Care Home: Radnor House

What the care home does well People are able to decide whether the home meets their needs by having an assessment by the placing authority, visits to the home before they move in, being given written information about the home and having a review to determine whether the home is meeting their needs before deciding to make the decisions to stay in the home on a long term basis. The people living in the home are supported to maintain links with the local community, friends and relatives and, to re-establish links with people where this is appropriate. This ensures that they keep in touch with people who are important to them. People living in the home are supported to undertake activities of their choice including attendance at day centres, colleges, days out to parks, cinemas, local shops and holidays. This ensures that they have interesting and fulfilling lives. The home ensures that peoples` cultural, dietary and religious needs are met according to their wishes. Staff are well trained and they continue to receive regular updates. There has been little turnover of staff ensuring good continuity of care for the people living there. There are very good relationships between staff and the people living in the home, their relatives and the professionals supporting their care. The premises are comfortable and suit the needs of the people living there. What has improved since the last inspection? Since the last key inspection several areas of the home had been redecorated. There is a walk in shower on the ground floor ensuring that individuals with mobility restrictions were able to access a shower facility. All new staff were undertaking an induction programme that ensured that they had the knowledge and skills to assist people safely. What the care home could do better: The home could develop the service to encourage more independence and rehabilitation services. Management systems needed to ensure that people were not put at risk of harm. Care plans coud be further developed to be more person centred ensuring that staff knew how personalised care should be provided. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Radnor House 29/31 Radnor Road Handsworth Birmingham West Midlands B20 3SP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 0 6 0 8 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 36 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 36 Information about the care home Name of care home: Address: Radnor House 29/31 Radnor Road Handsworth Birmingham West Midlands B20 3SP 01215236935 01212409051 care@radnor-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Alfonso Latchman,Mrs Kamla Devi Latchman,Mrs Silvena Latchman,Mr Leslie Latchman care home 29 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 29 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: Mental disorder, excluding learning disability or dementia (MD) 29 Date of last inspection Brief description of the care home Radnor House is a large detached house accommodating 29 people in the Handsworth area of Birmingham. The home provides ongoing support for people with enduring mental health needs and partly focuses on their rehabilitation and to be more Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 29 Brief description of the care home independent. The home is close to shops, a public park, local health centre, community centres and various places of worship. There is a short walking distance to public transport links for Birmingham and West Bromwich. Limited off road parking is available. Facilities available at Radnor House include 27 single rooms and one double room. Communal facilities consist of three lounges and two dining rooms. There are three toilets on the ground floor one includes a walk in shower. On the first floor there are two bathrooms and a shower room with toilet. The second floor has two shower rooms both with toilets. The bathroom on the first floor has provision for assisted bathing. All bedrooms have wash hand basins. Facilities are available to prepare hot drinks in the lounges on the upper floors. A passenger lift connects all floors of the home. The home has a large rear garden. The current fees at the home are based on the local authority rates. The reader should contact the home for up to date information about the fees. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was carried out on August 14th 2007. An annual service review was undertaken on August 4th 2008 when we decided that the home had continued to ensure they offered a good service to the people living there. This inspection was carried out by one inspector over a period of two days. The home did not know that we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need furhter development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that Care Homes for Adults (18-65 years) Page 6 of 36 have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. The care given to two people living in the home was case tracked. This involves estabilishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We also looked at aspects of care given to two other people living in the home. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with six of the people living in the home, the manager, deputy manager and two staff to get their views on the home. We sent 10 Have your Say surveys to people who live in the home, relatives and staff. We received 9 completed surveys from people living in the home, 1 from a relative, 6 from staff and 5 from professionals visiting the home. During the inspection we spoke to a relative, a social worker and student who had been on placement at the home. We were also accompanied by Terrie Riley, who is an expert by experience. This means that she had personal experience of services for people with enduring mental health issues. She spoke to staff and people living in the home. She provided us with a report of her visit to the home and comments from this report have been included in this report. 