Care Home: Raymond Avenue, 24

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What the care home does well When we arrived the manager spent time with people looking at a book that staff had put together about us and what we do. This included pictures, making it easier for people to understand. This helped to make people less anxious about us being there and what we were doing in their home. People have the information they need about the home so they can make a choice about whether or not they want to live there. Each person has a care plan so that staff know how to support them to meet their needs and achieve their goals. People can choose what they do, what they wear and eat and drink. People are asked what food they want and help to go and buy it. Staff support people to live a healthy lifestyle. One person said they had lost weight by eating healthily and going to the gym and swimming and that staff had helped them with this. Relatives said that people were able to do more things for themselves and staff helped them to be independent. People go on holiday if they want to with staff to the places they want to go to. If they do not like going on holiday staff take people out on day trips so they can experience new things and see different places. Staff support people to meet their health needs so improving their well being. People said they know how to complain if they are unhappy and that their views would be listened to. Each person has their own bedroom and bath or shower room. This is decorated in the way they choose and has their own things in it. The home was well decorated and furnished making it homely and comfortable for people to live in. Relatives said, `The home is always nice and clean.` Staff have the training they need to meet people`s needs. Relatives said, `Staff are lovely, friendly and experienced.` Staff said, ` I have training very relevant to my role.` `We have excellent training specific to our job roles and to the individual needs of the people living here.` `All the staff work well as a team.` `A great staff team, we will always continue to make improvements in our working practice to provide an excellent service to the people living here.` `The staff work well as a team, I enjoy working here, it is an excellent place to work.` The manager knows the people living there and what they need. Staff said that the manager is approachable and supportive. Relatives said the manager is a nice person. The owner is interested in the home and in how individual`s needs are met. This helps to support staff to know how they should help the people living there to live the life they want to. What has improved since the last inspection? There were no requirements made at the last inspection but recommendations made had been met. The quality assurance system had been improved and includes asking the views of the people living there and their relatives about the home. Regular audits are done to make sure that the home continues to improve and benefits the people living there. Staff have information about the risks that people take readily available to them. This means that they know what they need to do to reduce risks and help keep people safe. What the care home could do better: This home does many things well and few improvements are needed. However staff were clear that they needed to continue to make improvements. They said, `The home could do nothing better but continue to provide an excellent service.` `I feel the home in general does lots of things really well and we all need to strive to keep this up.` The ground floor toilet and office should be redecorated to make them more comfortable. The responsible individual was aware of this and said this was planned. Key inspection report Care homes for adults (18-65 years) Name: Address: Raymond Avenue, 24 Raymond Avenue, 24 Great Barr Birmingham B42 1LX     The quality rating for this care home is:   three star excellent 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: Sarah Bennett     Date: 2 1 0 1 2 0 1 0 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 30 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 30 Information about the care home Name of care home: Address: Raymond Avenue, 24 Raymond Avenue, 24 Great Barr Birmingham B42 1LX 01213570667 01213570668 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Platinum Care Services care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6 The registered person may provide the following category of service only: Care Home Only (Code PC) the service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 6 Date of last inspection Brief description of the care home The home is located in a residential area, set back from the main road, up a short drive. It is not distinguishable as a care home, as it is a converted and extended residential property. There are six single bedrooms each with ensuite, a lounge, dining room, relaxation area, large kitchen, laundry, ground floor toilet and gardens to both the front and rear. The home is located in North Birmingham, close to the Scott Arms shopping centre. The home is close to local amenities, including the One Stop Shopping centre, parks, canal sidewalks, and leisure facilities. The home has a vehicle and the people living there are also supported to use public transport. The first floor of the home is only accessible to people with full mobility. A disabled toilet, and two ground floor bedrooms have been provided. The home offers care to six men who have Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home a learning disability and additional needs including sensory impairment, autism, and behaviours that can challenge. Information about fee levels are available from the service. Care Homes for Adults (18-65 years) Page 5 of 30 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. This inspection was carried out by one inspector over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake 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, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home. The Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 6 of 30 (AQAA) was sent to the home just before the inspection and is to be completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by two people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, 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 looked around the home and at a sample of care, staff and health and safety records. The people living there, three relatives, a health professional, the responsible individual, the operations director, the manager and staff on duty were spoken with. We left surveys at the home for the people living there and staff to complete if they wanted to. We received two from people living there and five from staff. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: When we arrived the manager spent time with people looking at a book that staff had put together about us and what we do. This included pictures, making it easier for people to understand. This helped to make people less anxious about us being there and what we were doing in their home. People have the information they need about the home so they can make a choice about whether or not they want to live there. Each person has a care plan so that staff know how to support them to meet their needs and achieve their goals. People can choose what they do, what they wear and eat and drink. People are asked what food they want and help to go and buy it. Staff support people to live a healthy lifestyle. One person said they had lost weight by eating healthily and going to the gym and swimming and that staff had helped them with this. Relatives said that people were able to do more things for themselves and staff helped them to be independent. People go on holiday if they want to with staff to the places they want to go to. If they do not like going on holiday staff take people out on day trips so they can experience new things and see different places. Staff support people to meet their health needs so improving their well being. People said they know how to complain if they are unhappy and that their views would be listened to. Each person has their own bedroom and bath or shower room. This is decorated in the way they choose and has their own things in it. The home was well decorated and furnished making it homely and comfortable for people to live in. Relatives said, The home is always nice and clean. Staff have the training they need to meet peoples needs. Relatives said, Staff are lovely, friendly and experienced. Staff said, I have training very relevant to my role. We have excellent training specific to our job roles and to the individual needs of the people living here. All the staff work well as a team. A great staff team, we will always continue to make improvements in our working practice to provide an excellent service to the people living here. The staff work well as a team, I enjoy working here, it is an excellent place to work. The manager knows the people living there and what they need. Staff said that the manager is approachable and supportive. Relatives said the manager is a nice person. Care Homes for Adults (18-65 years) Page 8 of 30 The owner is interested in the home and in how individuals needs are met. This helps to support staff to know how they should help the people living there to live the life they want to. 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 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 30 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 30 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. People have the information they need to make a choice as to whether or not they want to live in the home. Their needs are assessed before they move in to ensure they can be met there. Evidence: The service users guide included pictures making it easier to understand. It included all the information that people would need to make a choice about whether or not they want to live there. The statement of purpose was updated in July 2009 and a copy of this was sent to us. It included all the relevant and required information that people would need to make a choice about living at the home. The people who live there told us in surveys that they had enough information about the home before they moved in. Since we last visited two people have moved into the home. We looked at the records of the last person to move in. These showed that before they moved in an assessment was completed of their needs to ensure that they could be met there. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The assessment process included meeting with the person, their family and professionals who were working with the person to get information about the person and their needs. It also included visits to the home for overnight stays and visits from staff to the home where the person was living. The manager said that the needs of the other people living at the home are always considered before it is agreed that a person can move in. It is assessed during visits how people get on together so that the person moving in does not impact on other peoples well being. Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a lot of information so they know how to support people to meet their needs and take risks whilst ensuring their safety and well being. Evidence: The records of two of the people who live there were looked at. These included an individual care plan that detailed how staff are to support the person to meet their needs. It was written in a person centred way and gave staff a lot of information about what the person likes and dislikes and how they like to be supported. Care plans were written in way that was easy to understand and included pictures so to help people to be more involved in their plan. Records showed that care plans are reviewed regularly. Reviews were in picture format making them easier to understand and involving the person it was about. Records included information about what choices the person had been involved in such as choosing their clothes. During the day people were observed making choices about Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: what they did, where they spent their time and what they had to eat and drink. Records showed that regular meetings are held with the people living there to talk about the home, what they want to do, menus, their key workers, celebrations such as bonfire night and Christmas and what to do if there is a fire. The manager said that referrals had been made to advocacy services but these were not available. However, the people living there do have regular contact with their family and if needed they help people to make decisions about their lives. The manager was fully aware of the Mental Capacity Act and how decisions are made in peoples best interest if they lack the capacity to do this. This ensures that an independent view is available so that staff do not make decisions for people. Records included individual risk assessments that showed staff how to support the person to take risks whilst reducing the risks to their health and safety. The people who live there can sometimes