Care Home: Pia - 45 Old Hinckley Road

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What the care home does well Care plans are in place for everyone at the home. The care plans contain good levels of information about people`s needs and care routines to enable staff to know what support they should provide. People are supported to get out and about and to stay in touch with their relatives. They are involved in everyday choices such as planning menus and activities. People are supported to look good and wear nice clothes so that they maintain a good self image. Support is given for the people at the home to gain access to relevant health professionals to make sure their health needs are met properly. Encouraged is given for people to express any concerns or complaints and staff are trained to recognise and report any suspicions of abuse, so that people are protected from harm. Staff are provided with access to a satisfactory range of training and receive regular updates in Health and Safety related training subjects to make sure that they are equipped to support people in a safe manner. Suitable arrangements are in place for checking that the home runs properly. The people at the home and their relatives are asked for their views so that they can contribute to developments at the home. What has improved since the last inspection? New assessment paperwork has been put in place so that new people referred to the home may have their needs properly assessed before they move in. People`s contracts now include details of charges for transport so that people know what they are expected to pay for. Work has taken place to remove a switch that controlled access through the hallway to restrict a person living at the far end of the home from moving through the home freely. Excellent work has been carried out to develop a sensory garden at the rear of the home. This is particularly beneficial as some of the people at the home have specific sensory needs and this provided a lovely relaxing environment for them to enjoy. What the care home could do better: Overall the home is comfortable and clean for people to live in. However the lounge has seats with washable covers and also has hard flooring that is washable. This area could be improved to make the lounge look warmer for people to relax in. The emergency lights are being tested every three months and should be tested every month to make sure they are in full working order in the event of a fire at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pia - 45 Old Hinckley Road 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA     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: Kevin Ward     Date: 0 1 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 31 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 31 Information about the care home Name of care home: Address: Pia - 45 Old Hinckley Road 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA 02476382960 02476640146 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) : People in Action care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 7 Date of last inspection Brief description of the care home 45 Old Hinckley Road is a registered care home for six people with learning disabilities. The house is a converted detached building within walking distance of Nuneaton town centre. The majority of rooms and facilities are on the ground floor. There is a ground floor flat for one service user who has been assessed as benefiting from a degree of separateness from the rest of the home, although he is encouraged to interact with the rest of the home at appropriate times. One service user has a bedroom upstairs, which is also where the staff sleeping-in room is located. There is a large garden area at the rear and car parking area at the side of the building. The garden has been made secure for the benefit of the single resident who lives on the ground floor flat. People In Action provide 24 hour care and personal support to the young adults living in the Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home home. The current fees start at five hundred and fifty pounds per week. People have to pay for personal items, such as clothing toiletries and costs and leisure. 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 quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a key unannounced inspection, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Care Homes for Adults (18-65 years) Page 6 of 31 Questionnaires were returned by four people at the home, giving their views of the service they receive. The inspection included seeing everyone living at the home and case tracking the needs of two people. This involves looking at their care plans and records and checking how their needs are met in practice. Discussions took place with two 4 staff, as well as the manager and the assistant manager. A number of records, such as care plans, complaints records, and fire safety records were also sampled for information as part of this inspection. An annual quality assurance assessment was completed and returned by the provider in time for this inspection, providing the managers views of the homes performance during the last year. What the care home does well: What has improved since the last inspection? What they could do better: Overall the home is comfortable and clean for people to live in. However the lounge has seats with washable covers and also has hard flooring that is washable. This area could be improved to make the lounge look warmer for people to relax in. The emergency lights are being tested every three months and should be tested every month to make sure they are in full working order in the event of a fire at the home. Care Homes for Adults (18-65 years) Page 8 of 31 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 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. Suitable admission procedures are in place and new people are provided with information to help then to make an informed decision to move into the home. Evidence: The manager explained that there have been no new people admitted to the