Care Home: Lyttle`s Residential Care Home

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What the care home does well People are supported to keep in touch with family and friends so they maintain relationships that are important to them. Each person has their own bedroom with their own en suite toilet and shower or bathroom, which gives them privacy. People receive good support from staff to maintain their personal care and general well being. People who are able, are supported to go out independently and live fulfilled lifestyles. One of the people told ex by ex that they do cooking with the staff the ex by ex said "It pleased me that they are able to be involved and that staff value their contribution with the household." Health and safety is well managed to ensure the safety of people living there. What has improved since the last inspection? Hand washing and drying facilities are available throughout the home to minimise the risk of infection. Staff supervisions are more structured so staff get the support they need to do their job. What the care home could do better: Care plans should be person centered so people get the individual support they need to be independent and achieve their goals. Guidelines should be in place so staff know what to do if people are upset or unhappy. People with more complex needs should get the support they need to live fulfilled lifestyles. People`s communication needs should be known and planned for so their needs , wishes and wants are understood. Menus should include pictures and reflect the choices of the people who live there. Staff should have more training so they understand peoples needs better. Key inspection report Care homes for adults (18-65 years) Name: Address: Lyttle`s Residential Care Home 61 Vesey Road Wylde Green Sutton Coldfield West Midlands B73 5NR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Donna Ahern     Date: 2 8 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Lyttle`s Residential Care Home 61 Vesey Road Wylde Green Sutton Coldfield West Midlands B73 5NR 01212405286 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: thomaslyttle@blueyonder.co.uk Mrs Anne Marie Lyttle care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Mrs Lyttle must ensure that Mr Adrian Lyttle takes no part in the day to day operation and management of the home. The maximum number of service users to be accommodated is 9 The registered person may provide persnal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 9 Date of last inspection Brief description of the care home Lyttles Residential home is a three storey property situated in a residential area in Wylde Green that is part of Sutton Coldfield. The home is registered to provide care and accommodation for nine people with a learning disability. The accommodation consists of nine single en suite bedrooms three on each floor with communal rooms on the ground floor. The home does not have a lift and would therefore not be suitable for people with physical disabilities to be accommodated on the upper floors. There is a mature garden with patio and disabled access. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 9 Brief description of the care home Fee details where not detailed in the service user guide. This information can be obtained from the home. People contribute ten pounds per month towards the homes vehicle running costs. CQC inspection reports were availble for people to read if they choose to. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the home was undertaken by one inspector over one day. We, the commission were assisted throughout the day by the manager. The home did not know that we were visiting that day. There were nine people living there. Information was gathered from speaking to five people who live at the home and observing care and support. Three staff were spoken to. Two peoples care was case tracked. Case tracking involves discovering peoples individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were also looked at. Before our visit we reviewed any notifications received about the home, these are reports about things that have happened in the home that they must tell us about. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home Care Homes for Adults (18-65 years) Page 6 of 32 think they are doing well and where they need to improve. It also gives us some numerical information about the staff and people who live at the home. Prior to our visit we sent out surveys to the nine people who live at the home and we also enclosed a copy for their relative or advocate if they wanted to pass one on to them. At the time of writing this report we had received seven completed surveys from people who live at the home and four from relatives. This comments are included in the report. We were assisted by an Expert by Experience (in this report known as ex by ex).This is someone with personal experience of using care services who visited with their supporter. Expert by Experience observe what happens in the home and talk to people to obtain their views about what it is like to live there. She produced a report based on the findings and details of this are included in this report. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 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 32 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 and their representatives have most of the information they need so they can make a choice about whether or not they want to live there. Evidence: The statement of purpose contains most of the required information that people would need to know to make a choice about living at the home. Information about the range of fees and what these cover should be included in the document so people know what they are paying for. The service user guide would be better if it was produced in an easy read format so it is easier for the people living there to read and understand. Since we last visited six people have moved in. They moved to the home in an emergency so pre assessments were not completed. We were therefore unable to fully assess this standard. There is a pre admission assessment procedure in place that indicated assessments and visits would be made prior to the people moving in so the home can be sure that needs can be met . Birmingham council supported the six people to move there and people had some Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: social work input after they moved in. Assessments of needs by social services were completed for four people several months after they moved in and remain outstanding for two of the people who have now lived there for almost two years despite the manager requesting this information. Care Homes for Adults (18-65 years) Page 12 of 32 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 do not have all the information they need to know so they can support people to make choices about their lives and express their needs, which could impact on peoples well being. Evidence: For many of the people the home had very little information about them before they came to live there. So the home has worked on developing care plans.We looked at two peoples care plans. Care plans explain what each persons needs are and the care and support they require to make sure these needs are met. The two plans looked at had lots of information about how staff should support the person in order to meet their individual needs in relation to personal care, health care, social activities, cultural needs and personal development. There was a lot of information for staff to read through. This could be problematic for new staff who may have to read through a lot of information to find what they need to know. The information wasnt written in a person centered way so it didnt read as if the person had been fully involved in developing their care plan. It didnt always say how the persons independence could Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: be promoted, give full assistance was recorded. Information was not written in a way that it was accessible to people using services e.g pictures or symbols. These can make peoples care plans more personal and accessible to them so they are more involved in their plan. One of the people told us they can look at their care plan if they want to. People who have some behaviours that may challenge, information for staff about how to support them were not in place for all the people who need them. This may mean that people do not get the support from staff they need if they become anxious or upset. We saw from records that reviews take place with peoples day centres. This should ensure that people get consistent support and any relevant information about peoples wellbeing can be shared. An advocate comes into the home to chair the house meetings with the people living there. It is really positive that someone from outside of the home is helping to run these and that regular meetings take place. However there were no minutes of the meeting so it is unclear what decisions people have made and what action has been taken to act on these decisions. Records included individual risk assessments that showed staff how to support the person to take risks whilst reducing the risks to their health and safety. Some further development of these were required. Including risk assessments for people who use a wheelchair to access the community so staff support people safely. Assessments should also be in place for specialists beds and the use of bed rail covers so people are supported safely. The ex by ex observed one of the people who looked upset or frustrated. Staff offered the person some of their personal items, but this didnt seem to be what the person wanted. The ex by ex was concerned that the person just got more upset and that staff didnt seem to know how to redirect the persons attention to prevent them getting upset. When we looked at the persons records there wasnt any information about what may cause the person to get upset and how staff could prevent this or what to do when this happens. Some of the people who live there have limited verbal communication. We saw from looking at peoples files that speech and language assessments had been completed on people. The ex by ex asked staff about accessible communication systems and communication passports which would identify how the person communicates basic Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: needs and choices. Staff told the ex by ex that these are not in place. The ex by ex asked how do they make choices, decisions or communicate basic things such as if they are hungry, thirsty or in pain. These are not in place for people and these are fundamental for helping staff to support people to make these decisions. The ex by ex said This is very dangerous , as staff would have to go through a process of elimination to determine what was wrong and if it was a medical complaint this could put them in danger of becoming seriously ill. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people are supported to enjoy a range of activities but not all the people living there have the same opportunities to live fulfilled lifestyles. Evidence: Some people go to day centres which they have attended for many years and some people go to college classes. One of the people told us about flower arranging classes that take place weekly at a local community centre.Some people do not have a structured day care and the home are responsible for ensuring they take part in a range of activities to meet their needs. On the day of our visit the minibus was not working it was unfortunate that alternative travel arrangements were not made so the planned activity of hydrotherapy session could of still taken place. We saw from reading records and talking to staff that activities for people with more complex needs who dont attend a day centre were still under development. So people get the opportunity do meaningful activities during the day and evenings. In the surveys Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: people completed and sent to us four people indicated that they can do what they want in the day and evening and