Care Home: The Bungalow

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well People are supported to lead full and active lives based on their individual needs and capabilities. People are involved in decision-making. Staff know how people communicate and encourage them to make choices throughout the day People are able to choose what they want to eat and are supported to make meals which meet their dietary needs. Staff support people to be independent, providing additional support to people as and when they need it. Observations made during the inspection found staff to be very kind in their approach to people. People generally have good care plans that tell staff the support they need. People are helped to keep in touch with friends. This helps them to keep relationships which are important to them. What has improved since the last inspection? At the last inspection it was advised that the ordering and recording of medication be more closely monitored, because excessive amounts of cream were found stored at the home. At this inspection we found this had improved although further improvements with the ordering of medicines could still be made. These improvements had also been identified by the regional manager. At the last inspection the home was advised to contact the fire authority to seek advice on door closure devices, which meant that doors can be kept open but close on the sounding of the fire alarm. At this inspection we saw these had been fitted to the doors where the current people have access. The regional manager confirmed to us that door closure devices would be fitted to the remaining doors. Door mats have been placed over floor tiles by the front door, which were identified as a slip risk at the last inspection. What the care home could do better: The two people who live at The Bungalow have good quality outcomes. However throughout our inspection we found some shortfalls, for example with care planning, staff induction and safety of outside spaces. When we identified the shortfalls we had reassurances they would be addressed. However management systems and processes should be effective to prevent these shortfalls occurring, which requires action on the part of the manager and regional manager to put in place. A summary of the shortfalls is as follows:People are not always provided with up to date information about the home which may result in misunderstanding about the services offered and fees charged. People are generally well supported to take appropriate risks, although some improvements are needed to ensure consistency amongst staff with how risks are assessed, documented and managed. Whilst looking at incident reports we saw that for one person there appeared to be difficulties whilst supporting this person to get ready for bed. We thought improvements needed to be made with how staff report these incidents. The manager agreed to do this and also to supplement a reactive management plan with guidance for staff around the management of when the person wants to go to bed. There was some confusion between the staff and manager`s perception of a risk to people choking whilst eating. We advise that if people are at risk of choking then suitable, documented assessment of the risk should be completed. One person did not have curtains in their bedroom. The manager needs to explore ways to promote a more homely atmosphere in bedrooms of people who show behaviours of concern. We found unsecured garden tools and a shattered pane of glass in the rear garden. Staff reported to us that the people living at the home would not be in the garden unattended, however the manager and staff need to ensure all parts of the home, including outside spaces are safe so that people are not placed at risk of injury The home needs to seek advice from the local fire officer about the suitability of the front door lock and consider fitting appropriate door closure devices on all fire doors in regular use which need to be kept open. This is to ensure people are kept safe and ensure fire safety systems are effective. We found that a member of staff had not received a suitable induction when they first started working at The Bungalow. The home is required to ensure that all staff receive an induction programme appropriate to the work they are to perform. This will ensure staff have the skills and knowledge to meet the needs of the people living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: The Bungalow 115 Cross Keys Lane Hadley Telford Shropshire TF1 5LR     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: Rosalind Dennis     Date: 0 9 0 7 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: The Bungalow 115 Cross Keys Lane Hadley Telford Shropshire TF1 5LR 01952260712 F/P01952260712 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: CareTech Community Services Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide personal care and accommodation without nursing for service users of both sexes whose primary care needs on admission to the home are within the following category: Learning disability (LD) 4. Date of last inspection Brief description of the care home The Bungalow is a detached property in Hadley, Telford, close to local facilities such as shops, pubs and medical facilities. A narrow drive leads to The Bungalow, which is best accessed from Haybridge Road. A bus service stops nearby. The home has two lounges, kitchen and dining room. Three bedrooms are on the ground floor and one is on the top floor. Two bedrooms have en-suite facility of shower, wash hand basin and toilet. The other bedrooms have wash hand basins, toilets and bathrooms are nearby. There is a choice of steps or ramp to the front door. There is level access to the rear patio and garden. Stairs provide access to the first floor, the home does not have a lift. Care Homes for Adults (18-65 years) Page 4 of 31 4 Over 65 0 Brief description of the care home People who use the service and their representatives are able to gain information about The Bungalow from the Service User Guide. Information on the current fees charged by the home was not included in the Guide, therefore the reader is advised to contact the service for this information. The last key inspection of the home was undertaken on 18th July 2007. 