Care Home: Strensham Hill

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What the care home does well People told us that they were happy living at the home and that they were able to choose how they spend their time. People have some opportunities to be involved in the running of the home. The home is sensitive to peoples` cultural needs so that they are supported to live their lives pursuing what is important to them. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. There are opportunities for people to do things for themselves, go out often, have a chance to develop new skills, and stay as independent as possible. Quality monitoring visits are undertaken by external senior managers so that any areas for improvement can be identified for the benefit of people living at the home. People told us: "We sit in the lounge and talk about what we would like in the home". "I sat on the interview panel for new workers at the home. I asked them about how they would like to work here. There were three people and I spent the day doing this. It gives us a voice". "We are going to a party at head office and I know some of the people who will be there as we go to college together". "I now do computer work at college". What has improved since the last inspection? Prior to coming to stay there people can be confident that the home will be suitable to meet their needs. People can be confident that they receive any private correspondence meant for their attention as it arrives at the home. People can be confident that their meals are stored and prepared in a hygienic manner. People have access to snacks at the times that they need and want. People living at the home can be confident that they are protected from harm. Facilities and equipment provided at the home meet the assessed needs of people living at the home. People are supported to promote their independence whilst maintaining their safety. What the care home could do better: People do not have all of the information that they need to enable them to decide if they want to live at the home. Health plans are not always written and this may compromise the health and well being of people living at the home. Staff must receive all the training they need to meet peoples` individual and collective needs. A review of staff work patterns should be undertaken in order to ensure that people living at the home can be confident that they are being supported by an effective staff team at all times. Due to a frequent change of managers, people cannot be confident that they will receive a consistent and well managed service. Key inspection report Care homes for adults (18-65 years) Name: Address: Strensham Hill 1 Strensham Hill Moseley Birmingham West Midlands B13 8AG     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: Amanda Lyndon     Date: 1 4 1 2 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 32 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 32 Information about the care home Name of care home: Address: Strensham Hill 1 Strensham Hill Moseley Birmingham West Midlands B13 8AG 01214424580 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Servol care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 8 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: Mental disorder, excluding learning disability or dementia (MD) 8 Date of last inspection Brief description of the care home 1 Strensham Hill provides care and accommodation for up to eight people between the ages of 18 and 65 years with mental health disorders. People of any cultural background are welcome at the home however, there is specific focus on the needs of Caribbean people. The home is situated in a residential area of Moseley bordering with Balsall Heath. It is close to public transport links and is within walking distance of a range of local amenities such as shops, parks, places of worship, a library, swimming baths, doctors Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 8 Brief description of the care home surgery and dentist. Accommodation is spread over two floors and upper rooms are accessed via a stairway, a passenger lift is not provided. In addition there are steps leading to and from both the front and rear entrances of the building. This means that the home is not suitable for people with mobility problems. All bedrooms offer single occupancy and an en suite facility of a toilet and shower are provided in one bedroom. All other people have access to shared toilet and bathing facilities. There is a communal lounge and a separate kitchen/diner which includes individual storage facilities for each person living there. The home is a non smoking environment and people that choose to smoke, do so outside. There is a private garden to the rear of the home which is suitable for all people to use and off road car parking is provided at the rear of the garden. There is also car parking space on the road outside the front of the home. In the reception area there is some information that may be of interest along with photographs of recent events. A copy of our last inspection report was not available and this will prevent people from accessing this information. Details of fees charged to live at the home are available from the home on request. Care Homes for Adults (18-65 years) Page 5 of 32 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 peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on areas that need further development. During our previous visits to the home on 20 and 24th August 2009, we assessed that the home had a zero star quality rating. This meant that people who live at the home experienced poor quality outcomes. Following the visit we met with Servol in order to discuss our concerns about the service provided there. This gave them the opportunity to tell us how they were going to improve the service. The purpose of this visit was to assess whether improvements had been made regarding the service provided to people living at the home. This visit was undertaken by one inspector over one day. The home did not know that we were visiting and there Care Homes for Adults (18-65 years) Page 