behave in a way that may challenge other people. Risk assessments clearly stated how staff are to support the individual when they behave in particular ways so minimising any risks. They also stated how staff are to support the person so that they feel safe and therefore less likely to behave in ways that can challenge. These were written in a positive way about the person and questioned staff supporting the individual as to why they may behave in certain ways. For example, one persons stated, am I doing this because I am bored? If this was the reason staff had clear guidance as to what they should do to stop the person being bored. Care Homes for Adults (18-65 years) Page 14 of 30 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. The people living there experience a meaningful lifestyle so ensuring their well being. Evidence: Some people go to college to do courses they want to do to learn new skills. One person is in their final year of school on a part time basis. Records show that staff support people to do courses if they want to but realise that not everyone will want to so activities are tailored to peoples interests. Records showed and people said that they do a range of activities that they enjoy. During the day some people went out with staff to the sea life centre in Birmingham. Two people seemed to enjoy this, but one person made it clear by their behaviour that they were not enjoying this. Staff brought the person back home where they spent time relaxing and playing their musical instruments. Staff said they will try this activity again with the person on their own and at a different time of day. This shows Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: that staff work hard to find activities that people enjoy and do not assume that because someone did not enjoy an activity on a particular day that they will never enjoy it. Relatives told us that their relative goes on holiday with staff to the places they like to go to. Staff have tried to take them to different places to see if they enjoy other experiences but they prefer to go to the same place. One person went on holiday with their family last year, which they enjoyed. The manager said that one person went on holiday to a cottage in Wales last year but did not seem to enjoy being away in a different environment. So this year they plan to take the person on day trips. Two peoples relatives visited during the day, as reviews were being held. It was clear that they knew the staff and the Responsible Individual and often visited the home. Staff made them welcome and spent time talking with them. People said and records showed that people often go to visit their families and sometimes stay overnight. Families visit the home and parties are held for special occasions, which relatives are invited to. Peoples care plans stated who the important people in their life are. Staff had written down individuals relatives birthdays so they could support them in remembering these with cards and presents. Records showed that people are supported to keep in touch with their family by phone calls. Relatives said that staff will always keep in touch and tell them about what the person is doing and if they are unwell. Relatives said that since their relative had lived there they have done more for them self so developing their independence skills. Records sampled showed that people are supported to develop their daily living skills through cleaning their bedroom, making drinks and snacks, baking and doing their laundry. In each persons bedroom there was a picture book that showed what support the person needed with cleaning their bedroom. Staff signed this with the person when they had completed tasks to show their progress in developing their skills. One person said they are on a healthy eating plan and they have succeeded in losing a lot of weight. As well as healthy eating they are encouraged to do exercise and often go to the gym and swimming. They also have their own exercise bike that they said they use. Records sampled showed that people have a varied diet that includes fruit and vegetables. A picture menu is displayed in the kitchen making it easier for people to understand. People are involved in choosing what they eat and in preparing it. We had lunch with some of the people living there. Staff sat with people to eat and talked to Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: them making it a social occasion. People were supported to be as independent as possible in eating and drinking. A choice of sandwiches, pork pies, crisps and drinks were offered. It was clear from conversations that staff knew what people liked to eat and reinforced the need for people to eat healthily whilst recognising that this can sometimes be difficult. This seemed to encourage people and the results of this encouragement was very evident for the person who had succeeded in losing weight. Care Homes for Adults (18-65 years) Page 17 of 30 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 health and personal care needs of the people living there are met so ensuring their well being. Evidence: People were dressed in individual styles that reflected their age, gender, the weather and the activities they were doing. Care plans detailed what support the person needed with their personal care. It was observed that attention had been paid to individuals personal care so helping them to feel good about themselves. Records sampled included an individual health action plan. This is a personal plan about what support a person needs to meet their health needs and what health care services they use. Records sampled showed that people had regular health checks and where appropriate were referred to other health professionals. Records showed that people are weighed regularly. Peoples target weight was stated in their records so that staff knew what they are monitoring when weighing people. Records showed that people were achieving their targets by putting on or losing weight whichever was relevant to the individual. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Health professionals told us that staff take on board the advice that is given to meet individuals health needs. They said that the health of the person they support is improving and staff are motivated to meet peoples needs. The people that live there have autism. Records sampled detailed what autism meant for that person. This shows that staff recognise that autism can affect people in different ways and they need to support people differently in a way that centres around them as an individual. Records sampled showed that people have their medication regularly reviewed. Where people are prescribed as required (PRN) medication, protocols are in place that state when, why and how much of the medication should be given. This ensures that staff know how to use the medication to benefit the person. One person is prescribed an Epipen to be used only in an emergency. A protocol was in place that stated how, when and why this is to be used. All staff have received training in how to use it for the person, so they can help them if needed. Medication is stored in a locked cabinet. People have individual boxes within the cabinet with their medication in so helping to ensure the cabinet is well organised and people get the medication they need. Records sampled showed that people had their medication as prescribed so helping to meet their health needs. Some medication is kept in a fridge so it is stored at the correct temperature. Staff check the temperature of this daily. Records showed that it was the right temperature to store the medication at. Sometimes the temperature of the room where medication is stored can be too hot. Staff have found ways of reducing this when needed to ensure that medication is stored appropriately so it is effective in meeting peoples health needs. The manager said that they check guidance on medication on our website. In response to this they have recently ensured that where people are prescribed creams that staff write on their medicine administration chart what these are for. This shows that the manager is keen to ensure that action is taken to ensure that medicine is given as prescribed and that staff know what each medication is for to meet individuals health needs. Care Homes for Adults (18-65 years) Page 19 of 30 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. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: The complaints procedure included pictures making it easier for people to understand. It included our address so that people could contact us if they wanted to. It was displayed in the hall so that people had this information. The people living there said they knew how to complain if they were unhappy. Staff said that they knew what to do if someone had concerns about the home and who to report this to. A record of complaints is kept. The home had received one complaint in the last year, which we were told about at the time the complaint was made. Social Services were also informed of this and appropriate action was taken to safeguard the people living there. Records sampled showed that records of peoples belongings had regularly been updated when people had bought new things. This helps to safeguard peoples possessions and staff know what belongs to each person, should anything go missing. Finance records sampled showed that people receive their money regularly. It is held safely for them at the home and staff check it regularly to ensure it has not been misused. Records showed that people spend their money on personal items, not on Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: things that should be provided by the home, as part of the fees they pay. Receipts are kept of all expenditure and these matched the records that show what people spend their money on. Records sampled showed that the manager was aware of the Deprivation of Liberty Safeguards and how this legislation may affect the people living there. They had contacted the Best Interests Team to assess whether or not safeguards put in place for one person were in their best interest or were depriving them of their liberty. It had been agreed that it was in the persons best interests. Staff training records showed that staff had received training in raising concerns, whistle blowing, safeguarding and the Mental Capacity Act. This helps to ensure that staff know how to safeguard the people living there from harm. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe, homely and comfortable environment that meets their individual needs. Evidence: The home was well decorated, maintained and furnished in a contemporary style that reflected the age of the people living there. Rooms were homely and comfortable making it a nice place to live. The home is up a small lane off the road and has a large garden. Some peoples bedrooms look out over the garden. The manager said that there are plans to make part of the garden into a vegetable patch. This is to help people to be more involved in their garden and will encourage them to continue to eat healthily. Each person has their own bedroom. Bedrooms are personalised to individuals needs, tastes and interests. Each person has their own en suite toilet and bath or shower. One person is working with staff to paint a mural on one of their walls that reflects their age and interests. People said they can choose how their bedroom is decorated and what things they have in it. Where people are able to they have a key to their bedroom. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The office was small and needed redecorating to make it more comfortable for staff to work in. The small toilet was in need of redecoration to make it more comfortable. The Responsible Individual was aware of this and said this was planned. They responded to the draft report stating that this was redecorated in the second week of February. The response to this is to be commended and shows their willingness to respond to recommendations made to improve the home. The home was clean and free from offensive odours making it pleasant for people to live in. The people living there are involved in cleaning their house and bedroom so to develop their daily living skills. Care Homes for Adults (18-65 years) Page 23 of 30 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. The arrangements for staffing, their support and development ensure that the needs of the people living there are met so ensuring their well being. Evidence: Training records showed that seventy five per cent of staff have completed National Vocational Qualification (NVQ) level 2 or above in Care. This exceeds the standard and should ensure that people are supported by staff with the skills and knowledge to meet their needs. Other staff were doing NVQ training at level 2 and 3 and one staff was doing level 4. Staff rotas showed and it was observed that there are enough staff on each shift to meet the current needs of the people living there. There are no staff vacancies. Relatives said that staff are experienced. Staff said that they enjoy working at the home and that there are always enough staff on duty. Records showed that