Care Home: The Grange

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What the care home does well The home has a thorough admission process which includes people being able to visit the service and being given information to help them make an informed choice about the service. People`s needs are assessed as part of the process and this minimises the risk of a person being admitted whose needs cannot be met. Where people may have a problem understanding a document staff spend time explaining it to them, people then sign the document in agreement. Each person has a wide range of care plans that provide the reader with detailed information about the person`s needs and the steps required to meet those needs. This plans are regularly reviewed and updated as required. Where there are restrictions to peoples freedom and choices the reasons are identified. There are a good range of risk assessments in place to minimise potential risks while enabling people to go about their day to day lives, some shortfalls were identified and brought to the attention of the manager. People live active lifestyles and staff provide the appropriate support where needed. People are part of the local community making use of the facilities as they wish. People`s religious needs are identified and some people attend the local Church regularly where they are members of the choir. People are being supported to learn new domestic skills around the home to promote their independence. Where people have communication difficulties staff make use of photos to enable people to make choices more easily. Staff support people to make use of health professionals as required. Medication administration is managed effectively and this minimises potential risks to people living in the home. People living in the home are protected from abuse through robust procedures and good reporting by the manager and her staff team. Where people may display behaviour that challenges there are detailed guidelines in place for staff to follow and these are supported by staff training. Where people are unable to manage their own monies there are robust systems in place to minimise the potential risks to people. The building is maintained to a high standard throughout. People benefit from a home that is clean, tidy and comfortable. People living in the home are empowered to choose style of decoration. The home`s recruitment procedure is thorough and this minimises the potential risks to people in the home. Staff are provided with regular training to meet the needs of people in the home and also address their personal development needs. Health and safety around the home is well managed through training, policies and procedures and regular checks of various areas by staff. What has improved since the last inspection? All of the requirements and recommendations from the previous inspection report have been completed. What the care home could do better: Where ever possible care plans should promote developing skills as well as maintaining them. Documents used by people in the home should be developed into a user friendly format. Persons Centred Plans (PCP) should be completed for each person and detail the goals they wish to achieve and provide evidence of the progress/completion. The manager should ensure that records management is effective enabling people to access information easily. Where people are being supported to learn new domestic skills around the home these should be identified and peoples progress recorded. The manager should refer to the National Minimum Standards and Key Lines of Regulatory Assessment to identify what further actions could be taken to ensure quality assurance in the home is promoted and achieved. Key inspection report Care homes for adults (18-65 years) Name: Address: The Grange 15 Holmwood Drive Tuffley Gloucester Glos GL4 0PS     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: Paul Chapman     Date: 0 4 1 1 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 Grange 15 Holmwood Drive Tuffley Gloucester Glos GL4 0PS 01452300025 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: info@holmleigh-care.co.uk Mr Rodney Wayne Correia care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability learning disability Additional conditions: The registered manager must complete her NVQ 4 in Management by May 2006 The registered manager must complete her NVQ 4 in Care by May 2006 The registered person may provide the following category of service only; Care Home Only (Code PC)to service users of either gender whose primary needs on admission to the home are within the following category: Learning Disability ( Code LD) The maximum number of service users who may be accomodated is 10 Date of last inspection Brief description of the care home The Grange is a large detached Victorian house situated in a quiet residential area approximately three miles from the centre of Gloucester. The home offers residential care for up to nine adults with Learning Disabilities who from time to time display some challenging behaviours. Residential accommodation is provided on two floors, with three ground floor bedrooms and six first floor bedrooms. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 10 9 Brief description of the care home The ground floor of the property provides a lounge, dining room, kitchen, laundry, conservatory, staff office, the communal bathroom and toilets. On the first floor in addition to the bedrooms there are two bathrooms, and an office. To the rear of the property a respite unit named Wren House which can provide accomodation for one person, a fenced garden/lawn area and a parking area. At the front there is a small garden area, with trees and shrubs. A Service Users Guide and Statement of Purpose is available from the homes manager. Fees to live in the home are dependant on the persons assessed needs. 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: Before completing the inspection site visit to this service we (the CQC) sent the registered manager questionnaires to distribute to people living in the home and for staff to complete. In addition to questionnaires the registered manager also completed an AQAA (Annual Quality Assurance Assessment). