Care Home: Plas Newydd

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What the care home does well Plas Newydd provides an individualised, person centred service to people with a diverse range of needs. Staff are provided with good induction, training and on going support to ensure that they can meet the diverse needs of the individuals they support and in a manner that respects their privacy, dignity and safety. The home is welcoming, provides a positive atmosphere and is a comfortable and homely place to live, ensuring individuals feel safe and secure. The newly appointed manager is proactive, organised and appears committed to her role. She is open and responsive to suggestions for improvement. Staff are proactive in closely monitoring peoples` health needs and work well with health and social care professionals; ensuring their health and wellbeing is promoted. People living at the home are supported by an established and committed team of staff who demonstrate a clear understanding of their needs, which benefits their care. What has improved since the last inspection? Plas Newydd has sustained a high quality service, providing good outcomes for people receiving a service. Staff have attended training appropriate to their role and relevant to the needs of individuals using the service. This has equipped them with the skills and knowledge to ensure peoples` needs are met safely and effectively. The management of medication has improved following a recent error whereby an individual failed to receive their prescribed medication. Revised procedures are more robust and the manager is working to action a number of recommendations made. Staff retention has improved providing people who use the service with more consistent care. What the care home could do better: The home is considered to be performing well with no requirements made as a result of this inspection. We did suggest that care records be streamlined so that information is more readily accessible for staff supporting individuals. The manager wants to explore ways to support individuals with developing their communication so that their needs are better understood and staff provided with the expertise and guidance. We also advised the manager to make sure staff record decision making processes, given the communication needs of the people living at the home. Comments gained about what the home could do better include: "I think more in house activities could be provided for rainy days" "Care files should be reorganised so information is more accessible" "There is always room for improvement but there are no big issues here" Key inspection report Care homes for adults (18-65 years) Name: Address: Plas Newydd 34 Hereford Road Shrewsbury Shropshire SY3 7RD     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: Becky Harrison     Date: 2 4 1 1 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 28 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 28 Information about the care home Name of care home: Address: Plas Newydd 34 Hereford Road Shrewsbury Shropshire SY3 7RD 01743271064 01743289127 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bethphage Great Britain Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 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: 5 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) 5 Date of last inspection Brief description of the care home Plas Newydd is registered with the Care Quality Commission as a care home providing personal care and accommodation for up to five adults with a learning disability. The home is situated in Meole Brace in Shewsbury, close to local shops and facilities. The building has good access and parking is provided to the front and rear of the property. The home is a large adapted town house providing five single bedrooms, en-suite facilities are not provided. People have access to a range of shared areas to include a Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home large, dining room and domestic style kitchen that people can access with staff support. A large lawned area is provided to the rear of the property. The landlord is Bourneville Village Trust with Bethphage being the registered care provider. People are able to gain information about the service from the Statement of Purpose and Service User Guide. The organisation receives a payment through a block contract agreement with the local authority and therefore it is not possible to quote the fees charged to individuals who use the service. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 28 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 visit to the service was undertaken by one inspector over 5 and a half hours. People who live and work at the home did not know that we were coming. A range of evidence was used to make judgements about this service. The care received by two people was looked at in detail. This included looking at their personal records such as support plans, health records, daily records and discussing their care with the staff who support them. This forms part of a key inspection and helps us gain information and understand the experiences of people who use the service and the quality of care they receive. Given the needs of the people living at Plas Newydd, individuals were not able to actively contribute to the inspection process or share their own experiences of living at the home. However we had the opportunity to observe two people being supported by the staff on duty and spoke with four members of staff and the manager. We looked at Care Homes for Adults (18-65 years) Page 6 of 28 some parts of the home and also reviewed the homes quality assurance processes and sampled a number of records to include complaints and protection, staff training, recruitment and health and safety records. The manager completed an Annual Quality Assurance Assessment (AQAA) document for us, as requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. The AQAA provided us with very detailed information about the service and included improvements made in the last twelve months and areas for continued development. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home is considered to be performing well with no requirements made as a result of this inspection. We did suggest that care records be streamlined so that information is more readily accessible for staff supporting individuals. The manager wants to explore ways to support individuals with developing their communication so that their needs are better understood and staff provided with the expertise and guidance. We also advised the manager to make sure staff record decision making processes, given the communication needs of the people living at the home. Comments gained about what the home could do better include: I think more in house activities could be provided for rainy days Care Homes for Adults (18-65 years) Page 8 of 28 Care files should be reorganised so information is more accessible There is always room for improvement but there are no big issues here 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 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 28 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 28 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 about the home is made readily available to help people make an informed choice about whether the service is able to meet their individual needs. Assessment and admission procedures are in place to ensure the home only admit individuals whose needs can be met. Evidence: The home currently has no vacancies however if a vacancy became available there is lots of information about the home in the Statement of Purpose that would help prospective residents and those close to them understand what Plas Newydd has to offer. Each individual is provided with a Service User Guide, which is in a pictorial format to promote peoples understanding. The Guide informs people about what they can expect from the home and how they will be supported. There have been no new admissions to the home since our last visit. Assessment and admission procedures were previously found to be satisfactory, ensuring the home only admits individuals whose needs can be met. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Plas Newdd can be confident that staff have a clear understanding of their needs because they have detailed support plans in place, which informs staff about their individual needs and how they prefer these to be met. Individuals are supported and encouraged to make decisions and take risks as part of their everyday lives because staff actively promote their rights, choices and independence enabling them to lead the lives they wish. Evidence: We looked at the care records held for two people who live at the home. Both were detailed and covered areas to include peoples health and personal care needs, daily living, activities, communication, medication and finance. There was evidence that the individual needs of people are kept under regular review by their designated coordinators who have the responsibility for compiling monthly reports based on a range of information to include personal and health care needs. Annual reviews involving individuals and those close to them have also been undertaken, providing opportunity Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: for discussion about peoples changing needs and the service that they receive. Although information was available on the files sampled it was not easily accessible. However staff spoken with demonstrated a sound understanding of the needs of the individuals whose care we looked at in detail, which was consistent with the information held on their care files. One person wears splints on his arms due to self injurious behaviours and although staff are receiving support from a behaviour specialist the service has yet to submit an application for a deprivation of liberty authorisation to ensure this restriction is in the best interests of the individual concerned. Information was available on the care files sampled about how individuals make their needs known and their capacity to make decisions given they have very limited verbal communication and learning disabilities. Staff are reliant on other ways to support people with their preferred communication methods, for example through the use of gestures, body language and photographs. A referral has been made to a specialist team to look at additional methods to promote and improve communication and provide staff with guidance in supporting peoples needs. The AQAA states We at Plas Newydd believe that a residential care home should ensure that individuals are involved in decisions affecting their lives, with support from advocacy were needed, to ensure they are involved in life changing decisions as well as the day to day decisions that affect their daily lives. We also support service users with and plan to improve personalisation for each individual. The AQAA reports the needs and choices of individuals are continually monitored and assessed and this was clearly reflected in the records seen for the two individuals whose care we looked at in detail. For example it had been identified and documented that one individual may enjoy a trip to an aquarium, which had been actioned and took place on the day of the inspection. Choice files have also been developed for each person to evidence that individuals are supported to make choices in their daily lives such as choosing new clothes to purchase, equipment and a holiday. Records seen and observations made evidence that staff work hard with individuals to promote choice. Assessments of risk are in place to provide staff with