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 quality rating for service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day by two inspectors. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake 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, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last annual service review. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think it meets the needs of people living there. Care Homes for Adults (18-65 years) Page 6 of 31 The two people currently living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, 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. One person was able to tell us about their day to day life at the home and the support they receive from staff. Another person was not able to give us information but was able to indicate they are satisfied with the home. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with staff and the manager during the inspection to establish their views of working at the home and if anything needs to be improved. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The two people who live at The Bungalow have good quality outcomes. However throughout our inspection we found some shortfalls, for example with care planning, staff induction and safety of outside spaces. When we identified the shortfalls we had reassurances they would be addressed. However management systems and processes should be effective to prevent these shortfalls occurring, which requires action on the part of the manager and regional manager to put in place. A summary of the shortfalls is as follows:People are not always provided with up to date information about the home which may result in misunderstanding about the services offered and fees charged. People are generally well supported to take appropriate risks, although some improvements are needed to ensure consistency amongst staff with how risks are Care Homes for Adults (18-65 years) Page 8 of 31 assessed, documented and managed. Whilst looking at incident reports we saw that for one person there appeared to be difficulties whilst supporting this person to get ready for bed. We thought improvements needed to be made with how staff report these incidents. The manager agreed to do this and also to supplement a reactive management plan with guidance for staff around the management of when the person wants to go to bed. There was some confusion between the staff and managers perception of a risk to people choking whilst eating. We advise that if people are at risk of choking then suitable, documented assessment of the risk should be completed. One person did not have curtains in their bedroom. The manager needs to explore ways to promote a more homely atmosphere in bedrooms of people who show behaviours of concern. We found unsecured garden tools and a shattered pane of glass in the rear garden. Staff reported to us that the people living at the home would not be in the garden unattended, however the manager and staff need to ensure all parts of the home, including outside spaces are safe so that people are not placed at risk of injury The home needs to seek advice from the local fire officer about the suitability of the front door lock and consider fitting appropriate door closure devices on all fire doors in regular use which need to be kept open. This is to ensure people are kept safe and ensure fire safety systems are effective. We found that a member of staff had not received a suitable induction when they first started working at The Bungalow. The home is required to ensure that all staff receive an induction programme appropriate to the work they are to perform. This will ensure staff have the skills and knowledge to meet the needs of the people living at the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always provided with up to date information about the home which may result in misunderstanding about the services offered and fees charged. Evidence: The two people who currently live at The Bungalow have lived there for some time and we observed staff supporting these people well. The manager told us that if new people are to be admitted then the home would ensure their needs would be fully assessed before they were admitted and a transition plan completed. We were informed that a person was admitted for a short while in 2008 and we asked to look at these care records to see the processes which had been used to ensure their needs could be met at The Bungalow. The manager looked for these records but could not find them. At this inspection we were unable to assess the effectiveness of the homes admission process. In the care files of people we case tracked we saw the homes Statement of purpose and a service user guide. The service user guide was up-to-date and included pictorial representation to assist people with their understanding of what the service provides. It included information on peoples rights, how to complain and what is not included Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: within the fees. A section where the fee should be entered was blank, this was completed when we informed the manager. The statement of purpose included the aims and objectives of The Bungalow, but parts of the document needed updating. We were later told the Statement of Purpose had been updated but copies had not been put in these files. A document called Statement of Services was present in both files and was for the year 2007-2008, and included information on the fees charged at that time. Looking at the documentation highlights a need for the manager to ensure people and their representatives are provided with up-to-date information about the home and services offered. 