staff sickness levels are low.The manager said that if staff are off sick other staff work extra hours so that bank or agency staff are not used. This ensures that the people living there are supported by staff that know them well. Records showed that regular staff meetings are held. Minutes of these showed that staff are involved in these, for example, one member of staff had recently given a Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: presentation on autism as part of the staff meeting. The notes from this were kept with the minutes which staff who do not attend are asked to read. This helps staff to develop their knowledge and keep updated with best practice. The records of three of the staff that work there were looked at. These included the required recruitment checks including evidence that a satisfactory Criminal Records Bureau (CRB) check had been received to ensure that vulnerable people are protected. The manager is trained in delivering training to staff in moving and handling, autism and Non Violent Crisis Intervention (NVCI), which is the way that staff manage peoples behaviour that only uses physical intervention as a last resort. All staff have received training in this. They also have regular practice sessions so that they can practice how to use the techniques if a person is not able to calm down without physical intervention being used. This ensures that staff know how to do this safely so protecting people from harm. Training records show that staff have received training in relevant areas so that they know how to meet the individual needs of the people living there. Staff said, We all have excellent training specific to our job roles and to peoples individual needs. I have received training very relevant to my role. The manager said that they use the Key Lines of Regulatory Assessment (KLORA) with staff to work through in their appraisals. This is the tool used by CQC to assess the ratings of care homes and judge how they meet the standards. The manager said that some staff had given a presentation to the directors of the company on how they plan to achieve an excellent rating using the KLORA. Staff said that they knew about the KLORA and used it in their everyday work to improve the home for the people living there. Staff said, We will always continue to make improvements in our working practice as we strive to be the best we can, in providing an excellent service to all the people living here. Staff have regular appraisals and meet with their manager for supervision. Staff said they have regular supervision and are well supported in their role. Staff said, I am never afraid to approach my manager if I need to, her door is always open. Care Homes for Adults (18-65 years) Page 25 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements ensure that the home is well run, so ensuring the safety and well being of the people living there. Evidence: The Responsible Individual and Operations Director were at the home for the day. They had planned to be there for the reviews of two people by the City Council who were reviewing the fees they pay. They assisted us with our inspection. Relatives who visited for reviews obviously knew them and the manager said that they often visit and are interested in the home and the people living there. We were told that it is one of the best private providers to work for as they do care, staff feel valued and will be supported if it is in the best interests of the people living there. The manager has several years experience of working with and managing homes for people who have a learning disability. They have the skills and knowledge to manage the home. The manager said she is well supported in her role. Staff said they are well supported by the manager. The manager is additional to the Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: number of staff needed on the rota. However, she said and records showed that she will work alongside staff with the people living there so she gets to know them and how to meet their needs. It was observed that she knows the people living there well and how to guide staff in supporting individuals. A representative of the owner visits the home monthly unannounced and writes a report of their visit. They look at how the home is meeting the needs of the people living there and what can be done to improve this. An action plan is made after each visit which details what action is needed to make improvements. During their visit they ask for the views of the people living there and staff. Since we last visited a new quality assurance system has been put in place. This includes asking the views of the people living there, their relatives and professionals who work with people who live there. Records showed that their views were positive, where any concerns were raised these were responded to and action taken to resolve them. Regular audits are completed which include looking at health and safety, food safety, infection control and medication. Where needed recommendations are made from these and action taken to make improvements. Fire records showed that the risk assessment is regularly reviewed and updated to ensure that the risks of there being a fire are minimised. Staff regularly check the fire equipment to make sure it is working. It is regularly serviced by an engineer to ensure it is well maintained and would work if needed. There are regular fire drills to make sure that staff and the people living there would know what to do if there was a fire. A grab bag has been put in place. This is kept near to the door of the home and contains personal information about the people living there and what medication they take, a torch, spare keys and contact details. This is so that if there were a fire this bag could be taken out by staff to reduce the impact a fire would have in supporting the people living there. Copies of peoples care plans and other required records are kept safely away from the home so if they were destroyed by fire these would be available. Each person has an emergency evacuation plan so that staff know how to support individuals. Records sampled showed that gas and electric equipment is regularly checked and serviced to ensure it is safe to use. Records showed that staff test the water temperatures regularly to ensure they are not too hot and that people are not at risk of being scalded. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 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 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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