guidance on how to manage potential risks such as community activities, use of public transport, the environment, road safety, eating out and complex behaviours. These show that people are not stopped from taking risks but that staff have guidelines to follow to minimise the risk of harm, while providing individuals with opportunities to lead the lives they want. Care Homes for Adults (18-65 years) Page 13 of 28 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 enjoy a full and stimulating lifestyle based on their personal preferences. Routines are flexible and support is provided to promote peoples rights, independence and to maintain relationships important to them. Evidence: Discussions held with staff on duty evidence that the team are committed to ensuring that people who use the service are able to live an ordinary life, and have access to all community facilities and services. We looked at the records held on behalf of two people and established that they lead meaningful lifestyles and take part in a range of activities that they enjoy. Staff were able to explain to us the individual lifestyle choices people make and there was lots of information available about activities that people have undertaken on the records sampled. Staff also assess if an activity was a positive experience for the person concerned and record their findings to aid future planning. On the day of the inspection, two people were supported to visit an Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Aquarium in Cheshire, one person was out attending a day service and the other two people were supported at the home. We observed one person being supported to make a dessert, an activity that he very much enjoyed. The other person spent time in the lounge and then relaxed in the surroundings of their own room with staff making regular checks and giving the person the option to return to the lounge or partake in something different. Discussions with staff on duty and observations evidence that people are encouraged to take part in day to day routines of the home, based on their ability. People have access to their rooms and the shared areas of the home although there are some environmental restrictions to keep people safe from known risks such as the laundry area, which is based in the cellar. The AQAA reported that individuals are able to keep in touch with family, friends and representatives and the home supports them to maintain relations and develop new ones. Contact with family was seen recorded on the files sampled and confirmed through discussion with the staff on duty. We also saw photographs of family and friends in the rooms we toured and evidence that people are supported to purchase birthday cards to send to people close to them. People living in the home are involved in shopping and cooking depending on their abilities. Menus seen evidence meals provided are varied and nutritional. However menus could be produced in a photographic or symbolise format to support individuals with menu planning. During our visit one person was supported to make a dessert. The member of staff supporting him made the activity fun and promoted his independence throughout the task. An assessment had been undertaken by the relevant professional for an individual who was experiencing difficulty with eating and a soft diet was recommended. Information was available for staff to ensure food is pureed separately so that as many of the food flavours and colours are maintained whilst remaining appetising in appearance. Guidance on supporting the person at meal times and seating arrangements were available, ensuring individual needs and preferences are acted upon. Care Homes for Adults (18-65 years) Page 15 of 28 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because there is good evidence of multi agency working in the best interests of the people living at the home. The management of medication has improved to ensure people receive their prescribed medication ensuring their health and wellbeing. Evidence: The level of personal care and support individuals require was clearly detailed in the support plans examined. This ensures that staff are able to provide the necessary levels of assistance to ensure individuals assessed needs are met. People are supported to maintain a positive self-image and were well groomed and dressed in appropriate styles to their age and gender. The AQAA states Service users health is monitored and potential complications or problems are identified and dealt with at an early stage. This was evident on the records sampled for the two people whose care we looked at in detail. For example one individual has experienced an increase in seizures and the home sought the necessary advice of a health professional and a review of medication was undertaken. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Staff have also received epilepsy training to ensure they are equipped with the skills and knowledge to effectively support the individual concerned. Records sampled evidence that people are supported to attend routine healthcare appointments such as doctors, optician and the dentist and outcomes recorded. Individuals have a health action plan which is a personal plan about what they should do to maintain good health. The manager committed to ensuring these are regularly reviewed and updated to reflect peoples changing needs. We saw evidence that other specialists are also involved in reviewing individuals for example a behaviour specialist has visited the home and reviewed the behaviours of one individual and provided staff with the necessary advice to ensure any behaviours that challenge our managed positively. One person was subject to a medication error whereby he did not receive his medication as prescribed. Although this did not have an adverse affect on the individual