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). Care Homes for Adults (18-65 years) Page 6 of 31 This site visit was unannounced and completed over 1 day in October 2009. On arrival at the home we were greeted by the manager who was present throughout the site visit. People were due to go out and complete some activities so we took the opportunity to meet with them individually before they left. Whilst completing a tour of the premises we were able to observe the interactions between staff and people in the home and these were seen to be respectful and friendly. We examined the care of 3 people in detail and this included meeting with them to discuss what they thought of the home. In addition to assessing the quality of care provided in the home we also looked at other records including staff training, health and safety records and medication administration. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: The home has a thorough admission process which includes people being able to visit the service and being given information to help them make an informed choice about the service. Peoples needs are assessed as part of the process and this minimises the risk of a person being admitted whose needs cannot be met. Where people may have a problem understanding a document staff spend time explaining it to them, people then sign the document in agreement. Each person has a wide range of care plans that provide the reader with detailed information about the persons needs and the steps required to meet those needs. This plans are regularly reviewed and updated as required. Where there are restrictions to peoples freedom and choices the reasons are identified. There are a good range of risk assessments in place to minimise potential risks while enabling people to go about their day to day lives, some shortfalls were identified and brought to the attention of the manager. People live active lifestyles and staff provide the appropriate support where needed. People are part of the local community making use of the facilities as they wish. Peoples religious needs are identified and some people attend the local Church regularly where they are members of the choir. People are being supported to learn new domestic skills around the home to promote their independence. Where people have communication difficulties staff make use of photos to enable people to make choices more easily. Staff support people to make use of health professionals as required. Medication administration is managed effectively and this minimises potential risks to people living in the home. People living in the home are protected from abuse through robust procedures and good reporting by the manager and her staff team. Where people may display behaviour that challenges there are detailed guidelines in place for staff to follow and these are supported by staff training. Where people are unable to manage their own monies there are robust systems in place to minimise the potential risks to people. The building is maintained to a high standard throughout. People benefit from a home that is clean, tidy and comfortable. People living in the home are empowered to choose style of decoration. Care Homes for Adults (18-65 years) Page 8 of 31 The homes recruitment procedure is thorough and this minimises the potential risks to people in the home. Staff are provided with regular training to meet the needs of people in the home and also address their personal development needs. Health and safety around the home is well managed through training, policies and procedures and regular checks of various areas by staff. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that may wish to move into the home are given the opportunity to experience the service and they are provided with information to help them decide as necessary. The manager completes an assessment of prospective new admissions to the service and this minimises the risk of people being admitted to the service whose needs cannot be met. Evidence: We spoke to a person that had been admitted to the home since our previous inspection. They confirmed that the home has a Statement of Purpose and a Service Users Guide and that as part of their admission they received copies of each document. To help them decide whether they wished to move into the home they said they had visited on a number of occasions including staying for a weekend and other days. As part of the admission process the manager had completed an assessment of the persons needs before offering them a service. Care Homes for Adults (18-65 years) Page 11 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. There are a wide range of care plans in place that identify peoples needs and the actions staff must take to meet those needs. On the whole risk assessments minimise potential risks to people but there are some shortfalls that put people at unnecessary risk. Care plans and risk assessments are reviewed at regular intervals and this minimises the risk of peoples changing needs not being met. People are empowered to make choices in their day to day lives. Evidence: We examined the care of 3 people in detail to assess the needs identified by the manager and her staff and the care plans created to meet those needs. We spoke to the 3 people whose care we examined and they confirmed that staff had spent time with them explaining their care plans and asking their opinions. Further evidence supporting each persons involvement in their care plans was that they had signed each document stating that they agreed with it. Each person had a wide range of care plans covering areas including; personal care Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: and hygiene, vulnerability, sexuality, medication, communication, finances, Independent living skills, Meal times, Health/exercise and diet. In addition to these plans people also had other care plans to address specific personal needs. The care plans we examined were thoroughly written and reviewed at regular intervals. Speaking to the manager about care plans we suggested