Care Home: The Dell

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What the care home does well People have information to help them decide if the service provides what they are looking for. They have opportunities to come and visit first, so they can see for themselves what the service offers. People`s needs are assessed, so that there is a firm basis on which to plan their future care and support. People enjoy some opportunities to do things they value and go to places they like. They get supported to keep in touch with people who are important to them. Staff give good basic care, and treat people with warmth and friendliness. They are supported to keep important medical appointments. There are good systems in place for managing people`s medication, so they get their medicines when they should, and in the right amounts. Staff work hard to make sure that the house is clean and tidy, and provides people with a comfortable and safe place in which to live. Important checks are made before staff start work at the home to make sure they are fit for their jobs. The Manager is open and approachable, and keen to develop the service for the benefit of the people that use it. Essential equipment is checked and serviced regularly, so that people living and working in the home can stay safe. What has improved since the last inspection? Some efforts have been made to meet recommendations made at the time of the last inspection. Care plans have been reviewed and some changes made. Work has begun on developing communication passports to support people in making choices and decisions. Improvements have been made to the management and administration of medicines in the home, ensuring these are given as prescribed and stored as recommended. Professional support has been sought so as to improve staff understanding and knowledge of good nutrition. More consultation is taking place about the home`s menus. The Manager has completed and submitted her application to become formally registered. Some progress has been made to develop quality assurance and monitoring of the service. The rolling programme of maintenance and refurbishment has been continued, to make sure that people continue to enjoy living in a comfortable home. What the care home could do better: Produce information about the home in other formats to make it more accessible to people who have difficulty reading written documents. Develop care plans to include goals with measurable outcomes, and evaluate these regularly. Extend the use of person-centred approaches, to ensure that staff have guidance about how to give support in ways that suit individuals best. Offer more opportunities for people to do activities on a one to one basis. Plan activities purposefully by making clear links between activity opportunities and people`s agreed goals. This is to make sure people get the support they need to achieve the things they say are important to them. Ensure that staff always treat people as adults, so as their rights to personal dignity are fully respected. Develop and implement Health Action Plans to ensure that people get all the support they need to stay healthy and well. Recruit to vacant posts to ensure that people can benefit from continuity of care. Review staffing arrangements to support individual activities. Produce a complete training and development plan for the staff team. Ensure that all staff receive regular formal supervision and an annual appraisal. This is to ensure they have all the knowledge, skills and support they need to do their jobs well Ensure that sufficient time is allocated for the Manager to fulfil all her management responsibilities. Develop quality assurance and monitoring of the service, so that it can be seen how information gained is used to improve the service for the benefit of the people that use it. Review record keeping practices. Archive or dispose of old material, so that files are current working records, and important information can be found easily. Key inspection report Care homes for adults (18-65 years) Name: Address: The Dell 30 Monument Avenue Wollescote Stourbridge West Midlands DY9 8XS     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: Gerard Hammond     Date: 1 9 0 1 2 0 1 0 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 30 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 30 Information about the care home Name of care home: Address: The Dell 30 Monument Avenue Wollescote Stourbridge West Midlands DY9 8XS 01384826050 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Select Health Care (2006) Limited care home 7 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 7 The registered person may provde the following category of service only Care Home only to service users on the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 7 Date of last inspection Brief description of the care home The Dell is a large detached property, which provides accommodation for up to seven people with learning disabilities. It is a privately owned care Home, which is part of Select Healthcare Limited. The Home is situated in a quiet residential locality in the Wollescote area of Stourbridge and is within walking distance of the local village, which has shops, public houses, a park and other local amenities. The town centre of Stourbridge can be accessed by public transport. There is a small parking area at the front of the building and a patio and garden at the rear of the property. There is no lift access for residents. It 7 single bedrooms. There are lounge and dining room facilities on the ground floor together with a conservatory. The Home has bathing facilities on the first floor and a very small en suite in the ground floor bedroom. There are toilet Care Homes for Adults (18-65 years) Page 4 of 30 7 Over 65 0 Brief description of the care home facilities sited throughout the Home. There are limited car parking spaces at the front of the home. Access is via a steep drive, which has been improved with handrails, ramps and steps. There was no information relating to fees contained in the service user guide. For information