Care Home: St Mark`s Road Care Home - Block A

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What the care home does well People were supported to go to college and go out to the shops, pubs and other places that they enjoyed. The home was kept clean and nicely decorated and had enough space for everyone What has improved since the last inspection? People were supported to take their medicines safely. At the last inspection visit some staff hadn`t had training about how to support people with epilepsy and about moving and handling people safely, this has now been done. What the care home could do better: At this inspection there was some staff that weren`t up date with all their training which means that some staff might not have the skills they need to keep people safe and support them properly. Key inspection report Care homes for adults (18-65 years) Name: Address: St Mark`s Road Care Home - Block A 24 St Marks Road Derby DE21 6AH The quality rating for this care home is: one star adequate 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: Angela Kennedy Date: 2 3 1 1 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 35 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 35 Information about the care home Name of care home: Address: St Mark`s Road Care Home - Block A 24 St Marks Road Derby DE21 6AH 01332294066 01332242338 robinia.24stmarks@hotmail.co.uk www.robinia.co.uk The Robinia Group PLC care home 8 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: Date of last inspection 1 0 0 6 2 0 0 9 A bit about the care home Robinia Care Group is the responsible provider for 24 St Marks Road. The home is located on the same site as another home owned by this organisation. The home was purpose built to a high standard and registered in July 2005, to provide personal care and accommodation for up to 8 people in the category of learning disability, aged between 18 and 65 years of age. The home is situated in Chaddesden just outside Derby City centre and is close to local amenities. A car park in available at the front of the premises and a garden Care Homes for Adults (18-65 years) Page 4 of 35 at the rear. The home provides a spacious environment with all rooms being of single occupancy with en-suite shower facilities. Care Homes for Adults (18-65 years) Page 5 of 35 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: one star adequate 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 Care Homes for Adults (18-65 years) Page 6 of 35 How we did our inspection: This is what the inspector did when they were at the care home We arrived at the home without an appointment. An expert by experience came with us for part of the inspection. An expert by experience is a person who because of their shared experience of using services or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Information from the findings of the expert by experience has been included in this report. We looked at the files of two of the people living at the home to see if the information about them told the staff how they liked to be supported and what kind of support they needed. We looked at other records to make sure that the people living at the home were kept safe and were supported to do the things they liked. We also met some of the staff working at the home. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well What has got better from the last inspection People were supported to take their medicines safely. At the last inspection visit some staff hadnt had training about how to support people with epilepsy and about moving and handling people safely, this has now been done. Care Homes for Adults (18-65 years) Page 8 of 35 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 9 of 35 If you want to speak to the inspector please contact Angela Kennedy Care Quality Commission (East Midlands) Citygate Gallowgate Newcastle upon Tyne NE1 4PA Phone 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 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 11 of 35 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. An accurate assessment of needs is undertaken prior to admission. This means that people moving into the home can be confident that their needs can be met. Evidence: The pre inspection information said that thorough pre-placement assessments are completed prior to people being accepted into the service. Robinia employs a Business Development Manager who assesses the suitability of people on the basis of needs and aspirations and compatibility of the people already living at the home. The files of two of the people living at the home were looked at in detail. One person had recently moved to the home and the other had lived there for several years.Both files seen provided a detailed and clear picture of the individuals support needs, their abilities, their level of understanding, their likes and dislikes and their methods of communication. This enabled the staff team to support people in a way they preferred and understood. The person that had recently moved into the home had a comprehensive needs assessment in place that formed the basis of their support plans. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: Information had been obtained from this persons former residential home to further develop their support plans and provide a profile of this person. This profile informed staff of their interests and things they enjoyed doing,their communication needs and how they communicated with others and their personal, health and social care needs. The other person case tracked had no assessment information prior to their admission available. The manager stated that he believed that this information had been archived and was unable to locate it. There was evidence in place to demonstrate that the appropriate health and social care professionals were involved in the care of this individual in ensuring that the home continued to meet their needs.Such as Circle of support reviews on file. These reviews provided detailed information relating to the needs of the person and were provided in an easy read format. There was evidence