6 of 32 were five people living at the home. Prior to the visit taking place we looked at all of the information we had received, or asked for since our last visit. We did not request an Annual Quality Assurance Assessment (AQAA) as one had been completed prior to our previous inspection earlier this year. We looked at the improvement plan that was sent to us by the home in response to the shortfalls that we identified during our previous visit. This identified that actions were being taken to address the regulatory requirements made for the benefit of the people living at the home. We had not received any complaints about the service provided. Two people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to three staff members about the care they provided to these people. We gave all people living at the home the opportunity to be involved in the inspection. We sampled care, staffing and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean and comfortable for them. There were no visitors to speak with whilst we were at the home. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? Prior to coming to stay there people can be confident that the home will be suitable to meet their needs. People can be confident that they receive any private correspondence meant for their attention as it arrives at the home. People can be confident that their meals are stored and prepared in a hygienic manner. People have access to snacks at the times that they need and want. People living at the home can be confident that they are protected from harm. Facilities and equipment provided at the home meet the assessed needs of people living at the home. People are supported to promote their independence whilst maintaining their safety. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 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 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission processes are thorough and this should mean that people living there can be confident that their care needs will be met. Evidence: The statement of purpose had not been updated since our last visit to the home. It did not identify the full range of services and facilities that the home provides, including long term care. This will prevent people looking for a care home from having accurate information to help them decide if the home is suitable for their needs, and whether they would like to live there or not. Given that the home has three vacancies, it is important that this information is up to date. We saw that these are produced in a normal sized print format. However the acting manager stated that they could be produced in other formats and languages on request, so that more people could access the information. Details about this were not included on the documents, so it is not clear how people would know this. He also stated that he is in the process of updating both the statement of purpose and service user guide. Information about the fees charged to live at the home are available from the home Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: on request. In addition to this we saw that people living at the home had signed comprehensive contracts that included information about what the fees cover, so that they were aware of this information. In addition to the four people who had lived at the home for a long period of time, since our last visit another person had recently come to live there. We did not have an opportunity to speak to this person as he was out for the day. However we sampled the pre admission assessment for this person. This identified that the acting manager had liaised with and obtained comprehensive information from a range of health and social care professionals who were involved in his care. This is in order to determine whether his care needs could be met at the home. We saw that prior to admission the person had visited the home on two occasions during day time hours, and an overnight stay had also been arranged. This gave him the opportunity to meet other people living at the home and experience what it would be like to live there. People living at the home told us that felt it was beneficial to meet with people prior to them coming to live there. Care Homes for Adults (18-65 years) Page 12 of 32 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 that live in the home receive support to make choices and decisions about their day to day lives, so that they lead lifestyles that meet their needs and expectations. Evidence: Assessments of peoples individual, physical, emotional, and social care needs are undertaken on admission to the home, and are reviewed periodically throughout their time there. Care plans are written from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves and in what areas they require support. Although we could evidence that people were involved in writing and reviewing these, not all people living at the home are able to read. The acting manager stated that he is looking to introduce a computerised care planning system so that more people will be able to have access to this information. He said that this will include a speech activated programme. We looked at the care plans of the two people case tracked. We found that the vast Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: majority of care plans were personalised, included peoples preferences regarding their daily lives and identified what the person could and couldnt do for themselves. They also gave instructions for staff about the support to be provided. This is important so that people are encouraged to maintain their independence, and means that their preferred routines can be maintained whilst living at the home. