DOLs. It would enhance staff understanding of the new legislation if they were to receive more formal training. We were told that peoples relatives were appointees for their finances but that the home does look after small amounts of money on peoples behalf. We saw that receipts were available for expenditures. At the last inspection it was found that the home used part of peoples money for petrol that is used to transport them to various places. There was no record of any agreement for this practice in individual files. At this visit discussion with the manager and sampling of finance records shows that people no longer contribute towards petrol. Care Homes for Adults (18-65 years) Page 20 of 31 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 environment is generally safe, clean and homely. Evidence: The home is a domestic style terraced building that is situated on a main road, the front door opens directly onto the pavement. The home was clean and odour free and a comfortable temperature. All areas of the home were homely in style. On entering the home a hallway leads into a pleasant dining room to the rear of the building, which was adjacent to the kitchen. The kitchen has been completely refurbished since the last inspection and is now a well fitted modern facility. The washing machine is located in the kitchen. Some people at the home may sometimes be incontinent. The homes infection control procedures did not detail how soiled clothing would be laundered safely. The procedures need to be reviewed to ensure there are good infection control practices. When we visited we saw that laundry was being dried on radiators throughout the home. We were told that the home did not currently have a dryer. Minutes of a meeting with people at the home in August recorded that that they were told the home would be getting a new dryer. The manager told us she hoped to purchase one after Christmas. This needs to be done as it is not practicable for a care home to launder clothing and bedding efficiently without a dryer, particularly in the winter. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The bedrooms occupied by both people are on the first floor. Both people at the home are over seventy years old and are therefore becoming less mobile. Since the last inspection the home has installed a stair lift and this makes it easier for people to access the first floor. Each person had their own bedroom that was personalised according to their individual taste. The carpet in one bedroom was not laying flat and had a small ridge running across it. This will need to be repaired so that it does not pose a trip hazard. There was a separate toilet on the ground floor and a bathroom with over bath shower plus a separate shower room on the first floor, so providing a choice of bathing facility and access to a toilet on both floors. The bathroom is quite small and dated in appearance. We saw that the hot water tap on the bath was broken, we were told it had been like this for some time. Discussion with staff and people at the home indicate that people usually prefer to have a shower. Repair of the bath tap would however give people the choice to have a bath should they want to. An occupational therapist has assessed the bathing facilities and as a result of this a bath chair is now available to enable people to get into the bath where they have their shower. The homes annual quality assurance assessment told us that the home plans to modernise the bathroom and have a ground floor shower in the next twelve months. Care Homes for Adults (18-65 years) Page 22 of 31 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. The arrangements for staffing, their recruitment, support and development are variable, which could impact on the well being of the people living there. Evidence: The annual quality assurance assessment told us that two staff have completed a National Vocational Qualification in care. This means that people are usually supported by staff who are well qualified. During our visit we observed interactions between people at the home, the manager and one staff. The manager and staff treated people with respect and spoke to them in a friendly manner. One person at the home commented staff are nice. The owner manages the home and employs three staff. Duty rotas indicated that there was one member of staff on duty during the day and one member of sleep in staff overnight. This provides a staffing ratio of one member of staff to one or two people depending who is in the home. Staff undertake all tasks to include caring, cooking and cleaning. Two new members of staff have been employed since the last inspection. We looked at their recruitment records. For one member of staff, information was available to show that a robust procedure had been followed. However for the other member of Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: staff the Criminal Records Bureau (CRB) check had been used from another organisation. The home should have undertaken their own check before the staff started working in the home to ensure people are safeguarded. Although two references had been obtained neither were from the member of staff last employer. The manager told us that references had been requested several times from the employer but had not been received. Copies of the request letters should be kept on the staff file to show this. The newly employed member of staff had undertaken induction training before starting work in the home. This included safeguarding people from abuse, infection control, first aid, medication and manual handling. Staff had undertaken a range of training that included manual handling, basic food hygiene, fire prevention, first aid and safeguarding, but it was not up to date in some cases. At the last inspection it was identified that staff also need to have training in other areas specific to peoples needs e.g. epilepsy. The manager provided evidence that she had recently attended epilepsy training and said that one other member of staff had attended the same course. The homes annual quality assurance assessment (AQAA) told us that in the next twelve months it is intended to improve training. However the AQAA was not specific about the improvements to be made. We saw minutes of staff meetings that showed there had been two in the last year. There should be at least six staff meetings a year so that staff can be updated in the changing needs of the people living there, how the home is run and best practice. Care Homes for