Care Home: Stacey Drive

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What the care home does well Some staff have worked there a long time so they know the people living there well.People can keep in touch with their family and friends so they can keep relationships that are important to them.People are asked what they want to do and what they want to eat and drink, so they can make choices about their lives.Each person has their own bedroom that they can keep their own things in.There is a nice garden that all the people living there can use if they want to. One person said, ` I like gardening and also watching the birds from the lounge.`People are helped to move around safely and where they need help with this aids are provided.Relatives said, ` The home is first class.` `Staff could not be better.` `The staff always make us welcome.` What has improved since the last inspection? The home has been separated into three bungalows with four people in each. This helps people to have more individual, person centred care to improve their well being.Staff records showed that `suitable` people work with the people living there.People have information about the home that they can understand so they can make a choice about living there.Care plans are more individual so staff know how people want to be helped.Care plans show staff how to support people to take risks but be as safe as possible.Health and medication records are kept up to date. This makes sure people are getting the right health care to help them keep well.Staff have the training they need so they know how to help people to meet their individual needs. What the care home could do better: There must be enough staff to help people to meet their needs and be safe.There should be enough staff so that people can do the things they enjoy in the home and go out when they want to so they enjoy their lives.People should have a healthy diet to help them keep well.Records should be kept of how well staff give injections to people that need these to make sure they can do this safely.Records of people`s belongings should be updated so people know what belongs to them and if things should go missing staff can take action.Staff must check fire doors often and report when they are broken to help keep people safe if there was a fire.Equipment such as fridges, baths and showers must work well so that people`s needs can be met and they are safe.The home should be clean so it is comfortable for people to live in.The manager should be supported to help her run the home well. Key inspection report Care homes for adults (18-65 years) Name: Address: Stacey Drive 8 - 12 Stacey Drive Kings Heath Birmingham West Midlands B13 0QT 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: Sarah Bennett Date: 2 2 0 4 2 0 1 0 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 46 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 46 Information about the care home Name of care home: Address: Stacey Drive 8 - 12 Stacey Drive Kings Heath Birmingham West Midlands B13 0QT 01214412677 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Midland Heart Limited Name of registered manager (if applicable) Manager Post Vacant 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 maximum number of service users to be accommodated is 12 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 12 Date of last inspection 0 7 0 5 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 46 A bit about the care home The home is in a private road off Haunch Lane, Kings Heath. There are parking spaces at the front. The home is in walking distance of Kings Heath shopping centre. There are local shops and bus stops near to the home. The home provides accommodation for twelve adults who have a learning disability. Some people may also have other needs. Care Homes for Adults (18-65 years) Page 5 of 46 The home is three bungalows. Each bungalow has its own front door. In each bungalow there is a lounge, kitchen/diner, four bedrooms, WC, bathroom and laundry area. There are a number of aids and adaptations available to assist with the care of the people living there. The service users guide does not state how much it costs to live there. The manager can give you this information. Care Homes for Adults (18-65 years) Page 6 of 46 Care Homes for Adults (18-65 years) Page 7 of 46 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 8 of 46 How we did our inspection: This is what the inspector did when they were at the care home One inspector did the inspection in one day. The home did not know we were going to visit. We met with people who live at the home. Care Homes for Adults (18-65 years) Page 9 of 46 Some people were not able to tell us what they thought of the home due to their communication difficulties. So we asked staff about their needs and spent time watching the care that people had from staff. We looked at the care plans, health records and daily notes for three people. This is called case tracking. Care Homes for Adults (18-65 years) Page 10 of 46 We also looked at staff and health and safety records. We looked at some areas of the home including some peoples bedrooms. What the care home does well Care Homes for Adults (18-65 years) Page 11 of 46 Some staff have worked there a long time so they know the people living there well. People can keep in touch with their family and friends so they can keep relationships that are important to them. Care Homes for Adults (18-65 years) Page 12 of 46 People are asked what they want to do and what they want to eat and drink, so they can make choices about their lives. Each person has their own bedroom that they can keep their own things in. There is a nice garden that all the people living there can use if they want to. One person said, I like gardening and also watching the birds from the lounge. Care Homes for Adults (18-65 years) Page 13 of 46 People are helped to move around safely and where they need help with this aids are provided. Relatives said, The home is first class. Staff could not be better. The staff always make us welcome. Care Homes for Adults (18-65 years) Page 14 of 46 What has got better from the last inspection The home has been separated into three bungalows with four people in