Care Home: Stoneleigh

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What the care home does well All the comments received were positive. One person living in the home stated "I love it here" People are provided with a homely, comfortable living environment and are safe in their surroundings. It is cleaned to a good standard and comments received included; "It is very clean". "It is a proper home rather than a care home". There was good interaction noted between staff and people living in the home, indicating that people living in the home feel comfortable approaching staff. No complaints had been received and everyone was given the opportunity on a regular basis to discuss any concerns. People are supported by staff who are enthusiastic about their work and are trained to a good standard, so they understand people`s needs. The home currently has the investors in people award. People are supported to keep in touch with family and friends so they maintain relationships that are important to them. Visitors are made welcome at a time that suits them and they stated they were kept informed of any areas of concern by staff. The meals are of a good standard and everyone spoken to stated they enjoyed the food. There are good systems in place to manage people`s money, so that it is safeguarded. Health and safety is well-managed ensuring peoples safety. What has improved since the last inspection? The requirements from the last inspection have been met in respect of medication ensuring a more robust system in the home The deputy manager has achieved National Vocational Qualification (NVQ) level 4 in care plus the Registered Managers Award, so she has the necessary qualifications to manage the home. She has applied to us for registration as the care manager. Staff are in the process of developing talking passports for individuals to enhance the communication process. Some people living in the home have achieved vocational certificates from centres, developing their skills. People living in the home are planning to go on holiday this year and the range of activities/outings has been extended, so people lead a more meaningful life. The policies and procedures have been reviewed and updated to ensure staff have up to date guidance. They have replaced carpets and re-decorated some of the rooms in the home, enhancing the environment for people living there. What the care home could do better: The deputy manager told us they have organised accredited training in medication for staff, so there knowledge is developed further regarding medication systems. Manager must ensure all recruitment documents have been received before a member of staff commences employment, so people living in the home are safeguarded. The process for care plans and risk assessments etc needs to be reviewed and one person centered plan devised that outlines the support required by people from staff to achieve goals that are important to and for them. The quality assurance system should be developed further to enable continuous improvement and outcomes for people. Systems should be introduced for regular checking of wheelchairs and walking frames to ensure they are fit for use. The manager will need to complete the process of developing the policy/procedures for homely remedies and obtain a stock of medication, so that it is available in the home when required. Key inspection report Care homes for adults (18-65 years) Name: Address: Stoneleigh Stoneleigh Care Homes Ltd 166-168 Stourbridge Road Holly Hall Dudley West Midlands DY1 2ER     The quality rating for this care home is:   two star good 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: Ann Farrell     Date: 1 4 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Stoneleigh Stoneleigh Care Homes Ltd 166-168 Stourbridge Road Holly Hall Dudley West Midlands DY1 2ER 01384235590 01384353830 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sanjiv Jain,Mrs Sonu Jain care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 24 The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old Age (OP) 24 Learning Disability (LD) 24 Date of last inspection Brief description of the care home Stoneleigh House is situated on the main road between Dudley and the Merry Hill Centre. The Home consists of two Victorian buildings over three floors that have been converted into one with off road parking to the front of the property for approximately six vehicles. It provides domestic style accommodation and care in an ordinary environment for people with learning difficulties. The majority of rooms are single occupancy that do not have en-suite facilities. There are two main lounges on the Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 24 24 0 Brief description of the care home ground floor and separate dining rooms. A stair lift gives access to the areas for peole with mobility problems. There is an enclosed well maintained garden to the rear with patio, and seating that can be used when the weather permits plus additional parking. To the rear of the main building is a six bedded unit called Jasmine Court, which is a modern purpose built unit providing ground floor accommodation. All bedrooms in Jasmine Court have en-suite shower and toilet facilities plus a separate bathroom, lounge/dining room and kitchen. The home is accessible by public transport and is close to local shops and amenities. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was undertaken in May 2007 and Annual Service Review (ASR) was completed in June 2008. The Annual Service Review process does not include a visit to the home, but information is obtained from various sources in order for us to make an assessment as to whether there have been any changes in the service since the previous key inspection and at the time information indicated there were no significant changes to suggest a visit was required. This key inspection demonstrated that the home continues to provide good quality outcomes for people. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. Care Homes for Adults (18-65 years) Page 6 of 31 One inspector undertook the fieldwork visit over one day. The manager was available for the duration of the inspection. The home did not know that we were visiting on that day. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet peoples needs and and focuses on aspects of service provision that need further development. Everyone living in the home has a learning disability and they are of varying ages. We case tracked two peoples care this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. We looked around some parts of the Home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We sent out surveys to people living in the home, relatives and staff to seek their views and opinions. We received eight completed surveys from people living in the home, six from relatives and ten from staff. All comments were positive and are contained in the main body of the report. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The requirements from the last inspection have been met in respect of medication ensuring a more robust system in the home The deputy manager has achieved National Vocational Qualification (NVQ) level 4 in care plus the Registered Managers Award, so she has the necessary qualifications to manage the home. She has applied to us for registration as the care manager. Staff are in the process of developing talking passports for individuals to enhance the communication process. Some people living in the home have achieved vocational certificates from centres, developing their skills. People living in the home are planning to go on holiday this year and the range of activities/outings has been extended, so people lead a more meaningful life. The policies and procedures have been reviewed and updated to ensure staff have up to date guidance. They have replaced carpets and re-decorated some of the rooms in the home, enhancing the environment for people living there. Care Homes for Adults (18-65 years) Page 8 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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. Information is made available to people before they move into the home enabling them to make an informed decision about moving into the home. The assessment process was satisfactory ensuring peoples needs can be met on moving into the home. Evidence: The home had a service user guide and it was stated that it was in picture format making it accessible to people living in the home or wishing to move into the home. Feedback from surveys completed by people living in the home indicated that they were given enough information before they moved in and they were asked if they wanted to move into the home. The service user guide gives people information about the services and facilities to enable them to make an informed choice about moving into the home. The home provides care for people who require long term or respite care. People can visit the home before moving in and spend varying amounts of time, so they can view Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the facilities, meet staff and other people who live there in order to sample what it would be like to live in the home. The records of one new reviewed and documents indicated that an assessment had been completed and a letter had been sent confirming the home could meet the persons needs before they moved in. The assessment form covered a number of areas including physical health and well being, emotional health, intellectual assessment, lifestyle choices and social care ability. However, it had not indicate who was involved in the assessment and it had not been signed and dated by the person completing the assessment. Staff will need to ensure these areas are addressed in the future and they may benefit from obtaining a copy of the assessment completed by social workers. The pre-admission assessment enables staff to determine if peoples needs can be met when they move into the home and gives reassurance to people and their relatives that needs will be met upon moving into the home. Following admission to the home there is a trial period of one month and a review is held at the end of the month with the person living in the home, their relatives, the social worker and staff. This provides an opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes are required. Care Homes for Adults (18-65 years) Page 12 of 31 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. People are supported to make decisions enabling them to have control over their lives. The care planning and risk assessment process needs to be reviewed to ensure it is person centered and comprehensive to ensure consistency in care. Evidence: Following admission to the home a care plan is drawn up based on the pre admission. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Risk assessments are also completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being is promoted. Two peoples care files were looked at in detail. There was evidence of a care plan that had been adapted to make them more accessible to people living in the home with Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: pictures. The statements in the care plans as to how people were supported were not detailed enough to indicate the support they required. In addition, there was a person centered plan. These are individual plans that should be written by or with the person and should include information about their needs and aspirations. On inspection this plan indicated some of the persons needs and goals, but did not indicate the support they required to meet them. In addition, there was a copy of a communication passport on file, which was also held by individuals. These gave information about the person, where they lived and some of their needs in a format that was accessible to them, which they could understand and use to communicate with people. This resulted in duplication of information in some cases and in some cases information was not available in sufficient detail. At the last inspection it was identified that one person had undertaken training in respect of person centered planning and that other staff should undertake training in the values and principles of this form of support, in order that they have an understanding suitable for ensuring its implementation effectively. There was no evidence of further training in this area and it is suggested that this area be re-visited, so that staff have the appropriate knowledge and the process can be implemented. this would enable staff to draw develop one plan of care that is based on areas that are important to and for the person and the support they require to achieve the goals. Staff recorded daily events; appointments etc. which was satisfactory. There were systems in place such as monthly evaluations by the manager and monthly reports by key workers, so that aspects of care were monitored and changes made as required. The managers evaluation was rather brief in some instances and did not always reflect information about events during the month or the effectiveness of the plan. This would benefit from being developed further to provide a more comprehensive overview of the events during the month On inspection of risk