about fees that the home charges you are advised to contact the Home Manager. Additional costs include hairdressing, toiletries and private chiropody, which can be provided within the home for an additional fee. Care Homes for Adults (18-65 years) Page 5 of 30 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: This was the homes first key inspection of the current year 2009-10 and was unannounced. We gathered information from a number of places to inform the judgements made in this report. The Manager sent us a completed Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self assessment of how well the service is doing, and provides some numerical information about it. We made two visits to the home and met all of the people currently using the service. Seeking peoples views directly was limited by their communication support needs and levels of learning disability. We were able to directly observe interactions between people using the service and the staff looking after them. We spoke with the Manager and staff on duty and looked around the home. We looked Care Homes for Adults (18-65 years) Page 6 of 30 at records including personal files, care plans, staff records, previous inspection reports, health and safety records and other documents. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Some efforts have been made to meet recommendations made at the time of the last inspection. Care plans have been reviewed and some changes made. Work has begun on developing communication passports to support people in making choices and decisions. Improvements have been made to the management and administration of medicines in the home, ensuring these are given as prescribed and stored as recommended. Professional support has been sought so as to improve staff understanding and knowledge of good nutrition. More consultation is taking place about the homes menus. The Manager has completed and submitted her application to become formally registered. Some progress has been made to develop quality assurance and monitoring of the service. The rolling programme of maintenance and refurbishment has been continued, to make sure that people continue to enjoy living in a comfortable home. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people decide if the service provides what they need. Peoples strengths and needs are assessed, so that their care and support can be planned properly. Evidence: We saw that the home has a current Statement of Purpose and Service Users Guide. These documents tell people who the service is for and what it provides. These are also available in picture / symbol versions. It is recommended that the service explores other accessible formats, to make the information about the service more available to people who may have difficulty reading written documents. The format currently in use has limited application, as it will only be understood by people familiar with that particular programme. One person moved into the home since the last inspection. We looked at her personal records and saw she had made a number of visits to the home before she moved in. This shows that positive efforts were made to introduce her to the home gradually and give her opportunities to see what it was like before coming to live there. We also saw Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: that an assessment of her needs had been completed before she was admitted. We looked at the personal file of another person that has lived at the home for a number of years. We saw that his assessment had been reviewed by a social worker during the last twelve months. Ensuring that peoples needs are assessed and then kept under regular review is important, so that their care and support can be planned properly. Care Homes for Adults (18-65 years) Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and management need improvement to ensure that people get supported in the ways that suit them best. Evidence: The people using this service have high level and complex support needs. We looked at their personal records to see how their care is planned and managed. The complexity of their care needs means that there is a lot of information to be managed, and this should be acknowledged. The records we looked at would benefit from a good tidy up: material that is no longer current or has been superseded should be removed and archived or disposed of as appropriate. The files we saw contained care plans and risk assessments, and evidence that these have been kept under review. It is recommended that care plans and risk assessments are indexed and cross-referenced, so that important information is easier to find. Care plans need continuing development, so that staff have clear guidance about how to give support in ways that suit people best. We saw some evidence of attempts to Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: introduce person-centred approaches, but these need further development. Staff need to receive proper training and support in person-centred planning if these tools are to be used effectively. Each person has a named key worker. This member of staff is responsible for completing a monthly report: this is so that care plans can be kept under constant review and updated or amended as appropriate. This would work better if care plans were developed to include some clear goals with measurable outcomes. These should be directly linked to peoples wishes and their assessed needs. Being clear about this should help to guide planning for peoples activities, and their health and personal care support. Goals could then be evaluated each month, to see what is working and what needs to be changed. The way in which records are currently being completed suggests that staff need more support and training to make the best use of these. Doing this well would help to ensure that peoples care plans are live working documents, and ensure they get the support they need to achieve the things that are important to them. During our visits we directly observed staff offering choices to people about what they wanted to eat and drink, about doing activities and about going out. We saw that some work has begun on developing communication passports. This should be encouraged and developed further. The end product of this work should be to provide people with workable aides to support better communication, not just photgraph albums of past activities. Improving peoples capacity to communicate more effectively can have enormous impact on their ability to make choices and decisions. The importance of this cannot be overstated. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activity opportunities for people who use this service are limited: improvements are needed to the ways in which these are planned and managed.This is to ensure that people get the support they need to achieve their agreed goals. Evidence: In the homes Annual Quality Assurance Assessment, the Manager shows that people go out to day centres, go shopping, bowling,to discos and to church (if required) and on holidays. We saw a picture activity board timetable: unfortunately, extreme wintry conditions meant that activities outside the home were very restricted on the days we visited. Available records about peoples activity opportunities are limited, so it is difficult to make a fully informed judgement about these. Peoples communication support needs also make it difficult to consult them directly about what they think of their opportunities. Entries about what people have done are restricted to things like ball games and books, relaxing, personal care and walking around the house. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: There are tick box records of ILS (independent living skills) such as laid tables, wiped counters, made bed, tidied room, etc. but no indication of how this information is used or evaluated. We saw picture boards displaying photographs of people doing activities around the house, and of their holiday to Southport and day trips to Elan valley and the Severn valley Railway. Records also show that people are supported to keep in touch with their families and loved ones, where this is possible. There is room for significant development in the ways in which peoples activities are planned and managed. It has to be acknowledged that the complex care needs of this particular group of individuals present significant challenges to this. As recommended above, improving the use of person-centred approaches would provide clearer guidance about the things that are really important to each individual. This should support the setting of clear goals with measurable outcomes. Peoples activities can be the vehicle for providing opportunities to help them meet their agreed goals and achieve their aspirations. This means that there should be clear links between what people get to do and their assessed needs and agreed goals. Making all activities purposeful could be helpful in this regard, so that staff are clear about what they are doing and why. Activities might be about teaching or maintaining skills, for therapeutic reasons (promoting good health), or just because people enjoy them. Doing this well helps to ensure that people get the support they need to achieve things they see as important. Action should also be taken to ensure that people get the support they need to do activities on an individual basis. A lot of the opportunities people currently have are on a group basis. This is an area for improvement identified in the homes Annual Quality Assurance Assessment (AQAA) We looked at food stocks and saw that these were plentiful, including fresh fruit, vegetables and salad items. It was disappointing to see that stocks were mainly of the supermarket value range variety and milk long life not fresh. The home operates a rolling four week menu and there is a pictorial version of this available. At the last inspection it was recommended that support be obtained from the community dietician to improve the care teams knowledge and understanding of nutrition. The Manager told us that this had been done, and staff records show that additional training has been provided in this area. The organisation has introduced a food quality audit that is completed regularly. It is difficult to see how many of the people using this service are able to take part in this in a meaningful way, due to their communication support needs and levels of learning disability. Care Homes for Adults (18-65 years) Page 16 of 30 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. Improvements are needed to peoples care plans to ensure they get the support they need in the ways that suit them best. Developing Health Action Plans will help to ensure that peoples healthcare is more actively promoted and systematically managed. The home acts positively to ensure that people get their medication safely. Evidence: When we visited the home we saw that people were well dressed in clean, good quality clothing: it was also clear that people had received the support they needed with their personal hygiene. Staff and residents appeared to have a good rapport, and to be comfortable in each others company. We saw that interactions were warm and friendly, and that, in general people were treated with respect. However, we did observe some inappropriate interaction, and spoke with the Manager and a member of staff about this. It is important for staff to remember at all times that the people in their care are adults, and should be responded to accordingly. When people seek to engage with staff, it is not appropriate to respond in the way one might to a dependent child. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: As reported above, peoples care plans are in need of development. Extending the use of person-centred approaches would be a positive step towards achieving this. Care plans should provide clear guidance to staff about how to support each individual in the ways that suit him or her best. We saw that (under personal hygiene) one persons care plan just showed requires assistance. The care plan should show what that person can do independently, and then identify clearly the things staff need to do to give support in the ways he or she prefers (e.g. in person-centred language: what works / what doesnt work for me). We looked at peoples personal records to see how their health care is planned and managed. Files we looked at contained records of involvement of other professionals including GP, consultant psychiatrist, psychologist, speech and language therapist, dentist, optician, chiropodist, and so on. We saw records of medical appointments and annual healthchecks. On one persons record it was difficult to see which of the named professionals involved in her care related to a previous placement, and which remained current. We saw charts for monitoring peoples weights, but these had not been completed in all cases. There were records of bowel care and fluid intake (incomplete and undated), but it was not possible to see if these were also current. As reported above, peoples records should be weeded so that material that is no longer in current use be archived or disposed of. It is recommended that each person has a Health Action Plan, in keeping with the aspirations of the Government White paper Valuing People (2001). This will help to ensure that peoples health care is planned and managed more systematically. Doing this well should proactively promote individuals health and wellbeing. It is recommended that the support of the local Health Facilitation Team be sought in order to achieve this. We looked at the arrangements in the home for administering, handling and storing medication. Two staff are involved each time medication is administered. One gives it and the other witnesses, with both staff signing the administration records. This is good practice and helps to minimise the risk of errors. Recommendations made at the last inspection have been met. Clear guidance is given to staff about storing creams and lotions, and these are now separate from internal medication. We saw that medication had been given as prescribed, and the Medication Administration Record (MAR) completed appropriately. We sample checked stocks of medicines not dispensed in blister packs, and these tallied with the record. Daily temperature checks of the medication store are recorded, and monthly audits completed of medicine stocks. Sample signatures of staff responsible for administering medication were available. We saw that the local Boots Pharmacist had recently completed an audit: the report showed no problems, with the comment very good. These things show that the home takes positive action to ensure that peoples medication is safely managed. Care Homes for Adults (18-65 years) Page 18 of 30 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. Developing systems for recording complaints would help to show how peoples worries are acknowledged and dealt with. The whole staff team needs to have safeguarding training to ensure that they have the knowledge and skills they need to keep people safe. Evidence: We looked at the homes complaints policy and procedure, and saw that the company has also produced this in picture / symbol format. We asked if anyone in the home has an understanding of the picture / symbol format used for the accessible version of the complaints procedure. The communication support needs and levels of learning disability of the people using this service mean that formal procedures and written documents have little relevance to them individually. People using this service generally rely on the understanding and vigilance of the staff team to notice changes in behaviour, demeanour or body language as indicators that they are unhappy or concerned. We looked at the homes complaints file. The Annual Quality Assurance Assessment shows that one complaint has been received since the time of the last inspection. We saw that this had been dealt with appropriately. It is recommended that the systems for recording peoples concerns are reviewed. The Keyworkers monthly report might provide good opportunities for achieving this. This is so that the ways in which peoples worries are acknowledged and addressed can become more transparent. Developing the homes complaints culture in this way can provide opportunities for learning, as well as improving the service to meet the needs and Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: wishes of the people who use it. We talked to staff on duty about safeguarding. They were able to tell us the different forms abuse can take, and identify things that they know they must constantly look out for. They showed that they understand their responsibilities and know what action they must take in the event of suspecting or witnessing abuse. The Annual Quality Assurance Assessment (AQAA) shows that no safeguarding referrals have been made since the last inspection. We have not received any safeguarding referrals about this service either. We saw that there was an easy read copy of the local multi-agency guidelines (Dudley Safeguard and Protect) available in the office. The current full text version of this was not available, as recommended at the last inspection. Available training records did not show that all staff have received safeguarding training, and this should be addressed. The Manager told us that safeguarding training for newer members of staff, and training on the Mental capacity Act / Deprivation of Liberties safeguards for all staff, is scheduled in the near future. Care Homes for Adults (18-65 years) Page 20 of 30 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 enjoy the benefit of living in a comfortable safe and homely environment Evidence: We looked around the house in the company of the Manager and a senior member of staff. The home is a large detached house, developed and adapted for its current use. Previous inspection reports show that there has been a rolling programme of redecoration and refurbishment, to ensure that people living there are provided with a comfortable living environment. We saw that this has continued, and that the staff team works hard to make sure that people enjoy living in a house that is homely and welcoming. We saw that peoples rooms were individual in style and contained personal