three people indicated they can sometimes do what they want. One of the people told the ex by ex about the successful completion of travel training so they can now use the buses and trains independently and feels confident to travel alone and not reliant on staff. The ex by ex said I was very impressed as this was a huge achievement for them and I was pleased to see that the home was supporting them to do this. One of the people told us they are hoping to enroll on a computer course and staff are helping them to find somewhere that they can do this. The ex by ex said I was pleased to hear that one person had a volunteer job at a local hospice, and they really enjoys this. Whilst it is important that people have jobs, ideally this should be paid work. One of the people told the ex by ex that he loves cooking. They told the ex by ex that they had made a lasagna with staff support and they would like to make a bread a butter pudding. The ex by ex said It pleased me that he is able to be involved and that staff value his contribution within the household. People told us they keep their own rooms clean and help with household tasks such as washing up, vacuuming, polishing and sweeping. This supports people to maintain and develop their independent living skills. People told us and records showed that they go to visits their families and friends and their families also visit their home. Peoples care plans stated who the important people in their life are and how to maintain these links. Some people have no family links and the manager has got an independent advocate involved for one of the people so that the person will get support to speak out for themselves and make informed choices. Relatives told us in completed surveys The home takes an interest in the health and well being of people and brings to our attention any concerns The home functions very well and gives people a happy life style My relative seems very happy there Good food and plenty of it and laundry could be a little better. The ex by ex was told by staff that meal times are done in two sittings. The ex by ex told us they they thought this sounded more like a restaurant than someones own dining room in their own home. The manager told us there are two sittings because this is what people living there have requested. It also means people can get the support they need at meal times. The menu had two choices written on it but everyone had the same meal. The ex by ex said At 16:30 everyone went into the Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: dining room. They were concerned that a person was left on their own and they didnt hear any staff explain to the person what was happening. We were told that the manager does the food shopping. The ex by ex said that people living there should be involved in planning the menu and shopping for their own food. The menu was not on display it was kept in a folder. The ex by ex said It would be best practice to have a menu on display that is accessible to all, using methods of communication such as pictures or symbols. We looked at records of food and drinks and saw that people do eat a varied diet. We saw that fresh fruit and snacks were available to people. We looked at the records of fluids for people who are not able to verbally ask for a drink. There was no detail recorded about what time people were offered or given a drink which could result in people not being offered frequent drinks. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place ensure peoples personal and health care needs are met. so ensuring their well being. Evidence: People were dressed in individual styles that reflected their age, gender, the weather and the activities they were doing. For people who require a lot of support to meet their personal care needs, their care plan said needs full assistance. It did not detail how the person could be supported to promote their independence and dignity. When we spoke to staff it was positive to hear how they do encourage and support people to be more independent with meeting their personal care needs. We saw that protocols are in place for people who have epilepsy so they get the right support from staff and prompt medication should they need it. This should ensure that their seizures are managed. Records seen showed that any seizure is closely monitored and good recording systems were in place . Other professionals have been involved with writing the protocols so peoples needs are well managed. Records we looked at included a health action plan. This is a personal plan about what Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: support a person needs to meet their health needs and what health care services they use. We saw that some health care needs such as dry skin had been identified in the care plan but not monitored through the health action plan which may lead to this need not being fully monitored.We saw that the person was receiving the care and support from the staff team to meet this need but this information hadnt been followed through on the health action plan. Records sampled showed that people have the support to attend health checks up and referrals have been made to other professionals for their help and advice including speech and language therapy, community nurses and consultant psychiatrists so they get specialist advice and support. We saw that people are weighed regularly which is good practice as weight gain or loss can be an indicator of health problems.One of the people had lost some weight however the action the home was taking was not recorded. It was positive to hear that the manager is introducing a nutritional tool to improve the support people get to meet their needs. Medication is stored in a locked cabinet. Records sampled showed that people had their medication as prescribed so helping to meet their health needs. There was no specific storage for medication classified as controlled medication, that needs to be stored in more secure storage. The home currently had no controlled drugs being stored however some of the medication it is storing, it