home since the last inspection. The manager has recently introduced a new assessment document that is to be used when new people are referred to the home, to assess their needs. The assessment has been completed for the current people living at the home. The assessment covers a wide range of needs. The manager confirmed that new people referred to the home are offered opportunities to visit, with relatives, to see if they like it. A service user guide is available at the home, containing information about the service. The service user guide has been illustrated with pictures to make it more attractive and easier for people to understand. The service user guide did not contain the current fees and transport charges. This was updated by the manager during the course of the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: site visit so that people are provided with the correct information. The manager said that she would put the new service user guide on display in the home so that people / relatives can read it. Three peoples contracts were seen on file. The contracts contain information about peoples rights and responsibilities. Two of the contracts had been countersigned by peoples relatives indicating that people have been given support to understand what they are signing. 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 needs are planned for and reviewed so that they can be met in a safe and sensitive manner. Evidence: Two peoples care plans were checked and records were also sampled from another persons file. The care plans contain good levels of detailed information about peoples needs, such as personal care, communication and health care needs. Both care plans included good levels of information about peoples personal routines and the way they like their care provided. This information is helpful so that staff are able to fit in with peoples preferred routines. This is particularly important when people have autism or difficulties in verbally communicating their needs to people. Review documents were seen on file as evidence that people have recently had their needs reviewed by social workers, with support from relatives, where appropriate. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Both peoples fies contained good behaviour management guidelines, signed by health professionals, as evidence that their advice and agreement had been sought for the correct approach for staff to follow. A good range of risk assessments were seen, such as using kitchen equipment, carrying out personal care and access to the community. Some risk assessments are due to be updated and the manager said that she would be doing this very shortly. Where there have been recognised changes in peoples needs their risk assessments have been updated, e.g. one person had new interim behaviour guidelines in place following some changes in their mental health and another persons file contained evidence to show that they had been assessed by an occupational therapist to check if they had any special requirements for equipment following recent changes to their mobility. A risk assessment is in place for a person who uses a specialist bed to identify and reduce any likelihood of them getting accidentally trapped. In surveys returned by the people at the home they confirmed that they are able to choose what they want to do each day. People were offered a choice of cereals for breakfast. A person who is unable to communicate verbally was shown the cereal boxes so they could make their choice. One person slept in till mid morning in keeping with her wishes, as she had been up late the night before. Meetings are held regularly with the people at the home, (records seen) which includes making everyday plans, such as choosing activities and planning menus. One person has received support from a speech therapist and has been provided with a talking communication passport. A voice message is activated when photographs in the communication passport are touched, telling the listener what is wanted, e.g. a picture of a relative is touched and a message states I want to call my sister. A keyring containing pictures of a range of everyday activities has also been provided so that the person concerned is able to point to the relevant picture to show others what they want. 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 are provided with the support they need to gain regular access to the community and to take part in activities that they enjoy. Peoples food choices and dietary needs are properly considered so that they are provided with well balanced meals that they enjoy. Evidence: Comments by people at the home and staff indicate that people are supported to take part in a good range of everyday activities. One person explained that she attends a day service several days a week, which she enjoys and also helps out at People In Actions office. Another person said they enjoyed shopping and going to parks. On the day of the site visit, two people went shopping for cups and vegetables to make home made soup. Other examples of activities included trips for coffee, meals out, trips to the pub and day outings such as Coombe Abbey Park, zoo, gang show, water park and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Abba tribute band. One person has also been supported by staff and relatives to go to Liverpool football ground. The person concerned said that this was a lifelong ambition achieved. The trip was videoed as a keepsake, providing memories of the day. Comments by the people at the home and staff confirmed that everyone goes on at least one holiday during the course of each year. Some people went to Disney Land and the Norfolk Broads last year and plans are in place for this years holidays. People are supported to travel in small groups so they get to go the places they enjoy. People confirmed that they are able to receive visits from their relatives and said that they are made to feel welcome at the home. Relatives and others were invited to Christmas celebrations at the home and photographs are available for people to look at. In addition to