each. This helps people to have more individual, person centred care to improve their well being. Staff records showed that suitable people work with the people living there. Care Homes for Adults (18-65 years) Page 15 of 46 People have information about the home that they can understand so they can make a choice about living there. Care plans are more individual so staff know how people want to be helped. Care Homes for Adults (18-65 years) Page 16 of 46 Care plans show staff how to support people to take risks but be as safe as possible. Health and medication records are kept up to date. This makes sure people are getting the right health care to help them keep well. Care Homes for Adults (18-65 years) Page 17 of 46 Staff have the training they need so they know how to help people to meet their individual needs. What the care home could do better There must be enough staff to help people to meet their needs and be safe. Care Homes for Adults (18-65 years) Page 18 of 46 There should be enough staff so that people can do the things they enjoy in the home and go out when they want to so they enjoy their lives. People should have a healthy diet to help them keep well. Care Homes for Adults (18-65 years) Page 19 of 46 Records should be kept of how well staff give injections to people that need these to make sure they can do this safely. Records of peoples belongings should be updated so people know what belongs to them and if things should go missing staff can take action. Care Homes for Adults (18-65 years) Page 20 of 46 Staff must check fire doors often and report when they are broken to help keep people safe if there was a fire. Equipment such as fridges, baths and showers must work well so that peoples needs can be met and they are safe. Care Homes for Adults (18-65 years) Page 21 of 46 The home should be clean so it is comfortable for people to live in. The manager should be supported to help her run the home well. 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 22 of 46 If you want to speak to the inspector please contact Sarah Bennett CQC West Midlands Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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 23 of 46 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 24 of 46 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need so they can make a choice as to whether or not they want to live there. Peoples needs are assessed so they know their needs can be met there, before they move in. Evidence: Each person has a copy of the service users guide. This was produced using pictures so making it easier for the person to understand. It included most of the information needed for people to make a choice as to whether or not they want to live there. It did not include the fees charged to live there. However, the manager said this was complicated and based on individual needs and whether or not they were resettled from a long - stay hospital or had moved in since. The statement of purpose was being updated by a member of staff who was not on duty that day and the manager did not have access to their computer file. The manager said the range of fees charged would be included in this. Each person living there would have a copy of this. It is to include pictures so making it easier for people to understand. There were eleven people living there so there was a vacancy for one person. The Care Homes for Adults (18-65 years) Page 25 of 46 Evidence: manager said some referrals had been made to fill this but the people had not been assessed as suitable to live at the home. One persons records sampled included an assessment of their needs completed before they moved into the home. The persons community nurse and social worker had been involved in this. The information was sufficient to allow the manager to make a decision as to whether or not the persons needs could be met there. The person said they liked living at the home. The person had visited the home and staff had visited them at hospital before they moved in. It was planned that they were to visit more before moving in but as they were blocking a bed in hospital they had to move in sooner. The manager said normally more visits would be done so that the person and the other people living there would be able to get to know each other better. The person had settled in well and said they liked living there. Care Homes for Adults (18-65 years) Page 26 of 46 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 so they can support people to meet their needs so ensuring their health and well being in a way they need and prefer. Evidence: The records of three of the people who live there were looked at. These included an individual care plan that stated how staff are to support the person to meet their needs. The information in these were more detailed than when we last visited. Care plans also included some information about what the person liked and disliked and what their individual preferences were. They included information as to how to support the person to be as independent as possible. Care plans had been regularly reviewed and updated so they reflected the individuals needs where they had changed. Meetings are held with the people who live there and minutes of these were looked at. People said they would like to go out more and this is discussed further under the lifestyle section of this report. People also said they liked where they live. Since we last visited the home has been separated into three bungalows as it was Care Homes for Adults (18-65 years) Page 27 of 46 Evidence: previously run as one home. Minutes of meetings showed that the people living there and their relatives had been consulted about this and agreed to it being done. One relative told us that it was better now the bungalows were separate, as staff could concentrate on working with a smaller group of people. During the day people were observed making choices as to what they did, where they spent their time and what they ate and drank. Records sampled included individual risk assessments. These stated how staff are to support the person so they can take risks in their day to day life whilst ensuring their safety and well being as much as possible. Risk assessments were detailed