Care Home: The Grove

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What the care home does well Daily routines are relaxed and flexible. People are supported to follow their chosen lifestyles and take part in activities they enjoy. People have their own care plan that tells staff how they like to be supported. People are helped to stay in touch with their friends families. They are enabled to access local health care and are well supported with their health needs. They live in a homely and safe house and have nice single bedrooms. They are supported to do things for themselves and make their own decisions. People say they like the staff who are caring and friendly. People are happy in the home. They are able to give their views and feel that staff will listen to them. People medicines are looked after safely. The home is run well. What has improved since the last inspection? Some parts of the home have been made nicer and a new water system has been fitted. More staff training has been provided in some areas such as care planning. The way the owners monitor the service has been developed. What the care home could do better: Information about the service and peoples` daily lives could be made clearer for them. Staff could be offered more training to help them do their job. More staff may be needed to enable people to out regularly. A different vehicle is need for one person. There could be more male staff as most of the people in the home are men. More staff could become qualified. The fire arrangements could be clearer and night staff should take part in drills. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Grove 8 Blakebrook Kidderminster Worcestershire DY11 6AP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Littler     Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 35 Information about the care home Name of care home: Address: The Grove 8 Blakebrook Kidderminster Worcestershire DY11 6AP 01562820728 01562820728 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Tracscare Group Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 0 mental disorder, excluding learning disability or dementia physical disability Additional conditions: 12 12 The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia (MD) 12 Physical disability (PD) 12 Date of last inspection Brief description of the care home The Grove is registered to provide residential care for up to 12 adults, who may have an acquired brain injury or a physical disability. The Grove is a large, detached, Grade 2 listed building, situated in a pleasant residential area of Kidderminster and within walking distance of the town centre. There are 12 single bedrooms on two floors, and each floor is provided with lounge, dining room, kitchen, bathroom and toilet facilities. The house has a pleasant garden and there are plans for a conservatory. The company operating as TRACS Ltd. was established in 1983, and has several care homes in Wales and the West Midlands. The current range of fees is between thirteen hundred and sixteen hundred pounds a week. Care Homes for Adults (18-65 years) Page 4 of 35 Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The service was rated as Good at the last inspection and therefore has not been inspected for two years. We, the Commission, carried out this unannounced inspection over one day. The deputy was on duty and helped with the process. We looked around the home and two people let us see their bedroom. We spoke to people in the home and to some of the staff. Care Homes for Adults (18-65 years) Page 6 of 35 We looked at records such as care plans and medication. We saw how people spend their time and mix with the staff. The deputy sent us information about the service before the visit. This is called an Annual Quality Assurance Assessment AQAA. We sent out feedback surveys to the people in the home, to the staff and to health and social professionals who visit the home. What the care home does well: What has improved since the last inspection? What they could do better: Information about the service and peoples daily lives could be made clearer for them. Staff could be offered more training to help them do their job. More staff may be needed to enable people to out regularly. A different vehicle is need for one person. There could be more male staff as most of the people in the home are men. More staff could become qualified. The fire arrangements could be clearer and night staff should take part in drills. Care Homes for Adults (18-65 years) Page 8 of 35 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 set out 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 35 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 35 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. Potential new residents are given information about the service but this can be improved. They will have their needs assessed and be given the opportunity to trial the service. Evidence: There is a Clients Handbook or Service Users Guide. An Easy Read version has not been developed to help people understand or remember the information. The fees are included but no information about what is and is not included in the fees, for example activity and holiday costs. There is a Statement of Purpose and this has been kept under review. In April 2008 the providers agreed with us to remove one of the categories of registration. They will no longer admit people with a learning disability. There are currently four vacancies. In the last year one resident passed away and another has been admitted. The homes procedure for new admissions is for an assessment to be completed and for staff to work closely with the person, their social worker, parent or carer and any other key Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: people during the assessment and transition process. An initial review meeting takes place after thirteen weeks. The circumstances of the new man were quite unusual. He was not able to give much background information and had no representatives. Apart from one incident early on that did not affect other residents he has settled well and the placement has been a success. Staff are still finding out information from him and from their observations. He did visit once before moving in. The policies state that people in the home will be consulted about people moving in. Consideration should be given to having more than one visit to give residents the chance to form an opinion about the person concerned. A record of how they have been consulted should be kept to show that this policy is followed. TRACS employ a clinical support nurse who can be involved