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks and promote their independence. From discussions with staff and people who live in the home, it was evident that people are encouraged to maintain and develop their independence, as able. We saw that risk assessments had been written for people with behaviours that can be challenging to others. From records sampled we saw that staff had a good understanding of the support to be provided in this area. Each person living at the home has two key workers, and both staff and people living at the home met during the visit had a good understanding of this system. This means that people should be supported by staff who are familiar with their care needs. People met were able to tell us who their key workers were and that they were satisfied with the level of support provided by these people. We saw that regular care reviews are undertaken involving people living at the home, people important to them, health and social care professionals, the management team, and their key workers. This provides people with the opportunity to put forward any suggestions for improvements to the service provided, and assess whether their care needs were being met. We saw that during these reviews, achievable goals are set agreed with people living at the home in order to promote their independence. Written records identified that the success of these are reviewed and new goals are set in order for people to develop further skills. People told us that they can choose how they spend their time and we saw that following risk assessment, they are able to go outside of the home on their own as they choose. From our discussions with people living at the home and our observations during the visit, it was evident that people can choose the time that they get out of bed and have their breakfast. We saw however, that staff provide support to encourage people to be ready in time to leave the house for their day time activities. From discussions with people living at the home and our observations on the day, we saw that people are supported in a respectful manner, and interactions between staff members and people living at the home were good. This will promote peoples selfesteem. We saw that since our last visit a system had been introduced to ensure that Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: people receive any correspondence addressed to them as soon as it arrives in the post. There are some systems in place to capture the view of people living at the home. Group meetings are arranged and we sampled the minutes of the most recent meeting. However these had not been typed up and were not on display. This will prevent people who did not attend the meeting from having this information. One person met with during the visit said We sit in the lounge and talk about what we would like in the home. People told us that actions are taken in response to suggestions they put forward. The acting manager told us that a further group meeting was planned for the day of the visit, and we saw the agenda for this. In addition, one person living at the home met with during the visit told us that she was involved in interviewing prospective staff members. This means that she has a say in who will be supporting her and the other people living at the home. She said I sat on the interview panel for new workers at the home. I asked them about how they would like to work here. There were three people and I spent the day doing this. It gives us a voice. Care Homes for Adults (18-65 years) Page 15 of 32 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 experience a meaningful lifestyle that promotes their independence, and is reflective of their individual needs and interests. Evidence: From our observations during the visit and sampling of records, we identified that there is a range of activities provided for people to participate in, if they choose to do so. These include both group and individual activities both within and outside of the home, and people told us that they have a say in arranging these. People told us that they were enjoying a busy social life at the current time due to Christmas celebrations. One person met with during the visit said We are going to a party at head office and I know some of the people who will be there as we go to college together. Another person said We have ordered a new Christmas tree and if I am in I will help to decorate it. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Staff encourage people to do things for themselves in order to promote their independence and develop life skills. We saw that activity records are reviewed regularly so that activities arranged are specific in line with peoples personal goals. From discussions with staff it was evident that they had a good understanding of the importance of encouraging people to achieve these goals in order to improve the quality of their lives. We saw people undertaking household duties during our visits to the home. This means that they are involved in the running of their home. People are supported to maintain links with the community thus lead fulfilling lifestyles. All people living at the home attend local colleges and day centres. This provides people with the opportunity to meet with like minded people and develop their social skills. One person met with during the visit said I now do computer work at college. People told us that the home is sensitive to their cultural needs which means that support is provided in an understanding manner. The majority of people living at the home are Caribbean and the culture mix of staff reflected that of people living at the home. Examples of this included the choice of meals provided, beauty and personal care regime, the decorative style of the home, and support to find activities linking in with other people of the same cultural background. Arrangements are in place so people can follow their religious beliefs if they wish. This means that people can pursue interests and beliefs that are important to them. People are encouraged to maintain contact with their family and other people important to them. They told us that their visitors were made to feel welcome at the home and we saw that people regularly spent time outside of the home with their friends and family. There were no visitors at the home during our visits. Staff prepare communal meals for people living at the home three times a week. We saw that these included a variety of healthy meal options. People are responsible for preparing meals and