that as well as maintaining peoples skills, where appropriate there should be goals to improve peoples skills. The manager agreed with this. We were able to examine the PCP (Person Centred Plan) for 1 person, unfortunately the manager was unable to find the PCPs for the other 2 people. The manager assured us that they had been completed, but due to a filing error unavailable. The PCP we examined was incomplete and did not identify goals the person wished to achieve, we brought this to the attention of the manager who was surprised by our findings. We explained to the manager it is really important that PCPs are completed and that there is good evidence of peoples goals being achieved. This becomes a recommendation of this report. Whilst discussing the use of PCPs we spoke about a person in the home who wishes to become more independent, this was a good example of where a PCP would be really effective in identifying the goals they wished to achieve. When speaking with the 3 people whose care we were examining they were able to give us examples of making choices in their lives. They spoke about choosing the activities they wish to complete and the food they like to eat. Where some people have communication difficulties the home makes use of pictures to help people make choices, an example of this is meals/food people eat. The care plans we examined also provided a range of examples of people being able to make choices. In some cases it has been necessary to place some restrictions on peoples choices. This may be due to the assessed risks being to great. Where this is the case it is detailed in care plans/guidelines. It was noted though that where this is the case the guidelines also say that if the person insists then staff should respect the persons choice. This is seen as good practice. Supporting peoples care plans and the activities they take part in are a range of risk assessments. Each of the people whose care we examined had a range of risk assessments in place, again like the care plans these had been signed by the person being assessed. On the whole risk assessments were thorough and regularly reviewed. We identified a couple of risk assessments that could be more comprehensive, 1 being a persons assessment for bathing (where there was no mention of the persons epilepsy. With another person their risk assessment for vulnerability in the community highlighted a training need for staff around asphergers, and we found another 2 risk Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: assessments for absconding and road awareness that were out of date. In addition to this we were unable to find a risk assessment for the person when they were using company vehicles. It becomes a requirement of this report that the manager ensures that all of these issues are addressed. The AQAA completed by the manager highlights a goal for the coming 12 months as making care plans more user friendly enabling people with communication difficulties to understand them more easily. The manager confirmed this as a goal, it becomes a recommendation of this report that the manager ensures that all care plans are produced in a user friendly format. 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. The service is led by the needs of people living in the home and staff support people to lead active lifestyles in and around the local community. People are empowered to choose what they would like to eat and a good range of meals and snacks are always available. Evidence: From speaking to people living in the home, staff and from examining records people lead active lifestyles led by their interests and wishes. On the morning of the site visit the 3 people that spoke to us were about to go out to different activities. 1 person was on their way to college independently, another was going into town with staff support whilst the 3rd was going to the day service provided by the organisation. As identified above 1 person travels to college independently, we asked the manager what steps had been by staff to ensure that this practice was safe. They explained the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: steps staff had taken but were unable to provide any paperwork to support the actions. In addition to this filing error we were unable to find the minutes of the house meetings that take place monthly. The manager stated that this was due to a filing error, the manager must be wary of this in the future. People told us about a range of activities that take place regularly, these included; going to the cinema, pub, 10 pin bowling, line dancing, day services, college, shopping locally, walks in the local community, eating out and water aerobics. In addition to this activities take place in house and 1 person we spoke with said that she enjoyed baking cakes. At the time of this site visit 3 people spent the morning doing art and craft with staff. 2 of the people we spoke with attend a local Church regularly, and have become members of the choir. From this they have developed some really good friendships with other members of the Church which they visit for tea. The manager stated they feel a change since the previous inspection is the homes place in the community. They feel the home is now more part of the local community by taking part in local events and using local facilities. The manager explained that as an organisation they fund fire training for children at a local primary school. Another activity we were told about was each week 4 people are dropped off at a local pub (a mile away) where they stop for a drink before walking home. The manager says they think this works really well giving people the opportunity to talk without staff being present and gives them some exercise. In addition to this walk people regularly go for walks in the country, the manager told us about 1 occasion when it snowed and staff supported people to go walking and have a snowball fight. When speaking to the manager we suggested that they should maybe investigate local rambling clubs as an option for people to go out walking. Each of the people we spoke with had been on holiday this year, supported by staff. 