Care Home: Mary & Joseph

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What the care home does well People were provided with a wide range of information to enable them to make an informed choice about the home and their needs were assessed before they moved in. This meant that they were assured that their needs could be met. People talked about having choices to enable them to exercise day to day control over their lives, having support from staff who respected their right to make choices and being supported by staff who listen to, and act on, what they say. The people who use the service that we spoke to were pleased with the care received. One person said, "this place has helped to take my problems away, I think that`s why my drinking is more controlled". Another person said, "you have a key worker but all the staff look after you, if you need anything they help you". The range of meaningful activities available to people using the service was excellent. In particular, people had obtained real benefits from art and garden therapy. One person said, "some of the lads that come here haven`t touched a pencil since school and we find out we can do art". Another person said that the activities, "chills us out", and added, "instead of being in our flat watching TV, we paint, it relaxes us". People`s religious and cultural needs were well met. One person said, "there is no discrimination, it is all by choice". People were supported to maintain their health and their personal needs were met in the way they preferred and with respect for their choice, privacy and dignity. The peoples` GP said that the service was, "excellent", and added, "they contact us a lot, but you can tell that they`ve always got the care of residents as their first concern". One person said, "they help you to stay well, eat well, help you with medicine, if you take ill you press a button in your flat and staff come to you". People were confident that the manager and staff would listen to their concerns and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. People trusted the manager and one person concluded that, "the home is continually improving and from the evidence I`ve seen, everything that falls short of anyone`s expectations is investigated and rectified". This is good for people using the service. One member of staff said that "the residents are actively encouraged to participate in choices and decisions which affect the environment in which they live". People confirmed that this was the case and demonstrated pride in their home. Staff were well-trained and supported which meant that they were confident in their work. People using the service were very happy with the staff. One person concluded that the staff were, " fantastic, they`re like a family". Throughout the inspection process, we got feedback from people using the service and staff to say that the running of the service was excellent. One person using the service said,"I can`t think of anything that`s not good, it`s run so well this place it`s unbelievable". Another person said, that the manager is, "great", "fantastic", "she deals with everything well, it`s changed my life around". The GP also spoke highly of the manager who was described as being, "very, very good". Health and safety checks were regularly maintained, so that people`s safety and welfare was protected. What has improved since the last inspection? We saw clear evidence of continual improvement to most aspects of the service. This was achieved through constant monitoring of the service and the managers determination to make sure that the service continually developed in the best interests of people using it. Specific improvements included the way that people were supported to take their medicine which had improved since the last inspection by making sure that there was always a clear audit trail of medication. What the care home could do better: Overall, the recruitment procedure was robust enough to protect people. However, it was recommended that all staff application forms were carefully checked to make sure that a full employment history was always provided and that the arrangements for shadowing a new member of staff while the Criminal Records Bureau (CRB) check was awaited were always documented. The manager recognised the need for this improvement and implemented it immediately. Key inspection report Care homes for adults (18-65 years) Name: Address: Mary & Joseph Palmerston Street Ancoats Manchester M12 6PT     The quality rating for this care home is:   three star excellent 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: Helen Dempster     Date: 1 3 1 1 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Mary & Joseph Palmerston Street Ancoats Manchester M12 6PT 01612736881 01612736864 maryandjosephhouse@eastserve.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Joseph Cox Charity care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Male. Whose primary care needs on admission to the home are within the following categories: Past or present alcohol dependence: Code A Mental disorder, excluding learning disability or dementia: Code MD The maximum number of service users who can be accommodated is: 41. Date of last inspection Brief description of the care home Mary and Joseph House is a care home providing 24-hour residential care and accommodation for 41 men who are alcohol dependent and may also have mental health problems. The home is situated close to Manchester City Centre, near to local amenities and public transport links. The home was purpose built to meet the needs of the client group and is sited in a mixed residential and commercial area. Bedroom accommodation is provided over the ground and first floors. All bedrooms are single with hand washbasins and there are a number of self-contained flats. The building is accessible for people who use wheelchairs and accommodation is based on the ground Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 41 41 Brief description of the care home floor. Communal space is provided throughout the building and there is a large well maintained garden. There are also laundry and kitchen facilities based on the ground floor. On admission to the home, people are not expected to stop drinking alcohol, however, they are offered support to reduce or stop their alcohol use. The current fees for the home are £455.49 per week. Information about the home can be provided by contacting the home direct. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 report was written on behalf of the Care Quality Commission. Therefore, throughout the report the term, we, is used. This key unannounced inspection included a site visit. The manager and staff at the home did not know that the visit was going to take place. In November 2008, an Annual Service Review (ASR) was done, as part of the lead up to this inspection. This involved the manager filling in an annual quality assurance assessment (AQAA), and people who use the service and staff filling in surveys to tell us their views of the home. We then considered this information, and all the other information we had received about the service, so that we could decide when we needed to visit the home to do a key inspection. The outcomes for people who used the service at that time were excellent. This reassured us that people at the home continued to be happy with the way they were supported at the home and that they continued to receive a good service and this helped us to plan the timing of this inspection. Care Homes for Adults (18-65 years) Page 6 of 30 Prior to this inspection, we sent surveys out again to people who use the service and staff so they could tell us what they thought about the service. Three of the people who use the service and six of the staff returned their surveys. Comments from these surveys are included in the report. We asked the manager of the service to complete an AQAA again. This form gave the manager the opportunity to tell us what they feel they do well, what they needed to do better and what had changed since the last key inspection and ASR. This helps us to determine if the management of the service see the service they provide in the same way that we see it. The form was well completed and the manager was able to tell us what plans there were to develop the service. All of the key inspection standards were assessed at the site visit and information was taken from various sources. This included observing care practices, talking with people who use the service, the manager, a visiting GP and the staff team. Two people were looked at in detail to learn about their experience of the service from when they first used it to the present-day. A selection of records were looked at, including medication records, training records and care records. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: People were provided with a wide range of information to enable them to make an informed choice about the home and their needs were assessed before they moved in. This meant that they were assured that their needs could be met. People talked about having choices to enable them to exercise day to day control over their lives, having support from staff who respected their right to make choices and being supported by staff who listen to, and act on, what they say. The people who use the service that we spoke to were pleased with the care received. One person said, this place has helped to take my problems away, I think thats why my drinking is more controlled. Another person said, you have a key worker but all the staff look after you, if you need anything they help you. The range of meaningful activities available to people using the service was excellent. In particular, people had obtained real benefits from art and garden therapy. One person said, some of the lads that come here havent touched a pencil since school and we find out we can do art. Another person said that the activities, chills us out, and added, instead of being in our flat watching TV, we paint, it relaxes us. Peoples religious and cultural needs were well met. One person said, there is no discrimination, it is all by choice. People were supported to maintain their health and their personal needs were met in the way they preferred and with respect for their choice, privacy and dignity. The peoples GP said that the service was, excellent, and added, they contact us a lot, but you can tell that theyve always got the care of residents as their first concern. One person said, they help you to stay well, eat well, help you with medicine, if you take ill you press a button in your flat and staff come to you. People were confident that the manager and staff would listen to their concerns and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. People trusted the manager and one person concluded that, the home is continually improving and from the evidence Ive seen, everything that falls short of anyones expectations is investigated and rectified. This is good for people using the service. One member of staff said that the residents are actively encouraged to participate in choices and decisions which affect the environment in which they live. People confirmed that this was the case and demonstrated pride in their home. Staff were well-trained and supported which meant that they were confident in their work. People using the service were very happy with the staff. One person concluded that the staff were, fantastic, theyre like a family. Throughout the inspection process, we got feedback from people using the service and staff to say that the running of the service was excellent. One person using the service said,I cant think of anything thats not good, its run so well this place its unbelievable. Another person said, that the manager is, great, fantastic, she Care Homes for Adults (18-65 years) Page 8 of 30 deals with everything well, its changed my life around. The GP also spoke highly of the manager who was described as being, very, very good. Health and safety checks were regularly maintained, so that peoples safety and welfare was protected. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from access to a wide range of information to enable them to make informed choices and have their needs assessed before moving into the home, so they know that their needs can be met. Evidence: In the AQAA the manager stated, the needs of new residents are assessed by a series of meetings prior to admission. These include visits to the House by the resident and their families or representatives, visits to the residents current environment to assess their circumstances, and through assessments and care plans produced by professional bodies prior to admission. We use all this information to create a comprehensive care plan which the resident is fully involved. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to two people from the point of their admission to the present time. We also talked to people using the service and staff and looked at the information in surveys that three of the people using the service and six of the staff had filled in. We saw that a wide range of helpful information was provided to people who were Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: considering moving to the home. People using the service confirmed that the information they were provided with told them what they could expect from the service. We talked to the manager, staff and people about the admission process and were told that people were invited to visit the home to meet people and have a meal, their needs were assessed before they were admitted and they were fully involved in the decision to live there. We also saw lots of evidence to demonstrate that peoples needs were regularly reviewed, especially in the first six weeks of their admission to the home, to make sure that the placement was meeting their needs. We looked at the assessments for two of the people who use the service and we saw that there was careful planning for the admission, which included assessments being completed by appropriate professionals, e.g. the social worker. Therefore, information was detailed and thorough to enable a care plan to be formed. All six members of staff who completed a survey said that they were always (5), or usually (1), given up-to-date information about the needs of the people they cared for. All three people using the service who completed a survey said that they were asked if they wanted to move into the home and did receive enough information about the home before they moved in to see if it was the right place for them. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from choices to enable them to exercise day to day control over their lives and from having support from staff who respected their right to make choices and their right to privacy and dignity. Evidence: In the AQAA the manager stated that, we involve residents in the production and regular review of their care plans in a way appropriate to their personal needs and preferences. Staff will work in imaginative ways to involve residents who would not actively participate in a more formal review meeting. Plans are individual and person centred, and have been produced in a clear format which the resident will easily understand. They give a clear insight into the residents goals and aspirations and how staff will support them to reach their potential. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to two people from the point of their admission to the present time. We also talked to people using the service, the manager and staff, and looked at the information in surveys that three of the people using the service and six of the staff had filled in. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We saw clear and detailed historical and current needs assessments which were focused on what each person could do independently, all of which were written from the point of view of the individual. We also saw that care plans were in place which gave detailed information about each persons physical health, mental health, personal care, alcohol needs, dietary needs, mobility, orientation, memory and communication needs, finances, independent living, education, recreation, social contact, family and friends, medication and religious and cultural needs. Care plans we saw were written from the point of view of the person using the service and we saw clear evidence of a strong focus on staff obtaining the views of people. Care plans were being reviewed very regularly, on an ongoing basis, in response to a recommendation made at the previous inspection. We saw that risk assessments which addressed a range of risks and each persons progress, including the outcome of any healthcare visits and activities they had taken part in, were reviewed on a monthly basis. We saw that all encounters between the manager and staff and people using the service were warm and friendly and respectful. People using the service confirmed that the manager and staff always respected their right to choice, privacy and dignity. The people who use the service that we spoke to were pleased with the care received. One person said, this place has helped to take my problems away, I think thats why my drinking is more controlled. Another person said, you have a key worker but all the staff look after you, if you need anything they help you. All three people who completed the survey said that the care staff and managers listen and act on what they say. All six members of staff who completed surveys said that the way in which information about people was shared worked well and that staff had enough support, experience and knowledge to meet the different needs of people who lived at the home. One member of staff stated, the home values the wishes of the residents, always holds residents meetings to allow them to express themselves, monthly reviews for residents, activities for residents and always tries to make a pleasant home for them. Another member of staff said, the home gives high quality care for the residents, offers choices to them, respects their values as individuals and respects their religious and cultural needs. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from choices to enable them to exercise day to day control over their lives. The range of meaningful activities available to people using the service was excellent. Evidence: In the AQAA the manager stated that, our service at Mary & Joseph House offers our residents many opportunities for residents to be independent and involved in all areas of daily living within the house and enjoy full and meaningful lifestyle. They are given opportunities to express their views and make choices about how they wish to live their lives. Our Therapeutic Activity Co-ordinators ensure that they provide a flexible and wide range of activities to meet the changing needs and choices of the residents regarding leisure, education and pastimes. Activities are planned with the full involvement of the residents and cater for individual and group needs and preferences. To assess whether this was the case, we spoke to people and staff, Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: looked at the