assessments it was found that some had not been signed by the person completing them and there were no risk assessments in respect of the use of bed rails and tissue viability, which were areas of concern for one person. Although people were weighed regularly there was no evidence of a nutritional risk assessment for people to determine if there were any areas of concern. The manager will need to develop this area further to demonstrate they have considered all the possible risks, alternatives, have put suitable strategies in place to reduce them and they are recorded appropriately, so the person is protected. Eight surveys were returned from people living in the home. Everyone told us they always make decisions about what they do each day and can do what they want Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: during the day, evening and weekend. At the time of inspection people were busy getting up, having breakfast and getting ready to go out. They were enthusiastic and people were seen receiving good support from staff. They were able to make different choices about how they spent their time. Some people went out to the day centre and one person declined the opportunity to go out and this was respected. People were seen freely accessing their bedrooms and different areas of the Home. Comments received included; Staff give lots of support Regular meetings took place with people living in the home and minutes were available demonstrating that people had the opportunity to talk about various aspect of the home etc. Care Homes for Adults (18-65 years) Page 15 of 31 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 who live in the home are supported to make choices about their lifestyle and are able to develop skills through social, educational and recreational activities. Evidence: We looked at care plans and daily records to establish that people were taking part in activities that they enjoy. Care plans gave some information about what people like to do. A number of people attended day centres on a regular basis and the AQAA stated that some had achieved vocational certificates since the last inspection. On the days that people dont go to the day centre they are supported to go out shopping, for a walk, etc. or with home based activities. One person had sensory equipment in their own bedroom, which is used for relaxation purposes. At the time of inspection one person was listening to their music, some were watching television and staff were seen supporting another person with a game. One person went out shopping and had Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: lunch with their relative and another was seen to be going out in a taxi. People were very excited telling us about the holiday to Devon, which was planned for June There was also a notice on the board about outings that had been planned for later in the year e.g. a trip to Llandudno and Blackpool plus trips to the theatre to see Chitty Chitty Bang Bang and Oliver Twist. It also stated trips to the Safari Park, Black Country museum and Severn Valley Railway were to be arranged. People were seen to wander freely around the home, from one area to another. Some people have developed friendships in the home plus relatives and friends can visit at a time that suits them, so people living in the home can maintain relationships. People in the home had photographs of family and confirmed they went out with them regularly. One visitor stated they could visit at any time that suited them and stated Its fantastic One person living at the home who was spoken to stated, I love it here. A relative told us in the surveys, It makes you welcome at all times. It is a proper home rather than a care home. There was a four week rotating menu that offered a choice at all three meal times and met peoples special dietary needs. On the day of inspection it was observed that staff provided assistance where required. The people spoken to at the inspection stated they liked the food and they received enough to eat. We saw people being offered drinks and snacks between meals and records of the meals eaten by people were recorded in the daily records completed by staff. Staff may wish to consider consulting people living in the home about providing menus in picture format. Care Homes for Adults (18-65 years) Page 17 of 31 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. Peoples health and personal care needs are met appropriately and people are treated with respect. The recording systems need to be more robust to ensure consistency. Evidence: There is a mixed group of people living in the home in respect of age, gender and ability. Each has a key worker, who is responsible for ensuring their needs are met. Care plans provided some information about the support people required with personal care and they were dressed appropriately for their age, culture, gender and weather according to their own personal choice. Everyone living in the home was registered with a local General Practitioner (GP). There was evidence of visits to/from health and social care professionals such as chiropodist, dentist, optician and specialist nurses. There was also evidence of annual health screening undertaken at the GP practice. Such follow up ensures peoples health and well-being is maintained to optimum levels. Homes are required to have a health action plan, which is a document that outlines Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: the care a person with learning disabilities requires to stay healthy. Although it could be demonstrated from records that peoples health needs were being addressed and regular screening was undertaken the plan did not inform us of the support they required to achieve this. Records of health care appointments indicated when visits occurred and in a number of cased the outcome of the visit. However, this was not consistent and in one case the deputy manager contacted the GP by telephone, so that the details for one person could be confirmed. Care should be taken in future as incomplete records may lead to peoples health care needs not being met. Peoples weight was being monitored on a regular basis which can be an important indicator of health care concerns. We were told that advice is sought from health care professionals if problems are identified and support is needed to maintain well being. We saw that information about specific health conditions had been researched and the information was available for staff to read, so they have a greater understanding of peoples health care needs. Equipment was available to promote peoples independence including ramps, stair lift, handrail and hoist. Staff had received training in respect of moving and handling, so they could support people to maintain their independence where necessary. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. Medication was stored in locked cupboards and trolleys ensuring the safety of drugs. On inspection of the medication for the current month it was found that the majority of audits were correct. In one case it could not be audited as the amount of medication entering the home had not been recorded accurately. Also paracetamol had been used for one person from anothers supply. It was stated by the deputy manager that is was an urgent situation and none could be purchased at the time as all the shops were closed. She stated they were in the process of developing a homely remedy policy with the pharmacist and GP and will ensure there is a supply of such medication available in the home at all times when it is completed. It was noted that one person was receiving medication in food, but there was no record of a multi-disciplinary meeting/discussion about it on the file. The GP confirmed the decision had been made in the best interest of the person. Staff will need to ensure records are maintained of such multi-disciplinary decisions in future. The home holds a small supply of controlled medication for named people living in the Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: home. The record of controlled medication was satisfactory and it was recommended that two signatures are obtained when checking the medication into the home to ensure safe systems. The temperature of the medication fridge is recorded daily. It is recommended that the pharmacist be consulted about recording the minimum/maximum and current temperatures on a regular basis to ensure medication is stored at the correct temperature at all times. Care Homes for Adults (18-65 years) Page 20 of 31 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. There are suitable systems in place to listen to people and protect people from the risk of harm. Evidence: All surveys returned indicated that people living in the home knew who to complain to if they had a complaint One relative stated I have never had any complaints about the way ----- has been looked after The home has a complaints book to record details of any complaints and none were recorded. We have not received any complaints about the home. Monthly meetings are held with people living in the home and they are asked by the deputy manager if they have any complaints and none were recorded. At the time of visiting no one raised any concerns and interaction between people living in the home and staff was good suggesting that they feel comfortable approaching staff. Staff had received training in safeguarding and the Mental Capacity Act. Some senior staff have had undertaken training in respect of the Deprivation of Liberty safeguards and had developed a policy based on the information from the Local Authority. This will need to be cascaded down to staff , so they are kept up to date with recent legislation and have an understanding in order to protect people appropriately. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe and comfortable home, which promotes their well being. Evidence: The Home consists of two Victorian buildings that have been converted into one with off road parking to the front of the property for approximately six vehicles. It provides domestic style accommodation and care in an ordinary environment. The Home looks no different to others in the area and is not distinguishable as a care home. The interior is well maintained, clean and odour free with a homely atmosphere. There is an enclosed well maintained garden to the rear with patio, and seating that can be used when the weather permits plus additional parking. To the rear of the main building is a six bedded unit called Jasmine Court, which is a modern purpose built unit providing ground floor accommodation. All bedrooms have en-suite shower and toilet facilities plus a separate bathroom, lounge/dining room and kitchen. Bedrooms doors had locks and lockable facilities were available to enhance arrangements for peoples privacy. The main building is over three floors and was found to be clean, warm, uncluttered and provided a homely atmosphere. Surveys from relatives told us; It is a proper Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: home rather than a care home. Very clean home Bedrooms are located on three floors and there is a chair lift located on one of the stairways to enable access to upper floors. Adaptations were in place to support people living in the home such as handrails, bath seats, ceiling hoist, commode etc. There was no evidence to indicate the home was not meeting the physical needs of people residing there. People are encouraged to personalize their bedrooms and can take their own belongings in to their bedrooms to reflect their individual tastes, age, gender and culture, so meeting their needs and providing a more homely environment. There is a choice of lounges and dining rooms for people to use and they can move freely about the main home and Jasmine court. The home had two laundries both of which were clean and well equipped. Systems were in place to support active infection control including the provision of staff training, the provision of protective equipment, appropriate flooring, a washing machine with a sluice facility. It was noted that latex gloves were in use and these can cause allergies with regular use. Vinyl gloves are now recommended for general use reserving latex for any incidence of blood spills. It is recommended that this practice be reviewed in line with current guidance. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive a good range of training, so people are supported appropriately. The recruitment procedures in place generally protect people from the risk of harm. Evidence: The staffing rotas for the week of the visit and a further three weeks were inspected and it was based on a fixed rota where staff work the same shifts each week plus a temporary rota that showed changes between members of staff. It indicated there were three care staff in the main home and two care staff in Jasmine Court during the day; two care staff in each building overnight plus the proprietors. In addition, there was an administrator on the day of inspection and they stated a handyman is employed to support care staff. Staff appeared to interact well with people living in the home, which indicated that good relationships exist between people living there and the staff supporting them. Recruitment records were sampled for five staff and showed that appropriate checks had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Protection of Vulnerable Adult checks and written references had been received before employees began work with the exception of one person. These checks are to ensure people living in the home are protected from the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: risk of having unsuitable staff work in the home with them. The manager must ensure in future that no member of staff commences work in the home until appropriate checks have been returned. It was stated that people living in the home were also consulted about new staff involving them in the process of deciding who will work in their home. Following employment new staff undertake the induction training, which meets the standards of the Social Skills Council and records were available to demonstrate this. There is a rolling programme of basic training that included first aid, manual handling, infection control, health and safety, food hygiene, challenging behavior, equality and diversity, dementia, sexual orientation and palliative care. In house training has been given in respect of medication and the deputy manager stated accredited training had been organised for staff. Records indicated that 50 of staff had completed NVQ 2 training or above and a number are currently undertaking training with a local provider. One member of staff told us the induction training was in depth and surveys indicated that they received training that was relevant, kept them up to date and helped them understand and meet peoples needs. At the time of visiting an assessor was present and staff appeared very enthusiastic. The assessor stated she had found the home was always clean, there was a lovely atmosphere and had no concerns. She also stated, There was good interaction between staff and residents. Staff meetings take place every two months and this provides an opportunity for staff to discuss good practice and development issues. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place generally promote the health, safety and well being of people. Evidence: One of the providers is currently registered as the manager of the home. It was stated the deputy manager has applied to us to become the registered manager. She has been working at the home for a number of years and knows the people living in the home very well. She has obtained the Registered Managers Award and NVQ level 4 in care during the past year, so she is suitably qualified to undertake the role as manager. The manager and deputy were open and welcoming during the inspection process. The quality assurance system includes feedback from surveys to people who live in the home, relatives and professionals who visit the home in order to seek their views on how the home is being run. The feedback from these was found to be positive. There was evidence of regular audits of medication by the supplying pharmacist. Also staff had undertaken an annual audit of accidents, so that any issues could be Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: identified and addressed. The deputy manager stated accidents were reviewed more frequently, so that any trends could be identified and action taken where necessary. The quality assurance system would benefit from being developed further to include audits of other areas of practice within the home, as some areas of further development were identified during the inspection in respect of care planning, risk assessments etc. Also it may be useful to consult people living in the home to determine if they would like documents in picture format and which ones e.g. complaints procedure, menus, daily activity diary etc. A sample of health and safety records were checked including fire, emergency lighting , servicing of hoists, bath seats and stair lift etc. They were all found to be satisfactory ensuring peoples health and safety is promoted. It is recommended that systems are introduced to ensure wheelchairs and walking frames are checked on a regular basis to ensure they are fit for use. The AQAA had been completed to an adequate standard, but would benefit from more specific detail as some of the comments were rather vague in respect of the developments and future plans. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must complete risk assessments to include all areas of risk and implement strategies to reduce risks. To reduce risks and safeguard people living in the home. 20/06/2009 2 34 19 Managers must ensure all 20/06/2009 checks are received in the home before any member of staff commences employment in the home. To ensure people living in the home are protected by the recruitment practices. 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 2 The assessment should be signed and dated by the person undertaking the process. Staff may wish to consider requesting a copy of the social workers assessment in order to enhance the process further. Page 29 of 31 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 2 6 The care planning process should be reviewed and developed to provide one comprehensive person centered plan indicating the support people require to achieve the areas that are improtant to them and for them to ensure their well being. Staff must ensure all multidisciplinary meetings and health professionals visits are recorded in order to demonstrate peoples health needs are being met effectively and consistency is maintained. Complete the policy in respect of homely remedies and obtain a supply of medication on the list, so that staff have guidance and a supply of homely remedies that can be used in the home. Consult the pharmacist regarding recording of the minimum/maximum and current temperature of the medication fridge to ensure medication is stored at the correct temperature at all times. Two signatures should be obtained for all controlled medication entering the home to ensure safe systems in place. It is recommneded that the use of latex gloves should be reviewed in line with current guidelines It is suggested that people living in the home be consulted about the production of documents in alternative formats to make them more accessible to them It is recommended that the quality assurance system be developed further, so that continuous improvements can be achieved. Systems should be put in place to ensure there are regular checks on wheelchairs and walking frames to ensure they are safe for use at all times. 3 19 4 20 5 20 6 20 7 8 30 39 9 39 10 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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