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 involved in decisions about their lives, planning their care and the support they receive. People are generally well supported to take appropriate risks, although some improvements are needed to ensure consistency amongst staff with how risks are assessed, documented and managed. Evidence: We looked at the support plans for the two people we case tracked to see how staff are supporting them to meet their needs. The plans were personalised and focused on the persons likes, dislikes, abilities and preferred routines. For example one persons plan describes how they dont like to be woken up early and we spoke with this person who confirmed staff follow the plan, waking him up at the time he prefers. This person also told us how staff provide support whilst he applies a cream which has been prescribed by a doctor. The support plan described in detail how staff should support him with this procedure, which should ensure all staff reading the plan are aware of the procedure to follow. One persons plan describes how they communicate using pictures and objects of reference and we saw this being used as a communication aid Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: by staff. Both people had very good guidance on the actions needed by staff if behaviours of concern occur, describing possible triggers for that behaviour and the support needed during and after the behaviour. Both people communicated to us they are happy at The Bungalow. Whilst looking at incident reports we saw that for one person there appeared to be difficulties whilst supporting this person to get ready for bed. We thought improvements needed to be made with how staff report these incidents. The manager agreed to do this and also to supplement a reactive management plan with guidance for staff around the management of when the person wants to go to bed. Staff told us that people living at home are included in meetings and involved with the recruitment of new staff, this helps to ensure people are involved in the running of the home. We observed people being supported during the day with making choices, for example with what they wanted to eat and what they wanted to do. Risk assessments were present on the care files, however whilst looking at one persons file we saw documentation indicating this person had choked whilst eating and a risk assessment had not been completed for this. The manager had earlier told us that no one was at risk of choking, but a member of staff told us both people are at risk of choking and that staff know this so they always supervise whilst people are eating their meals. This indicates some confusion between the staff and managers perception of the risk, therefore we advised that if people are at risk of choking then suitable, documented assessment of the risk should be completed. Care Homes for Adults (18-65 years) Page 14 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 are supported to make choices about their lifestyles, develop their skills and maintain contact with their friends. People are involved in planning what they want to eat and meals meet their dietary needs and preferences. Evidence: We saw lots of information to show people living at the home are supported to take part in different activities within the home and the community. One persons social plan included entries of visits to Telford, Wellington, college, disco, karaoke, pub, bingo and church. We spoke with them about the photographs within their person centred plan, which showed them visiting friends at another care service, painting their bedroom, gardening, visiting Shrewsbury, going to see wrestling and they indicated they had enjoyed all these activities. They confirmed they are supported to go to church every Sunday, and they like going. Their support plan included guidance to staff on meeting their religious and spiritual needs. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The staff also support another person to attend the same church, although we saw it recorded in their plan that they are of a different religious background. We discussed this with staff and the manager and we viewed their religion could be explored further by the home to ensure their religious needs are being met. The home agreed to do this. Both people living at the home have different abilities, likes and dislikes and the information we saw demonstrates that people are supported to carry out activities individually. In the dining room, was a large handmade calendar covering two walls. The calendar included pictures and showed special events throughout the year to assist people with remembering certain dates. We observed that people are supported with basic housekeeping tasks to develop and maintain their independence. One person was supported during the inspection to clean some kitchen cupboards, another person sorted out items for recycling. Both people when shown photographs of themselves doing tasks such as cleaning and sweeping indicated they like doing this. The home does not have its own transport, staff told us either public transport, taxis or transport from another care service is used to go to community events. The home is currently looking to arrange a holiday later in the year. Records show that people are enabled to keep in touch with friends and people who are important to them. A friend from another care service visited during the inspection. People were supported to make their lunch and drinks. Staff also asked throughout the day if they wanted another drink. Staff told us that at the start of each week they discuss with the people who live at the home what they would like to eat during the week. During the inspection we heard one person asking staff what had been planned for the evening meal, staff asked if they wanted that or something else and the person chose an alternative, which was cooked for them. People indicated they like the food. Staff sat to eat with people whilst they ate and drank. A member of staff described how the home is intending to expand on the photographs it has taken off different foods, so it can be a resource to enable people less able to communicate verbally to show what they would like to meet. The fridge was full of fresh produce and all opened products had been dated to indicate when they had been opened. Care Homes for Adults (18-65 years) Page 16 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. People receive support and care in the way they prefer and need. Their health needs are met, although the way staff record in health care records does not always show this. Evidence: Both