snacks at other times, with varying levels of support from staff as required. This promotes peoples independence in this area. We saw that staff and people living at the home eat their meals together thus promoting a social and homely living environment. Risk assessments sampled identified that people living at the home do not always choose to buy foods that are healthy, and this means that they are at risk of having an unbalanced diet. Staff told us that they provide support in this area and assist a number of people living at the home with their food shopping. This means that people can be encouraged to choose healthy options, whilst still being able to exercise control Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: over their food shopping. In addition to this, picture guides of healthy food options were on display in the kitchen, so that people could refer to these when planning their meals. Since our last visit improvements had been made regarding the recording of peoples dietary intake. This means that individual assessments of peoples nutritional intake could now be undertaken to ensure that they are receiving a healthy diet. Since our last visit arrangements had been put into place so that snacks were available to people living at the home at the times that they require. Care Homes for Adults (18-65 years) Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some systems in place to ensure that the health and personal care needs of people living at the home are met. Evidence: The majority of people living at the home required minimal assistance from staff to meet their personal care needs. We saw that people were clean, hair was neatly styled and people were wearing clothing appropriate to their age, gender, culture, and the time of year. We looked at the personal care plans of two people living at the home. People told us that they had been involved in writing these, despite a number of the documents not being signed or dated. These included information about peoples preferences regarding a choice of bath or shower. From discussions with staff and people living at the home it was evident that staff had a good understanding of this. However, one care plan needed further development to reflect the actual support required in this area. We sampled the health plans of two people living at the home and found that these included some information about their health needs. However as identified during our previous visits to the home, these had not always been produced in a format that the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: majority of people living at the home could understand. We found that despite one person having gained a significant amount of weight recently and her doctor being informed about this, a health plan had not been written. This may prevent staff from providing the appropriate support in this area, in order to monitor and improve the health of this person. From food records sampled and from our discussions with the staff team however, it was evident that they had a good understanding of the healthy diet that this person required. People can retain their own doctor on admission to the home, if the doctor is in agreement. If able, people are encouraged to attend the doctors surgery in person with the support of staff. In addition we saw that advice can be sought as needed from a range of other health and social care professionals. We saw that staff had obtained information from an organisation specialising in services for people who are blind in order to improve the quality of life of a person living at the home. Since our last visit a number of staff members had also received training in this area. A number of staff told us that they would like training about diabetes in order to improve their knowledge about this when supporting people living at the home. We looked at the system in place for the management of medication and found that this was well organised and that medication administration charts were well maintained. A system for ensuring that people received their medication as prescribed was in place and the majority of staff had undertaken recent training in this area. Care Homes for Adults (18-65 years) Page 20 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are arrangements in place to listen to the views of people living at the home. Systems in place should protect people from harm. Evidence: Since our last visit we have not received any complaints about the service provided at the home. In addition the home have not received any complaints about the service provided there. The complaints procedure was not on display in the home, and we saw that the service user guide included two different complaint procedures, both being out of date. This may prevent people from having current information about how to raise any concerns that they may have. Despite this however, people met during the visit told us that they knew how to make a complaint. One person met with said I talk to my key worker and other staff. We saw that a Suggestions Box is located in the reception area of the home and this was empty during our visit. Since our last visit a system for recording low level concerns had been implemented and there was one entry within this. This means that people can be confident to raise any concerns and are made aware of any actions taken in response to these. During a previous visit to the service we suggested that the agenda of group meetings of people living at the home should include time for people to raise any concerns that they may have. The agenda for a recent group Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: meeting identified that this had been included. Since our last visit we have not received any information about safeguarding issues at the home. We saw that there was a comprehensive adult protection policy in place and local multi agency guidelines were available. From sampling training records and from discussions with the staff team we identified that since our last visit staff training about safeguarding issues had been provided. A number of staff members including