is advised that it should be stored as controlled medication. We saw protocols are in place for people who take medication on an as required basis. However a protocol was needed for a person for pain relief so staff know when this medication should be given. Care Homes for Adults (18-65 years) Page 20 of 32 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 in place ensure that people are listened to and are safeguarded from the risk of harm. Evidence: We were informed by the manager that the complaints procedure is explained to each of the people living there. In some of the peoples bedrooms we visited we saw that they had their own postcard with the complaint details on and CQC details on and a contact number so they could speak to someone outside of the home if they were not happy. People told us during the visit and in completed surveys that they knew what to do if they were not happy about something. However some people would require considerable support to raise their concerns. A record of complaints are kept . We received one complaint about management of a persons finances. Records we saw indicated the matter was investigated appropriately. Records of peoples belongings are kept, this helps to safeguard peoples possessions and there is a record to refer to if anything should go missing. Many of the people have been supported to open bank accounts since they moved into the home so they can save for things they want. Some people go to the cash point and take their own money directly from the bank. Some people need support to manage their money from staff. The ex by ex spoke to people about managing their Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: own money and said I was really pleased to hear that X had access to their own money. The ex by ex was unsure why the persons bank card was kept in the office. They felt that people should keep their own bank card as it belongings to them. The manager had involved an advocate to support one of the people with their finances which should ensure they receive the support they need to spend their money appropriately. The manager has completed training on the Deprivation of Liberty Safeguards and was aware of how this important legislation may effect the people living there. Staff training records showed that staff have completed training on mental capacity and safeguarding. This helps to ensure that staff know how to safeguard people living there from harm. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, homely, well maintained environment that meets their individual needs. Evidence: The home is a three storey converted Victorian property. The ex by ex said Arriving at the home I observed the house was a lovely residential area, close by to the train station at Wylde Green and local bus routes into Sutton Coldfield and Birmingham. The ex by ex said The home environment was pleasant , with good quality furnishings . It smelt nice and felt like it was someones home. People using wheelchairs had their bedrooms on the ground floor as there was not a lift and the rest of the bedrooms were on the second and third floor. We looked at some of the bedrooms. One of the people invited the ex by ex to see their bedroom. They told the ex by ex that they had chosen their own bedroom and loved living at the top of the house. The ex by ex said Their bedroom was lovely. It was well furnished , with furniture they had made themselves in a woodwork class. There were lots of pictures of dinosaurs which they said they loved. The ex by ex was invited into another bedroom and said Again I was pleased that the room was so personal, and it was clear this person had chosen all their belongings. It was well kept and had an ensuite bathroom. The room was extremely spacious with lots of natural light and they seemed relaxed in there. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: On the ground floor there is a kitchen that leads into the dining room and there is a separate lounge. There is an office on the first floor and a separate small work room for staff where they can complete records and store information securely. This room can also be used for meetings. To the rear of the home there is a well maintained secure garden that people can enjoy when the weather is fine and is accessible by ramps. There are rotas in place for daily cleaning tasks and people living there are encouraged to assist the staff in doing the tasks. The home was clean and free from offensive odours making it pleasant for people to live in. Care Homes for Adults (18-65 years) Page 24 of 32 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 in place for staffing do not fully ensure that peoples needs will be met. Evidence: The AQAA told us that over 50 of staff have completed the National Vocational Qualification (NVQ) level 2 and senior staff are completing NVQ level 3. This should help towards ensuring that staff have the skills and knowledge to meet peoples needs. The manager told us and staff rotas showed that there are between two and six staff on duty throughout the day . There is an overlap of shifts in the afternoon when staffing levels increase as the manager said that this is the busiest time of the day. Its important that the staffing levels are kept under review and that staffing is flexible so people who need a high level of support to access an activity are able to do so. Records showed that regular staff meetings take place so staff are kept updated on good practice issues and the changing needs of people. Staff said they have a handover when they come in . We saw staff read up on information before they started they shift. They told us they see the manager most days and that communication between staff is good. this should help ensure that staff are kept up to Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: date with meeting peoples needs. The ex by ex said The staff on the whole were very friendly, but I found the idea of living with nine other people over whelming. I was concerned that most of the interactions between staff and residents was with the people