celebrating Christmas, the home has also celebrated Chinese new year and Burns night, including themed meals. peoples sexuality needs are addressed in their care plans. Comments by the manager and staff indicate that proper consideration is given to enabling people to express their sexuality in a sensitive and dignified manner. Peoples spiritual / religious needs are recorded in their care plans. Two people are supported to go to church on a regular basis and another person goes occasionally to Kingdom Hall with support from relatives. The people at the home confirmed that they are involved in everyday living activities to maintain their independence, such as shopping, cleaning their rooms, washing up and food preparation. People were seen to return their crocks to the kitchen after breakfast and one person explained that she had made her own packed lunch to eat later in the day at the day centre. As previously noted people confirmed that they are involved in menu planning and evidence of this was seen in meeting notes. There are several people with communication needs. Peoples dislikes are recorded in their care plans but the home does not currently use visual aids, such as photographs of meals, to help people to choose. The manager said that she would address this matter. The menus provide well balanced and varied meals and indicate that people are provided with a healthy diet. One person likes vegetarian food and confirmed that her needs are catered for. Another person has been on a weight reducing diet and keeps a personal record of all they eat so that it can be monitored by the dietitian. This has resulted in the person concerned achieving a total weight loss of approximately three stone, over several years, whilst still enjoying the food at the home. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Most of the people at the home take part in shopping for groceries and encouragement is being given by staff for people to choose low fat health food options, evidence of which was seen in the home. A bowl of fresh fruit was seen in the dining room for people to help themselves to. Care Homes for Adults (18-65 years) Page 17 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 are provided with the care and support they need to meet their personal and health-care needs well. Suitable arrangements are in place for storing and administering medication so that people receive the correct medication to meet their needs. Evidence: Comments by the people at the home and responses in questionnaires that they completed as part of the inspection, indicate that they like the staff that support them and find them to be friendly and helpful. Staff were observed to approach people in a warm manner and there was a good rapport apparent between the people at the home and the staff supporting them. Everyone was dressed in age appropriate, well laundered clothing. Everyone was well groomed. Two women confirmed that they are supported to go to the local hairdressers. They were both observed to have modern hairstyles, indicating they are supported to take a pride in their appearance and to maintain a good self image. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Comments by staff indicated a good understanding of peoples needs and personal routines. One member of staff spoke of the importance of retaining the routines of a person with autism to reduce and unnecessary stress and anxiety. The health records of the person concerned show that proper use of the consultant psychiatrist is being used to address changes in mental health and interim guidelines have been written in the care plan whilst the persons needs and medication are being reviewed. Protocols are in place for people using PRN (as needed ) medications. Discussions with staff and sampling of two peoples medication records indicate that PRN medication is used appropriately, after behavioural management guidelines have been followed. Peoples health records provide a good account of the outcomes of appointments, making it easier to track and monitor developments in peoples health-care needs. Information in peoples files indicates that the home makes good use of health professional advice, such as dietician, speech therapist (swallowing guidelines and communication assessments), community nurse and psychologist. Information in two peoples files show that they are being supported to get regular well person healthchecks, flu vaccinations and opticians visits. Two peoples records do not include a record of dental appointments. The manager said that in both cases the people concerned had refused these checks. The manager said that in future she would keep a record of any such refusals and raise this matter at the next care review, so that agreement may be reached with the social worker that this is the correct course of action. Medication is stored in a lockable cabinet. Three staff spoken to all confirmed they had received medication training and been assessed by the manager / assistant manager to ensure they understand the medication procedures. A checklist is used by the manager to underpin these assessments (seen on two staff records). Copies of medication workbooks were also seen on file which staff had completed as part of their training. Following two recent medication errors the manager has introduced extra medication checks four times a day to make sure that all medication has been given out correctly and signed for. This includes keeping a running total of all tablets in the home. Recent medication records were sampled and no anomalies were identified. Where PRN (as needed) medication is being given it is being correctly coded on the medication record and the reason for giving the medication is properly recorded on the back of the medication sheet. PRN protocol were seen on file providing advice for administering as needed medication, including diazepam (for severe epilepsy). Staff confirmed that they had been provided with epilepsy training, including the administration of diazepam. This was verified in training records and discussions with the manager. Care Homes for Adults (18-65 