Care Home: Milbury 694 Pinner Road

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What the care home does well The home continues to encourage residents to be as independent as possible, while providing support in a manner that respects the privacy and dignity of the resident. Members of staff are knowledgeable about the individual needs of the residents. Residents are encouraged to have fun and to join in activities. The manager supports her staff team. We asked members of staff what the service does well and they told us that they work together as a team in the best interests of the residents, residents` rights are respected and that residents are offered choice. The reviewing officer told us that the home offers choice and opportunity to the individual to pursue their goals or interests and that the home works in partnership with other agencies. What has improved since the last inspection? The home has worked to comply with the requirements identified during the previous key inspection and this has improved the service provided. Key documents used in the home have been amended and record keeping is more thorough to, enable monitoring. Daily routines are more flexible allowing residents more choice. The maintenance programme has addressed areas where some repairs were needed. What the care home could do better: During this inspection 7 statutory requirements were identified. Food records need to include details of alternative meals served so that residents` preferences are documented. Wishes in respect of the care of residents who are seriously ill or dying need to be recorded so that cultural needs and religious beliefs are respected. Some minor repairs and refurbishment are needed to maintain a well kept appearance for communal areas and 1 of the bedrooms. Odour control systems for bedrooms must be effective so that residents have pleasant surroundings. Although the home has a good package of training for staff members the progress towards members of staff achieving an NVQ qualification is slow and more members of staff need to enroll for this training. Where care plans identify a specific need, which has implications for staff training e.g. Makaton this needs to be addressed. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Milbury 694 Pinner Road 694 Pinner Road Harrow Middlesex HA5 5QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Schofield     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Milbury 694 Pinner Road 694 Pinner Road Harrow Middlesex HA5 5QY 02088681894 F/P02088681894 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Milbury Care Services Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 694 Pinner Road is a care home providing personal care and accommodation for eight people who have learning disabilities. The home is owned by Milbury Care Services Ltd, which is a national, privately run, care organisation operating in excess of 200 care services across the country. The London regional office, based in Henley, South London, provides senior management support to the staff and manager of the home. The home is located within a residential area of North Harrow. It is within walking distance of shops and rail links. It is on the main bus route between Pinner and Harrow. There is parking available at the front of the house and there is parking in the streets close to the home. The home was opened in 1995. It is a spacious two-storey building that was not originally used for residential care but has been adapted. All the homes bedrooms are single rooms and there are bedrooms on both the ground and Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home the first floor. The home has two bathrooms, a shower room, and one other separate toilet with bathing and toilet facilities on both levels. Access to the first floor is by stairs only. The home has a good-sized garden that is accessible and maintained. Information about the home, including a copy of the homes Service User Guide, is available from the home on request. Fees for placement were made available to the CQC. Details are available, on request, from the manager of the home. There was one vacancy at the time of the inspection. 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 inspection consisted of visiting the care homes over 2 days. On the first day we called at 9.10am and finished at 12 noon. We then returned at 1.20pm and finished at 4.10pm. The next day we arrived at 3.55pm and left at 5.35pm. During the time spent in the home we looked at all areas of the care home and with the permission of the residents we included viewing the bedrooms. We also looked at policies and procedures and staff files. We case tracked the care of a sample of residents and examined records. We checked compliance with the statutory requirements identified during the previous key inspection in 2007. We spoke with the manger, members of staff and met residents. We also observed the interaction between carers and residents as the feedback from residents was limited. Prior to the inspection we received 9 completed survey forms from members of staff and 1 from a local authority reviewing officer. We Care Homes for Adults (18-65 years) Page 6 of 32 would like to thank everyone for their assistance during the inspection process. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. A comprehensive assessment of the needs of the resident, prior to admission to the home, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. Visiting the home prior to admission enables the resident to decide whether they would like to live there. Evidence: Since the last key inspection in 2007 a resident has transferred to Pinner Road from one of the companys other care homes, that was closing. We saw that information supplied to Pinner Road, by the previous care home, included the personal details of the resident, a list of their likes and dislikes, an account of their preferred daily routines, their weekly plan, details of their health, medication and allergies and details of their diet and finances. The previous care home had also supplied copies of the last 2 monthly summaries of progress towards meeting targets identified in the care plan. The manager told us that as part of the pre admission process the prospective resident had spent a day at Pinner Road and had also had an overnight stay in the home. This gave the prospective resident the opportunity to view the accommodation and see the Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: immediate neighbourhood, meet the staff team and the residents already living in the care home and decide whether they would like to live at Pinner Road. When they visited during the day an advocate from Mencap accompanied them and the advocate supported them throughout the pre admission procedure. However, the records of what happened during these visits and the reactions of the residents already living in the home, which were recorded in the daily diary, have been archived and stored in the loft. The manager added that as the prospective resident was already receiving a service from the company a formal pre admission assessment was not carried out although she and the manager from the previous care home had met and discussed the needs of the new resident. This enabled the manager of Pinner Road to confirm that the service provided by Pinner Road could meet the needs of the prospective resident. At the time of the closure of the other care home Pinner Road had 2 vacancies but the company had carried out a matching process and only this person was referred to Pinner Road as a prospective resident. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed and regular reviews of the placement confirm that the care home continues to be able to meet the individual needs of the resident. The financial interests of residents are protected. Responsible risk taking contributes towards the resident leading an independent lifestyle. Evidence: We selected 3 residents to case track their care pathways. At present the manager is introducing a new format for the case file which includes risk assessments being identified for each need in the support plan and for these to be filed as they are identified rather than in a separate section. Support plans are more detailed and include a violence and aggression individual residents risk assessment. The new format gives a more logical and clearer picture of the needs of the resident and how they are to be met, while promoting and maintaining the safety and welfare of the resident. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: We asked members of staff on the survey form if they were given up to date information about the needs of the residents they supported and gave the care plan as an example. Six members of staff ticked always, 2 members of staff ticked usually and 1 member of staff ticked sometimes. We saw evidence that the plan of support had been reviewed on a regular basis, including a review meeting convened by the placing authority. However review meeting minutes from the local authority in 2008 had not been sent to the home. It is recommended that after 4 weeks from the date of the review meeting contact is made with the local authority if a copy of the minutes have not arrived. The home has a system of monthly summaries where the care plan and progress towards meeting goals is evaluated. When looking over the last 7 months these were not complete. We discussed advocacy services for residents as we had seen that an advocate supported the resident that had moved into the home most recently. The manager said that they could contact this advocate again if any resident in the home needed support. We then talked about residents finances and the manager said that all of the residents living in the home have a member of the company acting as their appointee. At the moment they are in the process of transferring this task to the manager and to the deputy manager in the home. We looked at the financial records of the residents that we case tracked. We noted that these were comprehensive and up to date. We saw that when the operations manager carries out an audit the records are signed. In addition a member of head office carries out an annual audit. Procedures are in place to follow when larger sums of money are to withdrawn or spent. We noted from the records that if a resident buys a meal out the home makes a contribution towards this. We saw that each case file contained a number of risk assessments. These were tailored to the individual needs of the residents and included the risk of falling, having a seizure, choking, becoming upset and developing dry skin. There was evidence that these were reviewed on a regular basis. General risk assessments relating to the group of residents are reviewed on an annual basis. Risk assessments related to an individual resident are reviewed every 6 months as part of the care plan review or more often if the need arises. Risk assessments identify the risk and also include risk management strategies. Care Homes for Adults (18-65 years) Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents attending day care services are provided with an opportunity to develop their social skills. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships. Residents are encouraged to make decisions and their wishes are respected. A varied and wholesome diet is offered to residents so that their nutritional and cultural needs are met. Evidence: We discussed the day care programme for each individual resident with the senior support worker, who was on duty. Residents have day care programmes that include day centre attendance although they have a day(s) at home between Monday and Friday. When we looked at the residents case files we saw that they contained a Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: weekly plan which also included evening and weekend activities and those occurring on the residents day(s) at home. Residents use the resources in the community including the cinema, snooker club, discos, swimming pool, restaurants, pubs, churches and parks. The home has the use of its own transport, which can accommodate 5 residents and 2 members of staff at any one time. Some residents also have a freedom pass for using public transport and some have a taxi card. Residents names have been entered on the electoral roll. The senior support worker that we spoke with is responsible for planning the annual holidays for residents in 2009. For residents wishing to go abroad there will be a choice of venue between possibly Spain or Turkey. For those residents where a holiday in the UK is more appropriate she is is looking into different options. Last year 5 residents went on holiday to Bognor Regis, 1 resident went to Blackpool and 1 resident went to Chester. Photographs of a previous holiday to Teneriffe were on display in the lounge. We discussed outings and activities with the manager. Residents go to a local theatre each month. Weekly music sessions are held in the home and these rotate between a piano session, guitar session and karaoke. During the inspection a karaoke session took place and we saw that the person coming to do the session chose the tracks according to the likes of each individual resident. Residents were encouraged to join in and to dance and they enjoyed the session. One of the residents fetched their guitar to strum along with the music. Weekly massage sessions are offered and residents can also relax in the home or play cards, do puzzles, watch television etc. A copy of the visitors policy was on display in the entrance hall. When visitors come to see residents the visits can take place in the privacy of the residents room or in the lounge, according to the wishes of the resident. It is an open door policy and visitors are made welcome to the home. One of the residents goes to visit their relatives. Residents are encouraged to develop their independent living skills by taking part in the household routines. One of the residents goes with a member of staff to help when shopping for the home is bought. With support residents are encouraged to help with the hoovering, taking their laundry to the laundry room, putting items in the dishwasher etc. The manager told us that at the last review meeting for the one of the residents a proposal was made to consider the option of supported living. We talked with members of staff about offering residents choice and in our observations of the members of staff care practices noted that residents were encouraged to make choices and that their wishes were respected. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The menu is prepared weekly and we saw a copy of the current and previous weeks menus. The daily menu is written on the white board in the dining room. Menus are varied and wholesome and do not list a dessert although the manager said that these are available. The home is trying to encourage a pattern of healthy eating. There is choice on the menu with 2 options for the lunch dish and 2 options for the evening meal dish. Although a record was kept of which residents had something different to the main dishes we noted that what the alternative was had not always been recorded. Residents are encouraged, with support, to prepare light snacks or drinks and 1 resident likes to peel the potatoes. Although there are no particular dietary needs 1 of the residents is African Caribbean and her care plan includes being given African Caribbean foods to meet her cultural needs. We saw that some foods for her were included on the menu and these were being prepared for the evening meal during the inspection. There is a large dining room with a table that can accommodate all the residents at one sitting. Care Homes for Adults (18-65 years) Page 16 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. Residents receive assistance with personal care in a manner, which respects their privacy. Access to health care services in the community assures residents that their health care needs are met. The general well being of residents is promoted by assistance or support from staff in taking medication, as prescribed. Evidence: We selected 3 case files to examine and looked at personal care and health care information. Files contained preferred daily routines to guide members of staff when they assist residents. There were also guidelines for members of staff when they support residents with epilepsy. Files contained a health action plan with evidence that it had been recently reviewed. One plan of support referred to pressure care as the resident uses a wheelchair most of the time although they can transfer and walk for short distances. We noted that pressure relieving equipment was in place for this resident, including a pressure relieving mattress and a special chair in the lounge for the exclusive use of the resident. A risk assessment in respect of pressure sores was present on their case file. Each file contained a manual handling initial appraisal and a people handling risk assessment. On one file there were guidelines to encourage Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: continence. When looking at case files we saw that residents had access to health care services. Appointments with the GP had been recorded. There were regular appointments with the dentist, optician, psychiatrist and chiropodist. The weight of residents is monitored and we saw that where