people living at the home appeared to be in good health. On the day of inspection their appearance reflected what was written in their care plan of how they prefer to look and dress. We looked at their health action plans, which are plans of what a person needs to stay healthy and healthcare services they need to access. One persons plan was detailed and up-to-date. The plan showed that healthcare professionals are involved in this persons care and that staff contact relevant professionals as concerns arise. For example on one occasion it was identified that the person was showing signs of discomfort, the home contacted the GP who visited the following day. Visits by health and social care professionals were clearly recorded. However for the other person at the service their plans were inconsistent and gaps in the recording could mean this person not having reviews of health care issues. For example, we saw that staff had recorded occasions when this person had a problem with their leg, antibiotics were given but when the problem happened again, staff Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: recorded that an appointment needed to be made to see a nurse, but there was no record of an appointment being made or visit taking place. Staff confirmed to us the person no longer had the problem. We also found that the person previously had medication for dry skin, which was stopped by the home earlier in the year. The persons records and the manager could not demonstrate this was stopped on the advice of a GP or other health professional. A member of staff told us the dry skin improved but has now happened again. The manager agreed to look into this and accepted that the recording of information was lacking. This shows that the manager needs to ensure staff are competent with their recording and introduce a system of monitoring/auditing of care records. We looked at the medication records for the two people we case tracked. The medication record for one person was up-to-date and properly completed. The other persons record showed they are not on any regular medication, although this needed further investigation by the home as described above. Medication is stored in a locked cupboard so that people are not at risk of taking medication they are not prescribed. Training records show that staff involved in the administration of medicines have received training in safe administration. The regional manager has recently identified that when prescriptions are ordered, then a copy of the order needs to be kept by the home, as it helps in the auditing of medication. The manager has not yet implemented this. Care Homes for Adults (18-65 years) Page 18 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. People living at The Bungalow are listened to and their concerns are acted upon. Staff have training so they know how to safeguard adults from harm. Evidence: The home has a complaints procedure that is included in the service user guide. The procedure includes pictorial representation to make it easier to understand, although it is likely because of peoples needs they may need additional support to raise any concerns. Both people living at the home indicated to us they are happy and feel safe. The AQAA from the manager stated that one complaint had been received in the last 12 months. This complaint had initially been received by us and we asked the service to investigate it using their complaints procedure. We received a detailed response of the homes investigation which resulted in the home taking action to address the concerns. The training records we looked at and the staff we spoke with shows that all staff working at The Bungalow receive training on safeguarding vulnerable adults from the risk of abuse. We saw documentation which showed planned training for staff who have not yet attended this training. A flow chart showing the local area policy on adult protection is clearly visible in the main office, which informs staff of the procedure to follow if a concern or allegation occurs. We saw evidence that staff receive training on managing crisis situations without using physical intervention and staff confirmed this Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: during discussion. The people we case tracked need support to manage their money. Both people have a book which staff complete to show amounts of money received and spent. We could see that staff check the amounts of money held by the home for these people twice a day, to ensure peoples money is kept safe. We looked at receipts for a recent trip that both people went on. All receipts had been kept which corresponded with the total amount of money spent recorded in the book. Some of the staff team have attended awareness training in the Mental Capacity Act (2005). Staff have not yet received training about Deprivation of Liberty Safeguards. The Act is about decision-making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where they incapacitating condition has been present since birth. It is important that staff know how to put the Act into everyday practice and the procedure to follow when peoples freedom may need to be compromised. We saw documentation showing this training has been booked for all staff. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Bungalow are provided with an environment which helps them maintain their independence and planned refurbishments should enhance the appearance of the home. More attention is needed to ensure the inside and outside of the home is kept safe so that people are not placed at risk of injury. Evidence: The people living at the home chose to show us their bedrooms. One persons room had recently been redecorated. The person was very pleased with the colours and told us how they had chosen the colour and painted the room with staff helping. Their bedroom reflected their personal interests and individuality. The other persons bedroom was sparsely decorated and did not have any curtains up. We spoke with staff and the manager about this persons room and were informed that the person can be destructive with objects. It was reported that the home has been waiting for sometime to have specially adapted curtains. Although