Care Home: Park Road 9

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What the care home does well We spoke to people who live at the home. Everyone told us they are happy living there and can make decisions about what they do. One person said, "It`s a nice home and the staff are nice." People who live at Park Road have a varied lifestyle. One person said they enjoy going out shopping with staff. Another person said they enjoy going to the pub and going out for coffee. On the day of the inspection some people were attending reflexology sessions. People who live at the home told us they are very happy with staff and the manager. Surveys from people who live at the home told us staff always treat them well. One person said `staff are helpful`. Another person said `they know how to treat a lady`. Every staff survey was very positive about the home and we received lots of information about what the home does well. These are typical comments, "I feel the service has a good team who work hard together to ensure the best for the clients." "Excellent support is given." "Service users are very well looked after." Park Road has been awarded the Royal National institute for the Blind (RNIB) accreditation. The RNIB customer charter says that the service has passed a detailed audit and attained a high standard of service to visually impaired people. People who live at the home are safe and know if they have a problem the manager and staff will listen and deal with it properly. People said they talk about reporting abuse at their meetings. One person who lives at the home said, "They (the staff) have told us if we have any problems with abuse we report it to the staff." Another person said, "If anyone hits us we have to tell staff and they would sort it out." The home is well managed and everyone feels supported. One staff said, "The manager is fantastic at supporting, discussing and running the home." Another staff said, "The manager is a very good manager. She has worked very hard at bringing the home up to a very good standard." The registered manager is experienced and is suitably qualified. What has improved since the last inspection? At the last inspection we made a requirement that people who live at the home must have a detailed care plan to make sure that they receive person centred support that meets their needs. At this inspection the registered manager and staff told us they are introducing new person centred care plans and making sure the care people receive is more person centred. One staff member said, "We are more geared around people, more person centred but we still have more to do." At the last inspection we said risk assessments must be carried out for people with challenging behaviour to identify risks from the behaviour. At this inspection we found people have good behaviour management strategies, which have been drawn up with support from healthcare professionals. These are very detailed and give everyone clear guidance on how needs should be met. Staff said they always follow the guidance andimplement any recommendations from any professionals. The home has more robust policies for dealing with allegations of abuse and handling of service users` monies, which helps safeguard people who live at the Park Road. What the care home could do better: The care planning process could be further developed to make sure people`s care needs and aspirations are properly identified. This will involve individuals more in the planning of their care which affects their lifestyle and quality of life. We received a survey which said the service `should be less task orientated and adopt person centred active support`. The home could be better at identifying potential risks to people who live at the home. This will make sure the risk of harm is minimised. People who live at the home could be given more opportunities to be involved in all areas of daily living in the home. This will help promote independence. Staff could receive more training that equips them with the right knowledge and skills. This will make sure people are safe, and their needs are met. Staff do not currently have an opportunity to complete an accredited Learning Disability Qualification (LDQ) Induction Award. Staff told us they receive training that is relevant to their role but said they would benefit from some more specific learning disability training. People who live at the home could be given an opportunity to complete surveys and put forward their individual views. This will help improve the quality of the service and make sure people receive a service that meets their needs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Park Road 9 9 Park Road Harrogate North Yorkshire HG2 9BH     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: Carol Haj-Najafi     Date: 0 7 0 4 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Park Road 9 9 Park Road Harrogate North Yorkshire HG2 9BH 01423521014 F/P01423521014 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) : Foresight Residential Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 12 Registered for 12 adults with a learning disability, some of whom may have an additional physical disability and/or sensory impairment. Date of last inspection Brief description of the care home 9 Park Road is registered to provide care to twelve people with learning disabilities and associated sensory impairment. The home is situated a short distance from Harrogate town centre with good access to the towns services and amenities. At the inspection, the registered manager said the weekly fees range between £601.64 and £1229.35. People who live at the home pay extra for hairdressing, chiropody, toiletries, reflexology and holidays. A Statement of Purpose is displayed in the home providing information about the home and the most recent inspection report is available for people to look at. A Service User Guide provides information about the home and is given to people before they move into the home. Care Homes for Adults (18-65 years) Page 4 of 34 Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was carried out in April 2007. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before this visit we reviewed the information we had about the home and the manager completed an annual quality assurance assessment (AQAA). The AQAA provides us with information about the home and tells us what has happened in the last twelve months. We used this information to help us decide what we should do during our Care Homes for Adults (18-65 years) Page 6 of 34 inspection visit. Surveys were sent out to people who live at the home and other people who have an interest in the service. We received surveys from eight people who live at the home, seven staff and one healthcare professional. Comments from the surveys have been included in the report. An inspector was at the home for one day from 9:15am to 5:00pm. We spoke to four people who live at the home, six staff and the registered manager. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 7.75 hours at the home. Feedback was given to the registered manager at the end of the visit. What the care home does well: What has improved since the last inspection? At the last inspection we made a requirement that people who live at the home must have a detailed care plan to make sure that they receive person centred support that meets their needs. At this inspection the registered manager and staff told us they are introducing new person centred care plans and making sure the care people receive is more person centred. One staff member said, We are more geared around people, more person centred but we still have more to do. At the last inspection we said risk assessments must be carried out for people with challenging behaviour to identify risks from the behaviour. At this inspection we found people have good behaviour management strategies, which have been drawn up with support from healthcare professionals. These are very detailed and give everyone clear guidance on how needs should be met. Staff said they always follow the guidance and Care Homes for Adults (18-65 years) Page 8 of 34 implement any recommendations from any professionals. The home has more robust policies for dealing with allegations of abuse and handling of service users monies, which helps safeguard people who live at the Park Road. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: In the AQAA the registered manager explained the process they follow before people move into the home. This includes providing people with information about the home, organising visits to the home and completing care plans and assessments. In the AQAA the registered manager also said, We would always offer prospective new service users to the company, full support with making the important decision of choosing their new home. The registered manager told us the same people have lived at the home since the last inspection so we did not look at any pre admission assessments. At the last inspection we found that people experienced good outcomes in this area, Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: and we said proper pre-admission procedures are in place so that people can feel confident that their needs will be met by the home. Six surveys from people who live at Park Road said they were asked if they wanted to move to the home; two people said they were not asked but then explained why. Everyone said they received enough information to help them decide if they wanted to stay. Staff told us that they are always given up to date information about the needs of people they support. Care Homes for Adults (18-65 years) Page 12 of 34 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. People are happy living at Park Road. In the main, peoples care needs are met but some needs and wishes could be overlooked because these are not yet fully identified through a person centred care planning process. Evidence: We spoke to people who live at the home. Everyone told us they are happy living there, and can make decisions about what they do. One person said, I get help and staff are helpful. They help me sort out my clothes. Another person said, Its a nice home and the staff are nice. Surveys from people who live at the home also told us that they are satisfied with the service. Seven people said they do what they want during they day and on an evening. One person said they sometimes do what they want to do. One person said, I am given a choice in what I do. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: In the AQAA the registered manager said, Our service users tell us that they are happy living at Park Road and we as a staff team feel that we offer an excellent standard of care from a dedicated, well trained staff team. In the AQAA the registered manager also said, Service users are consulted and asked to make their own decisions on everything that goes on in their life. They are encouraged to take risks if they want to but within a risk management framework. In July 2008, Park Road was awarded the Royal National institute for the Blind (RNIB) accreditation. The RNIB customer charter says that the service has passed a detailed audit and attained a high standard of service to visually impaired people. We talked to staff about the home; everyone said the home provides a good service. The home generally has a low turnover of staff and there is a core group of staff that have worked at the home for several years. Staff we spoke to had very good knowledge about peoples individual needs. People told us about monthly house meetings and said staff talk to them about the home. One person said, We talk about any problems and then sort them out. Every staff survey was very positive about the home and we received lots of information about what the home does well. These are typical comments, I feel the service has a good team who work hard together to ensure the best for the clients. Excellent support is given. Service users are very well looked after. At the last inspection we made a requirement that people who live at the home must have a detailed care plan to make sure that they receive person centred support that meets their needs. The registered manager explained that they are introducing a new person centred care planning process. She said they have been introducing it for several months but it is still in the early stages. This is because they are making sure the people who live at the home are fully involved in deciding how their needs should be met and staff fully understand person centred care. Staff said the new care plans would be good once they are in place. One staff member said, We are more geared around people, more person centred but we still have more to do. People who live at the home said staff talk to them about their care plans. One person said they have a keyworker meeting and talk about what they want to do. Their keyworker then writes it in their file. One survey said there had been some difficulties for some members of the staff team in understanding person centred approaches and when asked what the service could Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: do better, they suggested the service should be less task orientated and adopt person centred active support. The manager said staff have received in-house person centred training but thought the staff team would benefit from some external training. We