so that staff knew what to do. They had been regularly reviewed and updated where needed if the persons needs had changed. We observed that staff followed the actions that had been written in individuals risk assessments. Care Homes for Adults (18-65 years) Page 28 of 46 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that people experience a meaningful lifestyle or have a healthy diet, which could affect their well being. Evidence: Records sampled showed that when at home people watch TV, look at books and magazines, do drawing and craft activities, do knitting and have music sessions. In bungalow 10 there is a record player and a selection of records available that people enjoy listening to. People said they enjoy spending time in the garden or sitting in the lounge watching the birds on the bird table outside the window. During the morning in bungalow 10 people did very little activity. The TV was on but people did not appear to be watching it. Staff were very busy assisting people with personal care and doing cleaning tasks. We were told that a cleaner is to be recruited so that care staff will have more time to spend with people. People said in meetings that they would like to go out more. Records sampled showed that people did not go out of the home very often. One persons records showed that in Care Homes for Adults (18-65 years) Page 29 of 46 Evidence: three weeks they went out twice but this was with staff from the day centre supporting them, not staff from the home. One persons records showed that in four weeks they went out five times, three of these were to go to the day centre. The other persons records looked at showed that in four weeks they had been out six times, three of these had been to go to the day centre. Staff said that it was difficult to get people out of the home due to the staffing levels. There is one member of staff allocated to work in each bungalow and one support worker who floats between the three bungalows where needed. Some people need the assistance of two staff to do their personal care tasks such as washing, dressing and going to the toilet. There is also a qualified nurse on duty but if the manager (who is qualified) is not available in the home, the qualified nurse needs to stay in the home. This is so they can support people as needed with medication and any health needs. A vehicle is available to support people to go out in the community. However, only the manager and one of the qualified nurses are able to drive this. This does not ensure that people who contribute financially towards the cost of this can use it often or get value for money. Staff said that they had been talking with people about where they would like to go on holiday and day trips this year but nothing was planned yet. Staff said that some people went to a cottage in Gloucestershire last year which they enjoyed. One person said they would like to go on holiday to Blackpool or Weston. Another person said they preferred not to go away but would like to go out on day trips. Minutes of meetings with the people living there showed that holidays and day trips were discussed. Records sampled showed and people said that they are supported to keep in touch with their family and friends. Relatives visiting during the day said they were always made welcome by staff and could visit when they wanted to. People used to live together in one big home and could wander freely from one bungalow to another. This had disadvantages in that all areas of the home could potentially have twelve people there at one time but there were also advantages for people in making friends. We observed staff asking people if they wanted to visit their friends in other bungalows and supporting to do this if they wanted to. Records sampled showed and it was observed that people were supported to be as independent as possible. This helps people to feel good about themselves and contributes to their well being. Staff cook meals for the people in each bungalow. Food records sampled showed that people had a varied diet that included their individual likes and dislikes. People said they liked the food and had a choice. Not all people had a diet that met their individual dietary needs. For example, one person was on a low fat diet but their food records showed that they often ate foods with a high fat content such as chips and pork pies. This may compromise their health. Care Homes for Adults (18-65 years) Page 30 of 46 Evidence: On the record where staff record what people have eaten that day there is a space for staff to record how many portions of fruit and vegetables the person has eaten. Staff did not always record these accurately. Therefore, they did not show that people had the recommended five portions of fruit and vegetables each day for a healthy diet. The manager said that there is a delivery of fresh fruit and vegetables twice a week. Fruit and vegetables were available in the home so that people could be offered these. Care Homes for Adults (18-65 years) Page 31 of 46 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. Arrangements ensure that the personal care and health needs of the people living there are met, so ensuring their well being. Evidence: The people living there were well dressed in individual styles that reflected their age, gender, cultural background and the activities they were doing. People had been well supported with their personal care. Care plans stated how people like to be supported with their personal care, such as whether or not they had a wet shave or used an electric razor of if they wanted to wear make up. Records included an assessment of the support the person needed to move around in the home and outside. This showed staff how to support people so ensuring their safety and that of the person they are supporting. Each person had a health action plan. This is an individual plan about what support a person needs to ensure their health needs are met and they get the support they need they need from the relevant health professionals. These included pictures making them easier for the person to understand. Records of individuals weight were kept and these were monitored regularly. Some Care Homes for Adults (18-65 years) Page 32 of 46 