in place to demonstrate that this person had been supported to invite people that were important to them to attend their review. Care Homes for Adults (18-65 years) Page 13 of 35 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 endeavoured to promote individuals rights and choices and people were supported to take risks, to enable them to maintain as much independence as possible. Evidence: The pre inspection information said that person centred risk assessments were being developed, which will be reviewed as changes or progression occurs. It said that people are offered opportunities to be involved in the day to day running of the home and that individuals records are secure and confidential. The support plans seen were very detailed in content and gave staff clear instructions as to level and type of support required.The support plans in both files were written in an easy read format. Both of the people case tracked had support plans that covered their social, emotional, health and personal care needs. The care plans seen were detailed and clearly instructed the staff team on the level and type of support each individual needed. This included the communication needs of the individual and their preferences on how support was Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: provided. Risk assessments were seen and referenced to the appropriate care plans they related to. The risk assessments informed staff of the support each person required to enable them to stay as independent as possible. Both the support plans and risk assessments seen had been reviewed as required.This ensures that the measures for keeping the people were in place. There was no evidence in place to demonstrate that the individual or their representative had been involved or consulted regarding their support plans. Although as stated earlier in this report there was information seen to demonstrate that one of the people case tracked had been supported to invite people that were important to them to attend their review.Evidence was also seen to demonstrate that people living at the home were supported to maintain family links whenever possible. The Expert by experience was unable to communicate directly with the people living at the home as they were unable to verbally communicate. He was told that the people living at the home were unable to verbally communicate, did not use makaton, a type of sign language and would not be able to understand the picture format communication tool that he brought along with him. The expert by experience was unsure how people living at the home were supported to make choices and decisions and stated that the staff were unable to provide him with the answer as to how this was done. This manager was asked how people were supported to make choices and decisions in their daily lives. The manager said this was often through trial and error. For example going somewhere new in the community would involve staff taking an individual on a few occassions to assess their responses to the environment or activity, this was used to determine if individuals liked or disliked the activity and environment. There was information within the support plans that recorded individuals likes and dislikes and preferences regarding activities. For example, one person case tracked didnt like large groups or loud noise.This information was recorded in their support plan. This person was also observed listening to music in their room later in the day, as a party was being prepared for someones birthday and the party atmosphere in the dining area was too noisy for them. This demonstrates that their wishes were being followed.This persons records stated that they would sing when they were happy, which again is a good indicator for staff as to this persons acceptance and enjoyment of an activity, event or environment. The manager discussed an electronic communication aid that was used for one person living at the home. However at the time of this inspection it was stated that this was not working and was awaiting repair by the manufacturers. Observations that we undertook, showed us that staff knew the service user group well Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: and a positive and relaxed atmosphere was noted. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated as individuals and the staff team are generally responsive to their needs and preferences. Evidence: The pre inspection information said that people using the service access the community on a regular basis and that college placements were in place for relevant individuals. Information was seen in the support plans to demonstrate the activities that were undertaken. This included a timetable that demonstrated the daily routines,activities and community access that was undertaken.Such as attending colleges in Stapleford and Eastwood and the local Outreach centre . People were supported to access these services with staff from St Marks Road. Discussions with staff confirmed that usually there was two people attending college or centre at any one time which meant the staff had colleague support when out if they needed it. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: On the day of the inspection visit people that would usually be at college were at home due to staff sickness at the college. As the people living at the home were unable to communicate, verbally or through sign language, the expert by experience spent time observing the interactions between the people living at the home and the staff supporting them. The expert by experience felt that there was little interaction observed between the people living at the home and the staff team. He provided some examples to demonstrate how he had come to this conclusion. One example was regarding a person that lived at the home that was lying on the floor for over 40 minutes in the dining room. The expert by experience felt that the staff were ignoring this person. We discussed this observation with the manager and the staff and it was confirmed that this person spent a lot of their time on the floor. This was due to