looked at three peoples care plans and assessments. One person had a care plan in the new format although it still had a lot of information to add. The care plan had pictures and simple sentences to help the person understand the contents. It gave good information about communication and other important areas i.e fun things I like to do. They had not identified what support is required with personal care and household skills, and the action plan to identify goals and aspirations was still blank. Staff could not locate one persons care plan and said it had been sent to the head office because some information was being transferred to the new care plan. The day after the inspection the manager telephoned us and said the care plan had fallen out of the file and was at the back of the cupboard. Care plans are currently typed up at the head office because the home does not have a computer system. The manager said the home is getting a computer shortly so it will be easier to update and amend plans. Each file had good information about peoples specific conditions. For example one file had two information packs about the persons eye conditions. At the last inspection we said risk assessments must be carried out for people with challenging behaviour to identify risks from the behaviour. At this inspection we found people have good behaviour management strategies, which have been drawn up with support from healthcare professionals. These are very detailed and give everyone clear guidance on how needs should be met. Staff said they always follow the guidance and implement any recommendations from any professionals. Everyone has various risk assessments, including assessments for handling money, the use of a kettle, toaster, sandwich toaster etc. Staff have reviewed the assessments but recorded that the assessments have generally not changed for a number of years. One persons risk assessment for community access said see personal risk assessment but staff did not know if there was a personal risk assessment. The manager said they are reviewing the risk assessments as part of the new care planning process. Staff record important information about people and what they have been doing. The records are detailed and show how peoples needs are being met. This is good practice because peoples health, welfare and lifestyle can be properly monitored. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: People who live at the home have formal reviews to make sure the service is still meeting their needs. The home prepares a report for the review. We looked at one of these reports. It gave a very good detailed account of what the person has done and what support they need. Care Homes for Adults (18-65 years) Page 16 of 34 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 have an enjoyable and varied lifestyle. People do not get enough opportunities to take part in daily tasks around the home so some elements of independence are not promoted. Evidence: People told us they enjoy living at Park Road and have lots of opportunities to do different things. One person said they enjoy going out shopping with staff. Another person said they enjoy going to the pub and going out for coffee. On the day of the inspection some people were attending reflexology sessions. Daily notes had good information about what people do and they showed that peoples social needs are well met. We also looked at financial records. These showed us that people go out on a very frequent basis. For example the week before the inspection, Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: one person had been out with staff five times; twice to the pub, once for lunch, once for coffee, and once for shopping and coffee. When asked what the home does well, in the AQAA the registered manager said, Daily opportunities for access to varied day centres offering a wide range of classes/groups and service. We talked to people about what they do during the day. People said they enjoy attending day centres and college. One person said they couldnt go to the day centre during the holidays because their funding is no longer available. Daycare packages are varied. Staff said people generally go out 2.5 days per week. Some routines at the home are quite structured because the service is supporting eleven people. These routines do not always give people flexibility of choice and chance to develop independence skills in the home. One survey said the service usually supports people to live the life they choose but this is restricted because of the size of the home. We talked to people who live at the home about daily living skills. They told us staff are responsible for cleaning the house, laundry and cooking the meals. People said they have a bed changing day when staff support them to clean their bedroom but generally they do not clean other areas of the home. One person who enjoys cleaning said they do help around the house. On the day of the inspection we observed that after lunch staff cleared up and did the washing up. Staff and the manager confirmed that, in the main, people who live at the home do not take responsibility for domestic tasks and acknowledged people could take more responsibility. Some staff said people who live at the home are reluctant to do this. Care plans did not contain information about daily living skills. People should be encouraged to take responsibility within their own home and supported to be more independent. We joined everyone for a main meal at lunchtime. People who live at the home and staff sat together. The mealtime was very relaxed and there was a good atmosphere and interaction between everyone. In the AQAA the registered manager said they have improved in the last twelve Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: months by changing mealtimes to suit service users. The mealtimes are now flexible and meals can be taken in places other than the dining room. People who live at the home said they enjoy the meals. One person said, The food is lovely. We looked at the menus, which are varied and nutritious. A cook is employed five days a week, and senior care staff cook meals the other two days. Care Homes for Adults (18-65 years) Page 19 of 34 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. Peoples health and personal care needs are met. Evidence: We received one survey from a healthcare professional. They told us, The care service ensures there is good communication links and will seek advice/support and feedback any relevant information. The care service is always able to evidence that physical needs are being met. In the AQAA the registered manager said, Service users have access to a wide range of healthcare