Evidence: people had refused to be weighed and this was recorded. Staff used different methods to monitor peoples weight where they constantly refused, such as looking at their clothes to assess whether they had lost or gained weight. This is important as a significant loss or gain of weight can be an indicator of an underlying health need. One person had a risk assessment as they sometimes pretended to be ill or in pain. This detailed the persons needs and behaviour, so that the risks of staff not being aware when the person was ill or in pain could be reduced. Records sampled showed that people had regular eye tests and checks up with the GP when needed. One persons records did not indicate that they had regular dental check ups, which could impact on their well being. Medication is given to people by the qualified nurses that work there. Medication is stored in a locked cabinet in one of the bungalows. Medication is put into weekly trays for each person by the pharmacist and delivered to the home. Copies of prescriptions are kept so that staff can check these against the medication delivered and ensure people have the medication their doctor has prescribed. Medication records sampled showed that medication had been given as prescribed. Some people who live there are prescribed injections. A few years ago an agreement was made with the home that one person could be given an injection by the registered nurses employed at the home, if staff were assessed by the manager as being competent to do so. A protocol was developed on how staff were to give this. This was because the person became very anxious with people they did not know as well as the staff, resulting in them not always getting the injection they needed to be well. Since then other people have also been given injections by the registered nurses that work there. Since we last visited individual protocols have been put in place as to how staff are to give these. Staff said that the manager had observed them before they were deemed competent to give injections to the people living there. This competency had not been recorded and it was not clear how often this would be assessed. This should be recorded and regularly assessed to ensure that staff are competent to do this and it is in the best interests of the people living there to be given their injections by staff. Care Homes for Adults (18-65 years) Page 33 of 46 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: The service users guide included a copy of the complaints procedure. This included pictures making it easier for people to understand. The home has received no complaints and we have not received any complaints about the service provided in the last year. One safeguarding alert has been raised in the last year. This has been concluded and the home responded appropriately to ensure that the people living there were safe from harm. Records sampled included a list of peoples belongings. This mainly included the clothes that the person has and not any items of value or electrical items belonging to them. They had not been updated regularly. This should be done to ensure that it is clear what belongs to each person and action can be taken if things should go missing. The manager said there has been difficulty with getting the signatories changed on peoples bank accounts. This had to be done as the person who signs for people to get their money from their bank accounts was the previous manager who has now left. The bank has lost information relating to this and is now refusing to change it as their policy has changed. The manager is pursuing this to ensure that people can get access to their bank accounts whilst ensuring that they are safeguarded from financial abuse. In the Care Homes for Adults (18-65 years) Page 34 of 46 Evidence: interim the PCT are loaning money to individuals so they have the opportunity to spend their money as they wish. The manager said and training records showed that staff have regular updated training in safeguarding vulnerable adults from abuse. Monies kept safely for the people living there were sampled. The money held for the individual cross referenced with their individual record. Staff check peoples money at the handover of each shift to ensure it is being used appropriately. Records are kept of the money that people spend and receipts of all expenditure are available in the home. Care Homes for Adults (18-65 years) Page 35 of 46 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not ensure that people live in a homely and comfortable environment that meets their individual needs, which could impact on their well being. Evidence: Since we last visited the home has been split into three separate bungalows, four people are living in each, so that it is more homely. Some areas of the home are well decorated, homely and comfortable. Now the home is split into separate bungalows each kitchen is used to cook meals for the people living there. Previously most meals were cooked in the kitchen in bungalow 10. The kitchen cupboards in bungalows 8 and 12 are worn and in need of replacing. In bungalow 8 the drawers of some of the cupboards were broken. In bungalow 12 staff said that the drawers often broke but were repaired as needed. However, the cupboards looked old and worn. These should be replaced to ensure that peoples food is cooked safely. In bungalow 8 staff said that they had requested that a new fridge be provided as the current one is too small to store the food needed. The housing association have stated that it cannot be replaced as it is not broken. However, as there is only one shelf (one had to be removed so the milk could be stored) it is not always possible to store food safely. This could put people at risk of food poisoning and steps should be taken to reduce this risk. Care Homes for Adults (18-65 years) Page 36 of 46 Evidence: The bedrooms of two people living there were looked at with their permission. Both rooms were personalised to individual tastes and interests. One room needed redecorating and on the door part of the wood was cracked. This meant that if there was a fire there was a gap where smoke could escape to. The manager reported this to the housing association during the day and