the acting manager met with during our visit had a good understanding of safeguarding procedures in order to protect people living at the home. We saw that a risk assessment had been undertaken in respect of the risk of harm being sustained by people living at the home as a result of the behaviour of one person living there. We saw that the home had referred their concerns to the appropriate external agencies as per safeguarding procedures. During our visit the acting manager put additional safeguarding measures into place regarding this, in order to protect people living at the home. Staff help people to manage their money, and there is a system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Money is kept in a locked facility, and as an additional safety measure people choose to lock their rooms when they are away from the home. We found that receipts and a record of money received and spent was available. We saw that people sign for all money in and out of the safe. This means that it was possible to establish whether all money spent on peoples behalf was accounted for. It was of concern that the provider Servol acts as the appointee for one person who has lived at the home for a long period of time. This person is unable to manage their own finances. We did however evidence that the homes staff have requested that social services seek an alternative way to manage this persons finances. We saw that robust recording systems had been implemented in order to protect all involved until alternative arrangements are put into place. Care Homes for Adults (18-65 years) Page 22 of 32 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 an environment that meets their assessed needs. Evidence: The home is situated in a residential area of Moseley. There are a range of shops, leisure activities, and public transport links nearby. This is important to the people who live there as they make regular use of these amenities. The upper floors of the home are accessed via a stairway, and people have to negotiate steps leading to and from both the front and rear entrances of the building into the garden. This means that the home is not suitable for people with mobility problems. Information about this is included within the statement of purpose so that people are aware of this when choosing whether to live there or not. The rear garden is spacious and private, and people told us that they enjoy using this area. Smoking is not permitted within the building and people that choose to smoke do so in the garden. There is one communal lounge and one television with a Freeview facility in the home for people to share. One person has chosen to have a television in their bedroom as well. New carpet, window blinds, and furniture had recently been provided in the lounge and people told us that this was now a comfortable room to relax in. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: All bedrooms offer single occupancy and one of these has an en suite toilet and shower facility. Communal toilet and bathing facilities are accessible to other people living at the home. As identified during our last visits, bathrooms and toilets though fit for purpose and functional would benefit from modernisation. We looked at the bedroom of one of the people case tracked and saw that this had been personalised to reflect the persons age, gender, interests, and culture. We saw that since our last visit the carpet and bed linen had been replaced so that it was now a hygienic and comfortable place to relax in. In addition since our last visit a call facility had been provided in this bedroom, should the person need to call for assistance from staff during night time hours. People met during the visit stated that they were happy with their rooms. The acting manager told us that the person who had recently come to live at the home had chosen his bedroom. However we were unable to discuss this with him during our visit as he was out for the day. We saw that people living at the home and the staff team are responsible for undertaking cleaning duties at the home. Rotas had been devised so that people are aware of their individual responsibilities on a daily basis. In addition, a cleaner is employed twice a week. People living at the home told us that they were satisfied with the standards of cleanliness at the home and we found that in general the home was clean and fresh. One person met with during the visit said I clean my bedroom and the kitchen and empty the bins. We found that systems in place regarding food hygiene within the kitchen had improved since our last visit. This should mean that food is prepared in a hygienic manner. Care Homes for Adults (18-65 years) Page 24 of 32 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. People cannot be confident that staff have all the skills and knowledge they need to meet their needs. Evidence: The acting manager told us that there were no staff vacancies and that bank staff cover periods of staff sickness and holidays, in order to ensure continuity of support for the people living at the home. It was evident that a good rapport had built up between the staff team and people living at the home, and we saw that staff spend time sitting and talking to people living there. As identified during our last visit to the home, from discussions with the staff team and sampling of the staffing rotas, we identified that on the majority of occasions the staff member undertaking the sleep in shift worked the early shift the following day. This is despite the person undertaking this shift having to wake during the night to support people living at the home on occasions. Following the visit we discussed this with the Chief Executive who stated that this arrangement is being reviewed. He stated that this will be based on the dependencies of the people living at the home and the duties undertaken during the sleep in shift at any given time. The acting manager told us that since our last visit, there had not been any new staff Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: members employed at the home. We were, therefore, unable to