years) Page 19 of 31 Care Homes for Adults (18-65 years) Page 20 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. Suitable arrangements are in place for responding to peoples concerns and complaints and staff are trained to recognise and report suspicions of abuse so that people are protected from harm. Evidence: In surveys returned by four people at the home they all confirmed that they knew how to complain and who to see if they are unhappy. Two people spoken to at the site visit said that they would see the staff or the manager if they had any concerns. A complaints procedure is available in the service user guide. There have been no complaints made to us since the last inspection and the manager reports that no complaints have been made to the home. Three staff on duty confirmed that they had received safeguarding from abuse training and staff training records show that all staff are provided with this training. Comments by staff indicated a satisfactory awareness of different types of abuse and to whom they should report any concerns, should this be necessary. Similarly staff have been provided with whistleblowing training so that they know how to report any concerns they may hold about the running of the home. Staff training records show that staff have also been provided with training to equip them to respond appropriately to any incidents of challenging behaviour. As previously noted the home works well with psychiatrists and other health professionals in the development of appropriate Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: behaviour guidelines to support safe practice. One safeguarding has been carried out involving a member of staff at the home. The matter was properly referred to Warwickshire Social Services and appropriately dealt with under the safeguarding procedures. Care plans include a good record of the correct procedure for withdrawing money from peoples behalf when this is done on their behalf. Records are kept detailing peoples personal expenditure. This includes two staff signing to verify how money is spent and receipts are retained as evidence of expenditure. The manager checks and signs the record to monitor and safeguard peoples monies. Peoples monies are also audited by staff from the organizations finance department. The home has recently received an excellent report as a result of a recent audit commending the homes practices with regard to money management. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with clean and well equipped accommodation to meet their needs. There is scope for making the lounge look more homely. Evidence: The communal areas of the home are clean and comfortable and suitably equipped to meet peoples needs. New chairs have recently been purchased for the lounge. Everyone has an individual chair rather than sharing a lounge suite. The manager explained that the people at the home prefer their own seat rater than sharing a sofa and that the chairs were chosen with their involvement. The chairs are of a very upright design. Whilst they are very practical and in good condition they do not lend a homely feel to the lounge, particularly as their is plastic, wood effect floooring in the lounge. The manager said that she would arrange for a carpet to be laid in the lounge when the flooring is next due for replacement to make the lounge look warmer. Overall peoples bedrooms were clean, well decorated and well equipped. A strip of wall paper had been peeled off the wall, behind a bedroom curtain by a person at the home following a recent leak in the roof. The manager said that the leak had been mended and the wallpaper would be replaced following further roof repairs. People have been supported to personalise their bedrooms to their liking with pictures, Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: photographs, TVs and music playing equipment and other personal belongings. One person has lots of Liverpool football club memorabilia around their room. People are not currently able to lock their bedroom doors and do not have lockable furniture to enable them to lock personal valuables away should they wish to do so. The manager said that she would seek peoples views to ascertain who would like this provision. Two people share an en suite bathroom and there is also a walk in shower room (wet room) which provides good disability access and has been fitted with grab rails and a chair to help people to bath safely. Excellent work has been carried out to transform the garden at the rear of the house into a sensory area, with visual and tactile objects and wind chimes. A person at the home was seen to enjoy sitting out in the garden and relaxing during the site visit. Staff were seen to make use of aprons and gloves for personal care tasks. Plastic bags are provided to carry and continence laundry to the laundry and an industrial washing machine is in place with settings suitable for laundering continence laundry where necessary. A cleaning schedule is in place for people to follow to keep the house clean and staff make a note on the shift handover record to show that they have completed relevant cleaning duties in the home. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are properly recruited and provided with a good range of training opportunities so that people benefit from a suitable staff team who are well trained to meet their needs. Evidence: There are 7 people currently living at the home. Staff on duty explained that there are typically 3 or 4 staff on duty. An extra worker was on duty on the morning of the site visit as it was their first day at the home and they were shadowing other staff to learn about peoples needs. The manager and assistant manager were also on duty at the home. Comments by staff and the manager indicate that there are sufficient staff on duty to enable them to provide one to one support to a person who requires it, as well as providing satisfactory support to other people in the home. Comments by the people at the home indicate that they are able to gain swift access to staff support when required and are able to receive assistance