concerned, the home sought professional advice and made a referral under local safeguarding adult procedures and an internal investigation was undertaken. The service has reviewed its procedures and made a number of improvements to include staff undertaking competency assessments at an increased frequency, new staff undertaking safe handling of medication courses at the earliest opportunity, updating the medication procedure, improved medication storage and discussions in staff supervision and team meetings. An independent audit has recently been undertaken by the medicines management team and the manager reported that she is currently working towards the recommendations made. Care Homes for Adults (18-65 years) Page 17 of 28 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. Staff are able to recognise if individuals are unhappy with any aspect of the service they receive therefore residents can be confident that their feelings will be recognised and responded to. The home has procedures in place to safeguard people from potential abuse and staff receive training in adult protection and local procedures, ensuring people who live at the home are protected. Evidence: The home has a complaints procedure in place, which has been developed in an easy read version so that its easier for people to understand. However given the complex needs of the individuals living at Plas Newydd and their limited verbal communication skills staff are reliant on using alternative ways to ensure people are happy with the service they receive and that their best interests are represented. Observations made evidence that staff are well tuned into peoples body language and behaviours. Therefore even though people are not able to say if something is troubling them, staff are alert to changes in peoples behaviours and this knowledge can contribute to keeping people safe. We have not received any concerns or complaints about the service since our last inspection and there have been no complaints received by the home. The AQAA reports that the latest version of the local safeguarding adult procedure has Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: been obtained and is adhered to and that staff are trained in the protection of vulnerable adults, as evidenced in discussions with staff on duty. This ensures staff are aware of the various aspects of abuse and are able to recognise the signs to ensure peoples protection. As previously reported there has been one safeguarding referral under local procedures and this has been satisfactorily concluded and measures put in place to provide greater protection for people receiving support with their medication. People living at Plas Newydd require support with managing their finances. Staff spoken with were satisfied with the systems in place to ensure people are protected from financial abuse. People have their own cash tins which are kept secure and records evidence their cash is checked on a daily basis in addition to spot checks undertaken by the manager. Care Homes for Adults (18-65 years) Page 19 of 28 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. Plas Newydd provides a homely, clean and comfortable place to live where people feel safe and secure. Evidence: Plas Newydd is a large adapted townhouse situated in Meole Brace, Shrewsbury and is similar to other residential houses in the area. A large driveway provides space for residents vehicles, staff and visitor parking. One bedroom is located on the ground floor in addition to staff sleep-in accommodation. A passenger lift and staircase provides access to the four bedrooms and bathroom situated on the first floor. One bedroom has an overhead tracking hoist device fitted for an individual who is unable to weight bear so they can move safely. We looked at parts of the home to include the shared areas and the bedrooms of the individuals whose care we looked at in detail. We also looked at another bedroom that had recently been redecorated and new carpet fitted. Bedrooms were equipped according to peoples needs, choice of colour schemes and personalised with soft furnishings, photographs and ornaments. Shared areas are spacious and comfortably furnished. The manager reported that there are plans to purchase a new dining table and chairs and refurbish the shower room. The home was very welcoming and people appeared relaxed in their surroundings. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The home was found clean throughout. Substances such as cleaning products that could cause harm to people were safely stored and a number of staff have received training in the control of infection and contamination. The AQAA states Staff have a daytime and night time cleaning rota in place, ensuring all areas of the home are cleaned to a high standard for presentation and cleanliness. Care Homes for Adults (18-65 years) Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by skilled and competent staff in sufficient numbers to ensure their assessed needs are met promoting their safety and welfare. Evidence: Discussions held with staff on duty evidence they have a sound understanding of the individual needs of the people in their care. Staff appeared committed to their work and engaged with individuals in a professional and sensitive manner. The manager reported that 11 of the of the 13 permanent support staff employed have obtained a care qualification known as NVQ at level 2 or above in care or equivalent and many are now working towards their level 3 award. This exceeds the national minimum standards and demonstrates that the provider is committed to ensuring the individuals living at Plas Newydd are supported by a qualified workforce. Staff told us: Staff training is fantastic. Im very happy working here. The development side with the company is brilliant. They are always looking for