Care Home: Springfield Road

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What the care home does well Care plans are written so that the people living there can understand them. People help to write their care plan.Staff often ask the people living there what they think of the homeand how it could be better.The people who live there can go on holiday if they want to with staff. They can go to different places and have a break away from the home.People often go out to places that they want to go to so they do the things they enjoy.The people living there have regular health checks. Health professionals give staff advice on how to help people to help keep them well.Care plans show staff how to help the people living there to manage their behaviour. Staff have training in this so they know how to helppeople keep safe.Staff spend time talking to people and helping them to be relaxed and less anxious so they can be well.The home is clean and well decorated making it a nice, comfortable place to live.Staff have training when people`s needs change so they know how to help them.Equipment in the home is tested often so that it works well and is safe to use. What has improved since the last inspection? Staff write down people`s weight. If it has changed they tell one of the nurses about this. People go to the dentist often. This helps to keep people well.There is new flooring in some of the bedrooms so it is more comfortable for the people living there.A handrail has been fitted on the garden path in 182 so that all the people living there can walk around the garden safely.There are more staff meetings so that all staff know how to help the people living there.There are more fire drills so that staff and the people living there would know what to do if there is a fire.People had been asked what they think about the home. Staff had listened to what they said and helped them to do more of the things that they want to do. What the care home could do better: Care plans for people who may choke should say what staff should do if a person chokes so they can help them to be safe.There must be new radiators so that people are warm enough and do not have to use portable heaters which could burn them.All staff should be well supported to do their job so they can help the people living there.There should be a manager in each bungalow. This will help the people living there have a home that is well run so they are happy living there.The people living there and their relatives should be asked about who is going to run the home so that their views are always listened to. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Springfield Road 180 - 182 Springfield Road Moseley Birmingham West Midlands B13 9NE three star excellent service The quality rating for this care home is: 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: Sarah Bennett Date: 1 2 0 2 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Springfield Road 180 - 182 Springfield Road Moseley Birmingham West Midlands B13 9NE 01217777020 01217772761 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): South Birmingham Primary Care Trust Name of registered manager (if applicable) Mrs Debra Ann Brick Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 care home 12 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 12 The maximum number of service users to be accommodated is 12. Date of last inspection 1 9 0 9 2 0 0 7 A bit about the care home Twelve women who have a learning disability live there. They are given nursing care and accommodation. There are two bungalows that are next door to each other. Six people live in each bungalow. The bungalows are in Moseley in Birmingham. Midland Heart owns the bungalows. The care and support services are provided by South Birmingham Primary Care Trust. Each bungalow has six single bedrooms. There are bath and shower rooms. There is a lot of communal space. There is a lounge, dining room, quiet room, smoking area. In one bungalow there is a sensory room. Each bungalow has a large garden that people enjoy spending time in. 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is three stars. This means that the people who live there experience excellent quality outcomes. The visit was carried out over one day. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. We looked at what it is like to live there. We looked at how the care home meets the regulations, the National Minimum Standards and how they can make things better. Before the visit the home sent us the Annual Quality Assurance Assessment (AQAA). The manager completed this. It tells us how they think they are meeting the regulations. We looked at notifications that the home sent us about things that have happened there. Two people who live in the home were case tracked. We do this by meeting or observing the people, talk about their care with staff and look at their care files. Tracking peoples care helps us understand what it is like to live there. We talked to the people who live there, the managers and the staff on duty. Some people who live there completed our Have your say survey. We sent this to them before the visit and asked for their views on the home. What the care home does well Care plans are written so that the people living there can understand them. People help to write their care plan. Staff often ask the people living there what they think of the home and how it could be better. The people who live there can go on holiday if they want to with staff. They can go to different places and have a break away from the home. People often go out to places that they want to go to so they do the things they enjoy. The people living there have regular health checks. Health professionals give staff advice on how to help people to help keep them well. Care plans show staff how to help the people living there to manage their behaviour. Staff have training in this so they know how to help people keep safe. Staff spend time talking to people and helping them to be relaxed and less anxious so they can be well. The home is clean and well decorated making it a nice, comfortable place to live. Staff have training when peoples needs change so they know how to help them. Equipment in the home is tested often so that it works well and is safe to use. What has got better from the last inspection Staff write down peoples weight. If it has changed they tell one of the nurses about this. People go to the dentist often. This helps to keep people well. There is new flooring in some