to get and about when they want to do so. The files of two recently employed staff were examined to check that proper recruitment and vetting procedures are followed. The files demonstrate that people are Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: taken through a proper interview process and that two references and a Criminal Record Bureau check are carried out before staff start work at the home. These checks are necessary to make sure that staff are suitable to work at the home and do not present any known risks to the people living there. Staff on duty confirmed that they are provided with access to a good range of training opportunities including Health and Safety related subjects to ensure that are trained to carry out their work safely. This was also verified in training records provided by the manager, which show that staff are provided with regular ongoing training updates in subjects such as first aid, food hygiene, fire safety, safeguarding against abuse, challenging behaviour and safe handling of medication. The manager said that pressure area care awareness training is planned to take place shortly. This is important as it will be used to further structure the homes practice for risk assessing and monitoring peoples skin care needs. Similarly staff are provided with access to National Vocational Qualification (NVQs) training courses. These courses are necessary to properly equip staff to carry out their work effectively. The records show that staff are trained to meet peoples specific assessed needs, e.g. most staff have had epilepsy training (including the administration of diazepam) and seven staff have completed autism training whilst 2 more are booked on courses. The manager reports that 6 staff hold NVQ 2 and 3 staff hold NVQ 3 qualifications. Four staff are also in the process of completing NVQ 2 and an assistant manager is completing NVQ 4 in care. This amounts to over 50 per cent of staff trained in these qualifications in keeping with recommended standards of training achievement. Three staff explained that they receive regular planned supervision and this was also verified in supervision notes. The supervision notes are well recorded and indicate that these sessions are purposeful and used to consider policy, practice and training needs. Similarly regular team meetings are held at the home to support a consistent approach to peoples needs. Staff confirmed that they are provided with a proper induction when they start at the home. This was also verified in staff induction training records. Care Homes for Adults (18-65 years) Page 26 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. The home is well managed and staff are provided with regular supervision and guidance to carry out their work and provide people with the support they need. Evidence: The manager holds the Registered Managers Award and the National Vocational Qualification (level 4 ) in Care. The manager also holds a nursing qualification and has a number of years experience of working with people with learning disabilities. A number of checks are carried out to support Quality Assurance at the home. Questionnaires have been sent to the people at the home and the manager explained that surveys are also being sent to relatives in May to gain their opinions of the home. The manager checks peoples money on a regular basis and staff of the finance department also carry out periodic audits to ensure money is managed correctly. A shift handover is carried out which includes staff signing a record to say they have carried out relevant domestic tasks, appointments and checked peoples medication Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: and money. Staff confirmed that they are provided with regular supervision and are able to gain access to managerial support when they need it. This was also verified in staff supervision records. Similarly regular staff meetings are being held at the home to support a consistent approach to meeting peoples needs. The manager carries out a monthly quality assurance check (completed checklist seen) to check that the home is running well. A senior manager also visits the home on a regular basis to see the people that live there and sample records to satisfy herself that home is running properly. Where any shortfalls are identified these are documented and progress is monitored at the next visit. The fire safety log was checked. The alarms are being tested on a weekly basis to ensure they work in the event of a fire and fire drills are carried out at the home so that people know where to gather in the event of a fire at the home. However emergency lights are being tested every 3 months instead of every month as recommended by the fire officer. The manager said that she would ensure that the lights are tested weekly in future. Certificates were seen demonstrating that gas and electrical appliances are checked and maintained to ensure they remain safe to use. The manager said that she would be arranging for the electrical hardwiring to be checked as it is nearly five years since it was last tested. Hot water monitoring records show that the hot water temperature is routinely checked to make sure that it does not present a threat of people being scalded. Other records are also in place, detailing checks of step ladders, vehicles and other equipment at the home, indicating that appropriate measures are taken place to maintain a safe living and working environment at the home. Care Homes for Adults (18-65 years) Page 28 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 29 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 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 24 Action should be taken to make the lounge look more homely (e.g. by providing carpet) so that people benefit from a more relaxing environment. Proceed with plans to test the emergency lights on a monthly basis, instead of every months, to ensure that they are in good working order in the event of a fire at the home. 2 43 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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