Care Home: Noire House

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What the care home does well The people living there are asked what things they like and do not like.Each person has a care plan. This tells staff how to help the person.People living in the home can choose what they eat and drink. Their diet helps to keeps them healthy.Staff keep records so that they can check how well each person is. Staff help people to go to the doctors if they are not well.Bedrooms are decorated in the way that each person chooses. They have the things they like in their bedroom.Staff have training so they know how to help the people living there.The staff are able to communicate with the people living in the home in the way they like.Staff help people to go to church and the gurdwara if they want to. What has improved since the last inspection? Some of the staff have been there a long a time and know how to help the people living there.Some of the people living in the home had been on holiday abroad enabling them to have a holiday they liked. What the care home could do better: The support and activity plans need to be updated and regularly reviewed to ensure that the people living in the home received the support they wanted in the way they wanted.The records in the home should show how and what decisions the people living in the home have been supported to make.Staff should not work very long hours as this could people at risk of harm. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Noire House 31 Abbotts Road Erdington Birmingham West Midlands B24 8HE The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman Date: 0 7 0 7 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 39 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Noire House 31 Abbotts Road Erdington Birmingham West Midlands B24 8HE 01213820217 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Robinia Care West Midlands Limited care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 4 The maximum number of service users who can be accommodated is: 4 Date of last inspection 2 3 0 7 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 39 A bit about the care home Noire House is in Abbotts Road in Erdington in Birmingham. Four people can live in the home. The home is not suitable for people who cannot walk around easily. There is a garden at the back of the home. Care Homes for Adults (18-65 years) Page 5 of 39 There is a large lounge and somewhere to eat on the ground floor. There are four bedrooms on the first floor. Each person has their own bedroom. There is a bathroom with a shower. Bowling, shops and parks are nearby. Care Homes for Adults (18-65 years) Page 6 of 39 There are bus routes close to the home. There is information about the home available for people coming to the home. Care Homes for Adults (18-65 years) Page 7 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 39 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home and did the inspection in one day. The home did not know we were going to visit. We looked at what it is like to live there. We looked for signs that would tell us what the people living there think of their home. We looked at how the home meets the regulations and the National Minimum Standards. We looked at how the home can do things better. Care Homes for Adults (18-65 years) Page 9 of 39 Before we visited we looked at things we had been told about the home. The manager sent us the Annual Quality Assurance Assessment (AQAA). It tells us how they think they are meeting the regulations. We looked at notifications that the home sent us about things that have happened there. Two people who live in the home were case tracked. We do this by meeting or observing the people, talk about their care with staff and look at their care files. Tracking peoples care helps us find out what it is like to live there. We sent surveys to all the people who lived in the home, relatives, 5 staff, one GP and one other professional. We received completed surveys from the people who lived in the home, 4 staff and one Care Homes for Adults (18-65 years) Page 10 of 39 representative. They told us that they the home could: Organise holidays better. Meet all my needs. We looked at parts of the home and records about staff and health and safety. We talked to the people living there, the manager and staff. Care Homes for Adults (18-65 years) Page 11 of 39 What the care home does well The people living there are asked what things they like and do not like. Each person has a care plan. This tells staff how to help the person. Care Homes for Adults (18-65 years) Page 12 of 39 People living in the home can choose what they eat and drink. Their diet helps to keeps them healthy. Staff keep records so that they can check how well each person is. Staff help people to go to the doctors if they are not well. Bedrooms are decorated in the way that each person chooses. They have the things they like in their bedroom. Care Homes for Adults (18-65 years) Page 13 of 39 Staff have training so they know how to help the people living there. The staff are able to communicate with the people living in the home in the way they like. Staff help people to go to church and the gurdwara if they want to. Care Homes for Adults (18-65 years) Page 14 of 39 What has got better from the last inspection Some of the staff have been there a long a time and know how to help the people living there. Some of the people living in the home had been on holiday abroad enabling them to have a holiday they liked. Care Homes for Adults (18-65 years) Page 15 of 39 What the care home could do better The support and activity plans need to be updated and regularly reviewed to ensure that the people living in the home received the support they wanted in the way they wanted. The records in the home should show how and what decisions the people living in the home have been supported to make. Care Homes for Adults (18-65 years) Page 16 of 39 Staff should not work very long hours as this could people at risk of harm. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kulwant Ghuman 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 17 of 39 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 18 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people living in the home had information available to them about what help they could expect to receive whilst living in the home and how much they needed to pay. Evidence: The four people who lived in the home had all lived there for a long time. As no one had moved into the home recently the admission process was not assessed. The AQAA showed that the manager was aware of the admission process. This would include multi disciplinary team assessments, trial visits and short stays to the home to ensure that the move was appropriate for both the home and the individual. There was a service user guide that provided people with information about the home, the people who worked there and the services they provided. The service user guide was written in an easy read format with pictures to make it easier for people to understand. It needed to be updated as it did not include an indication of what the costs of living in the home were and the details for the Commission needed to be updated. The service user guide should also indicate how the registered manager could be contacted on the days he was not based at the home. Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: We looked at the file of one person who was living in the home and found that there was a copy of the service user guide on it and there was an agreement with the funding authority giving information about what the individual was paying for the service being provided at the home. There was a contract to be completed between the home and the person living there which had been signed by the manager only. There was also a copy of an agreement that would allow the organisation to take photographs of the individual that could be used when the organisations services were being publicised. Again this had been signed by the manager only. This did not show that the person living in the home or their representative had been consulted or made aware of these issues. Care Homes for Adults (18-65 years) Page 20 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The needs of the people living in the home were being met but the support plans were not kept reviewed and updated so that the staff knew the individuals current needs. Records did not evidence how and when choices were being made. Evidence: We case tracked two of the people living in the home. Case tracking helps us understand how the needs of the people living in the home are met. We do this by talking to the people living in the home, where possible, observing interactions, talking to staff and looking at the records kept in the home. We found that the files of the individuals were well organised. The information about the individuals was split between four files; the personal, care, health and finances files. In addition each person had activity plans and daily diaries to help give an indication of what sort of things the people living in the home did during the day. Where individuals were unable to contribute to the development of a care plan themselves, people who knew their needs were involved. The information gathered Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: about them included what their personalities were like, what their fears and dreams were, people and things important to them, what they liked to do and what they didnt like to do. There was information about what they liked to eat. One of the files we looked at included information about what the individual would like to change about their life. The support files showed what help the individuals needed and gave some indication of what they were able to do themselves. These files could include more information to guide new staff to support the individuals. For example, for one person the plan stated that the individual needed to be woken during the night to use the toilet however, there was no detail of how often this should be done. There was no information about whether the individual had a wet or dry shave, what support they needed with medication and how they would be helped to choose an activity or to be helped to pay for it. The people living in the home had activity action plans in place for such things as vacuuming their bedroom, managing their laundry, attending church or medical appointments. The action plans for vacuuming and managing laundry were well detailed but the others were not. For example, attending church only said to attend at least twice a month, it did not state the type of church to attend, which one or who with. We found the files were not regularly updated and it was quite confusing to follow what activities the individuals should or should not be doing. For example, for one person a review in April 2008 identified that they would like the staff to let them make more choices and felt that they did not go to church often enough. There was no information on how this was to be achieved or that it had been monitored since. We looked at the daily diary of this person and found that during a two month period they there was no record of them having gone to church or what choices they were being encouraged to make. We were shown some activity charts that had church on them for some Sundays but these were not supported by the daily diaries. Staff told us that they would write in the diary if they had undertaken this activity. The monthly summaries for this year indicated that over a four month period the staff had been recording that one person had been displaying some behaviours that could be upsetting to some of the other people living in the home. The individual had been referred to medical professionals but the documentation did not indicate what steps were being taken to manage the situation in the home. The staff had been asked to complete charts to show what was happening in the home immediately before and after the behaviours however, there was no reference to these being done in the files. Risk assessments were in place in respect of nutrition, escorting, use of the homes vehicle, moving and handling and use of physical interventions. These ensured that the people living in the home were safeguarded from harm. Care