programme of activities and looked at the information in surveys that three of the people using the service and six of the staff had filled in. The manager and staff said that people are encouraged to access courses at Manchester Education Resettlement Centre. People using the service talked about access to courses in learning to read, music, etc. The manager explained that courses are also available in maths, singing, photography and cookery. One person using the service said that they had learnt to read since admission to the home through the support of staff, and that this was very important to them as it was something they had not been able to address previously in their adult life. We saw evidence to demonstrate that education courses were advertised through residents meetings and individual discussions. During the inspection visit to the home, staff from the Booth Centre in Manchester visited people whom they had formerly known when they had been homeless prior to admission to the home. The manager talked about the importance of people maintaining contact with these people. She explained that the Booth Centre also runs a drop-in activity centre and the emphasis is helping people to maintain a stable lifestyle. The service employs a therapeutic coordinator for activities working 39 hours per week, a therapeutic gardener working 32 hours per week and a therapeutic art coordinator working 18 hours per week. These people were supported by staff to provide a wide range of meaningful activities for people living at the home. The home had an activities timetable which was produced on a weekly basis, and advertised a wide range of activities. We met a group of people who use the service in the art therapy room. These people were very enthusiastic about the activities that they were involved in. One person talked about learning to play the guitar and going to the adult education centre, to which they were accompanied by staff. Another person talked about learning to play the guitar and drums and added that their key worker was teaching this. One of the people said, some of the lads that come here havent touched a pencil since school and we find out we can do art. One person showed the lamp theyd made and said, a lot of lads do the garden, the gardener helps them, he is very good. One person said that the activities, chills us out, and added, instead of being in our flat watching TV, we paint, it relaxes us. People described a range of activities both inside and outside the home. This included Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: holding a tea dance every Tuesday, Christmas parties, meals out etc. One person added, they do a lot of outings here. People also said that they have a holiday once a year. One person said that the holiday this year was in Wales and Blackpool, and that they only had to pay for their own spending money, as the organisation pays for everything else. People talked about staff respect for their religious views. The home has its own chapel and Christian services are held on a weekly basis. People said that they can use the chapel any time. One person added , there is no discrimination, it is all by choice. This person explained that they can attend any church, and staff will take you. One person said that they didnt have any religious views and added, nobody has suggested that I go to church as I dont practice a religion. People using the service described a, good support network, and said that they are supported to see their family. In surveys a member of staff said the home would benefit from, better transportation to facilitate the increase of therapeutic activities outside the home. We saw that management were endeavouring to address this because in the AQAA the manager stated,we have purchased an additional vehicle (a people carrier), which will allow more access to the local community, activities, trips, and additional support and assistance with personal appointments. Menus had recently been reviewed and people using the service had been involved in a workshop to choose menus. The manager said that there was a three-week fixed menu to maintain good nutrition and a balanced diet. We had lunch with people using the service in the main dining room. The atmosphere was relaxed and unhurried as there were enough staff to serve the meals and support people. We saw that peoples files had their preferred food listed and that they were consistently offered choices. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported to maintain their health and their personal needs were met in the way they preferred and with respect for their choice, privacy and dignity. Evidence: In the AQAA the manager stated that, staff are trained to listen to our residents and deal with all personal and healthcare matters in a sensitive and respectful manner. We adapt our services to provide the support and care that residents would like and need in a way and at a time that suits them. Residents healthcare needs are assessed, recognised and addressed using guidance from appropriate professionals such as occupational therapists, psychiatrists, CPNs, GPs etc and appropriate support is put in place with the full involvement of the resident to ensure a person centred care plan is developed. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to two people, talked to people, the staff and the manager and looked at the information in surveys that three of the people using the service and six of the staff had filled in. When we looked at the files for two of the people using the service, we saw lots of evidence to demonstrate that their health needs were met by a range of healthcare professionals. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: We interviewed the GP for people who use the service. The GP explained that a monthly surgery is held at the home and people using the service also come to the surgery and are always accompanied by staff. The GP said that the service was, excellent, and that there was, constant communication. The GP explained that, they contact us a lot, but you can tell that theyve always got the care of residents as their first concern. The GP described the wide range of alcohol-related and other healthcare issues experienced by people using the service. The GP said that the home had managed people with terminal care with appropriate support, so that people could remain in the home for end of life care. The GP stressed that the manager and staff, always come to you if any medical or health care advice is needed, and added that the manager always follows instructions about medical issues. The GP was also pleased with the way that people were, weighed regularly and advice taken from dieticians. The GP concluded that the manager and staff, try to motivate people. People using the service were also pleased with the way they were supported to maintain their health and take their medicine. One person said, we have a full medical check, we are told what our tablets are for. Another person said, they help you to stay well, eat well, help you with medicine, if you take ill you press a button in your flat and staff come to you. We saw that medication was dispensed from a monitored dosage system kept in appropriately secured drug cabinets. Records, including the records of controlled drugs, were well maintained. Staff said that they had received training in the administration of medication and felt confident in what they were doing. Photographs of each person for whom medication was being administered, and details of their specific needs were seen. These details included their diagnosis, allergies, adverse drug reactions etc. The way that people were supported to take their medicine had improved since the last inspection by actioning a recommendation made to ensure that there was always a clear audit trail of medication. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were confident that the manager and staff would listen to their concerns and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. Evidence: In the AQAA, the manager stated that, complaints are welcomed, and time is spent during reviews and meetings ensuring that residents feel comfortable to approach staff, and understand the procedures in place to resolve their concerns. Residents know that their complaints are taken seriously and acted upon. Staff are trained to ensure that residents are protected from harm, abuse, and neglect. Procedures are in place for responding to any concerns and staff feel comfortable and regularly use the whistle-blowing policy. To see if this was the case, we looked at policies, procedures and records and talked to people, the manager and the staff. We also looked at the information in surveys that three of the people using the service and six of the staff had filled in. We saw that a copy of the complaints procedure was readily available and that a clear and detailed record of the investigation and outcome of complaints was held. All six staff that completed a survey said they knew what to do if someone had concerns about the home. People spoken to said that the manager listens to complaints and concerns and that Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: they could approach her with anything. One person said that if they had a complaint they would go to the manager and would, trust the manager, definitely. The GP for people using the service said that they, feel comfortable to discuss anything with the manager. One person concluded that, the home is continually improving and from the evidence Ive seen, everything that falls short of anyones expectations is investigated and rectified. This is good for people using the service. We saw that copies of the protection of vulnerable adults procedures were readily available at the home and that staff had received training in the protection of vulnerable adults. We also saw evidence to demonstrate that a safeguarding referral by members of staff had been dealt with appropriately by referring it to the adult protection team at Manchester City Council. This means that staff understand what to do in the event of a concern about peoples safety and are comfortable with the whistleblowing procedure. The GP for the people using the service explained that they were personally involved in a concern raised about bruising to a person. The GP concluded that it was dealt with, absolutely properly, and that they, absolutely trust the manager. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a warm, clean, safe, highly personalised and well maintained environment. Evidence: In the AQAA, the manager stated, we listen to our residents and staff and provide a clean and safe, homely environment which residents are proud to call their home. We provide creative solutions to problems around the building, that give maximum independence to individuals and meet residents needs. We support and encourange residents to personalise their own space and work as a group to make decisions about their communal environment. To see if this was the case, we talked to people, the manager and the staff. We also looked at the information in surveys that three of the people using the service and six of the staff had filled in. We were taken on a tour of the building, which included the bedrooms of the two people whose care wed looked at closely. We found that the premises was warm and homely and had been personalised both inside and out by displaying peoples art work and the beautifully maintained gardens that people using the servive maintained with the support of the gardening therapist. The home was clean and no unpleasant smells were noted. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: One member of staff who completed a survey said that, the residents are actively encouraged to participate in choices and decisions which affect the environment in which they live. People using the service talked about being motivated to be involved in the upkeep of the home and gardens. The focus was on involvement in, and responsibility for, the upkeep of their own home, thereby encouraging people to foster pride in their own home and to try to maintain a homely environment. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from support provided by experienced and committed staff. Overall, the recruitment procedure is robust enough to protect people and the need for a necessary improvement was recognised by the organisation. Evidence: In the AQAA the manager stated that, our home employs highly motivated, developed, and dedicated staff. Residents and staff are heavily involved in the recruitment and development processes within the House, and the recruitment of the right staff is paramount. The staff team is diverse and has a balance of skills, knowledge and experience that enable us to deliver an excellent service by sharing skills and knowledge. In addition to mandatory and formal training, staff are encouraged to access external development, training and qualifications which are beyond basic requirements. To see if this was the case we looked at the recruitment procedure, staff files and training records and we talked to people, the manager, and the staff. We also looked at the information in surveys that three of the people using the service and six of the staff had filled in. We saw that the recruitment procedure includes potential staff completing an application form, being interviewed, providing references and the manager ensuring that a POVA First check was obtained before a member of staff was recruited and Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: while awaiting the outcome of the Criminal Records Bureau (CRB) check. It was recommended that the arrangements for shadowing a new member of staff while the CRB was awaited were always documented. Although overall, people were cared for by staff that had been vetted, when looking at staff files, we saw that a full employment history wasnt always taken to identify any gaps in employment. It was recommended that all applications were carefully checked to make sure that a full employment history was provided. Some good recruitment practice was noted, including ensuring that people using the service were involved in the recruitment and selection of staff. We saw that staffing levels at the home did meet the choices and needs of people. The arrangements for staff training were a strength of the service. In particular, 13 of the 15 permanent care workers had completed the Skills For Care induction, all 15 of the permanent staff held the National Vocational Qualification (NVQ) level II and six staff had NVQ Level three. This demonstrates a strong focus on staff training and exceeds the minimum standard. One of the improvements noted since the previous inspection was the recruitment of a training and development coordinator whose role was to support staff through the sixweek induction and then assess and plan training for each member of staff. The training matrix provided evidence of staff being provided with a wide range of training, including recent training in medication administration, food hygiene, infection-control, pandemic flu, hand washing, safeguarding vulnerable adults, mental health, speech and language and fire safety. All six staff that completed a survey said that they were being given training that was relevant to their role, helped them to understand and meet the individual needs of people, kept them up-to-date with new ways of working and gave them enough knowledge about health care and medication. All six staff also said that their manager met with them to provide support and discuss how they were working either regularly (five), or often (one). People using the service were very happy with the staff. One person concluded that the staff were, fantastic, theyre like a family. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ran the home in the best interests of people who live there and their safety and welfare was promoted. Evidence: In the AQAA, the manager stated, I comply with all relevant standards and legislation to a high standard. Three of the Senior team have acquired NVQ Level 4, and 3 have attained the Registered Managers award, allowing for thorough Management processes within the House. I operate in an open and transparent way that allows all involved and connected with the service to be actively involved in the way that the House is run. To see if this was the case we looked at records and spoke to people, the manager and staff. We also looked at the information in surveys that three of the people using the service and six of the staff had filled in. The registered manager had been in the role for three years. She had previously been employed as an assistant manager and had worked at the home since 1999. She holds the NVQ level IV Registered Managers Award and we saw clear evidence to Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: demonstrate that she consistently updated her skills and training and always attended training provided to staff. Throughout the inspection process, we got feedback from people using the service and staff to say that the running of the service was excellent. One person using the service said,I cant think of anything thats not good, its run so well this place its unbelievable. Another person said that the manager was, great, fantastic, she deals with everything well, its changed my life around. The GP also spoke highly of the manager who was described as being, very, very good. The GP stated that, care of residents was the first priority. We observed that all interactions between the manager and staff, and between the manager and people who use the service, were respectful, caring and professional. When talking to people who use the service, many of them expressed the view that they, would be dead if we werent here. One person completing a survey who was asked about what was good about the service stated, everything, the staff, the residents, the care and support, everything, it literally saved my life. This is not a thought, feeling, or a theory, but a fact! I really cant thank and praise them highly enough. We saw that the service has a strong focus on quality assurance. This included holding regular meetings to establish peoples views and fully involving them in the running of the home. More formal quality audits were also completed and the outcomes collated and acted upon. The manager recorded information in the AQAA which demonstrated that health and safety procedures and checks were carried out at the home. We looked at fire safety records and saw that fire safety checks protected vulnerable people from the risk of fire. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 34 It is strongly recommended that all staff application forms are carefully checked to make sure that a full employment history is always provided and that the arrangements for shadowing a new member of staff while the Criminal Records Bureau (CRB) check was awaited were always documented. This is necessary to ensure that people are always reassured that staff have been carefully vetted to ensure their protection. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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