Care Home: New Hope Specialist Care Limited

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What the care home does well People have their own bedroom and bathroom. People can put things important to them in their rooms. Family can visit and are made to feel welcome. So people maintain relationships that are important to them. People are supported to go out and do activities that they enjoy so they live fulfilled lifestyles. People eat a varied diet that meets their dietary and cultural needs. People have a care plan that tells staff how their needs are to be met so they receive care in a way they need and prefer. Interactions between people and staff were friendly and relaxed. Staff treated people with respect and maintain their dignity. What has improved since the last inspection? The two requirements we made at the previous visits were met which indicates compliance. However only limited progress had been made on good practice recommendations. People’s epilepsy is now well managed so people are supported to be safe. Staff have received first aid training so the health and wellbeing of people is promoted and protected. Staff have received training in a number of areas specific to peoples individual needs. This should ensure they have the skills and knowledge to meet people’s needs. What the care home could do better: Pre admission assessments should be detailed and completed in full so the home knows that people’s needs can be met before they move in.New Hope Specialist Care LimitedDS0000070244.V378758.R01.S.doc Version 5.3 Peoples night time needs should be risk assessed and recorded so people get the care they need. Wheelchairs without footrest should not be used so people’s safety is promoted and the risk of injury is minimised. Peoples moving and handling needs should be assessed in full so they get the support they need to be safe. It should be clear who complaints are made to and how they will be dealt with so people can be confident that they are listened to. Incidents effecting peoples wellbeing should be reported to us so we know what action has been taken to protect people. Restrictions in place to protect people should only be in their best interest. Risk assessments should tell staff how to move people safely in the event of a fire so they are kept safe. Key inspection report CARE HOME ADULTS 18-65 New Hope Specialist Care Limited Bright House 32 Church Lane Handsworth Wood Birmingham B20 2EP Lead Inspector Donna Ahern Key Unannounced Inspection 26th November 2009 11:00 New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service New Hope Specialist Care Limited Address 32 Church Lane Handsworth Wood Birmingham B20 2EP 0121 241 3839 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) New Hope Specialist Care Limited Manager Post Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender Both. Whose primary care needs on admission to the home are within the following categories - Learning disability - code LD. The maximum number of service users to be accommodated is: 5 2. Date of last inspection 5th March 2009 Brief Description of the Service: The service is registered with the Care Quality Commission to provide residential care for up to 5 persons with learning disabilities aged between 1865 years. The service is provided from a detached house in a residential street in Handsworth Wood, Birmingham that is in keeping with other properties in the street. There are local facilities nearby such as shops, a library, and a leisure centre. Transport links are good, with various bus routes close to the home. The home is set over two floors and provides spacious accommodation for up to five people. The home has a combined lounge and dining room, a kitchen, ground floor bathroom, five en-suite bedrooms, laundry room and office. A passenger lift ensures access to the first floor for people with limited mobility. There is a secure garden with ramped access for people with mobility difficulties. The statement of purpose stated that the fee level is from £1550 per week. Previous inspection reports were available in the office for people to read. The date of the previous inspection was 5th March 2009. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes first key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. At the time of this visit five people were living at the home. People have a learning disability and have some behaviors that challenge the service. We case tracked three people this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The owner, manager and four staff on duty were spoken to. We looked around some parts of the home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We looked at notifications received from the home. These are reports about things that have happened in the home that the must tell us about. No immediate requirements were made on the day of this visit, which means that there was nothing urgent for the home to put right to ensure people were safe. The manager assisted us with the inspection. We sent out five surveys to people living in the home and their relatives to seek their views and opinions and ten to staff. We received one completed survey from people living at the home and four from people’s relatives and advocates and eight from staff. Comments received are included in the main body of the report. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Pre admission assessments should be detailed and completed in full so the home knows that people’s needs can be met before they move in. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 7 Peoples night time needs should be risk assessed and recorded so people get the care they need. Wheelchairs without footrest should not be used so people’s safety is promoted and the risk of injury is minimised. Peoples moving and handling needs should be assessed in full so they get the support they need to be safe. It should be clear who complaints are made to and how they will be dealt with so people can be confident that they are listened to. Incidents effecting peoples wellbeing should be reported to us so we know what action has been taken to protect people. Restrictions in place to protect people should only be in their best interest. Risk assessments should tell staff how to move people safely in the event of a fire so they are kept safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):1 and 2 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective new people have most of the information they