of the bedrooms so it is more comfortable for the people living there. A handrail has been fitted on the garden path in 182 so that all the people living there can walk around the garden safely. There are more staff meetings so that all staff know how to help the people living there. There are more fire drills so that staff and the people living there would know what to do if there is a fire. People had been asked what they think about the home. Staff had listened to what they said and helped them to do more of the things that they want to do. What the care home could do better Care plans for people who may choke should say what staff should do if a person chokes so they can help them to be safe. There must be new radiators so that people are warm enough and do not have to use portable heaters which could burn them. All staff should be well supported to do their job so they can help the people living there. There should be a manager in each bungalow. This will help the people living there have a home that is well run so they are happy living there. The people living there and their relatives should be asked about who is going to run the home so that their views are always listened to. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Bennett 77 Paradise Circus Queensway Birmingham B1 2DT 0121 600 5300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 . Prospective service users have the information they need so they can make a choice about whether or not they want to live there. Evidence: The statement of purpose was reviewed last year. It included the results of the surveys completed by the people living there. Changes were made to it after the survey taking into account comments that people had made about the information they need. The statement of purpose included the relevant information. This ensures that prospective service users have the information they need to make a choice as to whether or not they want to live there. No people had been admitted since our last visit so the standard relating to assessment of peoples needs before they move in was not assessed. The managers have been trying to develop an assessment tool that is more accessible to people living there. They have been given one that was developed by a local Primary Care Trust. They plan to adapt this so it is more suitable to the service. This will ensure that any new people moving into the home will be able to be more involved in their assessment. 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 . Staff have the information they need to support people to meet their needs, make choices about their lives and ensure their safety and well being. Evidence: Each person who lives in the home has a Named Nurse and a Named Person who are responsible for coordinating their care plans with them and ensuring their needs are met. The records of one person living in each bungalow were looked at. These included a detailed care plan. The plan was centred on the individual and used pictures and photos so that people found it easier to be more involved in their plan. Care plans had been regularly reviewed with the person, their Named Nurse and Named Person to ensure they had the updated information so that all staff knew how to support them. The people who live there they can sometimes behave in a way that is challenging to other people. Each person has what is known as a Safe Handling Pack. This states what the person likes doing, how they communicate and what support they need. This helps to reduce any behaviours that may be challenging but it also states how staff are to respond and support the person if they do display difficult behaviours. The plan states what the cues are to the person behaving in this way, what can trigger these behaviours and how staff may distract the person to reduce the behaviours. The plan cross referenced to relevant parts of the care plan so that staff had all the information they need. The person, all staff and relevant professionals are involved in developing the plan. It was written in a way that was easy to understand and included pictures. Minutes of meetings held with the people living there and records sampled showed that the people who live there are involved in choices about their lives. These include Evidence: what they do, where they go, what they eat and drink, what they wear, how they spend their money and the decoration and furnishing of the home. Records showed that people have regular opportunities to talk to their named Nurse and Person to say how they feel about the home and what can be done to make things better for them. In 182 the people living there had completed a survey about what they thought of the home and how it could be improved. The manager had looked at these surveys and made improvements to information, the day to day running of the home and the environment from peoples views. An action plan had been developed as to how things are to continue to improve and the people who live there are involved in decision making within the home. Records included individual risk assessments. These stated how staff are to support the person to be as independent as possible whilst minimising the risks to their health and safety. Some people are identified as being at risk of choking and risk assessments are in place for this. One stated how to reduce the risks of choking but did not state how staff are to respond if the person should choke. However, there had been an incident where they had choked and staff had responded appropriately. Their risk assessment was updated to include further ways to reduce the risk. Staff in bungalow 180 had received training in resuscitation so they would know what to do if a person should choke and require this. The manager in 182 said that staff were booked to do this but it had been difficult to get staff on this training as places were limited. 