Care Home: Peel Way

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What the care home does well People are supported by a committed and regular staff team that know them well. People said that they liked living at Peel Way and that staff were okay. Staff said: "the service provides a relaxed home and gives choices to people living here." " The service promotes independence." "There is a good variety of external activities and communication is good." Staff also said it was good to have a stable manager and that they received good support from her. The service is very well managed with a good staff team that are committed to ongoing developments and improvements in the service. They have a strong commitment to safeguarding people and are very aware of safeguarding issues. What has improved since the last inspection? The staff team have been working with people to make the house more comfortable and homely. There has been some decoration and new furniture and people have been choosing new furniture for their bedrooms. Staff have also been helping people to improve the garden. Person Centred Active Support is now being used when working with people and as result of this people are doing a lot more both in the home and in the community. The requirement from the last inspection has been met in that a system is now in place to reconcile and monitor people`s bank accounts and more tightly safeguard their finances. What the care home could do better: The kitchen is in a very poor state of repair with missing doors and damaged drawers. Although we were told that the money had been agreed for this there is still no start date for this work to be done. The kitchen needs to be refurbished so that it is safe, hygienic and meeting the required standards. Staff feel that the organisation has not been giving them the support or training that they need to address complex issues within the home. For example a member of staff said: "More support from Avenues will enable us to support the service users in the home better relating to individual needs. I think particular specialist training for staff is needed on certain subjects. We`ve asked for this for a long time but have not been given it". Another said: "It feels that the company don`t want to offer relevant training on how to deal with particular a service user." The organisation needs to ensure that the staff team are given the training and support they need to provide an appropriate, safe and professional service. Key inspection report Care homes for adults (18-65 years) Name: Address: Peel Way 6 Peel Way Harold Wood Romford Essex RM3 0PD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jackie Date     Date: 1 6 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Peel Way 6 Peel Way Harold Wood Romford Essex RM3 0PD 01708386478 F/P01708345478 peel.way6@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services care home 6 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 6 Peel Way is a purpose built home for six adults with learning disabilities, situated in Harold Wood, Romford. It is a detached two-storey house with parking space to the side, and an enclosed garden to the rear. There is an open plan lounge/dining area, conservatory, kitchen, and utility room on the ground floor, as well as two bedrooms, both of which have ensuite toilet and bath. The remaining four bedrooms are on the upper floor, and each have an ensuite toilet, and share a bathroom. There is a ramp to both front and back entrance, but no lift to the upper floor. The Avenues Trust, a company that has similar homes, both locally and in Kent, runs the home. There are good local transport links, and the home has its own transport. Personal care is Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 Brief description of the care home provided on a 24-hour basis, with health care needs being met by visiting professionals, or staff accompanying people to appointments. At the time of the visit there were 6 men living at the home. Some people have profound disabilities and limited ability to communicate verbally, whilst others are more independent. The fees for the service range from 1379.50 pounds to 1478.10 pounds per week. The manager provided at the time of the visit. Information about the service provided is contained in the service users guide. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of the service took place between the 18th & 24th of September 2007. This inspection was unannounced and started at 10 am. on the first day. A shorter visit was made a few days later to check some staff information. The inspections took place over nine hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. People using the service were asked to give their views on the service and the experience of living in the home. All of the shared areas and four of the bedrooms were seen. Staff, care and other records were checked. Feedback questionnaires were sent to people who use the service, staff and other professionals. Feedback was received from nine staff and one healthcare professional. Care Homes for Adults (18-65 years) Page 6 of 31 Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in May 2009. In addition the manager provided an updated version at the time of the inspection. Information provided in this document also formed part of the overall inspection. The inspector would like to thank the people living in Peel Way and the staff for their input during the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 31 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people to decide if they want to move into this home. Assessments completed by the home and information and reports received from health and social care professionals mean that staff have the necessary information available to enable them to determine whether or not the home can meet a persons needs. People and their representatives have a written contract/statement of terms and conditions and will therefore be clear about what they are entitled to. Evidence: Standards 1, 2, 3, 4 & 5 were tested. There is a Statement of Purpose and Service User Guide. These are updated when needed and are available at the home. This gives people information that helps them to decide if they want to move into Peel Way. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The AQAA (Annual Quality Assurance Assessment) states that all new service users would have a needs assessment and all of the necessary information would be gathered from other professionals and families before the move. It also says that people would be encouraged to visit the home at different times so they could get the feel of the home and meet the other people that live there. People are therefore given the opportunity to visit the service and to meet staff and other users of the service before they decide if they want to live there. There have not been any new admissions to the service since 2005. At that time the inspection found that in-depth reports were received from members of the specialist multidisciplinary team for people with learning disabilities. The manager had also carried out a pre admission assessment using the company standard format. Therefore sufficient information was gathered to enable the staff team to identify that persons needs. People have individually written contracts between themselves and the provider. The contracts were available at the home and copies were seen in individual files. Therefore people have details about the service that they are entitled to. The AQAA states that the contract is available in easy read, large print and could also the translated to different languages and Braille if needed. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans and risk assessments contain sufficient information to enable staff to meet peoples needs. People are encouraged and supported to be involved in decisions about what they do and what happens in the home. Evidence: Standards 6, 7, 8, 9 & 10 were tested. Avenues Trust is committed to the concept of Person Centred Active Support (PCAS) and each person has an individual person centred plan covering all of the necessary areas. These include communication, behaviour, environment, personal care and health, domestic, family and personal relationships, cultural, and social interaction. The plans give a good picture of who the person is, what he can do and what he likes. For example: I like the seaside, animals and my drums. I can wash with prompting but need assistance with shaving. The degree to which some people can be involved in the development of the plan is very limited due to their profound learning and communication difficulties. Others are able to take an active part in this process. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Three care plans were examined. These contained a lot of information about the individuals needs, likes and dislikes. The plans clearly described how to support the person and what good support would be like. The plans seen had been reviewed and were up to date and planning meetings are held every six months with relevant people being invited. There was sufficient information available for staff to work with the person and show that staff know people well and that they are working to meet individual needs and to provide a person centred service. Daily recordings are made about what each person has done and support that they have been given. Separate night logs are also kept. This information is used as part of the review process and to identify ongoing and changing needs. Residents meetings are held each month and a record is kept of these. Some people can and do express their views about what they want to do and what they like. Minutes show that they were consulted about holidays, what they do, what they eat and where they go. One person said he chose his bedroom furniture and told us where he bought it. On the day of inspection two other people had been out to buy new clothes and new items for their bedrooms. People are consulted about what happens in the home and to them. There were up-to-date risk assessments covering the necessary areas. These are relative to each individual, the activities that they do and their own specific behaviours. This means that risks can be reduced and that peoples needs can be met as safely as possible. In some cases restraint and/or restrictions form part of individuals care plans and these have all been reviewed and signed by the manager. The reasons for these are recorded and have been agreed with the individuals concerned as far as is possible. In addition the manager is aware of deprivation of liberty issues and these have been discussed with the local authority to ensure that they are in peoples best interests. Personal information and records are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Staff awareness of confidentiality issues is checked as part of the monthly monitoring visits carried out by the service manager. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities for personal development and are supported to be as independent as possible. They are encouraged to engage in appropriate leisure activities within the local community. People are supported to keep in contact with their relatives and visitors are made welcome at the home. People are given meals that they like and that meet their needs and preferences. Evidence: Standards 11, 12, 13, 14, 15, 16 & 17 were tested. Four of the people living in Peel way are more independent than the other two and they are able to assist to a greater degree with household chores and with the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: cooking. The washing machine controls have been colour coded to assist people to do their own laundry. One person can travel independently but the others require support from staff. This person has just started his third year at college and also goes to a computer club. People go to a variety of activities and these include bowling, pool, sauna, shopping, day trips and out for meals. People have all been or are going on holiday. This is in small groups according to individual needs and preferences. Two people had already been to Potters holiday camp and said that they had enjoyed this. Another person likes walking and peace and quiet and so staff took him to for a quiet countryside holiday. As one of his favourite things to do is to have a bath the accommodation that they booked had a hot tub which they said he really enjoyed. Staff said that people are doing a lot more both in the home and in the community. They also said that there is flexibility so that things can be done on the spur of the moment if this is what the service users want. Staff also said people do things with us and not just us doing things for them. The staff team support people to have contact with their families and most people have contact in varying degrees. One persons mother visits regularly and he visits her. She said that the staff are always welcoming. Others contact is not as frequent. The menus are varied and are available in pictorial form to help people to make a choice about what they eat. Some people are clearly able to indicate what they would like to eat and staff are aware of others preferences. People are encouraged and supported to assist with meal preparation and making their drinks as far as they are able. Individuals person centred plans contain information about peoples likes and dislikes in terms of food. For example one plan said, My favourite food is chicken. The menu seen appeared to be appropriate and nutritious. At present people do not have any specific dietary requirements in relation to their religious or cultural needs. However one person does have to have decaffeinated tea and this is provided. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service receive personal care that meet their needs and preferences. They are actively supported to receive the healthcare that they need. People are supported to receive their prescribed medication safely. Evidence: Standards 18, 19, 20 & 21 were tested. The people living at Peel Way require differing amounts of support with their personal care. Some are quite independent but others are dependent on staff to meet their personal care needs. Details of the help that they need and how they prefer to be supported are in their individual plans. The plans also show that people are supported to be as independent as possible in this area. For example one persons plan states, I can wash myself with prompts but need assistance with shaving. Each person is registered with a local GP and specialist help is received when needed. This includes input from the psychiatrist, psychologist, occupational therapist and physiotherapist. They also have a yearly health check. Staff support each person to Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: their medical appointments. Records are kept of medical appointments and their outcomes and also show that people have checks from the optician, dentist and when needed the chiropodist. For some people these professionals visit the home are other people go to community facilities. Each person has got a health action plan and these are taken when a person goes to hospital or for an appointment so that other professionals can have a clear understanding of their needs. Recently one person was diagnosed as having cancer and he was supported through his treatment by the staff team. Several of the staff team have worked at the service for some time and know people very well. They are able to identify if someone is unwell both in terms of their physical and mental health. Recently one persons behaviour has changed and he was taken to the GP and referrals made to the community learning disability team. Another person who in the past has exhibited very challenging behaviour was supported by staff to reduce and change his medication and as a result of this he is now more alert and participating more. Therefore people are supported to receive the healthcare that they need. Medication is administered by staff that have been trained and deemed capable to do this. Staff have annual medication assessments and updated training every three years to ensure that they are administering medication correctly and safely. Medication is securely and safely stored in an appropriate lockable cabinet in the main office. Examination of the MAR (Medication Administration Record) found that these had been appropriately completed. There was also descriptions of how medication needed to be administered. For example I like staff to hand me my tablets to take myself. It also showed how people are supported to be a bit more independent by applying cream themselves with support rather than staff automatically doing this. It has been identified that one person should be able to self-medicate and procedures are being developed for him to do this. For accountability the medication file must contain the names of the staff that are able to administer medication along with their signed initials. Some people receive PRN (as required) medication and protocols/guidelines have been developed. These had been signed by each individuals GP. However these did not always contain sufficient detail. For example it did not confirm the required gap between doses or how many doses could be administered in a 24-hour period. It is recommended that PRN (as required) guidelines are reviewed and made more detailed so that they contain all of the necessary information to minimise the risk of error and to enable these to be administered as safely as possible. Medication is checked as part of the monthly monitoring by the organisation. There was a BNF (British National Formulary) but this was dated September 2007. When we returned to complete the inspection the manager had already ordered a new one. There was an out of date inhaler and out of date urine testing strips in the cupboard. Systems need to be in place to check expiry dates of medication regularly. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: However overall people are receiving their prescribed medication safely. Staff have received bereavement training and funeral plans are in place for some of the people living there. One person has stated hymn preferences and his support plan states, when I die I would like carnations. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Peel Way are safeguarded by the working practices and support of the staff team. The organisation needs to be more active in ensuring that all of the necessary actions are taken to support staff to safeguard people as robustly as possible. Evidence: Two people are not able to realistically make a complaint due to their profound learning and communication difficulties but the others would be able to voice dissatisfaction. The organisation has an appropriate complaints procedure and this is available in a user-friendly format. This is included in the service user guide. People have access to independent advocates who can raise any concerns or issues on their behalf. Staff are aware of what to do and how to facilitate a complaint. The Commission has not received any complaints or concerns about the service since the last inspection. The manager is appointee for most of the people using this service. A random selection of three peoples finances was checked and cash amounts held agreed with records. Receipts were on file. Peoples monies are securely stored and checks are made at each handover. The organisation carries out financial audits and the service manager checks peoples monies, receipts, expenditure and inventories as part of the monthly monitoring visits. Bank accounts are now reconciled and checked and copies Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: of bank statements are sent to head office regularly. This offers safeguards to people in terms of their finances. Staff have received safeguarding adults training. They are aware of what constitutes possible abuse and of the action that needs to be taken. The staff have also received information about deprivation of liberty and are aware of the difference between restraint and restrictions. Restrictions placed on people have been discussed with the local authority and have been deemed to be acceptable and in their best interest. This offers more protection to people who are unlikely to be able to indicate that they have not been treated appropriately and are relying on other people to keep them safe. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living in the home. However the staff team have identified a potentially very serious safeguarding issue. This has been raised with the organisation and the local authority. However very little action has been taken to address these concerns or to support the staff team. The staff team are extremely vigilant with regards to this and have instigated measures to safeguard people. The organisation has a responsibility both to staff and users of the service and should have been more robust in supporting staff and addressing the issue with the local authority. The efforts of the staff team in terms of safeguarding have been excellent but the overall rating for this section has been assessed as good as a result of the lack of robustness of the organisation. Requirements in relation to these issues have been made in relation to staff training and support in the staffing section later in this report. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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 clean and comfortable home that is suitable for their needs. However the service is let down by the kitchen which is in a very poor state of repair and needs replacing. Evidence: Standards 24, 25, 26, 27, 28, 29 & 30 were tested. 6 Peel Way is a purpose built home for six adults with learning disabilities, situated in Harold Wood, Romford. It is a detached two-storey house with an enclosed garden to the rear. There is an open plan lounge/dining area, conservatory, kitchen, and utility room on the ground floor, as well as two bedrooms, both of which have ensuite toilet and bath. The remaining four bedrooms are on the upper floor, and each have an ensuite toilet, and share a bathroom. There is a ramp to both front and back entrances, but no lift to the upper floor. None of the people living there require any specialist adaptations. The kitchen is in a very poor state of repair with missing doors and damaged drawer fronts. Although the funding for a replacement has been agreed the work has still not been carried out. The kitchen must be renewed/upgraded to ensure that it is safe, hygienic and of an acceptable standard. This requirement relates to both standards 24 Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: & 28. Several areas have been decorated and new soft furnishings purchased. Bedrooms are personalised according to individuals likes and staff have been supporting people to improve their own bedrooms and people have bought new things. One person showed us his room and new furniture and told us where he had bought this. Other people had been shopping for new bedding. One person likes sensory equipment and has sensory equipment in his bedroom. Pot plants have been purchased to make the entrance more welcoming and one person showed us the garden and talked about the plants that staff had planted. He said that he had also helped with this. With the exception of the kitchen, which is outside staff control, a lot of effort has been put into improving the environment and making it more homely and comfortable. At the time of the visit the home appeared to be clean and was free from offensive odours and had a satisfactory food hygiene inspection in January 2009. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the recruitment practices of the service. People are supported by a competent and committed staff team who know them well. However the organisation has not been robust in its support and training for the staff team. Evidence: Standards 31, 32, 33, 34, 35 & 36 were tested. From the rota and from discussions with staff it was evident that people are being supported by regular staff to know them well. There is a minimum of three staff on duty during the daytime shifts and two staff during the night. That is one waking and one sleep in. From discussions with staff and from examining rotas it would appear that staffing arrangements and levels and are in general sufficient to meet peoples needs. However as previously stated a potentially serious safeguarding issue has been highlighted by the staff team and this has resulted in changes in work practice and supervision levels. Staff are limiting the effect on people as far as possible but the service must be able to demonstrate that staffing levels are appropriate to meet the needs of all of the people living there and this cannot be done until the necessary assessments and reviews have taken place and any specialist input identified. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: All staff have job descriptions, contracts and handbooks and are clear about their roles, responsibilities and duties. The staff team all have experience of working with people with learning disabilities. Staff on duty said that they had received training since they started work in the home and records were seen of staff training. Staff training has included the Mental Capacity Act, challenging behaviour, de-escalating and defusing, Protection of Vulnerable Adults, health & safety and infection control. Some staff have NVQ level 2 &/or level NVQ level 3. Therefore in general training is very good and staff are competent. However as stated previously staff identified a potentially serious safeguarding issue and feedback from staff was: It feels that the company dont want to offer relevant training on how to deal with a particular service user. I think particular specialist training for staff is needed on certain subjects. Weve asked for this for a long time but have not been given it. Staff are receiving regular supervision and staff meetings are being held each month. This gives staff the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. Feedback from staff was that they can raise issues or suggestions and that these are welcomed and listened to by the manager. Staff spoke of good support from the manager and of good teamwork. The organisation has a responsibility both to staff and users of the service and must ensure that staff have the necessary training to safely and professionally meet peoples needs. They must also ensure that, in addition to the support offered by the manager, the staff team receive professional support to enable them to discuss and address the complex issues that have arisen in the service. The organisation operates an appropriate recruitment procedure. Jobs are advertised, application forms completed and interviews held. Two references are obtained and POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) are undertaken. People living at Peel Way are involved in the interview process. They open the door and meet candidates. One person usually sits in on interview. Staff records are held centrally at the organisations head office in line with an agreement made with the Commission. Copies of the necessary information confirming the recruitment are stored in the files held at the home. The files of the two newest staff were examined during the inspection. One file contained evidence that the necessary checks had been carried out but the other was not available. The manager said that she had received a confirmation e mail. The necessary documentation was sent to the home and seen on the return visit. The recruitment procedure offers safeguards to people but the organisation is reminded that the necessary paperwork must be sent to the home once the recruitment has been completed so that it is available for inspection and complies with requirements. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Peel Way benefit from a service that is well-managed and where their opinions are sought and acted upon. They live in a safe home. Although the service is well managed by the manager the organisation has not been as robust as needed to support the service. Evidence: Standards 37, 38, 39 and 42 were tested. The manager has experience of working with people with learning disabilities and has completed NVQ level 3 in care and is now completing a diploma in management. She has been a senior and an assistant manager at a residential home and has also managed a supported living scheme. Staff feedback was, there have been great improvements since Karen came here. Things get pushed along. Its good to have a stable manager. Karen is constantly trying, she is fantastic. You can speak to Karen, she relates to people and will always help. Therefore people are benefiting from a well run home. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The quality of the service provided is monitored by the manager and by the organisation. The service manager carries out monthly unannounced monitoring visits to check the quality of the service provided. A report on this visit is left at the home. The reports cover the necessary areas and indicate any action that is needed. The service manager and the home manager review the progress of the service regularly and an action plan is agreed. Stakeholder questionnaires are sent to appropriate people to get feedback on the quality of the service provided, although there had been little response. Therefore the quality of the service provided to people is monitored by the organisation. The staff team carries out all of the necessary health and safety checks and records are kept of these checks. For example fire call points are tested weekly, as are hot water temperatures. Fridge and freezer temperatures are tested daily. Appropriate servicing is carried out on the fire system and fire equipment. Three fire drills have been held this year including a night-time drill. Appropriate service and checks are also carried out on equipment and services. For example gas safety and portable appliance testing. Monthly health and safety checks also carried out by the staff. A safe environment is provided. Although the service is well managed by the manager the organisation has not been as robust as needed to support the service. Previous sections in this report on staffing and concerns and complaints give further information about this. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The medication file must contain the names of the staff that are able to administer medication along with their signed initials. For accountability and to ensure that there is a clear audit trail of who has administered medication and when. 31/10/2009 2 20 13 Systems need to be in place to check expiry dates of medication regularly. To ensure that people are not given medication that has passed its use by date. 31/10/2009 3 28 23 The kitchen must be renewed/upgraded. To ensure that it is safe, hygienic and of an acceptable standard. 31/12/2009 Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 33 18 The registered person must demonstrate that staffing levels are appropriate. To meet the needs of all of the people living there. 30/11/2009 5 35 18 The registered person must ensure that staff have the necessary training. To safely and professionally meet peoples needs. 30/11/2009 6 36 18 The registered person must 30/11/2009 ensure that, in addition to the support offered by the manager, the staff team receive professional support. To enable them to discuss and address the complex issues that have arisen in the service. 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 20 It is recommended that PRN (as required) medication guidelines are reviewed and made more detailed so that they contain all of the necessary information to minimise the risk of error and to enable these to be administered as safely as possible. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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