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 following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 36 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 36 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 36 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. The admission process ensures that people have the information they need to decide whether to move into the home or not. Evidence: There was a service user guide in place that had been updated in May 2009. This guide included relevant information about what services were provided in the home. There was no direct information about the fees charged at the home so that people would not know how much they could be asked to pay. The manager explained to us that the fees are those charged by the local authority and all individuals signed a 3 way agreement stating the fees. We feel that people should have information about the costs of living in the home available to them to help them decide whether they move in or not. People were provided with a contract between them and the home once they had moved into the home. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: The files of two people who had moved into the home since the last key inspection were looked at to see how they had been assisted to decide whether the home was suitable for them. The files did not evidence that the individuals had been able to visit the home before they moved in but staff and a social worker spoken to on the day of the inspection confirmed that the individuals had been to visit the home. Assessments carried out by the placing authorities were in place. It was evident from the admission form used by the home that people were given information about the home. They were asked about issues such as preferences about who should assist them with personal care and whether they wanted keys to their bedrooms. Other information gathered at the time of admission included food likes and dislikes, hobbies and past times, what they would get involved in in the home, medical histories, mental health diagnosis and relapse indicators. The home was able to meet the needs of a diverse group of people including physical disabilities through the provision of equipment such as wheelchairs, assisted bathing facilities and access to upper floors by a passenger lift. Special diets such as diabetic or specific cultural requirements were also met in the home. Nine people living in the home returned completed questionnaires to us and they all said that they had been asked whether they wanted to move into the home and, five said they had received sufficient information to help them decide whether to move into the home. Care Homes for Adults (18-65 years) Page 12 of 36 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. The assessment and care planning process ensures that individual needs and choices are catered for. Evidence: We looked at two files in depth and two others briefly to see how the needs of the people living in the home were being met. We also spoke to the people living in the home, observed the practices in the home, spoke to staff and received information through completed surveys. During this inspection an expert by experience helped us to judge the care provided. She was able to spend time talking to the people living in the home to see how they felt about the home. Comments made by her have been included in this report. All the files looked at included assessment forms which were also used as the care plans. They were reviewed on a monthly basis and as at the last key inspection we were told that the last review form along with the assessment forms made up the care plan. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: The assessments included details in them on how some of the needs of the people living in the home were to be met. The majority of people living in the home could say how they wanted their care to be provided however there were individuals who could not verbalise this. The assessment could therefore be further improved to ensure that the staff were aware of how to assist the individuals and to ensure that person centred and consistent care was provided. The care plans covered areas such as a medical profile, mental state, triggers for relapse of mental health, routines for waking and retiring to bed, daily routine and interests, food likes and dislikes, personal hygiene, social needs and relationships, mobility and communication. These were signed by the individuals they related to showing that they had been involved in assessing their needs and how they would be met. There were some long term aims identified for individuals and the monthly evaluations commented on whether these had been met. What the documentation did not indicate was what activities would be undertaken to achieve the long term aims. Having these recorded would ensure that all staff would be aware of what progress had been made and what needed to be done to progress the matter. The home was suited to ensuring that peoples mental health was maintained and support provided. We were told that the home promoted some rehabilitation programmes but this is an area that the home could develop. One individual was to undertake some activities in the kitchen with an occupational therapist. There were some drink making facilities in the lounges on the upper floors of the home and some people could make drinks in their bedrooms but there was no specific facility where individuals could make drinks, snacks or assist in meal preparations. The main kitchen was not generally accessible to the people living in the home due to reasons of hygiene. The majority of the people living in the home were happy to have their laundry, cleaning, cooking etc done for them. One individual told the expert by experience He doesnt help around the home and has no interest in doing so, as the staff do it all for him. The staff should work more with individuals to develop or maintain their daily living skills. This would ensure that they maintained more control over their daily lives and developed their independence. The completed surveys returned to us by the people living in the home told us that Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: they felt that they could decide what to do during the day, evenings and weekends. They could make choices in the food they ate, what they wore, when they got up and what they did during the day. When asked about their care plan one of the people living in the home told the expert by experience he and