the windows have frosted glass so they cannot be looked through, we viewed that more could be done to make the room more homely and lessen early morning sunlight during the summer months. On the ground floor there is a music room which has a piano but the chairs in this room looked worn and soiled. There is a large lounge, with settees and two televisions. We saw that the televisions were not secured and therefore could be a risk Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: to the people living at the home, especially during incidents where behaviour may be challenging. The manager informed us that there are plans to make these secure when refurbishments take place. The kitchen is spacious and provides storage space and worktop space for preparing meals. Opposite the kitchen is a dining room and this is where people seem to prefer spending their day. People who do not have an en-suite facility have a wash hand basin in their room and toilets and a bath with shower are near to their rooms. Therefore people are provided with a choice of washing and bathing facilities. We thought the appearance of the front of the home did not give a good first impression, as there was a discarded bed base in front of the house and the external windows need re-painting. The front of the home is accessed by steps or by way of a ramp. Door mats have been placed over floor tiles which were identified as a slip risk at the last inspection. A new front door had been fitted. Staff were seen at the start of the inspection opening the front door lock with a key. The staff told us the door is not usually locked during the day and later we saw one person opening the door independently to wave to a member of staff as they left the premises. We did advise the manager to contact the local fire officer to check that the front door met their regulations and they assured us they would do this. The home has fitted devices which close on the sounding of the fire alarm to doors on the ground floor, but has not yet fitted them to doors upstairs. The regional manager confirmed to us this would be done. No one is living upstairs at the moment. We went into the first floor bedroom, which is not occupied and there was a strong offensive odour in the room and en-suite. We reported it to the manager and heard an urgent request for maintenance being made. No other parts of the home had any smell. There is level access to a large patio and lawned garden at the rear. Whilst looking around the exterior of the home we saw garden tools which had not been put away and two panes of glass, one of which was shattered. Although staff reported the people living at the home would not be in the garden unattended, the risk to people was brought to the attention of the manager and regional manager and we requested action to be taken to make this area safe. This demonstrates a need for vigilance for all staff, including the manager and maintenance team. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with training opportunities, however new staff are not always provided with an induction to equip them with the skills they need to meet peoples needs. People are supported by staff who have been checked to ensure they are suitable to work with vulnerable adults Evidence: When we arrived at The Bungalow, staff were welcoming and informed the people who live at the home of our role so they knew the reason for us visiting. One person was able to tell us his views on the home and staff. Another person was not able to talk with us but was able to respond to us using gestures. We watched the way the people interacted with staff and how staff interacted with them. This showed us that people are supported by staff who have a good understanding of their needs. The staff we spoke with told us they are provided with good training opportunities and gave us examples of the training they have done since working at the home. This included training in safe working practice, for example fire safety, infection control and food hygiene and more specific training including managing conflict, autism awareness and non-violent crisis intervention. The manager did not include in the AQAA information on how many staff have got a recognised qualification in care (National Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Vocation Qualification). At the inspection we were told that around 50 have NVQ level 2 or above with plans for all staff to undertake this qualification. This should contribute to ensuring the staff team have an effective knowledge of social care. Two staff on duty told us they are waiting to start their NVQ 2. A new member of staff told us about the induction they had when they started working at The Bungalow and we looked at a copy of this induction. This showed the induction was not to the standard expected for a new member of staff working with people with learning disability. Another member of staff had completed a full induction. Therefore our findings show that some staff are receiving a full induction and others are not, which could result in staff not developing the skills they need. We discussed this with the manager and regional manager who accepted these inconsistencies. They informed us that the company has just produced an induction programme for staff which meets the standard. We looked at the process used by the home to recruit two members of staff who had started recently. Information such as references and criminal record bureau (CRB) disclosures are not kept at the home but held centrally, a process which has been approved by the commission. Each file contained a checklist (proforma) which listed all the information we expect to be obtained before staff start working at a care service. This helps to ensure staff are suitable to work with vulnerable adults. We looked at the file for a member of staff who had returned to work at The Bungalow, this was not as organised as the other files and did not show this person had been rechecked for their suitability. We discussed this with the manager who later found documentation in a different place to demonstrate that a check had been done. This shows the manager needs to be more organised with record keeping. We