who had the more mild learning disabilities, and actually not enough effort was made to include the people with the more profound and multiple learning disabilities. The ex by ex saw that one of the people was falling asleep and a staff member poked them with their finger and told them to wake up and not fall asleep the ex by ex said This upset me because it was disrespectful way to speak to anyone, and staff should not be physically touching people in this manner and it was their choice to have a sleep. We shared this information with the manager at the end of our visit as people living there should not be treated in this way. The manager assured us that this would be dealt with through the homes procedures. The team consists of some experienced staff and some staff who are new to care work. We saw from looking at staff training records that staff have completed training in infection control, safeguarding, medication, coping with aggression. The manager said that all mandatory training should be completed by the end of March. He told us he then plans to arrange some more specialised training. He recognised that this was needed so staff have the required skills and knowledge. Some staff have completed epilepsy training. Further training in this is needed so people are supported to be safe. Staff havent completed any training in communication with people who have limited or no verbal communication which means they may not have the skills and knowledge to fully support people with these needs. We looked at the recruitment file for the two most recently appointed people. These included the required recruitment checks. A personal reference was required for one of the people who had no previous work history to ensure the procedures are robust and consistently applied. We saw that Criminal Records Bureau (CRB) check had been received to ensure that vulnerable people are protected. The manager said he is about to commence staff appraisals. We saw arrangements for this advertised in the staff room. Staff said they have supervision session and staff told us the manager is approachable. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place generally ensure the health, safety and well being of people. Evidence: The manager has several years experience of working with and managing homes for people who have a learning disability. He has continued to do further training so he has the knowledge and skills to manage the home. It is a family business so the manager works closely with the owners to ensure the home is well run. The manager was open and welcomed the inspection process. Previous requirements had been met. This visit has highlighted that improvements are needed in care planning, risk assessment and staff development so staff have the skills, knowledge and right approach to people so they can support people well. The manager responded appropriately to concerns that were observed during the visit. Information we needed to look at was provided promptly. Records were well maintained. Policies and procedures had been kept under review. The manager has developed his own quality assurance systems which have become a very good tool for ensuring the views of people are sought when developing the service. Areas covered include audits of Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: accidents and incidents, complaints and compliments, CQC reports, feedback on people about the activities they do, feedback from relatives and other professionals. All this information is analysed and peoples views are sought. In preparation for our visit the manager completed an Annual Quality Assurance Assessment (AQAA) which identifies the strengths of the home and areas for improvement. This was completed to a good standard and was returned to us within the timescales given. Fire records showed that staff test the fire equipment regularly to ensure it is working. It is serviced by an engineer to ensure it is well maintained and would work if activated. Fire drills take place so staff and the people living there would know what to do if the alarm went off. There is a work place fire risk assessment in place which should ensure that the manager has taken steps to minimise the risk of fire. The AQAA confirmed that gas and electrical testing and servicing had taken place so equipment in safe for people to use. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Storage for controlled medication must be provided. So medication is stored safely as required. 31/03/2010 2 34 19 The recruitment procedures must be consistently applied. So only staff who are suitable are employed to work in the home. 31/03/2010 3 35 18 Staff must have further training. So they can meet the individual needs of the people living there. 31/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should include details of fees and Page 30 of 32 Care Homes for Adults (18-65 years) 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 any additional charges so people know what they are paying for. 2 3 4 6 6 7 Care plans should be person centered and reflect what the persons needs and wishes are. Guidelines should be in place so people get the support they need from staff to be safe. People communication needs should be clearly recorded. People should be supported to have their own communication system so they can make choices and express their needs. Risk assessments should be in place for identified risk so people get the support they need from staff to be safe. Arrangement in place for activities should meet the needs of all the people living there so needs are met. Records of peoples fluid intake should be improved so staff can be confident that people are getting enough to drink. Menus should be available in a format that people living there can understand so they can make their own choices. Care plans should say how weight loss is being managed so people get the support they need. 5 6 7 8 9 9 12 17 17 19 Care Homes for Adults (18-65 years) Page 31 of 32 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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