1 person had taken his girlfriend on holiday with him. Friends and family are welcome in the home and staff provide support where necessary to maintain relationships by helping to write letters and make phone calls as necessary. A practice development since the previous inspection is the emphasis of supporting people to learn new skills around the home. People are being encouraged to take responsibility for their laundry, cleaning and some cooking. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The home has a house keeper who is responsible for cooking the majority of the meals. We spoke to them during the morning of our site visit about the food and how people are able to make choices. To support people who have communication difficulties staff have created a photo menu book that enables people to choose what they would like to eat from pictures, this is a really good practice. Staff and the manager also spoke about the importance of speaking to people individually about what they would like to eat. This came from recognising that the house meetings were not the right format to enables all people to make a decision fairly. We examined a sample of menus over the past 3/4 months, this showed people were given choices and a good range of meals were offered. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care needs are assessed and plans are in place that provide staff with detailed information minimising the risk of peoples needs not being met. Poor document management makes it impossible to confirm that peoples health needs are being addressed as required. Medication administration is well managed and minimises the potential risks to people in the home. Peoples wishes around increased mental and physical frailty are identified and plans have been developed to meet those needs. Evidence: Each of the people whose care we were examining had detailed care plans in place that identified their personal care needs and provided the reader with detailed information about how those needs should be met. As with other care plans these documents were reviewed at regular intervals and updates made as required. All of the peoples files contained information regarding their appointments with other health professionals. 2 of the 3 people whose care we were examining had hospital risk assessments and a my health record in place. Unfortunately we were unable to find these documents in the 3rd persons file. The manager again said this was down Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: to a filing error and assured us that the documents had been completed. We examined the homes medication administration with the manager. All medication is stored securely and correctly. Each person requiring medication has an information sheet that includes a picture of them, their date of birth and any special notes (allergies, etc). Each person that staff administer medication to have signed a document giving their consent to this. None of the people in the home manage their own medication. All medication sheets are printed by the pharmacist that provides the monitored dosage system that the home use. Where a change is made to a medication sheet staff sign the sheet confirming who has made the change. There is a list of sample signatures and initials enabling the reader to see who has administered medication. Only a limited number of staff are able to administer medication, all of these staff are appropriately trained/qualified to do this. All of the sheets we examined were correctly completed by staff with no errors or gaps. Medication administration in the home is being audited regularly by staff and this minimises the risk of mistakes being made and missed. When speaking to the manager about the auditing process they explained that all staff that administer medication are re-assessed 6 monthly. This is to ensure that their practice remains safe. The only shortfall we identified with this process was the managers 6 monthly practice assessment which the deputy manager is expected to complete. Discussing this with the manager we had 2 issues, it would be good practice for the manager to be assessed by someone from outside the home who was appropriately qualified in medication administration, therefore setting a baseline for the assessments and taking in latest practice. The other issue is around whether a deputy manager would feel comfortable criticising their managers practice. It becomes a recommendation of this report that these points are considered before future assessments are completed. Staff had addressed issues around peoples increased mental and physical frailty. We saw records showing that people in the home and their families had been spoken with and where appropriate plans developed to address these needs. Care Homes for Adults (18-65 years) Page 19 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. The home has a complaints procedure and comments from people in the home confirm that if they were unhappy they feel confident they could make a complaint. When people display behaviours that challenge there are guidelines in place for staff to follow, they are appropriately trained and this minimises potential risks to people in the home. Financial management in the home is effective and minimises the potential risks to people who are unable to manage their own finances. Evidence: The home has a complaints procedure. Speaking to people living in the home about making complaints 2 of the 3 people confirmed that they knew there was a complaints procedure and that they would be happy to use it if they were unhappy. 