Care Home: Nicholl Grange

What the care home does well Nicholl Grange provides a safe, comfortable and homely environment that the people living there say they like. The home carries out robust assessments that inform the home as to an individual`s specific needs and choices, this ensuring care plans reflect what an individual needs, wishes and wants. This is assisted by the use of a gradual and supportive admission process where individuals are involved in planning their care with identified staff. Individual plans are supported by robust risk assessments to minimise risk to people where possible, although not stifling their self autonomy and independence. The home is well managed and staff are well supported, this reflecting their professional and enthusiastic approach. We were told and saw that staff interaction with individuals was appropriate and positive. Use of robust and established quality monitoring systems support the home to identify ways in which they can develop and improve, this underlining that the management and staff are not complacent in respect of the positive outcomes for individuals living at the home that we found. People are happy with the activities available to them and tell us they can make choices that staff support. What has improved since the last inspection? The management and staff have ensured that improvements at the home have been maintained or continued since the last key inspection the following examples of how they have done so: - The home has been retained its Gold award for food hygiene from environmental services. - Staff training has continued with the home having increased the number of staff vocationally qualified. - The home has achieved its Investors in People award. - Staff Supervision has improved now occurring more frequently. - The management now have regular meetings with the home`s landlords to discuss maintenance of the environment on behalf of the residents. - The kitchen has been refitted. - The staff are now going out on pre- admission assessments this assisting the building of relationships with individuals before they move into the home. What the care home could do better: The only required action for the home is that they ensure their are clear directions from the pharmacy or prescriber in regards to prescribed creams and ointments, this as opposed to `as directed`, so that people are fully aware of the frequencies at which these should be applied. We have made comment as to a few areas where improvement could be made this including developing pictorial care plans (where appropriate), expanding the homes risk assessments in respect of infection control, and identifying a range of core training for staff in respect of mental health (including input on the Mental Health Act). We noted that management had identified two of these areas for improvement already. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Nicholl Grange Nicholl Grange 14 - 22 Nicholl Street West Bromwich West Midlands B70 6HW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jonathan Potts     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Nicholl Grange 14 - 22 Nicholl Street Nicholl Grange West Bromwich West Midlands B70 6HW 01215253828 01215253828 nicholl.grange@sandwellmind.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sandwell Association for Mental Health Name of registered manager (if applicable) Ms Jeanette Anne Witton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 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: Mental disorder, excluding learning disability or dementia (MD) 14 Date of last inspection Brief description of the care home Nicholl Grange is an independent sector home that provides residential accommodation, including four self-contained flats, for up to fourteen people experiencing mental ill health. The homes main objective is to provide a supportive environment in which to enable residents to live independently within a community setting. Support is provided with all aspects of daily living skills with a focus on Care Homes for Adults (18-65 years) Page 4 of 30 care home 14 Over 65 0 14 Brief description of the care home individual needs and maintaining good mental heath. The home is situated close to West Bromwich town centre with easy access to all local amenities and transport networks. Parking is available at the front and there are extensive well-maintained gardens at the rear. The ground floor consists of an entrance hall, office, 2 single bedrooms, laundry room, small lounge, dining room, kitchen, main lounge, storage cupboard and two separate toilets. Two staircases lead to the first floor, which includes two toilets with walk in showers, toilet and bath, a kitchenette, staff bedroom and eight single bedrooms. A further four registered places are provided in an adjacent building with self-contained facilities. Sandwell MIND has responsibility for both the management and staffing of the home whilst Jephson Housing Association is responsible for the maintenance of the building.The fees for this service were not detailed in the statement of purpose at the time of our visit. The home should be contacted for details. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced on the 1st day of our visit to the home, although was announced on the 2nd day to facilitate access to staff records. We assessed the homes performance against a number of key minimum standards, this primarily through tracking the care of 3 individuals living at the home. This involved us looking at case files, talking to the individuals concerned and where possible their key workers. Further to this we also had a tour of the building and looked at a number of management and staff records. We also considered the information we have received about the home since the time of the last inspection, this including the Annual Quality Assurance Assessment (AQAA) completed by the manager and questionnaires completed by residents, relatives and staff. Care Homes for Adults (18-65 years) Page 6 of 30 Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The only required action for the home is that they ensure their are clear directions