valued possessions. We saw pictures, ornaments, family photographs, collectables, TV and DVD and music players. Staff support people to try and make their personal spaces their own. There are ample bathing and toilet facilities to meet peoples needs, though only one (ground floor) bedroom includes en-suite amenities. On the ground floor is a lounge and conservatory area. This houses the activities cupboard which we saw was in need of repair. There is a small aquarium in the lounge, which one of the residents looks after with staff support. The wall lights in this Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: room needed new bulbs and lampshades. There is a separate living-dining room, which we saw was well used. There are picture activity boards and a staff board displaying photographs of the members of the team on shift that day. There are also photograph display boards in this room and in the hallway showing pictures of people engaged in activities around the house and on daytrips and holidays. The large kitchen, main office and staff room are located at the back of the house, off the dining room area. We saw that the kitchen was well managed and clean and tidy. A small laundry room is situated on the first floor. This has a washing machine with sluice cycle, and we saw that gloves, aprons, soluble laundry bags, and individual named laundry baskets were available and in use. Good standards of hygiene and infection control were being practised. The house was clean, fresh and tidy. The wintry weather conditions, including several inches of snow, meant that it was not possible to review the homes outdoor facilities. Care Homes for Adults (18-65 years) Page 22 of 30 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. There are enough staff employed at the home to meet peoples basic care needs, but this should be reviewed so that peoples opportunities for individual activities and support can be increased. Important checks are carried out to ensure that staff employed at the home are fit for their jobs. Arrangements for training and supervision of staff need some improvement. This is to ensure that they get all the support they need to do their jobs well. Evidence: We looked at staff records to see how the service selects and recruits people to work at the home. Files we saw contained completed applications (including employment histories), two written references, and evidence of checks with the Criminal Records Bureau (CRB). This shows that the service follows accepted best practice to ensure that people employed at the home are fit for their jobs. The Manager told us that there are three staff on duty each shift during the day. The Annual Quality Assurance Assessment shows that eight staff have left the team in the last year. This raises some concerns about the continuity of care provided for the Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: people using the service. This is particularly significant for people with high level and complex support needs, who may not be able to understand the changes. It is important that staff work with people consistently over time, in order to gain a good understanding of their likes and dislikes and how they communicate. Staffing arrangements are adequate to meet peoples basic care needs, but this should be reviewed so as to provide additional scope for people to be given support for individual activities. The manager provided a copy of the current staff training matrix, but this did not include information relating to newer members of staff. A current training and development plan should be produced. It is recommended that this be presented in spreadsheet format. The plan should show (for each member of staff) training completed and qualifications gained, with relevant dates. It should show when refreshers are due and when training has been scheduled. Presenting the plan in this way should give the manager an instant overview of the teams training and development needs. This should also be a valuable tool for planning and managing future training opportunities. The training matrix provided shows that only three of the current team hold qualifications at NVQ level 2 or above, which is below the recommended minimum 50 . It has to be acknowledged that losing a significant number of staff during the year will have affected this, and the Manager told us that new staff are enrolling on courses as soon as this can be arranged. The Manager advised that the company is introducing an e-learning programme to provide staff with training in the near future. It is important that the training policy be updated to reflect these changes. Staff should be given the time and support they need to follow any new programme effectively. Arrangements need to be put in place to ensure that competencies are assessed appropriately following completion of learning modules. Records for this should be maintained and available for inspection. We looked at staff supervision records. The Manager told us that annual appraisals for staff have not yet been done, but that this matter is in hand. Available supervision records show that some staff have received the recommended minimum six supervisions in a twelve month period, but some have not. There were no supervision records available for the homes Manager, but she said that she was well supported by her senior manager. Action needs to be taken to ensure that supervision meetings are scheduled and take place regularly for all staff to ensure that they get all the support they need to do their jobs well.However, we saw records showing that staff group meetings have taken place regularly, as required. Care Homes for Adults (18-65 years) Page 24 of 30 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 Manager needs to ensure that she allocates sufficient time to fulfill all her management responsibilities. Quality assurance systems need to be implemented fully, to ensure that the experiences and views of people using the service guide its review and development. Essential equipment in the home is serviced and checked regularly, to promote peoples health and