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 excellent 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 and are encouraged to widen their experiences so ensuring their well being. Evidence: Records showed that people do a range of activities that they enjoy doing and are suitable to their individual needs. One person had been to the cinema with staff that afternoon. They said they enjoyed the film and they often go to the cinema, which they like. They prefer to go in the afternoon and to a certain cinema that is less crowded than others so they do not get anxious. Another person said they were going to a cafe for a drink with staff later that day and this is something they often do which they enjoy. One person had been to their weekly flower arranging class with staff. When they came back they proudly showed off their arrangement, which they said they were going to display in their bedroom. In 182 the survey that people had completed showed that people did not know much about other cultures. Staff had responded to this by doing some cultural awareness sessions with the people living there in a way that they could understand. This had involved visiting a local synagogue and Sikh temple and trying out different foods and dress. They had also ensured that people celebrated festivals that were important to their cultural background such as Christmas. They had a Christmas party and had made Christmas cards. Photographs were taken of all these events and it was clear from these that the people living there had enjoyed this. The AQAA stated that incidents of racism towards staff of different cultures had reduced because of this work Evidence: as people were now more aware of differences and had been encouarged to celebrate these. Each person has their own activity plan that is produced using pictures making it easier to understand. The person helps to do their activity plan so they get to do the things they like. People are also encouraged to try out new activities and a record is made of whether or not they enjoyed these. In 180 people talked about the dog that visits under the Pets as Therapy scheme. They said they enjoyed this and looked forward to their visits. They also talked about a cat that visits most days and they feed, which they enjoy doing. People have the opportunity to go on holiday each year with staff if they want to. Two people were planning to go to Disneyland, Paris with staff this Spring which they were looking forward to. People said that they can choose where they go and which staff go with them. Records showed and people said that they are encouraged to keep in contact with their family and friends. Some visitors were there on the day and said they were always made welcome. They were able to spend some time in the persons room with them if they wanted this. Records and observations showed that people are encouraged to be as independent as possible and take part in jobs around the home. In 182 a token system has been set up. Minutes of meetings with the people living there showed that this was discussed before it was set up and people thought this would be a good idea. Each person has their individual, realistic targets to reach each day. These are clearly stated using pictures helping people to understand what is expected of them. When people have reached their target they get a token and can buy something from the tuck shop. This is provided out of the house budget and includes something that each of the people living there would like. One person said that their target that day was to clean the door handles and they were going to do this as they wanted to buy some chocolate. It also helped them to be involved in the running of the home. Menus showed that people had a choice of meals and a varied menu was offered. The menus included healthy options as some people were trying to lose weight. Menus included pictures so that people could understand what food was being offered. People said they liked the food and were offered choices. People had been given the opportunity to try foods from different cultures so widening their experiences and atstes. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Arrangements ensure that people receive support with their personal care and to meet their health needs so ensuring their well being. Evidence: The people living there were dressed appropriately in individual styles that reflected their age, gender, the weather and the activities they were doing. All women live at the home and the home is staffed by female staff. The managers believe that this is essential to the women who live there to meet their needs and reduce their anxieties. Care plans sampled detailed how the individual is to be supported with their personal care. One person went out with staff in the afternoon for a manicure at a local shop. They said they enjoy this and were pleased with the result. Care plans stated how staff are to support the individual to meet their health needs. Each person had a health record that included pictures so that it was easier to understand. Their health record detailed what appointments they had attended and the outcome of these. It included health checks such as regular weight checks to ensure they are keeping healthy. Other health professionals are involved in individuals care where appropriate. Records showed that staff follow professionals advice to ensure the individuals well being. Some people may find it difficult to communicate because of their needs. This can be a risk to their health if staff do not know when they are in pain or are ill. Care plans stated how the person may communicate this non verbally, using gestures or their behaviour so that staff know and can take action to ensure their well being. The medication was looked at in 180. One person needed their tablets crushed Evidence: because of their health needs. The psychiatrist had signed the protocol that stated why and how this should be done. Medication was stored in a locked cabinet. Qualified staff give the medication to people. Support staff do help with giving out medication and have received medication training so they know what effect the medication may have on the person and what they are giving it for. Boots supply the medication using the monitored dosage system in blister packs that are pre packed by the pharmacist. This makes it easier for staff to know who has what and when so helping to reduce errors. At the front of each persons Medication Administration Record (MAR) there is a photograph of the individual and clear details of how they like to take their medication. This helps unfamiliar staff to know who to give the medication to and in the way they like it. MAR had been signed appropriately indicating that medication is given as prescribed. Sadly, one person living there has a terminal illness. Staff have involved the relevant health professionals who have been involved in their End of Life plan so they know how to support the individual. Staff had followed the advice and were caring for the person to ensure they are comfortable. Staff were also ensuring that the person could continue to do the things they enjoy when they were well enough to so they continued to have a good quality of life. Advice and support was given from a local hospice. Staff had received training in palliative care so they knew how to support the person appropriately. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The views of the people living there are listened to and acted on, which helps to ensure that they are protected from abuse, neglect and self harm. Evidence: Records sampled included the complaints procedure of the Primary Care Trust in picture format making it easier to understand. This was also displayed in the home. We have not received any complaints about the service provided at the home since our last visit. The home had received no complaints about the service provided. There were complaints that some people living there had made about the behaviour of other people living there and how this affected their life. The manager had passed these to a representative from the housing provider Midland Heart as they were about not meeting the terms of their licence agreement. The manager had written to the person making the complaint in a way that they could understand to explain what action was being taken. One person who made these complaints had expressed a desire to move as they would prefer to live alone. With the help of an advocate they have been able to make this decision and plans are being made for this to happen. All staff have received training in how to safeguard the people living there from abuse. They have also spoken with the people living there about their rights to live in a home that is safe and free from abuse. At the next meeting of the people living there they plan to talk more about this using a DVD that has been produced for people who have a learning disability. People who live in the home can sometimes display behaviour that can be challenging to other people. Records sampled included an individual Safe Handling Pack. This detailed how staff are to support the person through different stages of their behaviour. It included triggers for each of the behaviours and what to do to distract the person from behaving in this way. All staff have received training in Studio 3 (a form of physical intervention that concentrates on distracting the behaviour rather than restraining the person). Records showed that physical intervention and the Evidence: medication to control peoples behaviours are only used as a last resort. Throughout the day staff were observed working with people in a way that prevented difficult behaviours. Where people did display these behaviours they responded calmly helping the person to relax and do something more positive. All staff have had training in the Mental Capacity Act. This Act came into force in April 2007. It requires an assessment of a persons capacity to be done where there is doubt that the person lacks the capacity to make a choice or decision about their life. If they need help to make a decision an Independent Mental Capacity Advocate can be appointed to help them. From April 2009 where people lack mental capacity it will be required that an assessment is carried out where it is questioned whether the care or treatment provided takes away the persons liberty. This is known as the Deprivation of Liberty Safeguards (DOLS). The managers have attended training on this and said that they will ensure that staff are aware of this legislation and how it may affect the people living there. 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 homely, comfortable and clean environment that generally meets their individual needs. Evidence: The bungalows were well decorated and homely and comfortable for the people living there. In 180 new furniture is to be provided in the lounge. Staff said and records showed that the people living there had been involved in choosing this. Bathrooms had pictures on the walls so there were not clinical despite having adaptations to assist people in moving around. In 180 there is a sensory room that has equipment such as bubble tubes, lighting and projectors that project images around the room. People can use this room to relax in and benefit from the sensory equipment provided. Bedrooms seen were personalised to individual tastes, interest and needs. Bedrooms were well decorated and included personal possessions where people wanted these. People said they are involved in choosing the decoration and furniture for their bedrooms. Since our last visit new boilers have been fitted in both bungalows. However, this had not improved the heating in all parts of the home. Staff said that the radiators are not big enough to cope with the capacity of the boilers so are not that efficient. In 180 portable heaters were being used to supplement the heating. This is not ideal as there could be risks from using these to peoples safety. A risk assessment was in place to try to reduce these risks. Staff said that it is planned to replace the radiators during the summer months. Since our last visit hand rails had been fitted in the garden 182 so that it is safer for people to use the garden. Staff said that the maintenance and gardening contractors had changed and this had improved the service. Evidence: Since our last visit some people have had new wheelchairs and others have had new beds that can be moved up and down so that staff can assist them safely in moving. One person had a new recliner chair that had been made specially for them so that they can sit comfortably in the lounge. Both bungalows were clean and free from offensive odours making them a pleasant place for people to live in. The people living there are involved in cleaning the home to encourage them to develop their independence skills. Staff receive training in infection control and their knowledge of this is reflected in the homes cleaning schedules. 