sample staff recruitment files on this occasion. Since our last visit a staff training matrix had been developed. During our last visit the majority of staff had required refresher training in a number of safe working practices and a requirement had been made about this. The timescale for meeting this requirement had not expired at the time of this visit and the acting manager stated that training was planned. From the sampling of records and from discussions with the staff team we identified that staff had recently undertaken training about manual handling food hygiene and safeguarding. As identified during our previous visit to the home staff told us that they required training about specific medical and care issues in order to meet the individual needs of people living at the home. A number of staff confirmed that they had recently received training about how to support people with sensory impairments. The acting manager stated that further training about this and how to support people with diabetes will be arranged in the near future. Records identified that staff meetings are held regularly. This means that staff have the opportunity to be involved in the running of the home and that they are aware of any training opportunities. Care Homes for Adults (18-65 years) Page 26 of 32 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 home would benefit from a permanent manager, so that it is run in the best interests of the people living there. Evidence: The acting manager had been in post for the past two months. He has a diploma in mental health, so should have the knowledge to lead the staff team in supporting people living at the home. The acting manager had been transferred from another unit within Servol in order to address the shortfalls identified with the service provided at the home. During this visit it was evident that improvements had been made for the benefit of the people living at the home. Positive comments were made by people living at the home and the staff team about his management style. This included The manager is very approachable. He has done a lot since he was here, and I am so happy with the manager. Shortly after the visit the Chief Executive told us that a new permanent manager had been recruited and had started her induction training prior to working at the home. He stated that the acting manager would continue to be at the home during this time, in Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: order to ensure continuity for people living at the home and the staff team. He stated that the new manager would be applying to register with us. Senior external managers undertake regular quality monitoring visits at the home and there was evidence that people living there are involved in these visits. We saw that actions had been taken to address any shortfalls regarding the service provided identified by the Chief Executive during his visits to the home. Service satisfaction questionnaires had been sent out to people living at the home in order to seek their views about the service provided there. The vast majority of feedback was positive, however a report based on the findings of this had not been written. This means that people would not be aware of the results of these and actions being taken. From records sampled we identified that regular checks are taken on equipment to ensure that it is safe to use. We saw that a fire drill had been undertaken recently. This involved people living at the home so that everyone was aware of the actions to be taken in the event of a fire. Since our last visit we saw that risk assessments had been written in order to identify and reduce the risk of accidents occurring whilst people living at the home undertook their daily tasks. In addition we saw that the cleaning cupboard containing cleaning products had now been locked and this will protect people living at the home. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R 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 1 35 18(1) Staff must receive 31/12/2009 appropriate training so they have the skills and knowledge to support people who use the service. Care Homes for Adults (18-65 years) Page 29 of 32 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 19 12 Each person must have a 26/02/2010 health plan that is accessible to them outlining their health care needs. This is so that they receive the appropriate care and support to promote and maintain their health. 2 35 18 Staff must receive appropriate training. So that they have the skills and knowledge to support people who use the service. 31/03/2010 3 37 8 Arrangements must be made so that a registered manager is in post at the home. This is so that the home is run in the best interests of the people living there. 31/03/2010 Care Homes for Adults (18-65 years) Page 30 of 32 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 1 The statement of purpose and service user guide should identify all services and facilities provided at the home, so that people have this information when choosing a care home. Minutes of group meetings should be accessible to all people including those unable to attend, so that they are aware of matters discussed and any actions to be taken as a result of this. Systems should be in place so that personal care plans are dated, signed andalways include specific details of the actual care to be provided. This is so that people receive support in the ways that they require and prefer. Arrangements should be made so that people living at the home and people important to them are aware of how to raise any concerns that they may have. A review of staff work patterns should be undertaken in order to ensure that people living at the home are supported by an effective staff team at all times. A report based on the findings of service satisfaction questionnaires and actions taken as a result of these should be produced. This is in order for people to be confident that their suggestions have been acted upon. 2 8 3 18 4 22 5 33 6 39 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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