Adults (18-65 years) Page 24 of 31 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. Management arrangements may not always ensure that the home is well run in the best interests of the people living there, which could affect their safety and well being. Evidence: The home previously had two owners, however their partnership was dissolved early in 2009. The remaining owner now manages the home. We made them aware of the need to apply to us for registration to reflect the new ownership arrangements. The remaining owner has had several years experience in caring for people, has completed NVQ level 4 in care and since our last inspection has completed the Registered Managers Award. The homes annual quality assurance assessment (AQAA) was completed and returned to us when we asked for it. However it had not been completed to a good standard as it was brief and gave very little information about the service indicating a lack of understanding of the purpose of the AQAA. There were some systems in place to seek peoples views about how the service is run Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: but these could be improved. There was evidence of meetings with people and the manager stated that she had some survey questionnaires to give to people. The manager said that in the past surveys had been sent to relatives in order to obtain feedback about the service but none had been returned. It was recommended at the last inspection that surveys should also be sent out to other stakeholders to obtain feedback, as part of the quality assurance system. This has not yet been done but the homes annual quality assurance told us that the home intends to do this in the next twelve months. On inspection of a sample of maintenance records it was found that weekly fire tests and regular fire drills had been completed. The home has a cupboard for the storage of COSHH items, these were seen to be securely stored at the time of our visit. Certificates were available to show that the gas and electrical installations in the home had been tested by qualified engineers who stated that these were safe. Staff regularly monitor the temperature of the hot water. Records showed that the temperature was safe and did not put people at risk of scalding. Staff have fire training as part of their induction to the home but there was not evidence that staff had recent refresher training in fire safety, this will need to be arranged. Records showed that one member of staff has not received first aid training, this is concerning as staff usually work alone in the home. The manager was able to provide evidence that the member of staff was scheduled to attend first aid training in March. A risk assessment will need to be completed to look at the first aid arrangements in the home to make sure they are satisfactory. Although the accident book was available in the home the manager could not locate the completed accident records that had been removed from the book. The manager said these had been filed away by a member of staff. These need to be available for inspection. Care Homes for Adults (18-65 years) Page 26 of 31 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 31 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 12 People need to be provided with meals that meet their assessed health needs and are in line with their care plan. This will help to make sure peoples nutritional needs are met and their health is promoted. 06/02/2010 2 34 19 Robust recruitment procedures must be in place for staff employed by the home. To make sure people are protected from having unsuitable staff working with them. 06/02/2010 3 42 13 Review training arrangements to make sure staff are suitably trained in fire safety and first aid. To help ensure peoples health and safety is promoted and protected. 31/03/2010 Care Homes for Adults (18-65 years) Page 28 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information about the range of fees should be included in the service user guide so that people know how much it costs to live there. Care plans should be further developed to make sure that they clearly record all the support that each person needs and are kept up to date so that people can be sure their needs will be met. Risk assessments should be further developed so that they are clear about what the nature of the risk is to the person. This will help staff to know what to do to promote peoples safety. The home should seek to improve peoples participation in community activities so that people are part of the local community and have a lifestyle they enjoy. Peoples weight should be monitored regularly as unplanned weight loss or gain can be a sign of ill health. Medication procedures should be reviewed in light of the recent medication error that occurred. This will help to reduce the risk of similar errors occurring in the future. The easy read pictorial version of the complaints procedure should be updated to include our contact details. Staff should receive more formal training about the new Mental Capacity Act and Deprivation of Liberty Safeguard Legislation. This will help staff to have a good understanding of how this legislation affects people who live in a care home. The hot water tap at the bath should be repaired and the carpet in one bedroom repaired so that the home is well maintained. Infection control and laundry procedures should be reviewed and a tumble dryer purchased so that the home has safe and efficient laundry and infection control practices in place. Review the staff training programme to help make sure staff have the training they need to be able to safely meet peoples needs. There should be at least six staff meetings a year so that 2 6 3 9 4 13 5 6 19 20 7 8 22 23 9 24 10 29 11 35 12 36 Care Homes for Adults (18-65 years) Page 29 of 31 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 staff can be updated with changes to the needs of the people living there and best practice. 13 39 A quality assurance system needs to be implemented and acted upon to ensure continued improvement for people who live there. Records required by regulation for the protection of people and the efficient running of the home should be secure and available for CQC to see. A risk assessment should be completed to look at the first aid arrangements in the home to make sure they are satisfactory. 14 41 15 42 Care Homes for Adults (18-65 years) Page 30 of 31 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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