the staff have worked together on this, the staff are very approachable and the staff work very hard. The expert by experience stated that although he did know what an advocate was there was no available service at the home. We noted that not everyone in the home had a key to the front door of the home. We were told that there were a number of reasons why some people did not have a key to the door but this reason had not been recorded. It was important that this was documented to ensure that individuals liberty was not being restricted unnecessarily. During the day we observed people going to the office to collect monies on either a daily or weekly basis depending on their abilities to budget. They were then able to go out and purchase items such as cigarettes and drinks. People living in the home told us about meetings that were held on a regular basis with them to decide on issues such as activities, menus and to discuss issues such as relationships within the home. For example, one individual who tended to get angry when another person sat in their chair would upset the other people living in the home. The people living in the home were informed of what to do to prevent matters escalating. We saw records of these meetings that confirmed that these issues were regularly discussed as well as issues such as tracing family members, smoking in bedrooms and complaints. The expert by experience told us that one of the people living in the home told her about the meetings they have once a month where they discuss house rules and ideas of what they would like to do. Risk assessments were in place in respect of any particular behaviours or illnesses the individuals living in the home had. One person had an oxygen cylinder in the home and it was clear that he had been told and that staff were vigilant about the risks of him smoking in his room. The door to the bedroom did not have a safety sticker on it to inform people that there could be a potential risk in the event of a fire. Files generally had tissue viability assessments on them but one persons file looked at did not have one in place. It was important that this was put in place as there had Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: been difficulties with the individuals incontinence and personal hygiene which could make the skin more likely to develop pressure ulcers. The records in the home were stored safely and securely ensuring that confidentiality was maintained. Care Homes for Adults (18-65 years) Page 16 of 36 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 supported to live lives that take into account their individual needs and choices. Evidence: There did not appear to be any rigid rules or routines within the home. The people living in the home were encouraged to go to the dining room for meals and drinks but there was flexibility about the timings. We observed during the inspection that one individual was told that he could not have any bananas as the member of staff was not aware that they had been put in the kitchen the previous day. This indicated that communication systems could be improved to ensure that the people living in the home were not given wrong information. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: We also observed that an individual was unable to have the cereal that they wanted as the new box was in the store room that could not be accessed until the cook arrived in the home which was not until the end of breakfast. This showed that some of the practices in the home could inadvertently limit the choices of the people living in the home. A number of people living in the home went to day centres and colleges to help them develop their skills. Other people had decided that they did not want to go and this was respected. There were a number of activities in place for people to take part in if they wanted but there were some difficulties in motivating some of the people living in the home. There were regular prayer and bible readings, painting and mask making activities, exercise classes, barbeques, trips to the cinema and shops as well as day trips and holidays. Contact with relatives was promoted and one relative we spoke to told us that they visited regularly, were made welcome at the home and contacted if their were any issues. They took their relative out regularly to their home and the Gurdwara. Another individual had regular telephone contact with a relative. These contacts were not regularly recorded on their files so that it could not be determined how often contact was actually taking place. The home was able to meet the cultural needs of the people living in the home. People were assisted to identify with cultural days, provided with appropriate food and contact with the local community. There was equipment available in the home to meet the needs of people with physical disabilities. One individual told the expert by experience that He would like to go out but doesnt feel anyone is available to take him out. Where individuals are unable to go out unescorted the home should ensure plans are in place to ensure that they are assisted to have their needs met. As stated earlier some people living in the home had keys to their bedrooms and the front door to the home, others did not. There were specific reasons for not having keys but these were not recorded. The reasons should be recorded to ensure that people living in the home were not being restricted from going out and coming into the home and from being able to keep their belongings private. With agreement, people living in the home could keep a pet. One individual had a cat Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: and there was a homes dog. During the inspection it was observed that there were some very good interactions between the staff and people living in the home. People went to the office throughout the day to ask advice from the manager, get their money and ask for letters to be posted on their behalf. There were a variety of meals on offer each day that catered for the cultural and dietary needs of the people living in the home. Records for the foods eaten were recorded only for people where there was a concern with their intake. People living in the home told us that they were happy with the food served and the weight records did not indicate that people were losing weight. The expert by experience joined the people living in the home for lunch and told us There was 3 choices available and the food I received was hot, fresh and delicious. I noted the interaction between the staff and residents was relaxed and there was lots of laughter. We saw that people were provided with assistance where it was needed. Surveys returned to us by the people living in the home told us Food is good. Like the food, potatos and beef and, enjoy the food. Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were supported to have their personal and health care needs met in a personalised way. Evidence: The care files sampled during the inspection indicated that the level of support required by the people living in the home to maintain their personal care varied. The majority of people needed only prompting and supervision but some people needed more one to one support. The staff were able to tell us about how they assisted the people living in the home but they were evidently finding one person difficult to assist. The individual often used delaying tactics so that personal care tasks were not undertaken and this resulted in negative comments from other people living in the home and he was restricted from going into some areas of the home at certain times. The manager needed to ensure that staff were clear about how long the individuals personal care needs could be left before involving other professionals. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: The people living in the home had their own preferences for dress style and chose when to bath, shave and change their clothes. On occasions they could look unkempt but this was part of their illness and the staff tried to encourage them to change their clothes. People living in the home were encouraged and supported to attend all medical appointments. One person living in the home told us (staff) take (me) in car for appointments. Medical appointments were recorded in the the diary and the resident record sheets. Information was then transferred to the monthly evaluation sheets. Comments we received from professionals were: The management and staff at Radnor House are competent professionals providing a high quality care. They maintain an effective service provision focussing on quality and client centred care. They have excellent planning and implementation of programmes of care tailored to individual needs, paying attention to their diverse needs. The staff maintain good relationships with the clients at all times, and with medical, social, statutory and voluntary organisations. The service does its best to work with challenging residents. The manager and staff alike are always approachable and willing to assist. Maintains the mental and physical well being of all of the service users. Integrates all service users, take on board cultural and racial needs. In response to the question about what the home did well one individual stated: The humane manner with which clients are treated especially with regards to respect and dignity. Some comments about what the service could do better were: Motivate service users to get up at reasonable times in the mornings. Encourage more independence within the home. The home utilised a monthly monitored dosage system for the management of medicines. The medicines were generally well managed ensuring that the people living Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: in the home got their medicines as prescribed. It was evident from the records seen that there had been occasions when people had not signed when medicines had been administered but this had been followed up with the individuals and the appropriate actions taken. Audits of the medicines were done on a regular basis and records kept ensuring that the management of medicines was kept under regular review. Some people were able to manage their own medicines and the appropriate risk assessments and compliance checks were in place. We audited some of the medicines and found that there was some confusion regarding one medicine as to whether it was to be given on a regular or as and when required basis. This issue needed to be referred to the prescriber and appropriate plans put in place to manage its administration. Records for some food supplements did not tally with what was remaining in the home. This could indicate that people other than those for whom they had been prescribed had been given them. Care Homes for Adults (18-65 years) Page 22 of 36 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. Complaints are looked into quickly and responded to accordingly and people are safeguarded. Evidence: It was evident from discussions with the manager that any issues raised regarding practices in the home have been dealt with appropriately. Where issues have been raised they are promptly looked into and lessons learnt where needed. The manager supports some of the people living in the home with managing their monies. There are suitable records in place to safeguard the individuals. The people living in the home are told how much money they have available and are supported to be reasonable in their expenditures. We evidenced during the inspection that people were responded to in a sensitive manner when they wanted to give staff things. There was no information about advocacy groups available to the people living in the home and this would be useful if people wanted to speak to an independent person about any issues concerning them. There have been some issues regarding the way certain individuals were behaving towards others and this was being managed appropriately. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: Staff we spoke to during the day indicated that they had a good understanding of how abuse may occur in care homes and they were clear that issues would be passed onto the senior team and that records needed to be kept but were not always clear about the process of who should speak to individuals where abuse was suspected. We had not had received any information about any safeguarding concerns at the home. Care Homes for Adults (18-65 years) Page 24 of 36 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. The environment is clean and comfortable providing a pleasant environment for the people living in the home. Evidence: The home consists of two large semi-detached houses which have been converted to accommodate 27 single and one shared bedroom. Each room is furnished with bed, wardrobe, seating, wash hand basin, chest of drawers, table, reading light and locks on bedroom doors. Other facilities in the home include a lift to all floors, toilet and bathing facilities, 3 lounges with cable television to two of them, two dining rooms, kitchen, laundry, pay phone and large garden with a patio and lawn. Meals are prepared on the premises. Basic toiletries such as soap, toothpaste, toothbrush and razors are provided by the home. The home is well maintained with a rolling programme for redecoration and refurbishment. There are some bedrooms that need redecoration and some furniture needs replacing. There was one person who needed to have his bed lowered to the floor due to risks of Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: falling. The height of the bed could be a risk for staff when they were helping the individual out of bed. In this situation an adjustable height bed would be appropriate and safe for both the person living in the home and the staff. The expert by experience who visited the home commented I noted that the outside of the building looked rather tired which made it feel a little uninviting. and Overall my view of the home was one of a relaxed atmosphere where everyone looked comfortable and well looked after and apart from needing a bit of redecorating the home was clean and tidy. A person living in the home told her it feels like this is my home and I am comfortable here. Some furniture in communal areas was torn detracting from the homely nature of the home. Surveys that the people living in the home completed for us told us that they though the accommodation was nice and 5 of the 8 people told us that the premises were always fresh and clean whilst the other 3 said it was usually fresh and clean. People living in the home were able to access all areas of the home except the kitchen. During the inspection we checked some of the hot water temperatures in the bathing facilities. In one facility the temperature was acceptable but in some of the others the hot water was dangerously hot 86 and 79 degrees centigrade. These facilities were made inaccessible until the following day when the plumbers were able to attend the home and resolve the problems. We were told that the hot water temperatures were checked regularly but not recorded. Care Homes for Adults (18-65 years) Page 26 of 36 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. There are enough staff on duty with the right skills and knowledge to support the people living in the home. Evidence: The staffing rota showed that there were always three support staff, a manager and cook on duty during the day. There were two waking night staff on duty and there were on occasions students on placement in the home. The majority of staff worked on a full time basis. There were 3 male staff available to assist the people living in the home. Surveys completed by staff suggested that more male staff would be useful in the home. This would help to reflect the genders of the people living in the home. There were no agency staff being used in the home and there had not been much turnover of staff ensuring that there was continuity of care for the people living in the home. Two staff were spoken with during the inspection who showed that they had a good knowledge about the needs of the people living in the home and the indicators that may suggest a break down in their mental health. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: Staff confirmed that there was regular training available. Information was given to them of the training available and they could nominate themselves for the relevant training. Staff stated that they felt well supported in the home and that their first priority was the welfare of the people living there. We looked at two staff files and this showed that the manager ensured that all the necessary recruitment checks were in place before people started their employment. However, for one person evidence of their eligibility to work was not recorded. There was evidence that suitable induction training was provided and that staff were supervised on an ongoing basis. The AQAA told us that 16 of the 19 staff had already achieved NVQ level 2 training and the others were undertaking it. All the catering staff had safe food handling training and 95 percent of care staff also had had this training. This showed that the staff had the training necessary to care for the people living in the home. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home responds quickly to issues raised resulting in the people living there being safeguarded. Evidence: The registered manager has been in post for many years and has a vast knowledge and experience in the management of a care home. It was evident that the he and the staff team supported the people living in the home in a professional and friendly manner. One of the people living in the home told us they were helpful, more than brothers and sisters. Staff described the manager as: sociable, considerate, understanding, caring, approachable, fair and bossy. They described the home as: friendly, busy, rewarding, caring and somewhere where the residents make you smile. There were regular staff meetings in the home that ensured that the staff were provided with up to date information about topics such as training, swine flu and care practices. This ensured that the people living in the home were supported by staff who Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: had the knowledge required. The quality assurance system in the home took into account the views of the people living there and people visiting the home by sending out surveys. We were shown the results of these surveys which indicated satisfaction with the home. The views of other people, such as professionals involved in the home, had not been included in this information. The quality assurance system needed to be further developed to include information regarding care assessment, practices and management issues