new opportunities for training...there is a good age range of staff that matches service users needs Staff morale is good and I feel there is always enough staff on duty to meet the Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: needs of the service users I love it here The home keeps service users nice and secure and provides a friendly and calm atmosphere...It has improved considerably over the last couple of years Service users needs are met to a very high standard Staff confirmed they are provided with mandatory training such as medication, manual handling, first aid, fire and health and safety in addition to service specific training such as epilepsy, the management of actual and potential aggression (MAPA) and autism. This ensures that staff are equipped with the skills and knowledge to meet the needs of the individuals in their care promoting their health, welfare and safety. Staff have yet to receive training in the Mental Capacity Act including deprivation of liberty. It is therefore recommended that staff access this training to ensure staff know what course of action to take, understand the assessment processes and are clear of their legal responsibilities. The AQAA states We have a robust recruitment and selection process in place and new staff are only confirmed in post following satisfactory completion of regulatory requirement checks. Our interview process is conducted by senior managers with an in depth knowledge of the service needs. In the interview process there are two stages with all service users participating in the second stage, which is held in the home. The manager stated Recruitment procedures are really thorough and new staff do not start work until all pre-recruitment checks are in place. This was confirmed in discussion with another member of staff on duty who confirmed the necessary prerecruitment checks are undertaken to ensure people living at the home are safeguarded and staff receive induction. The provider must ensure that a pro forma (information about staff who work at the service) is stored on the services premises if information required by regulation is held centrally. Care Homes for Adults (18-65 years) Page 23 of 28 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 have confidence in the home because it is managed effectively in their best interests and maintained in a manner, which ensures their safety. Evidence: A new manager has recently been appointed and has been in post for three months. She has the experience and qualifications to manage the service and is knowledgeable of the individual support needs of the people in her care and is in the process of submitting an application for registration with us. Discussions held evidence that the manager is enthusiastic and committed to promoting peoples rights and providing a quality service. Staff were complimentary about her management and leadership skills and feel well supported. Comments include: The manager is very supportive and approachable Im happy with the new management arrangements. The manager is really good, Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: shes approachable and is open to suggestions for improvement Satisfaction surveys were distributed in August across the organisation to people who use services, relatives, staff and professional stakeholders to gain their views about the services provided by Bethphage on a range of quality indicators. The feedback gained overall is positive with 90 of those who responded consider Bethphage providing a very good or good service. Comments about this particular service include: Bethphage is always looking at ways to improve and support staff, this should improve retention and help in recruitment as present staff should be promoting the excellent work we do. Managers at all levels should be working to improve the environment i.e. training and support... all helping to deliver a quality service to those we support. A full report on the findings is available from the home upon request. The Annual Quality Assurance Assessment (AQAA) forwarded to CQC reflects both the strengths and areas for improvement for the service to include developing personalisation within the organisation and to support people who use the service to put in place personal budgets. Evidence within the AQAA was sampled and found to be accurate With our findings. There was evidence that visits to support the performance of the home, as required by Regulation 26, are undertaken but not at the required frequency. This needs to be addressed in order to help assess how the service is currently performing and aid future planning. Health, safety and maintenance checks are undertaken to ensure that the equipment is safe and in full working order. Staff confirmed that they receive training in safe working practices for example food hygiene, manual handling, fire, first aid and infection control procedures. This helps ensure they and the people they support are kept safe. Service certificates were available in addition to other safety records required. We were advised that there are no outstanding requirements made by the Fire or Environmental Health Departments. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 32 All staff should receive training in the Mental Capacity Act Deprivation of Liberties. This will ensure staff know what course of action to take, understand the assessment processes and are clear of their legal responsibilities. That visits as required under Regulation 26 are undertaken at the required frequency and a report produced based on the findings. This will support the performance of the home, assess how the service is performing and aid future planning in the best interests of people living at the home. 2 39 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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