Homes for Adults (18-65 years) Page 22 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people living in the home appeared to be happy and content. The records did not always evidence that they had been supported to keep in contact with relatives and have their religious needs met as regularly as they would want. Evidence: The people living in the home were supported to undertake activities that helped them to develop individual skills. This was achieved by attending college where one person went to play music and undertake art activities and being assisted to undertake domestic chores at home. The personal service plans of individuals showed that they were involved in daily domestic activities such as vacuuming bedrooms, shopping and sorting out their laundry. There was evidence in the individuals daily diaries and activity plans that they accessed local community facilities such as the cinema, parks, shopping and leisure centres and went out for meals to local pubs. In addition, there was evidence that Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: people were supported to attend their chosen places of worship on some occasions. Records we looked at showed that on occasions the people living in the home were having to pay the full cost of staff escorting them to the theatre. The manager should look into how this could be better managed. One of the people we case tracked had identified in April 2008 that the things that they would like to change in their life were, firstly, staff to let him make choices and secondly, that he did not go to church enough. As the individual was not able to tell us verbally what choices he made we were largely dependent on the records for evidence. We looked at two months daily records and could not determine that these changes had been facilitated. The individuals activity plan stated that they should attend church on a Sunday morning, and their activity action plan stated that this should happen a minimum of twice a month. The daily records did not evidence that this had happened. We talked to the manager about this who showed us some activity plans that recorded church but this was not reflected in the daily diary for the same date. The staff needed to ensure that the daily recordings were a reflection of the days events so that individuals monitoring the care of the people living in the home could get an accurate overview. We were told that the people living in the home had regular contact with people who were important to them. We were able to evidence that one of the people whose care we looked at had had regular contact with people important to her and had been supported through a recent bereavement. For the other individual we were not able to evidence contact with relatives as the sheet for recording this had not been completed and the daily records over the period we looked at did not record it either. Staff told us there had been contact with relatives. We saw that one person liked to spend a lot of time in the conservatory and listened to his own music. He had been assisted to purchase seating for this area. His family had gone with him to help him choose the furniture. Another person was seen to spend a large amount of time in their bedroom rearranging their belongings whilst another person went out in the car on a regular basis. As he liked going out for drives he went with the staff to drop off and pick people up from college. This was good as it gave him a purpose in life. A downfall of the home is that plans are not regularly updated and reviewed. For example, for one person the last time their activity action plan had been reviewed was March 2008. The individuals personal service plan had not been updated since January 2007 and was clearly out of date as it indicated that the individual was waiting for a physiotherapy appointment. We were told that the appointment had taken place and they now had a rollator to use when walking outside. The plan indicated that the individual was no longer going horseriding however, in March 2008 the individual had been going horse riding. We were told by the manager that at the time of the inspection the individual was not able to go horse riding. It was important that the support, activity and behavioural plans were updated and reviewed regularly. Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: At the time of the inspection the kitchen in the home was being refurbished. There were two people at home at that time and they were taken out to eat lunch. When they returned one person told us that they had enjoyed their meal out. We were told by the staff that individuals were encouraged to choose what they had for breakfast by showing them the cereals available. There were rolling menus in place and we were told that people could have meals other than those identified on the menus. We looked at the food records but were unable to determine if the menus were being followed as the staff had not identified which week of the menus they related to. The food records did show that people were having a variety of meals which resulted in a varied and nutritious diet. We were told that the meals were discussed at the weekly meetings with the people living in the home. The records we saw of these meetings included little detail of anything that had been discussed or decided at these meetings so we could not determine if the meals were what the people living in the home wanted to eat. The action plan for one person indicated that they needed support when preparing meals but what this support was or what tasks the individual could do were not detailed. We were told by the manager that one person living in the home had been to Portugal on holiday and others had been on day trips out. Cottage holidays were being looked into for this year for the people living in the home. There is sometimes an issue with the length of time it takes for information to be processed and the monies agreed by the organisation meaning plans do not always come to fruition. During a review in October 2008 for one of the people living in the home an issue had been raised about the length of time it was taking to get a passport. At the time of the inspection