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 . Arrangements are in place to ensure that well trained and supported staff that know the people living there support them so their needs can be met ensuring their well being. Evidence: The AQAA stated that all support staff have National Vocational Qualification level 2 in Care or are working towards achieving it. This exceeds the standard that at least 50 per cent of staff have achieved this qualification. The AQAA stated that since our last visit five members of staff have left. This has been for promotion, going on to do their nurse training or transferring to another home within the Trust who they know will be staying within the NHS provision. Staff said that morale is low as they do not know what is happening to the home in the future. It has been decided that it will move out of NHS provision. However, they do not yet know who they will be employed by. This has clearly has an impact on staff and it is to their credit that they have continued to maintain a high standard of support to the people living there. Regular staff meetings are held and minutes of these are kept. Staff said that they now have a debrief session as part of every handover between shifts. This helps ensure that if incidents have occurred staff have an opportunity to talk about them and discuss how they might do things differently in the future to benefit them and the people living there. New staff have been recruited and they have received an induction and training in how to support the people living there. This has helped to maintain consistency for the people living there as unfamiliar staff can cause them to be anxious and distressed. Staff records sampled included the required recruitment records to ensure that Evidence: suitable people are employed to work with the people living there. These included evidence that a satisfactory Criminal Records Bureau (CRB) check had been undertaken. The managers regularly audit staff CRB checks to ensure that they are completed after three years of employment. This ensures that staff are still suitable to work there. Staff training records sampled showed that staff have the training they need so they know how to support the people living there. Staff have regular updated training in how to manage peoples behaviour and keep them safe. Where peoples needs change staff receive training so they know how to support people. Qualified staff have the training they need to maintain their registration with the Nursing and Midwifery Council. Support staff meet together quarterly in Action Learning Sets so they have an opportunity to develop their skills and learning, which benefits the people living there. The AQAA stated that all staff have six supervisions sessions a year with their manager so they are supported in their role. Staff records sampled showed that staff did not have at least six supervisions a year so these should be more regular for all staff. 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 arrangements ensure that the people living there benefit from a well run, safe home that is run in they way they want so ensuring their well being. Evidence: As stated earlier in this report it has been decided that the home is no longer to be provided by the NHS but at present it is uncertain as to who the new Provider will be. This has caused anxiety to relatives of the people living there and to staff, which could impact on the well being of the people living there. From talking to staff and relatives it appears that there has been little consultation with them about this and how it might impact on the people living there. Given the complex needs of individuals who live there it is unacceptable that this had not been considered. There is a registered manager in each bungalow. This is needed due to the complex needs of the people who live there and the high levels of staffing needed to support them. One of the registered managers is leaving due to the uncertainties of the future provider. Both registered managers have several years experience and knowledge of working with the people living there and those with similar needs. They are both Registered Learning Disability Nurses and have completed additional updated training so they have a good understanding of how to meet the needs of the people living there. It must be considered that in the future there is a Registered Manager in each bungalow to continue providing the high standard of care. A survey had been completed by the people who live in 182 expressing their views about the home. From this the manager had completed a report with a summary of what they said and what action was going to be taken to address these things and improve the service in the way they wanted this. This was produced using pictures Evidence: making it easier to understand. Some changes made as a result of this survey are: people now have safes in their bedrooms that they can keep their valuables in, some people now go to church as they said they wanted to do this and the food shopping is now done in local supermarkets with some people who live there not on the Internet. A representative from the PCT visits the home monthly to do an audit of the service provided. A report of this visit is written and available in the home. A representative from Midland Heart visits regularly to do an audit of the environment to ensure it is well maintained. Fire records showed that staff test the fire equipment regularly to make sure it is working. Regular fire drills are held so that staff and the people living there would know what to do if there was a fire. A fire risk assessment is in place that is reviewed every year to ensure that the risks of there being a fire are minimised as much as possible. Records showed that staff test the water temperatures weekly to make sure that they are not too hot, which could put people at risk of being scalded. Staff carry Scope alarms so that they can summon help from other staff if needed to ensure their safety and that of the people living there. Records showed that these are tested weekly to make sure they are working and batteries are changed as needed. Regular tests are done and equipment including gas and electrical is serviced regularly to ensure that it is safe to use. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 24 13 The radiators must be replaced. 30/09/2009 So that people are warm enough and do not have to rely on portable heaters which could be a risk to their safety. 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 9 Risk assessments for people at risk of choking should state what staff should do if a person chokes to ensure their safety. All staff should have regular supervision sessions with their manager to ensure they are supported in their role so to benefit the people living there. There should be a registered manager in each bungalow to ensure that a high standard of support continues to be given to the people living there. The people living there and their relatives should be 2 36 3 37 4 39 consulted on the future of the home to ensure their views are always listened to. 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