their learning disability and this was something they liked to do. This person was mobile and was able to get up off the floor whenever they wished. Further examples included a person who had a coughing fit and the expert by experience said that the staff ignored this. However when we discussed this with the manger it was confirmed that this person had a disorder that meant that they did have bouts of coughing and a professional assessment relating to this had confirmed that this person was not at risk when coughing. However without this knowledge it is easy to understand why the expert by experience was concerned at the lack of staff intervention. Another example given by the expert by experience related to a person who was given a pad to draw on but was given nothing to draw with,such as pencils or pens of any kind. Discussions took place regarding this and it was clear from the fact that this member of staff returned to see the picture the person had drawn that this was an oversight on their part. However as the people living at the home arent able to verbally communicate, staff should be mindful of this when supporting them to undertake activities. Further observations of staff interactions with the people living at the home were undertaken later on in the day when a Birthday party was being organised. At this time lots of interactions between the staff and the people living at the home was observed. One person was seen dancing to music with staff, others were seen in the kitchen with staff .The general atmosphere was lively and positive. As stated earlier in this report one person was observed listening to music in their room ,as the party atmosphere in the dining area was too noisy for them. Staff talked about how they supported people with activities and accessing the community. They said, we go out with service users to the cinema, assembly rooms and for meals. They have aromatherapy every Saturday. We do have a mobile hairdresser for the ladies as they prefer that but the men go out to the salon. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: As stated earlier in this report there was evidence to demonstrate that people living at the home were supported to maintain family links whenever possible. The expert by experience said the menu board seen offered no pictures and no alternative choice of food. In the kitchen there was a board where the lunch time meal had been recorded. However as the people living at the home were unable to read, this was not appropriate for them. Small pictures were available next to the board that could be used and a Velcro strip was attached to the board for this purpose, however no pictures were on the board. Discussions took place with the manager regarding how large pictorial types menus could be used to assist some people in making choices regarding meal preferences.Staff discussed how people living at the home were supported to go out for meals and try different types of food. In the files of the two people case tracked there was records in place regarding their likes and dislikes with regard to food and any specific dietary requirements. Staff spoken with demonstrated that they new the people they supported well and this included their dietary preferences and needs. Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in a way they prefer and want. The staff team support people to take medication safely. Evidence: The pre inspection information said that everyone has a Health Action Plan which outlines their preferences to be supported. Medication is only administered by staff who have received that appropriate training and this is done by two staff at all times. Audits are carried out after administering medication, on all medication that is not blister packed by Boots.Everyone is treated with respect and dignity at all times. The care plans seen informed the staff of the individuals preferred method of support in their personal care needs.This was broken down into morning routines, evening routines and mealtime routines. The information seen was detailed and clearly instructed staff of the level of support the individual required.These support plans again linked to risk assessments to ensure people were supported in a safe way and enabled them to stay as independent as possible. Evidence was seen within support plans that demonstrated that healthcare needs were met.The records seen demonstrated that individuals health and well being was monitored on a regular basis to ensure their healthcare needs were met. Examples of the records Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: seen include,Speech and Language therapy assessments, physiotherapy input records and health care records that showed input from G.P.s, opticians and dentists. Information was also in place regarding the contacts that supported with the health plan and the persons medical history both past and present including their prescribed medication. A health diary was in place, this is used for recording appointments. There was specific pages for professionals to write up their notes, along with follow up records, medication reviews, health checks and screening and monthly weight records. Since the last key inspection the service has told us about three medication errors. These medication errors resulted in either the wrong medications being administered or no medication being administered when it should have been. The appropriate actions were taken to address these errors and none of these errors resulted in any adverse effects to the people using the service that were involved. As a result of this the service has introduced a system of assessment for staff administering medication. Since the last inspection, there is now a cupboard for storing controlled drugs that complies with the regulations to ensure that controlled drugs are safely and securely stored. Cold storage medication is now stored securely. The medications and records for the two people case tracked were looked at and were stored and recorded correctly. The records for the receipt and administration of medicines for these two people were complete. This