professionals via our local resource team, including physiotherapists, psychologists, psychiatrists, behaviour support. The registered manager said they have had more involvement where needed with the community resource team in the last twelve months. In the AQAA the manager identified that they could improve the service by completing health action plans for people who live at the home, and provide more training for staff in specific conditions. We have covered staff training in the staffing section of this Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: report. When we asked staff what the home does well some staff said work well with professionals. One staff said, We ask for help as soon as we identify any problem. Staff said the home is good at meeting peoples personal and healthcare needs. People who live at the home said they have good support with their personal care and staff make sure they get the right healthcare support if they are unwell. One person said, I tell the staff if Im not well and they get the doctor out. We looked at information that showed us that healthcare professionals are involved in peoples care and people who live at the home regularly attend healthcare appointments. Individual records have good information about appointments and showed us that staff are vigilant and look for changes in peoples well-being. Health Action Plans are being introduced. The manager said these would identify peoples healthcare needs. Senior staff have attended formal training so they know how to introduce person centred healthcare plans. We talked to people about privacy and dignity. People who live at the home said staff always respect their privacy and dignity. People also said staff knock on their door before entering. Staff gave us good examples of how they promote privacy and dignity. We looked at medication systems. Medication is well organised and good systems are in place to make sure the right medication has been administered. The records were completed correctly. All staff who administer medication complete medication training. Care Homes for Adults (18-65 years) Page 21 of 34 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 who live at the home are safeguarded. People are confident that they will be listened to and that appropriate action will be taken when necessary. Evidence: Surveys from people at the home told us they know who to speak to if they are unhappy. One person said they speak to the manager or they can talk to the director if they think it is necessary. Staff surveys told us that they know what to do if people have any concerns about the home. The manager told us the home has not received any complaints since the last inspection. Staff said they would report any concerns to the manager and they are confident she would deal with them promptly and appropriately. One staff said, The manager tells us that we have to report any concerns including any concerns about the management. At the last inspection we recommended that the weekly auditing of peoples monies should be recorded and the homes safeguarding policy and procedure should be reviewed. In the AQAA the manager told us they have a more robust policy on abuse and handling of service users monies. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: In the AQAA the registered manager said they have a, DVD for people who live at the home explaining abuse and its forms and how to complain. People who live at the home said they talk about reporting abuse at their meetings. One person who lives at the home said, They have told us if we have any problems with abuse we report it to the staff. Another person said, If anyone hits us we have to tell staff and they would sort it out. All staff have attended external safeguarding training. Senior staff are completing a level 2 alerters course in June and a safeguarding trainers course in September. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. We looked at personal allowances for two people. The money held corresponded with the financial record. Personal monies are held individually and each person has a record of transactions. Staff check these to make sure they are correct. Care Homes for Adults (18-65 years) Page 23 of 34 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. People live in a homely, pleasant and safe environment. Evidence: Surveys from people who live at the home told us the home is always clean. When we looked around the home it was clean, tidy and looked homely. The Royal National institute for the Blind (RNIB) has awarded Park Road accreditation which confirms the environment has been suitably adapted for visually impaired people. The home is well maintained, furnished and decorated. In the AQAA they gave us good examples of how they have improved the environment which includes new carpets and sofas in communal rooms. All of the bedrooms we looked at were furnished and decorated to a good standard. People have individualised their rooms by furnishing them with their personal belongings. Bedrooms are on four floors and can be accessed by stairs. There is no lift and no ramped access to the home so the premises would not be suitable for people with mobility problems. Two people share a bedroom; they said they are happy with this Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: arrangement. There are a sufficient number of toilets, baths and showers with appropriate aids and adaptations to promote peoples independence and mobility. The kitchen was inspected by environmental health in July 2008. A report of the visit was seen and this shows the visit was satisfactory. The kitchen is clean and the necessary checks are made to promote good food safety practices. Systems are in place for the monitoring of hot water temperatures and any problems are referred to the maintenance worker for the organisation. We randomly checked hot water temperatures and found them to be within safe limits. Care Homes for Adults (18-65 years) Page 25 of 34 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. People who live at the home are supported by a caring staff team. In the main, staff are skilled but some gaps in training could result in peoples needs not being met. Evidence: People who live at the home told us they are very happy with staff and management. Surveys from people who live at the home told us staff always treat them well. Five surveys said carers always listen and act on what they say; two said usually. One person said staff are helpful. Another person said they know to how to treat a lady. Staff told us people who stay at the home receive a very good service. We received seven staff surveys and spoke to six staff. We received a good range of comments