1 person said they had made a complaint in the past and been happy with the outcome. The 3rd person said they did not know there was a complaints procedure, but said if they were unhappy they would speak to the manager. We explained this to the manager, they assured us the complaints procedure had been discussed with them. The AQAA completed by the manager before this site visit stated that there had been no complaints made to them since we completed the previous site visit. The manager has made 1 referral to a safeguarding adults team for a person in the home. We were informed of this through a notification when it happened and the actions taken since Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: have protected this person. This is ongoing. All new staff complete safeguarding adults training as part of their induction. Speaking to the manager they explained a number of the staff team are due to complete refresher training in safeguarding adults and this has been booked to be completed before the end of this year. Some of the people that live in the home become frustrated, angry and anxious from time to time when they feel that staff do not understand them, this causes them to display behaviour that may challenge staff. 2 of the people whose care we were examining are sometimes challenging and this was reflected in their notes and guidelines. From notifications received since the previous inspection and records we examined that in the case of 1 person the manager and her team have worked really hard to understand this persons behaviour and support them effectively and this is reflected in incidents of challenging behaviour becoming a lot less frequent. Both people had detailed guidelines in place for staff to follow when incidents occurred. All staff receive the appropriate training in this area that minimises risks to people living in the home and themselves. After all incidents staff complete detailed notes recording the actions of the person and how the staff managed the situation. There is an expectation that after every incident people and staff will be given the opportunity to de-brief, at the time of this visit the manager said that this had not been used as yet. When examining 1 persons guidelines we noted a shortfall, the manager had spoken to us about being able to identify when a persons behaviour was going to deteriorate, and by identifying these signs they were able to re-direct the person and stop the deterioration. The guidelines we read did not detail this and it was brought to the attention of the manager. It becomes a recommendation of this report that this information is added to the guidelines. None of the people in the home manage their own finances and each person has a care plan in place that details the support they require. Only the manager and her senior support team have access to monies in the home, records we examined detailed peoples income and expenditure thoroughly. Wherever possible people are asked to sign these records confirming the entry. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, tidy and comfortable environment that is well-maintained and meets their current needs. Evidence: We completed a tour of the premises with the manager visiting all of the communal areas, 1 bedroom (with the person present) and all of the toilets/bathrooms. This showed that the home is maintained to a high standard throughout. Speaking to the person who showed us their bedroom they said they were really happy with it and they had been able to choose the colour and the furniture in it. Other people we spoke with said that they thought the house was nice and they enjoyed living there. The manager explained that they are awaiting for a covered walkway to be built from the rear of the home to the new respite accommodation that has been built in the garden. Once this has been finished they plan to re-model the rear garden and create a sensory garden for people in the home. Since the last inspection the CQC have registered the new respite unit in the rear garden. Looking at the new building it provides people with a comfortable environment which is self-contained (except for meals that will be cooked in the main house). When Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: the unit is not being used for respite care the other people in the home use it for activities. The home was clean and tidy throughout and there were no offensive odours. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by staff in sufficient numbers that receive the appropriate training to meet their needs and maintain their safety. Evidence: We examined a sample of the rotas for the past 6 months, this showed that there was a small amount of sickness within the team over this period. The manager does not use agency staff to cover shifts as they feel it unsettles people in the home and effects the quality of the service being provided. These shifts will usually be covered by members of the staff team, or the manager themselves. The rotas we examined showed that the manager works a number of shifts in the home on a regular basis. Usually there are 3 staff on duty on each shift (2 shifts between 730am and 10pm), at night 1 member of the team will sleep in and another member of staff will work a waking night (the home employes people especially to work nights). Since the previous inspection the home has only employed 1 person. We examined the recruitment records which showed that the manager/organisation had collated all of the information required by these regulations. Speaking with the manager they stated that a goal for the future is to involve people living in the home in the recruitment of future staff. This is seen as good practice. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: From speaking to staff and examining records we were able to confirm that staff receive regular supervision sessions every 2 months. The manager also explained that they were going to start staff appraisals in the month following this site visit. The manager stated that staff meetings happen monthly, but speaking to staff they werent sure how frequently meetings were held. We were also unable to find minutes for recent meetings. The manager should ensure that minutes of these meetings are recorded and filed correctly. This becomes a recommendation of this inspection report. The manager supplied us with a copy of the training matrix for staff, this showed what training staff had completed and when refresher training was due to be completed. The manager explained that a number of staff are due to complete refresher training in topics including; fire awareness and Positive Behaviour Management (PBM). The manager stated that training had been arranged for the relevant staff before the end of this year. Records showed that where staff had required refresher training in the past this had been completed. Training records showed that of the staff team of 12, 9 have completed NVQs (National Vocational Qualification) to a minimum of level 2 in health and social care. When we spoke to staff and from questionnaires we received from other staff it was agreed that the organisation provide a wide range of training to meet the staff and peoples needs. 