Care Home: Murree Residential Care Home

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What the care home does well When we spoke with residents we asked what was good about the service provided. One of the residents told us that the staff "look after us well" and that he got on well with the people working in the home, whom he named. He had enjoyed the holiday that he had been on last year with another of the residents and said that he and the other resident got on very well together. The friendship was important to both of the residents. The resident was appreciative of the accommodation and more than pleased with his room. He was satisfied that the home responded promptly to his health care needs and said that he was happy living in the home. The majority of staff working in the care home were able to speak to an Asian resident in his first language i.e. Urdu. Support was given to the resident so that he could attend the mosque. Meals served in the home included Asian dishes and when the resident went to a restaurant he was able to enjoy culturally appropriate dishes. The television in the home receives programmes broadcast in Urdu. What has improved since the last inspection? During the last key inspection in June 2009 seventeen statutory requirements were identified. We reviewed compliance during this inspection and noted that the manager has addressed most of the issues that were raised. We have commented on the resolution of some of these during the body of the report. As no recruitment of staff has taken place since the last key inspection the home was unable to demonstrate that their practices have been amended. The redecoration of one of the bedrooms has not taken place yet as the resident is going to select a timescale that is suitable to them. What the care home could do better: During this key inspection we identified 5 statutory requirements. Records of assistance with financial transactions were not available for inspection. The book had been given to a relative to check. As records must be kept on site, the home must ensure that records are checked at Murree House and that important documents are not removed from the property. This is to ensure that records are not lost and that the home is able to demonstrate that the financial interests of resident are promoted. The redecoration of 1 of the residents` bedrooms needs to be carried out because the resident has requested a change. However this requires a plan and a risk assessment that is agreed with the resident and where the timescales specified meet the resident`s needs. A minor repair is needed to the panelled flooring in the in the lounge so a future hazard is avoided. Refresher training in manual handling is needed as this is overdue and competence relies on an awareness of current best practice. More detail in the training plan is required so that the manager is able to monitor and assess the need for training and ensure that planned training supports the aims and objectives of the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Murree Residential Care Home 17 Marquis Close Wembley Middlesex HA0 4HF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Schofield     Date: 2 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Murree Residential Care Home 17 Marquis Close Wembley Middlesex HA0 4HF 02089031571 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): murreecarehome@ntlworld.com murreecarehome.co.uk Mrs Shahnaz Abbasi Name of registered manager (if applicable) Mrs Shahnaz Abbasi Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Murree House residential care home provides personal care for up to 3 adults with learning disabilities. At the time of the inspection there were no vacancies. The property is off a road, which is part of a route linking Ealing Road with the North Circular Road. There is a barrier across this road, close to the home, and so access to the home by vehicle must either be from the North Circular Road or by using a detour around the barrier, if approaching from Ealing Road. There is space to park outside the home on the street. Although there is a paved area at the front of the house there is Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home no dropped kerb. Inside the home there is a bedroom on the ground floor and 2 bedrooms on the first floor. There are bathing and toilet facilities on both floors. There is a kitchen and an open plan loungedining area on the ground floor. The office is on the first floor. The laundry room is in a building in the attractive garden at the rear of the house. Information about the service provided and the level of fees may be obtained, on request, from the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We carried out the key inspection of the care home on the 27th April. The inspection started at 9.05 am and finished at 2.15 pm. During the inspection we looked at the residents case files. We looked at records including staff records and records associated with the running of the service. We referred to policies and procedures. We inspected the storage, handling, administration and recording of medication. We carried out a site visit. We checked compliance with the previous key inspection that took place in June 2009. We spoke with the manager and 2 members of staff. We met 2 of the 3 residents living in the home. We would like to thank everyone for their comments and assistance. Prior to the inspection we requested and received a copy of the homes Annual Quality Assurance Assessment (AQAA). We also received 2 completed survey forms from residents. Thank you. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 31 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Trial visits to the home prior to admission enable the prospective resident to sample life in the home and to decide whether the service provided is acceptable. Evidence: Although there have been no new admissions to the care home since the previous key inspection we reviewed the preadmission process with the manager. She confirmed that when a referral is received she requests copies of all the key documents, including care plans and risk assessments. The process also includes a visit by the manager to meet the prospective resident and to complete an assessment of need. When we looked at case files we saw that these documents were in place. We noted that the assessment of need was comprehensive and included the identification of cultural and religious needs, general health and medication, personal care and domestic skills, social contact and communication, community skills, leisure and day care, financial arrangements, behavioural problems and general attitude and risk Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: assessment. The assessment of need document is used to form the basis for the development of the care plan. The manager may also attend planning meetings prior to a new resident coming to live in the home and will help to draw up a transition plan so that the prospective resident has a programme of visits to the home. This programme includes short visits which lead to overnight and weekend visits. During the visits the prospective resident has an opportunity to view the accommodation, meet the residents currently living in the care home, meet members of the staff team and see the day to day routines. We noted when looking at case files that there was evidence that a programme of visits had taken place. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Regular reviews of the care plan and placement take place to assure residents that the care home continues to meet their needs. Residents have opportunities to exercise choice in aspects of their daily lives. Responsible risk taking contributes towards the resident leading an independent lifestyle. Evidence: We looked in detail at the case file of 1 of the 3 residents and then reviewed new information since the last key inspection for the remaining 2 case files. We noted that on each case file there was a care plan assessment and a care plan. The funding authority had reviewed the care plan and placement in 2009 for each resident. In addition, the care home carried out internal reviews on a regular basis. We discussed the availability of minutes of review meetings convened by the funding authority and recommended that the manager contacts the relevant local authority when these become overdue. During the last key inspection we noted that the kitchen door was kept locked during Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: times when one of the residents is prone to overeating. We discussed this situation with the manager who said that it had been discussed during the review meeting and a suggestion had been made to remove certain items from the kitchen. The manager said that staff are now alert to triggers which may prompt the resident to overeat and are monitoring the residents behaviour. As a result of this, the kitchen is now open during the day and only locked when the member of staff on sleeping in duties goes to bed. Drinks are provided in the residents rooms at night. One resident who is awake at night and sometimes wants a snack has a key to the kitchen as the resident is able to prepare a snack without support. We looked at the residents ability to make decisions and the manager confirmed that 1 of the residents continues to manage their financial affairs. The second resident is supported by their family and the third resident receives support from the care home. We were not able to view the records in respect of the support provided by the care home. We were informed that as the record book for all transactions made was complete the relative of the resident had taken the record book and the account book away to check. When we looked at case files we saw that they contained risk assessments. Previously the manager has attended risk assessment training. Risk assessments were tailored to the individual needs of the residents and included a fear of dogs and the risk of running away to avoid them, consuming large amounts of food etc. The format was comprehensive and included evaluating the risk, determining the likelihood of occurrence and risk management strategies. We noted that risk assessments are reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social, religious and cultural needs of residents are respected. Residents are encouraged and supported to maintain contact with their family and friends. Taking part in the daily routines in the home encourages residents to develop independent living skills. Residents have access to a diet which meets their personal preferences and their cultural and religious needs. Evidence: When we spoke with 2 of the residents they confirmed that they continued to attend a centre, which is within walking distance of where they live. The manager said that they attend the centre on 3 days per week. One of the residents said that they have played snooker at the centre and that they sit and socialise with other people that are there. On one of the days they attend Stonebridge college. We spoke with the manager about the residents day care programmes. One of the Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: residents continues to go out every day and during the week they go to the library, attend college and go to a clinic. They are continuing to attend a computer class and now attend a photography class. She said that at the centre one of the residents enjoys music sessions. On the 2 days that the residents do not attend the centre she said that they try to go out and when asked what the residents did the previous week we were told that they had gone to Roundwood Park on one day and Ealing park on the other day as the residents like football. We discussed the spiritual needs of the residents and the manager said that one of the residents goes to church on a Sunday and another resident attends a religious session at the centre on a Friday. This person also