need so they can make a choice about whether or not they want to live there. The homes pre assessment process does not demonstrate that a thorough assessment of peoples needs was completed prior to admission which could lead to needs not being met in full. EVIDENCE: Since our last visit two new people have moved into the home. The owner wants to increase registered numbers by one and this application was being determined at the time of our visit. We looked at the pre-admission assessment information and saw that only brief information had been recorded about people. We saw comments such as “full care” had been recorded which does not explain what the persons assessed needs are which could result in people needs not being planned for New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 10 and met. The pre assessment risk assessment did not seem relevant to a care setting and was more related to a person living at home receiving care from a care agency. We spoke to staff about the two people who have moved in. Staff told us before admission people had the opportunity to visit the home and meet the staff and the other people that live there. The statement of purpose gives inaccurate information about the arrangements for staffing the home at night. The manager details had not been updated to reflect the change of manager. Any restrictions in place such as the key coded front door should also be detailed so people have all the information they need to make an informed decision. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):6,7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have most of the information they need and a good understanding of how to offer care and support to each person, which should ensure peoples needs are met in a way they prefer. EVIDENCE: We looked at two peoples care plans. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. We found that the files looked at gave information about how staff should support the person in order to meet their individual needs in relation to personal care, communication, health care, and social activities. The manager New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 12 told us that care plans are still being developed for the people who recently came to live there. We spoke to members of staff who support each of the people and we also observed people being supported by staff. The staff demonstrated knowledge of people’s individual needs which was consistent with the information on peoples file. This indicates that staff know how to provide care and support to people so their needs are understood. We looked at risk assessments for financial management, using the car, medication and meal times. These give information for staff to follow so people are supported safely. Staff spoken with told us they knew what they must do so people are not put at risk of harm. We saw that reviews had taken place with people and other relevant professionals. Minutes of the one review detailed action and follow up points, it was not dated and it was unclear from reading records and talking to staff if these had been followed up which could lead to peoples needs not being fully met. Some of the people who live there due to their communication needs were not able to tell us about how they are supported to make choices and decisions about their lifestyles. We saw people receiving prompt support from staff and people were encouraged to communicate their needs by using what limited verbal communication they have. Staff offered different choices of drinks and food and supported people to relax in the lounge. People were supported to take part in activities in the house including foot spa, drawing and playing a guitar. We received the following comments in completed surveys “I think it is a nice place and they look after people well” “Very happy with the care of X” “The home is taking care of his needs and he is very happy” New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):12,13,15,16 and 17 This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in activities that promotes their independence and are reflective of individual needs. People enjoy a varied diet that meets their cultural dietary needs and preference. EVIDENCE: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to three staff members and observed care and support on the day. The records showed that people had been involved in trips out including cinema, shopping, lunch out and walk. Staff explained that activities plans are New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 14 in place but are being kept under review and will be developed as they get to know people better. It was really positive that one of the people who has now lived there a little while has been supported to attend a local college they told us “I like going there” “I like going out in the car”. On the day of the visit one of the people went out shopping in the morning. In the afternoon another person was supported to go to a hydro pool. It was positive to see staff prepare well for the visit and take a hot flask of tea which the person likes to have at the end of the session. Some people require a high ratio of staffing of 2:1 to enable them to take part in activities safely. On the day of the visit we saw that this level of staffing was provided. The care plans and daily records that we looked at showed that where possible people are encouraged to take part in day-to-day routines of the home such as clearing away after meals and taking their clothes to the laundry so they can develop their independent living skills. This is more limited for some individuals due to their needs. Staff provided transport to the home so one of the people’s relatives could visit. They were made very welcome and drinks were offered. We saw that other people are supported to make visits to their family and to make and receive personal telephone calls. Staff spoken with recognised the importance of people having contact with family and friends so relationships important to people living there are maintained. We saw that when people are at home they mainly accessed the communal areas of the home. We spoke to the manager about how the use of peoples own bedrooms could be utilised more for personal space during the day to listen to music or enjoy other hobbies and interest. The manager was keen to explore how people could be supported to do this. The daily records we looked at indicated that peoples food and drink intake is recorded daily and regular meals and drinks are offered. We saw staff asking people if they would like a drink. We saw a range of tinned, frozen and fresh food in the kitchen and store cupboards. Menus seen showed that culturally appropriate food is available and individual tastes are catered for. We saw the lunch time meal being served it was well presented and generous portions of food was served. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):18,19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not ensure that peoples personal and health care needs are fully met. EVIDENCE: Care plans that we looked at had information about how to meet peoples personal care needs. We saw that people were dressed in age appropriate clothing and people were well groomed, this indicates that people are supported to maintain a good self-image. We met all of the people who live in the home and saw that staff were prompt to offer personal care as needed throughout the day promoting their dignity. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 16 At night there is two staff on duty. Care plans we looked at need to detail how people would like to be supported throughout the night by staff so their care needs are met in a way they prefer. Any night checks completed by staff should be supported by a risk assessment so people are supported safely and in a way that respects that privacy and dignity. We spoke to staff about the use of a listening monitor and a small hand held T.V monitor that is in use. The manager told us the circumstances in which these are currently being used to monitor people at night. We were told that this practice is under review with the relevant professionals involved in the peoples care so that any monitoring in place is in the person’s best interest. An epilepsy specialist nurse has been very involved with the epilepsy management plan for one of the people. The staff spoke positively about the involvement of the nurse. There is now a clear protocol in place for staff to follow so the person is supported to be safe. Care plans looked at indicated that people are being provided with support to access healthcare professionals to meet their assessed needs. Staff told us and records seen indicated that referrals have been made to other health care professionals so people get the help and support they need to promote their health and well being. One of the people has their own comfortable seating for the lounge so they can sit comfortably when they are not in their wheelchair. One of the people is at risk of falling out of bed and the type of bed and equipment was under review with other professionals. We saw staff use wheelchairs to transfer two people around the home. Neither chair had a foot plate. People were asked to lift their feet up. This practice is dangerous and could cause injury to people. We saw that in a persons care plan it ask staff to monitor the persons bowels. However it doesn’t say why to do this or when staff should take further action. The manual handling assessments we seen referred to people being cared for in their own home and were not specific or relevant to a care home setting so did not fully assess if there were any risks to people. It was positive that hospital information sheets were available on people which staff could take to inform the nursing staff in the event of a hospital admission. We saw that for one of the people these had not been kept up to date with changes in their medication. This could result in an error being made if the wrong information was passed on. We saw that medical appointments’ including visits to the G.P had been recorded with the outcome so peoples well being can be monitored. We spoke to the manager about developing health action plans so peoples health care needs can be fully planned for. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 17 Medication is stored in a separate locked storage area off the landing on the first floor. The cupboard was found to be clean, tidy and well ordered. The medication administration records (MAR) looked at was signed indicating medication had been given as required. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. The people who live in the home cannot self-administer their own medication due to their complex needs. We did not see any information recorded about how people like their medication to be given to them. We received the following comments in completed surveys “I have always found my relative to be clean and well presented on all of my visits, communication is good as well”. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place for the protection of people do not fully ensure their protection and wellbeing. EVIDENCE: Since our last visit a complaint from a professional was made directly to the home. It was about the epilepsy management for one of the people. We saw professionals have worked closely with the home and the concerns have been resolved. However the outcome of this complaint had not been recorded in the home’s complaints file. The complaints procedure is provided in an easy read format so it is easier for people living there to understand. The complaints policy is generic to the organisation and it was not clear who people can complain to and what action will be taken which could result in complaints not being dealt with. Some of the people would require significant support to raise their concerns due to their communication needs. We spoke to staff who said they would recognise when people are not happy about something. Staff said they monitor people’s wellbeing and changes in behaviour for possible signs that they are unhappy about something. Staff we spoke to demonstrated a general New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 19 understanding of their duty to safeguard people and how to report concerns on too senior managers. We saw that safeguarding information was available from Sandwell Council who are the placing authority for most of the people living there. Birmingham procedures should also be available for staff to refer to as Birmingham Adult and Communities would need to be notified of any safeguarding concerns in the home. We looked at training records to determine that training in safeguarding vulnerable adults had been provided so staff know what to do if a concern was raised. Some people demonstrate behaviour that determines staff must work with them in a particular way to help keep them safe and well. We saw guidelines on peoples care plans, which explain how staff should support people with these needs. Some of these had passed their review date which may mean information about supporting people is not up to date. A thorough system for analysis of accidents and incidents should be developed to promote the health and safety of people living there. An incident impacting on the wellbeing of one of the people had not been notified to us on a regulation 37 notification as is legally required. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):24 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and comfortable home that meets their individual needs. EVIDENCE: The home is located near to local shops with public transport routes close by. There is limited off road parking to the front of the house. To the rear of the home there is a secure garden that people have direct access to. There is ramped access to the rear of the building for people who use a wheelchair this ensure there are no restrictions in entry to the building. Aids and adaptations include grab rails in bathrooms where required and a large New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 21 assisted bathroom on the ground floor that was under refurbishment during our visit. We looked at the shared areas of the home and the bedrooms of the people whose care we had case tracked. There were some unpleasant odours in the lounge area but all other areas were clean and fresh. The lounge is comfortable and there is a range of seating including two and three seater sofas so people can relax. We saw people sitting stretched out and relaxed during the visit it was good that people had the space to do this. The kitchen is compact with some storage space and worktop space for preparing meals. The kitchen was clean and equipped with adequate space to store fresh, frozen dried and tinned food. There is a separate laundry room. We saw substances such as cleaning products that could cause harm to people had been locked safely away. The enclosed passage way is used for storage and is an alternative route to the garden. We saw that there is flood damage to the ceiling and walls which could pose a risk to people’s safety. We were told that people living there do not use this area. All bedrooms have ensuite bathrooms, which ensures that personal care can be provided in a way that promotes peoples privacy. Two peoples bedrooms are located on the ground floor. One of the bedrooms was previously a staff sleep in room. There are four bedrooms on the first floor. The owner has put in a major variation application so registered numbers can increase from five to six. This application and the change of use of rooms were under discussion with CQC at the time of the visit. We saw that some of the bedrooms had the furniture secured to the wall so that it was safe for people. Some of the people choose to only have limited items in their room and the reasons why had been recorded in their care plan. The manager told us that people will be supported to make their bedrooms more personalised and comfortable and will be supported to use this space in the daytime as an alternative to the communal areas. We noted some minor repairs that needed attention including replacement of a toilet seat and the re hanging of some curtains in a bedroom. We were told that these matters were being dealt with so the home remains safe and comfortable for people. A food safety inspection had recently taken place and some recommendations had been made to ensure food is stored and served safely to people. The food safety officer had asked that food supplies were kept off the floor in the store room, we saw that some food was still being stored on the floor. We also noted New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 22 some strip florescent lights without the cover on. Again a recommendation had been made to ensure the lights have a cover on because if these are damaged fragments of glass will scatter and cause could injury to people. We saw that the other recommendations in relation to the serving and storage of food had been actioned. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):32, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a team of staff who have a good understanding of their needs. Robust recruitment ensures peoples safety. EVIDENCE: Some peoples communication needs made it difficult for us to talk to them so we watched the way that they interacted with staff on duty. We saw staff try to communicate with people using verbal communication and gestures and staff encouraged people living there to communicate back. Staff supported people mainly on a one to one basis and we saw staff sit and spend time talking with people. It was evident from what we saw during the visit that people seemed comfortable and relaxed with the staff on duty. We looked at the staffing rota for the week of the visit and the previous week. These showed that there are six staff on duty to care for the people living there during the day and two staff at night. On the day of our visit there was New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 24 adequate staff on duty to support peoples needs. Some new staff had been recruited and some staff transferred over from the previous provider. The provider told us at the previous visit he is keen to employ a staff team that is reflective of the gender and culture of the people living there but had encountered some difficulty attracting white staff to work in the home this remains the same at this visit. We looked at staff recruitment records for the three most recently employed people. Criminal Records Bureau checks (CRB) had been made and written references received before the employee began work so that people were protected from the risk of having unsuitable staff work in the Home with them. We spoke to three staff during this visit who demonstrated that they had read people’s care plans and had a good understanding of peoples needs. We spoke to staff about the training they had received and they said that they had completed induction training and in house training. We looked at the training matrix which indicated staff had completed training in challenging behaviour, autism, safeguarding, medication, health and safety, and fire. Staff have also completed training specific to the needs of the people living there including effective communication, diabetes, epilepsy, dementia, Parkinson’s autism, makaton. This should ensure that staff have the skills and knowledge to meet peoples needs. Eight of the fourteen staff have completed NVQ level 2 and four have completed or are completing NVQ level 3 this should ensure that staff have the skills and knowledge to do their job. Eight staff who completed and returned the surveys indicated that they receive the information they need to do their job and that they received a good induction. They made the following comments. “Still room for improvement in all areas as service is constantly changing in line with new legal developments” “All is well” “The home provides good training but would like more training” “We support individuals using a person centred approach” “The home can build on the good quality of care they are providing at the moment”. “They provide a high standard of care” “Provides a good service for people” New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 25 “They provide best care to service users”. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):37, 39, 40, 41 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure the wellbeing of the people living there. EVIDENCE: The organisations operations manager was present during the visit and she told us she had very recently taken over the management role and will be applying to CQC to be the registered manager. The previous manager had New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 27 gone on maternity leave and had not completed the process with us to become the registered manager. The manager was very open and welcoming and fully assisted with the inspection process. She responded very positively to information shared during the visit and feedback and indicated a commitment to develop the home in the best interest of the people living there. There is a quality assurance system in place which includes health and safety audits. The manager told us that the quality assurance system is still not fully implemented yet. She said surveys have been completed but these were at head office and not available for us to see. We were told that the owner has not completed monthly audit visits as he has regular contact with the home. Some of the homes documentation need’s developing including the pre assessment information so the home can be sure peoples needs can be met in full prior to admission. Some of the policies and procedures need some development so that they are specific to the home and are not general or more relevant to a domiciliary care agency setting. A thorough system for analysis of accidents and incidents should be developed to promote the health and safety of people living there. An incident impacting on the wellbeing of one of the people had not been notified to us as is legally required. This had occurred before the recent manager took over. The current manager demonstrated a good understanding of what must be reported to us and other agencies. We looked at records to see that peoples health and safety is being promoted. The fire alarm system had been tested and serviced on a regular basis. Individual fire risk assessments should be developed for each person so staff know how to support people safely in the event of the fire alarm being activated. The work place fire risk assessment which tells us how the home will keep people safe was due to be reviewed. Staff had completed emergency first aid training and ten staff have completed the appointed first aid training. This should ensure there is always staff on duty who can ensure emergency and first aid situations are well managed. New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 2 x 2 2 2 2 x Version 5.3 Page 29 New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA18 Regulation 13 (4) c Requirement Wheelchairs should not be used without footrest. This practice put’s people at risk of harm. Timescale for action 20/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The statement of purpose should be amended to include use of rooms, management and staffing arrangements. So people have all of all the information they need to know to make an informed decision about whether they want to live there. Pre admission assessments should ensure that a full assessments of peoples needs has taken place so the home knows it can meet their needs in full prior to admission. There should be evidence to show that actions agreed in peoples reviews have been followed up. To ensure people’s needs are met as agreed. The process for involving people in the choosing and evaluating of activities should be developed so that people are fully involved in making choices about their lifestyle. 2 YA2 3 4. YA6 YA12 New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 30 5. 6 7 8 9 10 11. 12 13 14 15 16. YA16 YA18 YA18 YA19 YA19 YA20 YA22 YA23 YA23 YA24 YA39 YA42 Guidelines should be in place for the use of any restrictions in the environment so peoples rights are safeguarded. Peoples night time needs should be recorded so they receive the support they need from staff. Peoples moving and handling needs should be assessed in full so they get the support they need. Care plans should details specific health care needs that are being monitored and state what action staff should take to ensure peoples wellbeing. Hospital sheets in use should be updated with medication changes so potential errors are minimised. Consideration should be given to recording on care plans how people like their medication to be given to them. The Complaints procedure needs some clarifying so people are clear about how and who will deal with complaints. Birmingham’s safeguarding procedures should be available for staff to refer to in the event of a safeguarding matter occurring. Incidents impacting on the wellbeing of people should be reported to CQC. Recommendations from the food safety officer should be actioned in full so food is served safely to people. The quality assurance system should be developed to include the views of people living in the home and their representatives. Arrangements must be in place so that incidents and accidents are analysed and steps taken to prevent further occurrence so people are protected. Individual fire risk assessments should be in place that tell staff how people should be supported to be safe in the event of a fire. The work place fire risk assessment should be updated so people are protected from the risk of fire. 17 18 YA42 YA42 New Hope Specialist Care Limited DS0000070244.V378758.R01.S.doc Version 5.3 Page 31 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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