of what the service does well. One person said our staff team do an awful lot to ensure our service is at the highest possible standard. Another person said I feel the service has a good team of enthusiastic and caring people who work hard together to ensure the best for the service users. In the AQAA the registered manager said they have a Core of long service staff who are all experienced with this client group. Staff said having a low turnover of staff has contributed to the good quality service because people receive consistency and Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: continuity of care. Staff said everyone has a good understanding of their role and they regularly meet with management to discuss how they are working. Everyone attends regular staff meetings. Staff told us staffing levels are generally good although some said they thought a couple of people who live at the home could benefit from some additional 1-1 staff time. Three surveys said there are always enough staff; four surveys said there are usually enough staff. All seven staff surveys said their induction covered everything they needed very well. The manager who signs off the induction programme said it has a learning disability context. Staff do not currently have an opportunity to complete an accredited Learning Disability Qualification (LDQ) Induction Award. The LDQ is only available through awarding bodies and the person or organisation providing the training would always have to be approved by an awarding body. The manager has not been approved by an awarding body. Staff told us they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. Staff said they would benefit from some more specific learning disability training. The manager said they have identified that staff should receive training in downs syndrome and ageing, and dealing with bereavement. She also said staff have received in-house person centred care training but everyone could benefit from receiving some external training. We looked at staff training records and they showed us that staff have received regular training. In the main staff have completed a good range of health and safety training although most staff have not completed training in the prevention and control of infection. In the AQAA the registered manager told us six staff out of the fourteen staff have NVQ level 2 or above in social and health care. Staff surveys told us a thorough recruitment process was carried out before they started working at the home. We looked at recruitment files for three people that have Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: started working at the agency since the last inspection. Two files had all the information to confirm that proper pre-employment checks were carried out. One file had most of the relevant information but did not have an application form. The senior staff on duty contacted the head office who confirmed the form was there. They said they would copy the form and send it to the home the following day. They also confirmed it had a full employment history. Care Homes for Adults (18-65 years) Page 28 of 34 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 home is well managed and everyone feels supported. Evidence: People told us they are very happy with how the home is managed and said the home is more focused around people who live there. One staff said, The manager is fantastic at supporting, discussing and running the home. Another staff said, The manager is a very good manager. She has worked very hard at bringing the home up to a very good standard. The registered manager is experienced and is suitably qualified. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us some good information about the service. It gave us examples of what they do well, how they have improved and what they want to do better. They also told us about changes they have made as a result of listening to people who use the service. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: In the AQAA the registered manager told us the home still needs to develop person centred care and encourage more independence for people living at the home. These are areas that we identified at the inspection and show that the manager has a good understanding of how the service can improve. The home has some good systems in place for monitoring the quality of the home. The manager and senior staff carry out a range of audits. People who live at the home attend regular meetings and are asked about the quality of the home. People who live at the home have not completed surveys about the type of care they receive as part of the homes quality monitoring process. We received some good information from the surveys that we sent out to the home. In the AQAA the manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. We looked at accident and incident forms. These had detailed accounts of what had taken place and action to prevent a similar incident occurring again. The senior on duty showed us documentation to confirm that an electrical wiring inspection had taken place in March 2009. The senior said the certificate was being issued but as yet the home had not received it. No concerns around safe working practices were seen on the day of the inspection. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 35 18 All staff must receive 30/06/2009 training that equips them with the right knowledge and skills. This will make sure people are safe, and their needs are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The care planning process should continue to be developed to make sure peoples care needs and aspirations are properly identified. This will make sure peoples individual needs and wishes are met. As the care planning process is developed, potential risks to people who live at the home should be identified, assessed and risk management strategies agreed. This will make sure the risk of harm is minimised. People who live at the home should be more actively encouraged to be involved in all areas of daily living in the home. This will help promote independence. Peoples healthcare needs should be identified through the care planning process. This will make sure their healthcare Page 32 of 34 2 9 3 16 4 19 Care Homes for Adults (18-65 years) needs are identified and met. 5 39 People who live at the home should be given an opportunity to put forward their individual views using a formal process such as surveys. This will help improve the quality of the service and make sure people receive a service that meets their needs. Care Homes for Adults (18-65 years) Page 33 of 34 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. 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