demonstrated that they had been supported to take their medicines as prescribed. One of the people case tracked did not have a photograph of them on their medication administration record. This should be in place to ensure that any new staff are able to identify this person before they administer their medication. Support plans relating to medication were in place within the records seen. These records provided staff with detailed information. Although the temperature of the clinical fridge was recorded daily, these records did not include the minimum and maximum temperatures of the clinical fridge. The temperature of the room where the medication was stored was not recorded. This information is needed to ensure that the clinical fridge is working correctly and that all medication is stored at the correct temperature as recommended by the manufacturers of the medication. Medications that were not blister packed, such as those that were direct from the pharmacy were in the original containers and were audited daily to ensure safe working practices were maintained. Staff that administered Medication received training from a suitably qualified external Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: source every two years. The manager confirmed that plans were in place to incorporate internal medication assessment in between these two years, to provide staff with some form of medication training update on an annual basis. None of the people living at the home were able to administer or store their medication independently. Care Homes for Adults (18-65 years) Page 22 of 35 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. A competent staff team that follow the correct procedures safeguards people using the service. Evidence: The pre inspection information said that all complaints are responded to within 28 days and the results are documented in the complaints folder. All staff receive Safeguarding Adults training as an ongoing training programme. All staff are CRB and POVA checked. All staff have two written references on file.All staff are aware and have access to relevant policies i.e. Whistle Blowing Policy and Vulnerable Adults. There is a satisfactory complaints procedure which is included in the service user guide and was available in a suitable format for the people using the service. However the homes Service User Guide did not have the correct contact details for the CQC as it still refers to Nottingham office address and not our current contact details. There have been no complaints made since the last inspection of the service in June 2009. At the random inspection in June 2009 it was confirmed that two complaints had been received since the previous key inspection in October 2008.The records held for these complaints were looked at during our visit in June.At that time it was indicated that one of these complaints had not been addressed appropriately and the operations manager addressed this satisfactorily during our visit in June. The pre inspection information stated that there had been two safeguarding referrals and Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: investigations and one referral to the Protection Of Vulnerable Adults, POVA list. The present manager was unable to confirm what these related to and was unaware of safeguarding referrals or investigations since he has been in post. We are not aware of any safeguarding referrals or investigations within the last 12 months that relate to the service. The providers self assessment was completed in April 2009 by the previous acting manager. It has been identified that information in the providers self assessment dated August 2008 is identical to that of the providers self assessment dated April 2009, regarding the figures for the number of complaints received and safeguarding referrals and investigations undertaken and referrals to the POVA list. As the figures in the 2009 self assessment do not correspond with the records seen it would appear that this information has not been amended from the previous years self assessment. Information within the electronic training matrix and the training matrix on display in the office did not correspond. The electronic training matrix showed that there were 19 staff employed, however it was identified that one person was no longer employed and two staff were casual staff that worked at the other home on the grounds, that was owned by the same organisation and their training records were held at the this service. Therefore the information provided on the training matrix in the office was used to inform us of staff training. This showed us that out of the 16 staff employed 13 had up to date training in safeguarding adults and 12 had up to date training in Team Teach (managing behaviours safely) The training certificates for two of the staff on duty on the day of this visit were looked at. There were records in place to demonstrate that they had up to date training in Team Teach and safeguarding adults. This indicates that the staff skill mix on duty had the skills and knowledge required to ensure the people living at the home were supported in a safe way. . Staff spoken with confirmed that they had undertaken this training and were able to show that they understood the safeguarding procedure and were aware of where the policy was kept. Only one staff survey was returned and this confirmed that training was provided in safeguarding adults. Care Homes for Adults (18-65 years) Page 24 of 35 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 stay in a safe, clean and comfortable environment that suits their needs and lifestyle. Evidence: The pre inspection information said that the home has a sensory room, which provides service users with appropriate stimulus. The home has a open planned lounge and dinning room with ample space for manoeuvring.The service is purpose built to meet the needs of our service users with complex and physical needs The service provided a well maintained spacious environment. The lounge had large leather sofas and separate dining room was available. Due to the the needs of people