from the pharmacy or prescriber in regards to prescribed creams and ointments, this as opposed to as directed, so that people are fully aware of the frequencies at which these should be applied. We have made comment as to a few areas where improvement could be made this including developing pictorial care plans (where appropriate), expanding the homes risk assessments in respect of infection control, and identifying a range of core training for staff in respect of mental health (including input on the Mental Health Act). We noted that management had identified two of these areas for improvement already. Care Homes for Adults (18-65 years) Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to chose a home that will meet their needs, this supported through the opportunity to sample the service on a phased and planned basis. Evidence: We saw that the home has a statement of purpose and service users guide that is specific to the home and the individuals that may use the service, this providing relevant information that would be useful to people that are considering moving to Nicholl Grange. This information is supported by an addendum that clearly sets out what the eligibility criteria for the home are. The only omission noted at the time we inspected was the current range of fees for the service, which had not been written in the gap in the document for this information. The manager told us that this information would be added to the document. The information we saw is also available online through Sandwell Minds website (www.sandwellmind.org.uk), where pictures of the home are available. The website also contains links to the latest CSCI reports for the home. Whilst most people that use the service can read, the manager stated that Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: they are looking at developing a pictorial service users guide. People told us that they all usually had sufficient information about the service and out of 6 residents that responded to our questionnaires all stated that they wanted to move into the home. The manager told us in the AQAA that she felt the service carried out robust assessments that allowed staff to be clear as to the service they could realistically offer to an individual. From sight of the assessments in individual case files we saw that this was the case, these supported by information from other professionals such as social workers and community psychiatric nurses. We were told by one individual about their personal experience in respect of their introduction to the home, this involving numerous visits and then overnight stays over a period of months, this allowing them to make a decision as to Nicholls Granges suitability for them. They told us that they received written information and the key worker, that they said they get on with, supported them throughout the admission process. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives within a framework that considers limitations within assessment of acceptable risks. The home encourages an active involvement in the care planning process this meaning individual plans reflect what is important for people living at the home in respect of their needs and wishes. Evidence: We spoke to three individuals about their plans of care and two out of the three said they were aware of their plans, the third not recalling seeing it but confirming its accuracy based on what they felt was important. One individual told us they could not read the plan but said that their key worker had sat with them and read through and agreed it within them. The production of a pictorial format of this persons plan would be seen as a beneficial development in assisting them to understand their plan. All of the individuals we spoke to confirmed that the plans reflected what they felt was important to them. We saw individuals plans to be well recorded covering the full range of a persons needs and setting out clear goals and objectives. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Discussion with the manager gave us an insight into how the home is looking to develop individuals involvement in care planning further with 1:1 sessions (with use of a set quality monitoring format that we saw). The intention of this is to further promote individuals involvement in care planning and also bring residents views into quality management of the home through review of their care plans and needs. This development will help build on the way the home currently reviews and updates plans, with the ones we saw and discussed up to date, drawing on changes in individuals views and situation. People we spoke to all clearly expressed their views although where there are any issues in respect of communication (such as hearing impairment) these are detailed within their individual plan. Issues in respect of communication and mental health are also clearly detailed as appropriate. Staff told us that the care plans are used as a working tool and inform them of what is important for the individual, with discussion in staff hand overs highlighting any significant changes so that staff are aware of important issues in an individuals life. We saw that plans are supported by detailed risk assessments that individuals living at the home told us are accurate. These are reviewed on a regular basis as are the individual plans and discussion with people living at the home indicated that they did not feel that their life was unnecessarily restricted or limited, with staff said to allow them choice in respect of how they wished to live. The manager in discussion showed an understanding of what deprivation of liberty safeguards are and evidenced that she has attended training in respect of the same. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their lifestyles. Social, educational, cultural and recreational activities meet individuals expectations with staff encouraging individuals self autonomy and choice. Evidence: We spoke to individuals about their lifestyles and they told us that are given choices by staff in respect of what they wish to do on a day to day basis and have the opportunity for independence and self autonomy, with people saying they could please themselves. People told us about the activities there are involved in, these said to be either OK or enjoyed. One individual said that they enjoyed their one to one time with their key worker when they took them shopping and others spoke of community activities they are involved in. All the people we spoke to told us they have keys to the front door and are able to go out independently when they wish, the only restriction Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: the need to return by 10pm. We received further comment from questionnaires sent to us by a relative stating I like the fact that they take residents out as much as they can and they do a lot of activities which is good for the residents. People told us that they are encouraged to have involvement in domestic routines such as cleaning their rooms and cooking, with help from staff or their relatives as appropriate. The manager stated in the AQAA submitted to CSCI that the home could expand available lifestyle opportunities for people at the home, this showing that the service is looking to improve on an area where people say there is good provision. The home we saw based on what we were told does encourage individuals to take control of their finances although staff do offer support and access to safe keeping facilities where needed. Where the individual uses the homes safekeeping facilities we saw that there are well documented records in place to protect individuals, with random checks carried out on these by senior management when they visit the home. Individuals also told us that where they wish they have access to lockable areas in their rooms. The home encourages residents to maintain contact with such as families and relatives told us that the home usually keeps in touch with them in respect of important issues. Comments we received indicated that the staff are very friendly with me and keep me informed although others stated as they visited on a regular basis they were kept informed at the time of their visits. Some individuals we were told do visit relatives at their home on a planned basis. We were told that the individuals have access to a phone that we were told could be used in private. We heard varying comments in respect of the food provided by the home with some commenting that they were not keen on the meals, where as others told us that the meals are good. The three individuals we spoke to all said that they are given a choice as to the meals provided and can pick an alternative to the options on the menu. We saw that there are regular meetings where meals are discussed with the residents (this confirmed by people we spoke to) and views on the menu can be shared. Sight of food records did show that a variety of foods are available to people living at the home and choices are encouraged, as well as individuals involvement in cooking (although some told us that they prefer the staff to do this). Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based around their individually agreed and assessed needs and the home promotes the principals of respect, dignity and privacy. Overall medication management protects individuals whilst promoting self administration through a structured risk based approach. Evidence: We saw that people receive personal and helathcare support that is effective and is driven by clear individual care plans that have involved residents in their formulation. People told us that individuals needs are usually or always met by staff at the home. We have been told that staff meet the diverse needs of the resident group however and comments we heard in respect of how the staff provide care are positive. Individuals we spoke to told us that they can manage their personal care in the way they wish, and have privacy as needed, staff available for support when they wished. We were told about individuals having key workers that they said they were comfortable with and enjoyed spending time with. One individual told us that staff help me by talking to me and another said that staff are on hand to give advice on personal hygiene. The majority of the questionnaires we received from residents Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: indicated that they felt well treated by staff and that routines were flexible. Individuals told us that their health care needs are met by the home, this supported by records that we saw in case files that showed regular and timely access to community health care services. We were told that people visit their G.P. when needed. Whilst the residents are mostly physically able the staff are aware of the need to ensure that mobility assessments are requested when needed, and aids provided that assist the individual. We saw that care plans do identify the need to be vigilant as to mental health needs and triggers that may indicate changes in well being are identified, this confirmed as accurate by residents and staff we spoke to. We saw that the home has an efficient medication policy and procedure and that staff that administer medication have received the appropriate training. Records that we saw relating to the administration of medication are completed appropriately and there was clear information in place to indicate as to when as required medication should be given, the latter from tracking of records seen to be accurate. The only prescribed items not having detail as to frequency were some creams which records stated were to be taken as directed. Where the home managed individuals medication they confirmed their consent to this, although the home is proactive in encouraging individuals to take part in management of their medication through a robust risk assessment process. Spot checks are carried out when residents self administer to ensure safety, this we saw to be in accordance with the documented risk assessments. We saw evidence that medication is reviewed by medical professionals. The last external audit of the homes medication by the homes contracted pharmacist was in October 2008, the one issue that had arose from this now addressed. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People told us that they are listened to by staff and that they are comfortable raising concerns with such as key workers with whom they have good relationships. Whilst the home has a robust procedure for dealing with complaints and safeguarding so as to protect individuals they are pro-active in looking to develop methods to encourage feedback from individuals living at the home. Evidence: We saw that the home has a robust complaints procedure that is available within the home. The manager said that they can have the procedure translated into other languages where needed. The manager did state that there is scope to develop this so that it includes how the home responds to informal grumbles. In discussion with the manager she saw the receipt of complaints as a means of gaining feedback on the service and the discussion of complaints was a standing item at managers meetings. People we spoke to at the time of the inspection had no concerns about the service and also said that they were comfortable with the staff team and comments we received from residents via CSCI questionnaires indicated that the majority of people knew who to speak to if they were unhappy. The home we saw has regular residents meetings were there is scope to discuss any concerns or comments (as we saw was the case through sight of minutes). Complaints are also monitored through senior managements monthly visits to the home, although Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: there has been no formal complaints raised over the last 12 months. The promotion and development of the 1:1 quality monitoring with residents that the manager has proposed will allow individuals to raise concerns with their key worker, that they do not wish to raise in a group. None of the individuals we spoke to had any concern in respect of their safety at the home. We saw that the home has appropriate safeguarding procedures that are supported by the availability of the local authorities procedures. We spoke to three staff as to the understanding of safeguarding and all showed a good awareness of these and what the reporting processes are, this including how to whistle-blow. This shows that training of the staff in abuse has been effective. All the staff team have received training in dealing with challenging behaviours and we saw that the approach of staff to the individuals living at the home was relaxed and non-confrontational throughout the inspection, even at points where one individual was seen to be upset. Discussion with the manager showed that she had a good understanding of safeguarding and the need to monitor any possible issues, in accordance with local authority guidance. We saw that the homes own procedures are supplementary to the local authority procedures as they refer to documentation within it, and stress the importance of staff not investigating beyond establishing the basic facts. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of Nicholl Grange is appropriate for the individuals living at the home. The environment is clean, safe and well maintained. Evidence: We saw that the home was decorated and maintained to a good standard and was judged, based on comments from the people we spoke to, to provide a good environment that met individuals needs and lifestyle choices. From sight of the environment and sampling of servicing certificates we found no obvious health and safety hazards to be present. The home we did see does have a robust health and safety audit programme in place as part of the homes wider quarterly quality monitoring. The home has been subject to a recent visit from Environmental health and the outcome of this was that the home has a Gold award, this showing that the home has reached a good standard in respect of food hygiene practices. The home has sufficient space available to allow individuals privacy without use of their bedrooms. This is supplemented by a large garden area which easily accessible. None of the bedrooms are shared and those that we saw are suitably furnished in accordance with the individual tastes of their occupants. Three of the bedrooms are en suite. The home has ample toilets and bathrooms, some of these of a very good size Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: and fitted with appropriate adaptations, with the ground floor toilet suitable for wheelchair access. Individuals have access to bath and shower facilities as suits their choices. People told us are satisfied with the environment and all have access to keys for lockable storage, their rooms and the front door. The home we found to be clean and tidy (as we were told is usually the case by people responding to our questionnaires). Individuals are supported by staff to maintain their living areas and such as their laundry (which was seen to be accessible and appropriately fitted and laid out). We found that there was little evidence of risk at the time of our visit in respect of infection control although in discussion with the manager we felt that the homes risk assessments in respect of the management of such could be expanded, this in line with Department of Health guidance. It was however promising to see that a number of staff have been enrolled on infection control training. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment and staffing arrangements ensure individuals living at the home are well supported and protected. Evidence: We saw that the home has good recruitment and selection procedures in place that promote the protection of the individuals living at the home, this view supported by those staff files we looked at. Observation of staff during the course of the inspection showed that they were professional in their approach and interaction with residents was relaxed and appropriate to their needs. Staff we spoke to showed an enthusiasm for the work that they did and came across as motivated and committed to the service. Our view of the staff was borne out by individuals that we spoke to who expressed confidence in the staff team. Staff we saw have designated responsibilities. There are three shift leaders and a senior care that form part of the management team and areas of responsibility are delegated between them. The homes management team are experienced and two of the shift leaders have gained an NVQ level 4 qualification. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: We saw from site of the staffing rota and the staffing levels at the time we visited that there are sufficient staff available to support the identified needs of the individuals living at the home. We looked at the homes training plan which shows that the home is committed to training, this assisted by the fact that Sandwell Mind has its own training and assessment centre. Based on staff feedback we formed a positive picture in respect of the support and training the manager and organization provide staff , the former further evidenced by our sampling of staff supervision notes. The home has well in excess of the expected bench mark in respect of vocational qualifications for staff at the home. We did however note that the detail on the homes training plan in some ways undersold what staff have achieved as some of the mandatory training areas were not included within it, this including such as first aid and medication training. In addition the identification of a core skills/knowledge base in mental health for staff would be useful, this then giving a bench mark for staff training. Issues that we identified that would contribute to this, is input in respect of such as changes to the Mental Health Act. This is an area that the manager is aware of and wants to improve however, as stated in the AQAA we received, and confirmed in discussion, with an identified priority training in respect of deprivations of liberty (Mental Capacity Act) . It was however pleasing to see that Sandwell Mind has achieved the Investor in People award. The home was seen to have a structured induction programme for new staff that follows Skills for Care standards. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is supported by a competent and motivated management team as well as quality monitoring systems that support the smooth running of the service. Evidence: Since the time of the last inspection the manager (J.Witton) has now applied for and been registered by us. Discussion with the manager during the course of our visit to the home showed us that she has a keen understanding of the issues influencing the service and a strong commitment to improving the service. She was knowledgeable as to the wider context of service provision as well as key issues in respect of the care of those people living at the home. She was able to demonstrate an on going commitment to her own development as well, now having an NVQ level 4, registered managers award, certificate in mental health services and and NVQ level 5. The manager told us she was well supported by senior management, with the responsible individual carrying out prompt monthly visits (with documented reports relating to these seen) and other managers in the group through planned meetings. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: From discussion with staff and seniors we noted that the managers professional stance was reflected in their approach, this underlining the support they told us they are given. From sight of the training and qualification some of the senior team have achieved we would judge that the manger is supported by a competent senior team. The comments made to us by individuals living at the home further support this view. The manager was honest with us as to the challenges that face the service on a day to day and longer term basis and has demonstrated that she will work with us on a professional basis. We saw that the home has a robust quality monitoring system that uses feedback from individuals living at the home, stakeholders and others that influence the service (such as the landlord of the property) to influence its development and improvement plans. As discussed earlier in the report the home is looking to further develop its monitoring of the service through 1: 1 consultations with residents on a periodic basis, this to add to comments obtained through questionnaires and meetings. The homes quality system is used to influence the services development of policies and procedures. The safe working practices within the home are audited on a quarterly basis through a robust and systematic process (including accident analysis) that informs the homes quality monitoring. This has assisted the home identify issues where attention is needed and address these in a timely fashion, this so as to ensure that individuals living at the home are protected from preventable hazards. Risks assessments relating to the environment and safe working practices are kept under review with involvement from the services landlord. Based on the former we are not surprised that no issues have arisen from the last Fire Prevention Officers visit to the home in April 2008, and the outcome of the last Environmental Officers visit to the home where they retained their Gold award further underlines the homes commitment to health and safety. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered manager must ensure that prescribed creams are given in accordance with clear directions from the prescriber or pharmacist as opposed to as directed. This is to ensure that prescribed creams are given at a frequency decided by the prescriber or a pharmacist. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered manager should ensure the statement of purpose/service users guide contains the current range of fees for stopping at the home. The registered manager should develop pictorial or alternative format care plans for individuals where needed (for example when they are not able to read their current plan). 2 6 Care Homes for Adults (18-65 years) Page 28 of 30 3 30 The registered manager should consider expanding the risk assessment and audit of the homes infection control practices, building on staff training input now been provided. To identify and provide a knowledge/skill base for staff in core mental health training as planned. 4 35 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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