there were concerns about a weight loss this was referred to the dietician. A referral has also been made to the endocrinology out patient department. We checked the storage of medication in the home and saw that it was safe and secure. The home uses the blister pack system for the administration of medication and when we looked at these we noted that the blisters had been emptied in accordance with the day of the week and the time of day that the inspection took place. Records of the administration of medication were made available. These were up to date and complete. None of the residents self medicate. We noted that one resident has a problem taking tablets and that the medication is given in food. This was documented on their case file and a letter of agreement to this practice was signed by the epilepsy nurse specialist. Guidelines had been produced for members of staff and they included letting the resident know that the tablets were in his food. We spoke with a senior support worker and they confirmed that they had undertaken medication training. They added that the manager assesses the member of staffs competence before the member of staff is allowed to administer medication. At present the home has identified a need for serious illness and funeral arrangements to be recorded on each case file. Care Homes for Adults (18-65 years) Page 18 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. A complaints procedure is in place to protect the rights of residents. An adult protection procedure and training for staff members in respect of protection of vulnerable adults procedures help to promote and protect the welfare and safety of residents. Evidence: We spoke with the manager about the complaints procedure. We had noted when we arrived that a copy of the Complaints and Compliments procedure was on display in the entrance hall. The procedure has timescales attached for each stage of the process and if a resolution cannot be achieved locally then the matter can be referred to a senior person within the company to investigate. The procedure advises the complainant of other agencies that may be contacted. The address for the CQC was out of date and it is recommended that details of the National Contact Team replaces this. The nine members of staff completing a survey form agreed that they knew what to do if anyone raised concerns about the home. A survey form completed by a reviewing officer confirmed that the service has responded appropriately if they or a person using the service had raised any concerns. They added the home acts promptly to address concerns that have been brought to their attention. When we looked at residents case files we saw that they contained a copy of the procedure for residents to raise concerns or to say if they are not happy about something. The format was suitable for the needs of residents. It could be used for a compliant or for a Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: disclosure of abuse. The manager told us that no complaints have been recorded during the previous 12 month period and none have been made directly to the CQC. There is an adult protection procedure in place in the home. Members of staff on duty during the inspection confirmed that protection of vulnerable adults (pova) training is mandatory and is refreshed on a regular basis. They told us that they had undertaken pova training already this year and they were able to explain the procedure to us and were aware of their duties and responsibilities in the event of a disclosure being made. Each of the members of staff said that they would comfort and reassure the resident concerned. The manager has also undertaken safe guarding training and has previously attended the investigating officer training course. A safe guarding referral was made to the local authority regarding one of the residents. This was made by a day centre manager in respect of an incident that occurred in the day centre. We were told that it was investigated and that appropriate action was taken. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a care home that is generally well maintained, although some minor redecoration and refurbishment is needed. Effective odour control systems would provide each resident with a bedroom that is pleasing to sit in and to relax. Residents are assured of clean laundry as suitable facilities are provided in the home. Evidence: During the inspection we carried out a tour of the premises. It was a warm day and we noted that residents were enjoying using the garden, either to relax in or to play football. There is a large patio area to the side of the house and a large area at the rear, which consists of mainly lawn and shrubs. As we walked around the house we noted that some of the radiators were on, despite the weather, and the temperature was uncomfortable close to these. We were told that there was a problem and that this was being investigated. Generally the upkeep of the property was good and it was comfortably furnished. There is sufficient communal space for residents on the ground floor and bedrooms are of a good size. However, the carpet in Room 2 was in need of cleaning or replacement and the paintwork on some of the woodwork and door frames in the home was chipped and scratched. The covering on the arms of the settees in the lounge was Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: cracked. There was an odour of urine in both Room 6 and Room 8. Laundry facilities are sited on the ground floor and there is a commercial sluice washing machine and commercial dryer. An infection control policy and procedures are in place in the home and the manager confirmed that training in respect of infection control procedures is mandatory for members of staff. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Increasing the number of members of staff taking part in a programme of NVQ training would assure residents that care practices are based on an understanding of the residents needs. Staffing levels in the home assure residents that there are sufficient members of staff on duty each day to support the residents and to meet their needs. Giving basic Makaton training to the staff team would assure residents that members of staff have the communication skills necessary to meet the needs of each of the residents. The safety and welfare of residents is promoted by good recruitment practices. A training programme is in place to provide members of staff with opportunities to develop their skills and knowledge. Evidence: There are 16 names of members of staff on the rota, excluding the manager. She informed us that 3 members of staff were studying for the LDQ, which is a course prior to NVQ level 2 studies and which replaces the LDAF training. In addition, 3 members of staff are currently studying for their NVQ level 2 or 3 qualification and a further 3 members of staff already have achieved an NVQ level 2 or 3 qualification. However, even if the 3 members of staff successfully complete their NVQ training the home falls short of providing a staff team where a minimum of 50 of its members hold an NVQ level 2 or 3 qualification. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: We observed the interaction between members of staff on duty and the residents and noted that members of staff were respectful to residents. When we spoke with members of staff they demonstrated that they were interested and committed to the work that they did. Although we noted on one of the case files that we examined that a need for staff to use Makaton when communicating with the resident had been identified the manager said that staff had not received Makaton training. We discussed staffing levels with the manager and looked at the current rota. All but 3 of the 16 names on the rota are permanent members of staff. In the morning there are 3 members of staff on duty and in the afternoon and early evening there are 4 members of staff on duty. At night there is 1 member of staff on waking night duties and another member of staff sleeping in but on call. The rota consists of both male and female members of staff. The managers hours are partly supernumerary but some hours are included as part of the staff team on duty, directly supporting the residents. When we asked members of staff on the survey form whether there are enough staff to meet the individual needs of all the people using the service, 6 members of staff ticked always and 3 members of staff ticked usually. When looking at recruitment practices 3 staff files were selected at random. One of these 3 members of staff that the files belonged to had been recently appointed. There was evidence to confirm that application forms had been completed, references had been taken up and that enhanced CRB disclosures are in place. We queried 2 files where proof to work or to reside in the UK was not clear and the manager said that she is in the process of following this up with the staff team as a whole and hopes to complete the task by the end of June. Training records were made available. We noted that there was evidence of induction training on the staff file that belonged to a newly appointed member of staff. The manager explained that the induction training covered a 6 week period and included information on health and safety, communication, conditions of employment, conduct and an introduction to the home. When we asked members of staff on the survey form if their induction had covered everything they needed to know to do the job when they started, 6 members of staff ticked very well and 3 members of staff ticked mostly. They all agreed that the training they have received since then is relevant to their role, helps them to understand and meet the individual needs of the residents and keeps them up to date with new ways of working. The company uses the El-Box training package for areas of learning that do not require a physical element. Other courses are carried out in a group as they contain a practical element e.g. manual handling where techniques are demonstrated and practised. When speaking with members of staff on duty they confirmed that training given covered safe working practice topics, Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: medication, pova and courses to meet the needs of the residents. While the inspection was taking place we met a person on placement in the home as part of the first year of their nurses training course. Care Homes for Adults (18-65 years) Page 25 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. The manager demonstrates her competence and commitment to a quality service by continuing to develop her understanding, skills and knowledge through further training. Systems are in place to gather feedback on the quality of the service provided to enable the service to develop in ways that meet the changing needs of the residents. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents and regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Evidence: The manager was appointed to the post at Pinner Road in August 2007 and her application to be the registered manager of the home that was submitted in 2009 has been acknowledged by the CQC. She has worked for the company since 2001 and has progressed from being a support worker, senior support worker, deputy manager and then manager. She has 6 years managerial experience and has achieved NVQ levels 2, 3 and 4 and the Registered Managers Award. Over the previous 12 month period she Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: has undertaken fire safety awareness training as a fire warden, mental capacity act training including deprivation of liberty safeguards, manual handling training and medication training for managers. When we spoke with members of staff on duty they said that they received good support and regular supervision from their manager and that regular team meetings took place. On the survey form for carers we asked whether their manager met with them to give them support and to discuss how they were working and of the 9 completed forms, 6 people had ticked regularly, 1 person ticked often and 2 people ticked sometimes. A discussion took place about quality assurance systems in place in the home. An annual service review takes place and questionnaires are sent to stakeholders i.e. relatives, doctors, social workers etc. The information obtained is used to inform the operations manager conducting the service review. In addition, the quality assurance manager carries out quality audits in the home and these include feedback from members of staff and from residents. The service manager is responsible for carrying out the monthly Regulation 26 visits to the home. Residents meetings are held on a monthly basis and regular staff meetings are held. Review meetings give relatives and reviewing officers an opportunity to comment on the care provided and there are informal occasions such as visits to the home where relatives can speak to the manager or to a member of staff. On a day to day basis the manager can monitor the quality of care provided and observe whether the residents are satisfied with the support given. Staff confirmed that they have received training in safe working practice topics and that these are refreshed on a regular basis. The manager explained that the computer soft ware package used for staff training flags up when refreshers are needed. The LFEPA carried out a recent inspection of the home in February 2009 and it was deemed to comply with the fire regulations. The home also had a valid service or inspection certificate for the portable electrical appliances, the electrical installation, the gas appliances, the fire precautionary systems and the fire extinguishers. Testing of the fire alarms and smoke detectors and the holding of fire drills were recorded and up to date. A recent visit by the environmental health officer had resulted in a 3 stars score on the door (good) for food hygiene standards. There was a valid employers liability insurance certificate on display in the entrance hall. Care Homes for Adults (18-65 years) Page 27 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 28 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 17 17 When a resident is given an alternative to the main dish the name of the resident and what the alternative is must be recorded. By maintaining complete food records the home is able to demonstrate that meals are given that are in accordance with the residents preferences. 11/07/2009 2 21 15 When drawing up and reviewing the plan of care the arrangements to be made in the event of a serious illness or of the death of the resident are to be included. This will enable the plan of care to reflect and to respect the wishes of the resident or their representative. 11/09/2009 3 24 23 When drawing up the 10/09/2009 maintenance programme for the home the making good and repainting of woodwork Page 29 of 32 Care Homes for Adults (18-65 years) and door frames as necessary and the recovering or replacement of the settees in the lounge is included and carried out. This will enable the residents to enjoy communal facilities that are in a good state of decoration and repair. 4 24 16 When drawing up the 10/09/2009 maintenance programme for the home the cleaning or replacement of the carpet in Room 2 must be included and carried out. This will enable the occupant of Room 2 to enjoy pleasant surroundings. 5 30 16 Effective odour control systems must be in place in residents bedrooms. This will enable residents to enjoy a bedroom that provides an odour free environment and is pleasant to use to sit and relax in. 6 32 18 The number of members of staff undertaking NVQ training must increase to a level where the home can meet the target of 50 of carers with an NVQ level 2 or 3 qualification. This will ensure that residents are supported by members of staff whose working practices are underpinned by a knowledge 10/06/2010 10/07/2009 Care Homes for Adults (18-65 years) Page 30 of 32 and understanding of the needs of the residents. 7 33 18 When drawing up a list of training courses for members of staff understanding and being able to use some basic Makaton is included and this training is then provided. This will enable the staff team to support a resident by using a means of communication that the resident is familiar with. 10/09/2009 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 6 That contact is made with the local authority reviewing officer if the minutes of the review meeting have not been received by the home within 4 weeks of the meeting taking place. That the monthly summaries of the care plan and of the progress made towards goals identified are completed on a regular and consistent basis. That details of the National Contact Team for the Care Quality Commission replace the details currently in the homes Complaints procedure. That the problem with the radiators is investigated and resolved so that these are off in periods of warm weather. That all of the hours worked by the manager are supernumerary and not included on the rota of those people giving direct support to residents. That the manager completes the task of establishing the right of members of staff in the home to work or to reside in the UK within the timescale that she has been given. 2 6 3 22 4 5 24 33 6 34 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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