safety. Evidence: The Annual Quality Assurance Assessment (AQAA) shows that the Manager is currently working towards gaining qualifications at NVQ level 4 in Leadership and Management. When we visited the home, her application to become registered as the Manager of the home was in progress. Staff that we spoke to told us that she is very approachable, and that they have no concerns about raising any issues with her. The Manager told us that she feels she is still learning aspects of her job, but that she feels she gets good support from her line manager and from her peers. She still takes a hands on role in the care and support of people who use the service. It is important that she devotes sufficient time to ensuring she is able to fulfil all her management Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: responsibilities. We talked to the Manager about monitoring and Quality Assurance of the service. She told us that she has to make a monthly return to senior managers in the organisation. We saw that reports required under Regulation 26 (Care Homes regulations 2001) have been completed each month. We saw records of other monitoring activity (for example food satisfaction surveys and general service user questionnaires). The information gained from service monitoring needs to be collated and analysed, and a report produced of the findings. Some thought should be given to making questionnaires and surveys for residents more user-friendly and person-centred, taking account of their specific communication support needs and levels of learning disability. The outcome of quality assurance monitoring and reporting should be to show clearly how the information gained has underpinned the review and development of the service. The report should show clearly how things have been improved for the benefit of people using the service. This should be circulated to all interested parties. As mentioned elsewhere in this report, we saw that record keeping in the home would benefit from a good overhaul so that old material that is no longer current is archived or disposed of as appropriate. When sampling records relating to the management and day to day running of the home, we came across material relating to the previous owners of the service. It is recommended in particular that individuals care records are tidied up, to ensure that they are current, working documents. We looked at records relating to the management of health and safety in the home. The Manager told us that the organisation has appointed an independent company to support them in this area of work. We saw that a detailed health and safet audit had been completed in recent months. The records we sampled showed that regular servicing and checks are being carried out on essential equipment, including the fire alarm, fire fighting equipment and emergency lighting systems, as well as gas and electrical installations. This shows that the home takes positive action to support people living and working in the home to stay safe. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 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 Explore other accessible formats, so that information about what the service provides can be made more widely available. Develop the use of person-centred approaches, so that people get the support they need in ways that suit them best. Ensure that staff get the support and training they need to use care planning tools effectively Index and cross reference care plans and risk assessments, so that important information can be found quickly and easily. Develop clear links between activity plans and individuals agreed goals. This is so that people get the support they need to do the things that they value. Develop opportunities to enable people to be supported to do things on an individual basis. Review peoples involvement in routine tasks around the house (independent living skills) so that these activities are purposeful, and staff are clear about what they are trying to achieve. 2 6 3 9 4 14 5 16 Care Homes for Adults (18-65 years) Page 28 of 30 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 6 18 Develop care plans and make them more person-centred. This is so that staff have clear guidance about how to support individuals in the ways that suit them best. Develop and implement Health Action Plans so that peoples healthcare needs are managed more systematically. Seek professional support to ensure this is done effectively. Develop systems for recording peoples complaints, so that it is clear how their concerns have been acknowledged and dealt with Ensure that all staff receive training in safeguarding and understanding their responsibilities under the Mental Capacity Act. This is to ensure they have the knowledge and skills they need to support people to stay safe. Review staffing arrangements so as to provide more opportunities for people to undertake individual activities Develop training policy to take account of new e-learning programme. Produce a complete training and development plan for the whole staff team. This is to ensure that staff have the support they need to gain new skills and competence. Ensure that staff receive regular supervision and an annual appraisal, so that they get all the support they need to do their jobs well Review priorities to ensure that the Manager has sufficient time allocated to enable her to fulfil her management responsibilities. Complete quality asurance and monitoring processes so that information can be collated and analysed, and the findings shared with all interested parties. This is so that the home can demonstrate how the experiences and views of people using the service guide its review and development Review record keeping in the home and archive material that is no longer required. This is so that files are maintained as current working documents, making it easier to find important information. 7 19 8 22 9 23 10 11 33 35 12 36 13 37 14 39 15 41 Care Homes for Adults (18-65 years) Page 29 of 30 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). 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