was told it would be treated as an urgent repair. Checks on fire doors must be done regularly to ensure that if there were a fire people would not be at risk. The manager said that it had been found that in the baths in bungalows 8 and 10 there is no air break between the shower and bath so there could be a risk of cross contamination between the flow of water. The manager said that the bath in bungalow 12 often breaks down. It was condemned by one engineer but when the company who manufacture the bath came to look at it they said it was condemned. This has resulted in the housing association stating that the bath does not need replacing. However, staff said that the bath has broken down five times since December 2009. On one occasion it took two weeks to repair and another time it took a week to repair. This means that people had to use the bath in bungalow 10. There are no separate shower rooms in the home so the only way that people can have a shower is by using the hose in the bath. This means that people do have access to a bath or shower if the bath is not working and their choice is limited, as well as impacting on the privacy of people who live in bungalow 10. This situation must be resolved as for many years the baths in this home have not worked properly. The lounge in bungalow 12 was well decorated, homely and comfortable. However the television kept jumping and changing to a different channel, which was not relaxing for people to watch. Staff said that there are difficulty getting channels as there is not a strong signal in this bungalow. This should be resolved so that people can relax and watch what they want to on TV. Several years ago the relatives committee raised funds to make the garden accessible to all the people living there and raised beds were installed. The garden is a pleasant place for people to relax in and accessible to all the people living there. Relatives said that it had recently been maintained so that people could benefit from using it. Care staff do the cleaning of the home. The manager said they plan to recruit a cleaner. This will improve the home so it is more comfortable and clean for people to live in. Staff said and it was observed that they have little time to clean the home. An offensive odour was noted in the lounge of bungalow 10 and there were stains of tea on some of the walls. In the toilets in bungalows 8 and 10 the extractor fans were very dusty and there was a lot of dust on top of the door frames. This could increase the risk of cross infection. Care Homes for Adults (18-65 years) Page 37 of 46 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. Arrangements for staffing, their support and development are variable, which could impact on the well being of the people living there. Evidence: The home is now separated into three bungalows. During the day, one support worker is allocated to each bungalow, with another support worker floating and supporting each bungalow as needed. A qualified nurse works between all three bungalows and is responsible for giving people their medication. Staff said there is sometimes another member of staff as extra but not very often. Staff said and it was observed that it can be difficult to meet peoples needs with this level of staffing. Some people need assistance from two staff to help with their personal care. We observed people have little staff support in the morning in bungalow 10 as staff were busy supporting other people with their personal care and with cleaning the home. Activity records showed that people did not go out very often. We observed that the people in bungalow 8 needed a lot of support to meet their needs and it was not always possible for one member of staff to do this. It had only been agreed a few days before that staff long term sickness and absence could be covered by bank staff. The manager had also calculated that 44 hours that are funded by the placing authority to support people to meet their needs was not being used. This was reported to Birmingham City council contracts following our visit. It is not acceptable that funding for staff support is not used appropriately. At night there are two support workers and one qualified nurse across the three bungalows. Care Homes for Adults (18-65 years) Page 38 of 46 Evidence: Staff generally work from 8 to 8 so they need to have breaks. Staff said that this is not taken into account when the staffing levels are calculated. The manager said that she had been asked to cover a shift per week as a support worker to help cover the hours. This is only acceptable if the manager has the time in the rest of the week to ensure the home is well run in the best interests of the people living there. Staff said that often the manager is taken out of the home to attend meetings and to do things within the PCT. A local home run by the PCT had recently closed and the manager had been asked to go there a few times in the last week to sell off items of furniture. It is accepted that this situation is a one off but is indicative of the tasks placed on the manager when she should be able to concentrate on managing the home. The records of two of the staff working there were looked at. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been undertaken to ensure that suitable staff are employed to work there. Records sampled showed that staff had an induction when they first started working there so they knew how to meet individuals needs. Training records showed that staff had the training they needed to meet the individual needs of the people living there. The manager said that staff are having six formal supervision sessions each year. This ensures that they are supported in their role and their training and development needs can be identified. There were no records of the manager having supervision. the manager said that her supervision is done informally and no notes are written but their manager visits the home regularly. These notes should be written so that it is clear what support the manager is getting to manage the home. Care Homes for Adults (18-65 years) Page 39 of 46 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 management arrangements do not always ensure that improvements are made in the best