attends mosque with their family members. Members of staff are able to support the resident with prayers in the home. Residents use community resources and facilities including parks, swimming baths, places of worship, restaurants, shops and cinemas etc. They travel on public transport, use dial a ride, use the homes vehicle or walk. Previously the manager has told us that the names of residents are entered on the electoral roll. We discussed the forthcoming general election and a resident told us that they had found the second debate between party leaders interesting and that they planned to vote next week. We asked the residents if they had been on holiday in 2009 and were told that two of the residents had enjoyed a holiday in Broadstairs. They told us that they had stayed in a cottage and that they had visited a nice pub. The manager said that they are looking into a holiday abroad for 1 of these residents. He has an interest in history and has expressed a wish to go to Pakistan. The third resident went abroad on holiday with his family on 2 occasions in 2009. He decided that he did not wish to join the other residents when they went to Broadstairs. Residents also go to the Apple club, if they wish, and have gone to Brighton for the day (twice) and had outings to Brent Cross, the Christmas lights, events to mark Eid and Diwahli, central London, the British Museum etc. When relaxing in the home there are board games and videos for residents to use. Residents told us that they had visits from family members and all of the residents go to visit their families. The manager said that one of the relatives was elderly and in poor health so they were taking the resident to see their relative. Residents confirmed that they can entertain visitors in their bedroom if they wish. They also confirmed that their relatives are made welcome by the member(s) of staff on duty and are offered refreshments. Residents also have visits from friends. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: When going to the local shop the 2 residents, who are good friends, will often go together as they are encouraged to become more independent. When out shopping residents are encouraged to exercise choice and will select ingredients for mealtimes. Residents choose what clothing to wear. They choose whether to spend time privately in their room or to sit in the lounge and enjoy company. They are encouraged to keep their rooms tidy and with support, to make the bed. Residents help with the shopping and may help with the hoovering. One of the residents likes to water the plants in the garden. Residents are encouraged to help with making a drink or a snack. One of the residents told us that the registered manager and her husband are both good cooks. He said that he liked cooking and that he does some cooking in the home and helps the manager. Records of the meals consumed by residents were available for inspection and confirmed that residents are able to exercise choice. They were up to date. They also demonstrated that residents do not have to have the same meal as each other. We looked at the menu plan and noted that it included meals to suit the cultural and religious needs of residents and their individual likes and dislikes. The manager confirmed that Halal meet was purchased for an Asian resident. She said that residents are consulted before the preparation of the evening meal takes place. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive prompting with personal care in a manner which respects their privacy and dignity. Residents health care needs are met through access to health care services in the community. Residents general health and well being is promoted. Evidence: When we arrived at the care home 1 of the residents had already left the care home to travel to college. During the inspection the other 2 residents left to go to the day centre. Residents, on leaving, were clean and tidy and dressed appropriately, according to the season. We had seen the third resident in the week prior to the inspection, when they were traveling to college, and they were immaculately turned out. This resident is self caring. The other 2 residents need prompting and some assistance with personal care. Progress in encouraging 1 of the residents to maintain a good standard of personal hygiene is continuing. We noted that both of the residents that we met looked well and one of the residents told us that that his health was good, although shortly after he first moved into the care home he had a minor stroke. He said that the home had acted promptly when this happened and had supported him. The manager informed us that after support Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: and encouragement 1 of the residents has agreed to have a minor operation, possibly as a day patient, for a problem that predated their admission to the care home. A resident told us that he had been to the optician and to the dentist recently and the manager confirmed that each of the residents had seen the dentist, although 1 resident refused to open their mouth to allow the dentist to examine his teeth. Two of the residents have had their eyes tested and 1 of these residents has spectacles. There was evidence that medication reviews take place and that CPA meetings take place, as required. Residents have outpatient appointments with the psychiatrist and there was evidence that some one from the care home accompanies them to give support. Two of the residents receive assistance with their medication and the third resident does not take any medication. We noted that a new system of administering medication to residents is in use. It consists of a weekly blister pack with a disposable cardboard cover. We looked at these and noted that the blisters had been popped in accordance with the time of day and the day of the week on which the inspection took place. We looked at the records of the administration and these were up to date and complete. The storage of medication is safe and secure. The manager confirmed that each member of staff has received training in the safe administration of medication. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy and training contributes towards the safety of residents. Evidence: We discussed the complaints procedure with the manager. A complaints procedure is in place and includes timescales for resolution of the complaint and advises the complainant of their right to refer to other agencies. We were told previously that the complaints procedure is discussed during the pre admission procedure and a summary is included in the service users guide. When we have spoken with 2 of the residents they have told us that they are aware of their right to complain if they are not satisfied with the care received. As this is a care home for 3 residents the manager said that she speaks with the residents on a day to day basis. She said that no complaints have been recorded since the last key inspection. When we spoke with a resident during the inspection they expressed satisfaction with the service provided. There is a comprehensive protection of vulnerable adults policy in place and this includes a whistle blowing procedure. The policies and procedures manual includes a policy for supporting residents with challenging behaviour. There is a copy of the local authoritys inter agency guidelines in the event of abuse. People working in the home have undertaken safeguarding training. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: An anonymous allegation of verbal, emotional and physical abuse had been made directly to the regulatory authority in 2009. The police investigation has been completed and no action was taken. The care home commissioned an independent investigation to determine whether disciplinary proceedings were required. The independent investigation is now complete and no action is to be taken. The member of staff has returned to duty. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a comfortable and homely environment with pleasant communal facilities. An ongoing programme of refurbishment assures residents that the maintenance of the property is kept to a good standard. Single bedrooms provide residents with privacy and somewhere to relax. Residents live in a home where standards of cleanliness. Bathing and toilet facilities are appropriately placed. Training in infection control procedures assures residents that good hygiene practices are in place. Evidence: The home is close to local shops and transport facilities and its appearance is in keeping with neighbouring properties. We carried out a tour of the premises and noted that the home was bright and airy. The home was comfortably furnished and the decor provided a homely atmosphere. Lighting, heating and ventilation were suitable for the time of year and weather conditions. Each resident has their own single bedroom. One of the 3 bedrooms is situated on the ground floor and the other 2 bedrooms are situated on the first floor. All 3 bedrooms are above the minimum of 10 square metres and are spacious. One of the residents told us that the upkeep of the home is good and that he liked the bedroom that he occupies as soon as he saw it. It was the one that he chose from a choice of 2 vacant Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: bedrooms. We asked the manager about the room where the resident said that he would prefer to have plain walls rather than wallpaper. The room has not been redecorated yet and the manager said that the resident would prefer to wait until there was fine weather. There are bathing and toilet facilities on both ground and first floor. There is a shower room, containing a toilet and a wash hand basin, leading off from the dining area, on the ground floor. There is a bathroom, containing a toilet and wash hand basin on the first floor. Each of the bedrooms contains a wash hand basin. There is a combined lounge and dining area, which is comfortably furnished and decorated. We noted when looking at the panelled flooring in the lounge area that some of the boards are lifting slightly at the edges. Residents have access to a garden at the rear of the property, which has a lawn, patio area and borders containing mature shrubs. There is a combined office and sleeping in room for staff on the first floor. While walking around the premises we noted that all areas were clean and tidy and free from any offensive odours. The laundry facilities are situated in a building in the garden and include facilities for the member of staff to wash their hands. The washing machine has a sluicing cycle. There is an infection control policy in the homes policies and procedures manual. Members of staff have undertaken training in respect of infection control procedures. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assisted by qualified members of staff. Staffing levels were sufficient to support the residents and to meet their needs. Recruitment practices assure residents that their safety and welfare is promoted. Further work on the training programme would reassure residents that planned training is linked to the needs of residents. Evidence: We reviewed NVQ training for members of staff. Of the four members of staff, 1 member of staff has completed their NVQ level 4 training, 1 member of staff has completed level 3 training, and the other 2 members of staff have completed their level 2 training. The home has exceeded the minimum of 50 of carers achieving an NVQ level 2 or level 3 qualification. We looked at the rota for week commencing the 26th April. The staff team consists of the manager and 4 members of staff. We noted that there is always at least 1 person on duty when residents are present in the home. The person that is on duty during the evening then carries out the night duties and is asleep in the home but on call, in the event of a resident needing assistance. There are male members of staff and female members of staff. One