saw documentation to show meetings for staff take place on a regular basis. Staff told us they find the meetings useful and feel able to raise concerns in meetings or straight away with the manager or deputy manager. People living at the home also attend the meetings. Staff told us they have regular supervision meetings with the manager, which enables them to reflect on practice and identify their training and development needs. We spoke with staff, observed them working and looked at staffing rotas which demonstrates that sufficient staff are usually on duty to meet the needs of the people currently living at the home. Most of the time there are two staff on duty during the day and evening, with one member of staff at night who is there on a sleep-in shift. The staff told us sometimes there may only be one member of staff on duty in the day and evening. When this happens they view the staffing levels mean people are still Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: safe but said it can cause a problem if one of the people living at the home wants to go out and they have to refuse. The home must therefore keep this under review to ensure peoples lifestyle choices and liberties are not affected. 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. The home is managed in the best interests of the people who currently live at The Bungalow and these people have good quality outcomes. However further effort is needed by the manager to be effective in her role in overseeing all aspects of the service and initiating improvements so that people and staff benefit. Evidence: The registered manager, Ms Claire Goodwin has worked at The Bungalow for some time. We observed Ms Goodwin supporting people in their daily activities and it was apparent Ms Goodwin has a good rapport with the people who live at the home. Staff told us they think the home is well-managed. The last inspection report identifies that Ms Goodwin was nearing completion of the Registered Manager Award. At this inspection the manager told us there has been a problem on the part of the college in recognising this award has been completed. The manager and regional manager assured us that this is being looked into. We saw the home asks people for their views and opinions on a regular basis. This may involve showing pictures so people can indicate how they are feeling if they have Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: difficulty communicating. Two people had completed the homes surveys last year with support from staff, which showed they were satisfied with the home at that time. We saw letters showing the home attempts to keep families informed of developments at the home. We did not see that the home had sought feedback from professionals who may have an interest in the home. The manager had completed the Annual Quality Assurance Assessment (AQAA), when we asked for it. The AQAA gave us some useful information about the service, including where it considers it has improved and plans for future improvement. Not all sections of the AQAA had been completed and this information was sought during the inspection. We looked at a selection of documentation which shows that regular checks are undertaken of equipment to ensure it is well maintained. We saw a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. The manager informed us that fire evacuation plans are being developed which will then go in peoples rooms. Checks on the fire alarm have been performed apart from a two week period in June. Staff test the temperature of the water to ensure it is not too hot. As noted in the Environment section, the home still needs to put in place devices which close on the sounding of the fire alarm to avoid the need to prop open the office door upstairs. A representative of the company monitors quality at regular intervals with monthly unannounced visits. The regional manager attended during inspection to complete one of these visits. We observed the most recent report produced as a result of a visit in June 2009.This showed that a wide range of matters are looked at to ensure the service is operating well. The report identified that fire safety checks had not been conducted for two weeks in June and gaps in recording of information in care records. An action plan had been produced for the manager to follow, noting the action to take and when. Throughout our inspection we found some shortfalls, for example with care planning, staff induction and safety of outside spaces. When we identified the shortfalls we had reassurances they would be addressed. However management systems and processes should be effective to prevent these shortfalls occurring, which requires action on the part of the manager and regional manager to put in place. 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 35 18 All staff must receive an 30/09/2009 induction programme appropriate to the work they are to perform. This will ensure staff have the skills and knowledge to meet the needs of the people living at the home. 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 5 The manager should ensure that information about the home, services and fees is kept up to date and that people are provided with the updated information. The manager should develop a system to monitor and audit care documentation and ensure staff are competent in maintaining care plans and health records. This is to ensure people are not at risk of not receiving the care they need. The manager should explore ways to promote a more homely atmosphere in the bedrooms of people who show behaviours of concern. The home should seek advice from the local fire officer 2 19 3 26 4 42 Care Homes for Adults (18-65 years) Page 29 of 31 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 about the suitability of the front door lock and consider fitting appropriate door closure devices on all fire doors in regular use which need to be kept open. This is to ensure people are kept safe and ensure fire safety systems are effective. 5 42 The manager and staff should ensure all parts of the home, including outside spaces are safe so that people are not placed at risk of injury 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!