living at the home there was few ornamental furnishings but the rooms were attractive. Bedrooms that were seen were personalised to reflect individual taste. From staff responses it was unclear to the expert by experience how the people using the service were supported to make decisions. We discussed with this some of the staff and the manager. It was confirmed this was done by physically showing the people using the service the choices available. For example when choosing colour schemes for their bedroom they would look at the different options and colours available either by looking at pictures or by going to the shops and looking at the choices.The pre inspection information said that new staff and existing staff are trained to a standard that gives them the skills and knowledge to identify each individuals means of communication, such Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: as their facial expressions, body language, behaviour, their level of communication.It said that prior to any events or changes taking place or plans that affect the individual in question, this is communicated appropriately so that the person understands what is happening and why it is happening. This gives them the opportunity to express their opinion,preferences and feelings. Improvements in the last twelve months included the purchase of new garden furniture, the redecoration of corridors and of bedrooms as new people were admitted. The manager confirmed that this was done with individuals involvement. The manager confirmed that there had been issues with the fire doors regarding the hinges which had meant that the fire doors were not closing properly. It was confirmed that this had now been rectified to ensure each persons safety was enhanced in the event of a fire. A separate laundry area was available within the home and housed sufficient equipment to ensure that all laundry was washed effectively and disinfection standards were maintained. All bedrooms had en suite showers and ceiling tracking for hoists to enable any moving and handling requirements to be undertaken safely. A communal bathroom was also available with suitable moving and handling equipment. The expert by experience report stated that the home was very nice and spacious,with lovely wooden floors throughout, which smelled nice and clean, and the entrance to the home looked welcoming. He said that a member of staff showed him around the home and this included looking at two bedrooms, the rooms were nice and big with en-suite bathrooms . The expert by experience looked at the sensory room that was available for the use of the people using the service and felt that improvements could be made to this room, as he thought it was to a basic standard. The expert by experience looked at the kitchen and thought that it was nice and big and of a high standard. They confirmed there was also a special lowered sideboard for the people living at the home to make their own sandwiches. Care Homes for Adults (18-65 years) Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are supported by staff that are safe to work with them but this safety may be compromised if staff are not provided with timely induction training and are not updated in current practices. Evidence: The pre inspection information said that all new staff undertake a two week induction, which means for the first two weeks they will shadow a member of staff, this enables them to get to know the people using the service and visa versa. The rota is done to ensure that people are supported in the the activities of their choice. That staff receive ongoing training and support and show people using the service respect, whilst supporting them in and outside the home. The rotas demonstrated that there was a good staff skill mix within the service. This consisted of two team leaders , seven senior support workers and four support workers. The manager confirmed that there was no deputy at the present time. The rotas showed that on days when people using the service accessed the college, six staff were on duty to enable four staff to support people attending college.On none college days five staff were on duty and five staff were on duty throughout the afternoon and evening. Two night staff were on duty through out the night. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: As stated earlier in this report the information within the electronic training matrix and the training matrix on display in the office did not correspond. The electronic training matrix had not been updated.Therefore the information provided on the training matrix in the office was used to inform us of staff training. Fifty percent of the staff team were qualified or working towards a qualification to ensure they had the competency and skill to support the people using the service. The records demonstrated that eight staff had achieved a National Vocational Qualification (NVQ) at level 2 or were working towards this qualification.A further three staff were enrolled onto this training. Checks had been undertaken to ensure the staff were suitable to work with the people living at the home. Two staff files were looked at and contained two written references and evidence of a satisfactory criminal record bureau check and Protection Of Vulnerable Adults (POVA) first check, which were obtained before both staff members commenced their employment. Employment histories were in place within the staff files seen. Staff training records demonstrated that mandatory training and training specific to the needs of the people at the home was generally kept up to date. However the records and discussions with the manager did confirm that not all staff were up to date in some areas of mandatory training. Three staff had no evidence to demonstrate that they had undertaken safeguarding training, a health and safety training update was overdue for five staff. Two staff had not yet received formal induction training. One commenced employment in August 2009 and the other in July 2009. The manager was one of these staff and confirmed that at the time of the inspection he had