of the residents speaks and understands both Urdu and English and 4 persons working in the home speak Urdu. Staffing levels are sufficient to meet the needs of the residents and to allow for choice of activities and availability of a Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: member of staff to act as an escort etc. Four members of staff are drivers and able to drive the homes vehicle. Three staff files were examined. Each of the files contained an application form and passport sized photograph. Each file also contained 2 satisfactory references, an enhanced CRB disclosure and proof of identity (passport details). No new members of staff have been recruited since the last key inspection in June 2009. We discussed training with the manager. We noted that a training programme is in place. However, there is a need for a training matrix to allow for monitoring and future planning so that the developmental needs of members of staff are met. It would also assist the manager in ensuring that the training plan is designed to meet the aims and objectives of the service. The current training plan refers to what is proposed, started and completed and is brief. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. By updating her knowledge and skills the manager is able to assure residents that she makes members of staff aware of current best practice. Systems are in place to gather feedback on the quality of the service provided so that it can develop in ways that meet the changing needs of the residents. Training for members of staff in safe working practice topics assures residents that their health, safety and welfare is promoted so refresher training must be kept up to date to keep pace with current best practice. Regular servicing and checking of equipment and systems in use in the home ensures that these are in working order and safe to use. Evidence: The manager is an RGN with approximately 14 years experience of supporting adults with learning disabilities, in the care sector. She has worked in residential and nursing homes and also in a day centre. The manager has completed an RMA course. She is able to speak and/or understand Urdu, Hindi, Punjabi, Arabic and Gujarati. Since the last key inspection the manager has continued to update and develop her skills and understanding and has attended short refresher training courses. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We discussed quality assurance systems in place in the home. An annual quality assurance questionnaire was sent to family members and stakeholders in 2009 but the manager informed us that none had been returned. Relatives are in contact with the care home and the manager and are able to give feedback on the quality of the service received, if they wish. More formally feedback is given during review meetings (and one of these was held in 2009 for each of the residents). The manager said that she would distribute a questionnaire in 2010 but would do this in person and not by post. We looked at training records to review training provided in safe working practice topics. The policy of the home is that training in safe working practice topics is mandatory and that further refresher training is then carried out at recommended intervals. We noted however that refresher training in manual handling is overdue. We looked at servicing/inspection certificates for systems and equipment in use in the care home. We noted that there were valid certificates for the fire extinguishers and for the fire alarms, smoke detectors and emergency lighting. There were also valid certificates for the testing of the portable electrical appliances and the electrical installation. There was a Landlords Gas Safety Record. Records are kept of a weekly fire alarm test and the manager said that residents evacuate the building when the fire alarm is sounded so that a fire drill is carried out at the same time. The records need to show that both activities are carried out together. There was a valid certificate for the employers liability insurance cover for the home. This expires in June 2010. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 When the relative checks the 01/06/2010 financial records of the resident they are asked to do this in the care home so that record and account books are not removed from the premises. This will ensure that the care home is able to provide records in respect of support with financial matters to demonstrate that the financial interests of the resident are being upheld. 2 26 23 The registered person and the resident must agree a plan for the redecoration of the bedroom, including a risk assessment and timescales for each stage of the process. The work must be carried out according to the agreed timescales. 01/09/2010 Care Homes for Adults (18-65 years) Page 28 of 31 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 This will assure the resident that their preferences are respected and acted upon. 3 28 23 The registered person must ensure that the panelled flooring in the lounge area maintains a level surface. This will assure residents that a tripping hazard does not develop. 4 35 18 The registered person must review the training plan to ensure that the detail is sufficient to demonstrate that the training provided satisfies the aims and objectives of the home. this will assure residents that members of staff have the skills and knowledge to meet their needs. 5 42 13 The registered person must ensure that all persons working in the care home refresh their manual handling training on an annual basis. This will assure residents that support is provided by competent staff acting in a safe manner at all times. 01/08/2010 01/08/2010 01/08/2010 Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 42 That the record book is amended to include the fact that a fire alarm test and a fire drill are carried out together. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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