interests of the people living there and their health, safety and welfare is protected, which could impact on their well being. Evidence: The manager has been managing the home for just over a year. She is not yet registered with us as the PCT did not issue the cheque needed for the registration fee in time, so another CRB check is now required. The manager said she is in the process of applying for this. Findings of this inspection show that the manager has made improvements to the running of the home so it is run in the best interests of the people living there. Staff said that the manager is supportive and runs the home well. However, we found that the manager is not always being well supported to manage the home. This includes formal supervision, and funding for staffing and equipment to support peoples needs not being provided by the PCT and the housing association. The Annual Quality Assurance Assessment (AQAA) had not been returned when we asked Care Homes for Adults (18-65 years) Page 40 of 46 Evidence: for it. This is a self assessment that tells us how they think the home is meeting the standards and regulations and what they need to do to improve. The manager said that as it was addressed to the Responsible Individual it would have been forwarded to them. Following the inspection we sent another AQAA to the home requiring that it be returned by 25th May 2010. A representative from the housing association visits the home monthly and does a report of their visit. The February and March reports showed that the bath in bungalow 12 was not working. This shows that the housing association are aware of this but have not taken action to ensure that people have a bath they can use to meet their individual needs. The manager said that a representative of the PCT does visit but reports of these visits were not available. These should be available in the home so that it is clear that the home is being audited and improvements made to ensure the home is well run. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Regular fire drills are held so that staff and the people living there know what to do if there is a fire. Staff have regular updated fire safety training so they know how to prevent a fire starting and what to do if there is one. As stated under the Environment standards of this report we found a fire door that was damaged. This was reported immediately and action was being taken for it to be repaired. However, regular checks must be made to ensure that all doors would protect people if there was a fire. An engineer visits monthly to ensure that water temperatures do not put people at risk of being scalded or of Legionella. The manager said that the thermostatic valves on the taps that regulate the temperature were changed last year. Some records of water temperatures showed that at times they were a little higher than the recommended temperature. This could put people at risk of being scalded. However, they are tested regularly by staff and an engineer and adjusted as needed. Most people living there do not use the water unsupervised by staff who test the temperature before people use it. Care Homes for Adults (18-65 years) Page 41 of 46 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 42 of 46 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 23 Fire doors must be checked regularly and where needed reported for repair. 31/05/2010 To ensure that if there were a fire people would not be at risk. 2 24 13 Fridges provided must be of sufficient size to ensure that food can be stored safely. 30/06/2010 So that people are not at risk of food poisoning. 3 27 12 Baths and showers provided 30/09/2010 must meet the needs of the people living there and be in good working order. So that people can have a bath or shower when they Care Homes for Adults (18-65 years) Page 43 of 46 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 choose to, helping to ensure their well being. 4 33 18 Staffing levels must be reviewed and staff must be provided in the right numbers. 30/06/2010 To ensure that the needs of the people living there are met. 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 12 Staff should have time to support people to do the activities they like to do inside the home so they experience a meaningful lifestyle. Staffing levels should ensure that there are sufficient staff to enable people to access the community so they experience a meaningful lifestyle. People should be offered a healthy diet so to ensure their well being. People should have regular dental check ups to ensure their oral hygiene needs are met. Records should be kept of the assessment of staff competency in giving injections to the people living there to ensure it is done competently and in peoples best interests. Records of peoples belongings should be updated regularly to ensure it is clear what belongs to each person and action can be taken if their things should go missing. An aerial should be provided in bungalow 12 so that people Page 44 of 46 2 13 3 4 5 17 19 20 6 23 7 24 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations can relax and watch TV programmes of their choice. 8 9 30 36 The home should be clean and free from offensive odours so reducing the risk of cross infection. Records should be kept of the managers supervision to ensure they are supported to manage the home in the best interests of the people living there. The manager should be registered with us so showing their commitment to the home and the people living there. The AQAA should be returned to us within the required timescale so that it is clear that the home knows how they are meeting the standards and regulations and what improvements they need to make. Reports of visist by a representative of the home should be available in the home. They should show that action is taken to ensure the home is run in the best interests of the people living there. Individuals ability to use water in the home should be regularly risk assessed to ensure that all action is taken to reduce the risk of people being scalded. 10 11 37 39 12 39 13 42 Care Homes for Adults (18-65 years) Page 45 of 46 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. 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