we were told that the passport had still not been obtained due to problems of getting authorisations and information. This means that the individual is not able to go abroad. Care Homes for Adults (18-65 years) Page 25 of 39 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 people living in the home were able to choose how support was provided and independence was encouraged wherever possible. Evidence: The people living in the home looked healthy and well cared for. The people living in the home were given support as they wanted it. Their personal service plans indicated what help they required to maintain their personal hygiene and what tasks they could undertake themselves. There was a choice available for them to have a bath or shower, when they wanted these and whether they wanted male or female assistance. There was evidence available in the records that they were seen regularly by different medical professionals including psychiatrists, GPs, district nurses, dentists and physiotherapists. People were referred for behavioural support where this was needed, however, ABC charts were not always being used to monitor these behaviours. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: It was good to see that the people living in the home were on very little medication. The behaviours of the individuals living in the home were being managed well removing the need for prn (as and when required) medicines to be kept in the home. The management of medicines in the home was found to be good. The people living in the home generally went to the office to get their medicines. All the staff who gave out medicines had undertaken training in the safe handling of medicines. The home used a blister pack system for managing most of the medicines. There were some medicines that were in boxes. There were copies of recent prescriptions available with the medication administration records and there were no medicines in the fridge. All the medicines checked during the inspection tallied with the records and showed that the people living in the home were getting their medicines as prescribed. Care Homes for Adults (18-65 years) Page 27 of 39 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 . The people living in the home were made aware of the complaints procedure and were protected by the policies and procedures in the home. Evidence: No complaints or adult protection issues had been raised with us about the service since the last key inspection in 2007. No complaints had been logged in the complaints book in the home. There was an appropriate easy read complaint procedure available in the home and there were multi-agency guidelines available for the management of any adult protection issues if they arose. The people living in the home were asked regularly if they had any concerns. Staff had undertaken safeguarding training. Some staff were more knowledgeable about the actions that they should take if they suspected abuse than others. The manager should discuss this issue with staff to ensure that there is a consistent response if the issue was to arise. The recruitment procedures were robust and safeguarded the people living in the home. The management of finances were good but staff needed to ensure that personal monies were not transferred to the activities monies as these are personal monies and Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: should be left in the individuals wallet. Care Homes for Adults (18-65 years) Page 29 of 39 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 environment continues to be well maintained and homely. Evidence: The home is situated in a residential area of Birmingham and appears to be an ordinary family home from the outside. Internally the home was well decorated, clean, comfortable and homely. Two of the people living in the home showed us their bedrooms and they appeared to be comfortable and suited their needs. The bedrooms were locked and the people living in the home knew where the keys were kept. All the bedrooms were situated on the first floor of the building. All bedrooms were singly occupied and furnished to the individual needs of the people occupying them. On the ground floor was a communal lounge, conservatory, kitchen, bathroom, laundry and office. There was a pleasant garden to the side of the house. Care Homes for Adults (18-65 years) Page 30 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people living in the home were supported by staff who were knowledgeable and skilled, and who were suited to working with people with learning disabilities. Evidence: The home had a full complement of staff and we were told that there had not been many changes in the staff team which meant that there was continuity of care for the people living in the home. During the day there were two staff on duty and one waking night staff during the night. We were told that this level of staffing met the needs of the people living in the home and that when the need arose the staffing levels were adjusted. Examples of this were on Wednesdays when the day staff stayed on shift for an additional hour to support the people living in the home when they went to a disco. When one of the people living in the home went into hospital staff were given time to sit with them at the hospital helping them to feel more reassured. The staffing rota showed that on occasions staff undertook a long day shift followed by a waking night shift. This is not good practice and can put the both the member of staff and the people living in the home at risk due to tiredness of the staff. These hours would also be against working hours directives as there are no rest periods built in. Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: The training matrix showed that staff received a good level of training and that the manager was aware of when updates were required and these were organised. It was important that all staff received training in communication skills such as Makaton as some of the people living in the home used this technique to communicate. The majority of staff needed to have training in epilepsy so that they understood the implications, effects and symptoms as one of the people living in the home had epilepsy. The manager was aware that this training was needed. Six of the eight staff had already achieved a minimum level of training to NVQ level 2 ensuring they had the required skills and knowledge to work safely. Staff undertook a brief induction into the home when they started but the competency based induction was not always completed within twelve weeks. Staff should not be working unsupervised until they have completed their induction training to ensure that they are able to support the people living in the home safely. We looked at the recruitment file of one person employed in the home and found that the process ensured that all the appropriate checks had been undertaken to ensure that people being employed were suitable to work with vulnerable adults. The staff team reflected the local community and were able to meet the needs of the people living in the home. Care Homes for Adults (18-65 years) Page 32 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The management of the home ensures that the people living there are safe, occupied, treated as individuals and live in a home that is well maintained and homely. Evidence: The manager was knowledgeable about the needs of the people living in the home and had the skills and training to provide leadership to the staff encouraging development of skills and activities. Since the last inspection the manager had been appointed as the registered manager for another home which he was managing. This meant that the manager was sharing his time between the two homes. There was no evidence to show that the people living in the home had been disadvantaged due to this change in management. The AQAA was well completed and told us that there were regular staff meetings, health and safety audits, medication audits and quality audits. Equipment in the home was regularly serviced ensuring it was safe for use. There was a business plan in place to ensure that the service continued to provide a good service and improved where necessary. A report should be made available to Care Homes for Adults (18-65 years) Page 33 of 39 Evidence: people with an in interest in the home to show what is being done to improve the service. Health and safety was well managed in the home so that the people living in the home home and the staff who worked there were safeguarded. The home continues to provide a warm and homely atmosphere with a stable staff team. The manager needed to ensure that the weekly meetings held with the people living in the home did give people an opportunity to make choices and that the records kept of the meeting were comprehensive. The manager needed to ensure that staff did not work excessively long hours as this can put the people living in the home and the staff working at risk of injury through tiredness. Care Homes for Adults (18-65 years) Page 34 of 39 Are there any outstanding requirements from the last inspection? Yes  No  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 35 of 39 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 Description 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 Description Timescale for action 1 42 13 The manager must ensure that the people living in the home are not put at risk by the staffing arrangements. 31/08/2009 This will ensure that the people living in the home are not harmed unnecessarily. 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 People thinking about moving into the home, or their representatives, should have all the information they need to make an informed decision about whether the home is suitable for them. The manager should ensure that the people living in the home, or their representatives, are fully informed about matters that may affect them. This will ensure that decisions affecting people who live in the home are made with the involvement of relevant individuals. 2 1 Care Homes for Adults (18-65 years) Page 36 of 39 3 4 6 6 Behaviours should be be monitored to identify any causes and plans put in place to manage them. Support plans should enable staff to be able to assist the people living in the home with their needs. This will ensure that the people living in the home are assisted in n personalised way. Monthly summaries should identify what actions have been taken in relation to any issues identified. The manager needed to look into how the staff costs of escorting people on activities can be shared. This will ensure that the people living in the home are able to undertake activities without having to bear the total costs of an escort. The home should evidence how people are enabled to make choices in their daily lives. This will ensure that the people living in the home are enabled to make decisions about thier lives. The people living in the home should be supported to get documentation they need to be able to go on holiday where they want. The people living in the home should be supported to maintain regular contact with people important to them. This will ensure that they maintain relationships outside the home. The personal monies belonging to the people living in the home should be kept separate from the activities monies provided by the organization to ensure that the monies are not used communally. Staff should be reminded about the actions they must take in the case of suspected abuse. This will ensure that there is a consistent response that will safeguard the people living in the home. Induction training for staff should be completed within 12 weeks of taking up employment to ensure that they are safe to work unsupervised after this time. The manager should ensure that the paperwork in the home is kept reviewed and up to date to ensure that the needs of the people living in the home are known by people supporting them. A report should be made available indicating how the home has taken account of views on the service and is planning to improve the service. Page 37 of 39 5 6 6 12 7 14 8 14 9 15 10 22 11 23 12 32 13 37 14 39 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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). 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. 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