not organised a date to undertake this training. The other member of staff was booked onto induction training in January 2010. It was confirmed by the manager that this person had missed the previous induction training due to being on leave. However induction training should be provided within the first six weeks of employment to ensure staff fulfill the aims of the home and meet the changing needs of the people using the service. Staff spoken with confirmed that the training provided was good and comments included, training is good, the organisation are very keen on training. And We get regular supervision every six weeks, theres good team work. Another member of staff said, staff work well together and get good management support. My induction covered everything and Im kept up to date with training. Only one staff survey was returned and this indicated that this person had received the training they needed to support the people using the service. Staff members spoken with demonstrated a good understanding of their roles and responsibilities and insight into the needs of the needs of the people they supported. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: There was evidence that staff receive supervision on a regular basis and staff members did confirm this during discussions. Care Homes for Adults (18-65 years) Page 29 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Health and Safety practices maintain individuals welfare but the safety of the people using the service is compromised by some staff not receiving the necessary training and updates. Evidence: The pre inspection information said that internal audits are completed on a monthly basis. Quality Assurance files are in place and a quality assurance auditing system is in place. Since our last inspection a manager has been appointed. They have worked at the home since July 2009. This manager confirmed that he has not applied for registration with the Care Quality Commission. Staff spoken with were complimentary about the managers ability to run the service. The manager confirmed that satisfaction questionnaires were sent out to the staff and the relatives of the people using the service in May 2009. He stated that there had been a poor response with only one survey returned, therefore an audited had not taken place Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: regarding the results of the questionnaires. However the organisation did send out a monthly newsletter to share information with staff about what was going on in the organisation on a monthly basis. The manager talked about production meetings that were held. These meetings were held by a group of people that used services run by the organisation, to represent the views of the people using the service. The home did not conduct their own meetings for the people that lived there. The manager confirmed that no relatives meetings were being held at the present time. The manager confirmed that provider visits were undertaken each month. These visits are used to review and where necessary improve the quality of care and support provided to the people using the service. Copies of these reports were not looked at during this inspection visit. A sample of service certificates was seen, this included the gas safety certificate and electrical installation certificate,the emergency call system service and hoist service certificates records and fire safety checks. These records demonstrated that all but the electrical installation service were up to date. This service was due in November 2009, but at the time of this inspection had not been undertaken. Since this inspection visit the manager has confirmed the electrical wiring 5 year examination was undertaken on the 1st December 2009. As identified earlier in this report not all staff training was up to up to date in mandatory areas such as health and safety and induction. This has the potential to put the people using the service at risk, if staff are not working to current safe practice. Care Homes for Adults (18-65 years) Page 31 of 35 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 Care Homes for Adults (18-65 years) Page 32 of 35 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 35 18 Evidence must be in place to 23/02/2010 demonstrate that staff have received all mandatory training and that this training has been updated as required. This will demonstrate that staff have the necessary skills and knowledge to undertake their duties safely following up to date practice. 2 35 18 All staff must receive structured induction training within six weeks of appointment. 23/02/2010 This is to ensure staff fulfill the aims of the home, work in safe way and meet the changing needs of the people using the service. Care Homes for Adults (18-65 years) Page 33 of 35 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 3 37 9 The manager must apply for registration with the care quality commission. 16/02/2010 In order to ensure that they are operating within the provisions of the legislation 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 6 Evidence should be in place to demonstrate that the individual or their representative has been involved or consulted regarding their support plans. large pictorial types menus or other suitable methods should be developed to further enhance the choices and decisions made by the people living at the home. The minimum and maximum temperatures of clinical fridge and the room temperatures of the medication room should be recorded each day to ensure that medications are stored at the temperature according to manufacturers instructions. Photographic identification should be in place for each person on their medication administration records to ensure they can be identified prior to medications being given. The development of quality assurance systems should be undertaken to ensure the views of those using the service and or their representatives are sought and used in the development of the service. 2 16 3 20 4 20 5 39 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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