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. Comments from staff and the records present in the home provide good evidence that on the whole the home is well-managed and led by the needs of people in the home. Quality assurance in the home has not been formalised but there is good evidence of peoples needs and wishes being addressed. Potential risks to peoples health and safety are minimised through training, policies and procedures. Evidence: The registered manager has been in post at this service for a number of years and is appropriately qualified. Feedback from 3 staff who spoke to us and from 5 questionnaires was positive about the service and the manager. Comments we received included; I feel that the home works to a high standard, The Grange is a homely place, all of the staff get on very well, we all give the service users the best of our ability, The staff team are great and care about the service users completely, We provide a strong staff team and receive ongoing training to meet the required legal standards and those of all the Granges residents, I enjoy working at the Grange. From this site visit we saw a good range of evidence to support that the home was being managed well. Our only concerns about the management of the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: service was around the number of documents that we were unable to find. During the site visit we made a number of recommendations to the manager about how current practices could be improved. As identified earlier in this report since the previous inspection there has been a major variation application processed by the CQC to register the respite unit. The report completed by the CQCs registration team into this process raises some concerns about how this process was managed by the organisation and the manager. These concerns centre on how information was provided to the CQC, that information was received late and was incomplete and that the manager showed poor awareness of the regulations. Speaking with the manager about quality assurance in the home they explained that Regulation 26 visits are completed monthly by a care consultant employed by the organisation. The practice of reviewing care plans, risk assessments and asking people what they would like to do supports quality practice in the home. Speaking to the manager we suggested that they look at standard 39 of the NMS 18-65, (National Minimum Standards 18-65), and the KLORA (Key Lines Of Regulatory Assessment) to decide how they ensure quality assurance is appropriately addressed. This becomes a recommendation of this report. The AQAA completed by the manager states that all of the homes policies and procedures were reviewed in January 2009. Health and safety around the home is taken seriously and risks to people living in the home are minimised through training, policies, procedures and regular checks completed by staff. We saw records to confirm that confirmed the following; fridge and freezer temperatures are recorded twice daily, a food probe is used to test hot food, fire equipment is regularly serviced and tested, PAT (Portable Appliance Testing) is completed annually. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The manager must ensure 27/11/2009 that all risk assessments are reviewed and up to date. All risk assessments must provide the reader with comprehensive information about the potential risks and the actions to minimise them. Failure to do this puts people in the home at unnecessary risks. 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 6 The manager should ensure that the goal to introduce user friendly care plans and other documents is achieved. Failure to do this de-values the current care plans as some people are unable to understand them in their current format. 2 6 The manager should review care plans to ensure that where ever possible care plans promote people learning Page 29 of 31 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations new skills as well as maintaining them. Failure to do this may mean that people do not get the opportunity to learn new skills. 3 6 Each person should have a completed PCP in place that highlights their wishes/goals, these goals should be clear and there evidence available that shows what work is in the process of being completed, or has been completed. The manager should ensure all paperwork required to be in place is available for inspection as necessary. Failure to provide paperwork supporting practices/actions makes it difficult to judge whether good practices have been adhered too. 5 19 The manager should ensure that document management is effective so that all of the records relating to peoples care is easily accessible. Failure to do this may present a risk of staff not being able to meet a persons needs due to the information they require not being available. 6 20 The six monthly assessment of the managers medication practices should reviewed to consider whether this assessment should actually be completed by someone from outside the home who is appropriately qualified. The manager should ensure that the details identified in the body of the report are added to the persons guidelines. Failure to do this may mean that indicators are missed and the persons behaviour deterioates unnecessarily. 8 9 33 39 The manager should ensure that the minutes of staff meetings are stored correctly. The manager should ensure that quality assurance procedures are formalised to meet the criteria of the standard and regulations. 4 13 7 23 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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