to give an overall assessment of the service. This would help to design a development plan showing year on year improvements. During the inspection we noted that there had been some occurrences in the home that had not been notified to the There were good management systems in place to monitor the administration of medicines and equipment was well maintained. However, during this inspection the hot water temperatures in some bathing facilities were dangerously high and although we were told that there were regulators in place and the temperatures checked regularly there was no evidence of the checks. The manager reacted promptly to isolate the areas that could put people at risk and arranged for appropriate actions to be taken the following day. Other health and safety issues included earlier in this report were in respect of bed heights and the use of oxygen within the home. One person in the home was using oxygen in his bedroom. There were no appropriate warning signs in place in the home. At the time of the inspection the home was experiencing some problems with the fire alarm system. At the time of arrival at the home we noted that the fire alarm had been activated and some people living in the home were waiting to be let out of the front door by staff. People living in the home were heard to say Whats the point of the fire alarm if we cant get out. The manager told us that the doors should be opened as soon as the alarm is Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: activated and that the foyer area had been agreed as a holding area with the fire authorities. There was no documented evidence for this and the manager needs to liaise with the fire authorities regarding the evacuation procedures. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 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 People living in the home should ensure that medicines are given according to prescribing directions. This will ensure that people are given their medicines correctly. 01/10/2009 2 42 23 The registered person must liaise with the fire authorities regarding the evacuation procedures. This will ensure that the evacuation procedures safeguard the people in the home. 30/09/2009 3 42 13 The manager must ensure 30/09/2009 that systems are in place to ensure that the people living in the home are protected from hot temperatures. This will ensure that any potential hazards and risks are highlighted enabling the Care Homes for Adults (18-65 years) Page 33 of 36 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 appropriate actions to be taken. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information about the fees that could be charged for living in the home should be provided to people when they are deciding whether the home will meet their needs. This will ensure that people can make decisions after having received all the information needed. Evidence of visits made to the home as part of the assessment procedure should be recorded. This will show how people are assisted to decide whether the home is suitable for them and the home to decide if their needs can be met at the home. Care plans should record the individual steps that need to be taken to achieve identified long term objectives. This will ensure that the progress of individuals can be closely monitored. The level of detail in the care plans should be such that it enables person centred care to be provided to all people living in the home. The home should ensure that where actions impacting on an individuals liberty are taken the reasons for this should be clearly recorded. This will ensure that these decisions are taken in the best interests of the individual only. Details of advocacy groups should be made available in the home. This will ensure that people can have access to independent advisors if they feel they need one. The home should try to involve the people living in the home in taking more responsibility for their day to day lives. This will encourage people to be more independent. 2 4 3 6 4 6 5 7 6 7 7 9 The home should ensure that risk assessments are in place for all identified risks. This will ensure that individuals are Page 34 of 36 Care Homes for Adults (18-65 years) 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 protected from unecessary harm. 8 13 The manager should ensure that staff are available to assist people to access the local community and leisure activities where they are dependent on staff to do so. This will ensure that people get the support they need. Care plans should record the length of time or indicators support services need to be contacted where people are unwilling to be supported with personal care. This will ensure that they are not at exposed to any unnecessary health risks or adverse comments from peers. Supplements prescribed for one person should not be given to anyone else as they are the property of the individual for whom they were prescribed. Staff should be updated about the process of referring incidents of adult protection. This will ensure that the appropriate procedures are followed to safeguard the people living in the home. Decor and furniture within the home should be updated where necessary to ensure the comfort of the people living in the home. The manager must ensure that all the necessary checks are in place when recruiting people. This will ensure that only people able to work are employed at the home. Some of the practices in the home could be improved to ensure that the people living in the home were not given wrong information and staff were kept up to date. The manager should ensure that all incidents that occur in the home that require a notification to be sent to us are notified. This will ensure that any issues that need to be followed up can be done so in a timely manner. 15 39 The quality assurance system should be further developed to include views of other professionals involved in the home and an assessment of the implementation of practices and procedures in the home. This would give an overall assessment of the service provided by the home. 9 18 10 20 11 23 12 24 13 34 14 37 Care Homes for Adults (18-65 years) Page 35 of 36 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. 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