in the assessment process and who helps develop risk assessments and guidance for staff about the support the new person needs. The nurse had been involved in developing guidance for this persons care plan. Care Homes for Adults (18-65 years) Page 12 of 35 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. Peoples needs are recorded in their care plans and kept under review. They are supported to make plans for their future and have goals to work towards. People are enabled to take risks in order to have a normal lifestyle. They are supported to make choices and decisions about their lives. Evidence: Each person has a care plan. Two were seen as part of tracking the service these people receive. The information about their needs and how these are met is written respectfully. It is detailed covering appropriate areas such as background life history, health, activities, personal support, preferences and goals. The information has been written in a person centred way. For example, one plan covered how often the person sees his mother and what causes him embarrassment in relation to his personal care. It has not been presented in a way that is easy for people to understand what has been written about them. Individual risk assessments are included covering areas such as health needs like epilepsy, accessing activities without staff support, helping in the Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: kitchen or garden, and leaving the house without staff support. Those seen indicated that a sensible approach is taken to managing risks and there is an appreciation that taking risks can enhance peoples life experience. Each person has an allocated keyworker. It was not established if they can choose who takes this role for them. Both plans have been reviewed regularly by keyworkers and more formally at reviews. One mans file showed a review meeting had been held recently and another is planned for six months time. The minutes recorded the situation regarding his epilepsy, general health and activities. It did not mention incidents and emotional issues or the use of as required medication. Monitoring these needs and associated strategies including the use of medication should always be included. The report showed that the man is gaining independence skills and is now accessing a day resource without staff support. He has expressed a wish to go on holiday, to go to a theme park and live independently again. His social worker was going to be contacted to explore housing options. The other persons file showed he had goals of walking further and taking his plate and cup into the kitchen. The AQAA reported that care plan training has been provided for staff in the last year. There is a plan to increase the level of monitoring of care plans. Feedback indicated that people feel they decide how to spend their time. An occupational therapist gave feedback that she had consistently witnessed staff asking her client what his choices are, listening to him, respecting his choices and provide them as far as possible. People were observed to be relaxed at home and making day to day choices with staff support for example they were offered outings such as going out for coffee. Colour samples for the new lounge carpet are being sent to enable people to be involved in the process. Assessments have recently been completed about peoples mental capacity to make decisions for themselves. One seen showed that staff felt the person could not make his own decisions in four areas of his life, such as money management. The assessment should be accompanied by a care plan guiding staff about how to promote the persons involvement in decisions making in these areas. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to become independent and make decisions for themselves. They have opportunities to plan their activities and tale part in home life. People stay in touch with family and friends and they enjoy their meals. Evidence: Part of the stated philosophy of the organisation is to positively encourage independent living and self care skills. Staff confirmed that people are encouraged to be independent and gave examples of recent personal development. Personal goals are included in their care plans. People are involved in the homes daily routines such as shopping, doing their own laundry and cleaning their rooms. People take part in a range of leisure activities in the community and in the home. Feedback indicated that people felt they could choose how to spend their time and Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: they planned activities with their keyworker. Their preferences are recorded in their care plans. Some examples of activities requested are card sessions, playing pool, going to the garden centre. One worker holds dance and movement sessions regularly. Staff told us that most people attend and enjoy these. People were observed to read newspapers with staff, play pool, go out for a walk, do art, watch TV and sit in the sun on the patio. Staff were seen to support people to look at photos from their past to help them use their memories. One person told us she loves the television programmes and plans ahead what she will watch. A keyworker told us that the man she is supporting likes to go to the barbers for a hair cut and beard trim. He also likes cars so she will be offering him a trip to car museum. People did seem to be offered to do things they like but records showed they sometimes decline offers. Some staff feedback indicated that staffing levels limited what activities are provided and that this particularly affected the two people who needed higher levels of support. One of these men was taken for a walk but staff said this was the first time he had been out for sometime. There is a relaxed atmosphere in the home. There are some restrictions such as no one has their own front door key, the kitchen is locked when not supervised by staff and people do not look after their own money or medication. Staff said they support people to make a drink or snack whenever they want one. The Deputy said the restrictions are needed because of peoples needs. They should be kept under review as most people seem quite able and with the right safeguards and memory support may be able to take on more responsibility. Staff manage several peoples cigarettes, which leads to people having to ask staff for a cigarette regularly. Consideration should be given to ways of supporting people to manage this area in a more enabling way. There were staff photos on wall and a poster about the next residents meeting. There is no pictorial rota displayed and no other user friendly information was displayed in formats to aid peoples memories such as activities timetables or daily routines. One person said she would like to have a menu on display in her upstairs kitchen that she can understand. Staff said most residents attend the monthly residents meetings, which are informal, but she felt ideas for new activities or outings usually have to come from staff. There is twenty pounds a month allocated for activities for each person and the fees include the cost of a three day break away each year. Staff told us that due to staff shortfalls no holidays and only two day trips were arranged in 2008. Staff feedback reported that the two vehicles do not suit two of the residents as they have some physical disability. Staff felt they have raised this many times but the organisation has not listened to them. As a result one person now cannot use it at all. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: The deputy confirmed this and said they are exploring other options. An occupational therapist said she believes staff understand that the service is the residents home and feels they seek to provide a warm and caring atmosphere throughout the daily activities. Information in care plans showed that people are being supported to stay in touch with relatives. Relatives are welcome to visit the home. People said they liked the meals provided. Staff said there is a different menu for both units but people seem to eat together downstairs so it is unclear why. Staff said the menus have been in place for a long time and they did not think they were chosen by the residents. They said choices are always offered if someone dose not like the menu meal. The meals observed seemed relaxed. Staff said they supervise meals and cut food up to help people at risk of choking, but that no one has a special diet. One person has diabetes but he reportedly does not follow a diet. Meals from other cultures have been cooked by staff from those countries and residents choose which takeaway meal they want once a month. A worker said that as one man was eating a lot of the communal fruit so he now goes out to buy his own supply. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and encouraged to be independent where possible with their personal and healthcare. Staff are not currently trained to have a full understanding on some peoples health conditions. They will be respectfully supported through the ageing process, and illness and death should they wish to stay at home during this time. Peoples medicines are being safely managed on their behalf. Evidence: The care plans sampled included details of peoples personal and healthcare needs. They showed that people are being supported on a daily bases with their personal care and that people are enabled to be independent where possible. Those residents who gave feedback all said they are happy with the support they receive. Staff interactions observed were friendly but respectful and they were seen to take steps to maintain peoples privacy and dignity. People are all registered with the local health centre and dentistry practice. Records are made in their care plans related to the outcomes of health appointments. As mentioned the organisation employs a nurse who gives advice about peoples Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: emotional and behavioural needs. The deputy reported that people have become more settled over time and there is currently no physical intervention being used. People can become upset and guidance is in place about low arousal techniques. One person is observed when with his peers to reduce the risk of incidents. Staff told us they are aware of these strategies and have attended relevant training. Other specialists are involved such as psychiatrists and occupational therapists. One person seemed to be potentially at risk of developing pressure sores. Staff told us that no pressure relieving equipment is in place and that they have not attended any training while at the service. The persons district nurse team should be approached to complete a pressure care assessment and staff training should be arranged. Some people have epilepsy. One care plan seen included details of how this condition affects the person and what measures are in place to reduce the risks. A chart is in use to record any seizures. Staff told us that they have not attended any training on epilepsy so this needs to be arranged. One person has diabetes which is monitored by a specialist nurse. If staff have also not had training on this condition this should also be arranged. Two professionals returned surveys. An occupational therapist was very complimentary about the staffs attitude and effort, saying they go the extra mile. She felt they are open and willing to accept alternative view points and act on her recommendations. A social worker told us that two of her clients who were residents have now passed away, one in the last year. She felt staff had worked very hard to provide the care and emotional support needed and enabled them to stay at home to the end. The deputy reported that peoples wishes about dying had been sensitively established and followed. The home has the monitored dose medication system MDS. This helps reduce the risk of medication errors. The storage of medication is appropriate except for the controlled drug storage. There are currently none in stock but it is advised that correct storage is fitted in case this is required in the future. The records were generally well maintained and clear. Information should be noted on the rear of the charts if a dose in the MDS system is used out of sequence. Two examples of this were seen but it was difficult to establish why this had been needed. Stock checks are carried out weekly, and a check is made at the end of each day that all doses have been given. Both of these systems are good practice. A whiteness signing chart is used but this seems to be redundant as staff usually administer medicines alone and sign both sheets. One person had two medicines prescribed to be given as required. One was included in a behaviour protocol in his care plan and had been administered recently. There was no mention of the other medicine and it has not been used recently. The GP should be consulted and if it stays in the home then a protocol needs to be in place about when staff should Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: give it. Staff complete in house on medication management after their induction. The training matrix showed only five staff have completed an accredited medication course but the deputy thought it may be more. All staff who give medicines should have this training. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to express their views and these are listened to and acted upon. Better records could be kept to demonstrate the efforts made to address concerns. People are being protected from potential abuse or neglect but training arrangements should be reviewed to ensure all staff have attended current training in this area. Evidence: A complaints procedure is in place and information about how to complain is shared with people in the home. A record of formal written complaints is maintained, but the deputy said none have been received since the last inspection. People in the home gave feedback that they know how to raise concerns and feel they are listened to. Monthly residents meetings are held which is a forum where people can share their views or they can speak to their keyworkers or the deputy who regularly works directly with people. A member of staff said she had passed on a concern a resident had expressed to her. She was satisfied that the deputy had taken appropriate action. The AQAA reported that the waking night policy has been reviewed following receipt of concerns about night time practice. It would be positive if concerns like these were logged in the complaints and compliments file to show how peoples views have been acted upon. We have not received any complaints or adult safeguarding concerns in the last year. People spoken with told us they liked the staff and felt safe in the home. Policies and Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: procedures are in place regarding safeguarding people and to inform staff about their duty to report concerns. Appropriate arrangements are in place to meet peoples emotional and behavioural needs. The AQAA reported that the organisation has appointed an appropriately qualified safeguarding trainer who has developed a training pack for each worker. A recently appointed member of staff told us she had attended safeguarding training. A senior who had worked in the home for much longer said she had not had training but has read the policy. Both said the homes culture is open and felt confident that any abuse or poor practice would be reported promptly and the procedures followed. The AQAA reported that the organisation is reviewing policies in light of the new Independent Safeguarding Authority. The deputy was not fully aware of how the changes related to her responsibilities while in charge of the home. Her supervisor needs to brief her properly. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, comfortable, safe and clean home. They may experience a more personalised service if the home is operated as two smaller group units. Evidence: The Grove is a large two storey, detached Grade 2 listed house, which is maintained to a good standard. It is situated in a pleasant residential area, within walking distance of the town centre of Kidderminster. The accommodation has been arranged on two floors, each providing facilities for six people. The upstairs is known as Beachfield and the ground floor as The Grove. Four people share the upstairs who are more independent and do not have significant physical disabilities. On each floor there is a lounge, dining area, kitchen, bathrooms, toilets, laundry and smoking room. The current culture of the service is for the people who live upstairs to spend most of their time downstairs. The communal areas are reasonable large as there is a conservatory as well as a lounge diner, however, they were at times quiet busy with five staff and up to eight residents. Some residents seemed to be in competition for staff attention. If more people move in serious consideration should be given to operating the service as two units to provide a more personalised service where people Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: about which staff are there to meet their needs. There is the potential for the upstairs unit to have its own front door access and arrangements about using part or all of the pleasant garden need to be considered. The AQAA reported that staff are to be supported by a part time gardener this year. The deputy said some people like gardening but can only concentrate for short periods of time. The communal areas of the home are nicely decorated and comfortably furnished. One down stairs bedroom has an en suite toilet and shower. The communal toilets and bathrooms are plain and could be made more homely and even personalised for the few people who share each one. One ground floor bathroom has a chair hoist. This is being replaced as it does not have a waist safety belt. Alternative arrangements have been for the one person who needs this adaptation. The downstairs kitchen is not particularly large. Although it has a section of the worktop lowered to be accessible for wheelchair users staff said that the one wheelchair used cannot access the kitchen easily. The bedrooms within the home are all single occupancy, and comply with the National Minimum Standards with regard to size and space. The two seen were comfortable and have been personalised. Appropriate locks are fitted to the bedroom doors. An occupational therapist has been involved for two people and new equipment has been provided as a result. Two bedrooms and the upstairs kitchen has been refurbished with a new floor fitted since the last inspection. It is positive that long term problems with the water system are being address with new boilers and a new tank coming soon. Two upstairs bedrooms have been refurbished and the hall carpets upstairs are also due to be changed. have been refurbished and future improvements include new flooring for upstairs hall. The AQAA reported that since the last inspection all the equipment has been routinely serviced. When the new bath aid is fitted the manufacturers should be consulted to see if six monthly servicing is recommended rather than annual. Staff carry out the domestic duties with some involvement from the residents. The home was found to be clean and there are infection control systems in place. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported by a positive staff team who they like and who respect them. The team needs many more male staff to reflect the resident group and better meet their needs. Staff training arrangements are not ensuring that workers are suitably qualified and have all the up to date knowledge to meet their needs. Peoples social programme has been affected by staffing shortages this year. They are being protected by the recruitment procedure. Evidence: There are twenty one members staff of employed at the home. The number of staff on duty is usually five during the week and four at weekends. Staffing levels would need to be increased if people are admitted into the four vacant bedrooms. At night there are two waking staff and one sleeping in member of staff who provided on call cover. Senior members of staff are available on call over twenty four hours a day. Five staff have left in the last year. Staff feedback reported that there have been staffing shortages. The deputys hours have also been vacant since August as she has been covering the managers hours. For some weeks the owners also arranged for staff to go to work at another of the owners homes nearby. To help cover the rota agency staff have been used. Staff felt that the shortfalls have had an effect on the Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: residents, for example no holidays were arranged in 2008. Some felt that staffing levels should be increased to allow for a more flexible approach to activities and to ensure the residents get an equal chance to go out. Several residents do seem to need a high level of staff attention and there are also many health appointments people need support to attend. Some also need one or two staff to be with them while in the community. As staff work long days they also need to take proper breaks during the day. There is only one male worker. This means the team does not reflect the people using the service as six residents are male. Consideration should be given to what is stopping males apply, for example, the long hours, and a proactive approach taken to recruitment of male staff. An occupational therapist said in her survey that there had been several staff changes at the end of last year and that staff were on their induction programme. She feels the manager and longer standing members of the team have the skills and knowledge to meet her clients complex needs. Records of two staffs recruitment checks were sampled. There is a systematic procedure and the staff had only started after full CRB checks and two references had been returned. Some shortfalls were found that indicated procedures can be further improved. One worker had not entered the full dates of her previous jobs so any potential gaps in her employment history would not have shown up. Employers have a duty to explore gaps to ensure they are taking references from the right people. One of the references for each worker had been obtained from a previous manager who is now retired. To ensure the references reflected the workers final record the care home should have been approached for one and the council for another. Both files showed that the staff are having supervisions sessions, however these need to be held more frequently to fit at least six sessions in each year in line with the minimum standards. Staff told us they are well supported and that morale is good. One of these members of staff was spoken with. She has been in post for six months. She found the induction programme very helpful and completed it within the desired twelve weeks. The Buddy support system had been disjointed as she did not work with the same person during her first two weeks. She had already attended several training courses that she had found relevant and others were planned. The AQAA reported that the induction programme has been improved and that staff training sessions are held at the monthly staff meetings. Training is organised centrally by the organisation. Staff feedback indicated that some staff feel they would benefit from more case specific training to meet individuals needs, for example personality disorder, acquired brain injury ABI, autism. One worker said she attended training on ABI last year. This should be a mandatory part of the induction for a specialist ABI Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: service. Staff gave examples of gaps in their training, such as safeguarding, moving and handling, epilepsy and pressure care. The Training matrix was not fully completed and showed many gaps such as fire safety, health and safety or infection control. It showed that some staff have not had a refresher in Studio 3 challenging behaviour training since 2003 or 04. This is a new tool and the deputy did not know the full training needs of the team other than for food hygiene and moving and handling courses. She agreed to collate information and forward it to us, but this has not been received. The service has still not managed to obtain the minimum standard of having half the care team qualified. The deputy said that several staff are working towards an NVQ award. Care Homes for Adults (18-65 years) Page 27 of 35 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. People are benefiting from a well run home that has a respectful ethos that prioritises their safety and wellbeing. The providers could have been more proactive in providing support for the deputy while the manager is on leave to help her maintain standards. Evidence: The manager has been in post for five years and has consistently managed the service effectively. She has the Registered Managers Award, having previously gained a BSc Honours degree in Human Biology and Health Sciences. No requirements were made at the last inspection. She is currently on maternity leave so since August 2008 the deputy has been running the home. She has worked in the home for 6 years in various support roles. The deputy has been provided with supervision and support from the area manager. She told us that there are now three seniors to support her but this was not the case when she took over. She has found it challenging to fulfil the manager and deputy role without being able to delegate management duties. Training has not been possible due Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: to staff shortages. The area line manager was at the home during some of the day. She reported that there are plans to train the seniors so they can take on more areas of responsibility and to bring in a trainee manager from another area to provide support. These may be positive steps but the owners should have taken action much sooner. Incidents and accidents have been appropriately reported in the last two years. The AQAA was completed by the deputy and returned to us on time in November 2008. The AQAA contained the information requested however it would be positive if in future years it contained more information about outcomes for people using the service rather than systems and procedures. The owners have been carrying out their statutory monthly visits to monitor the service. The AQAA reported that all policies have been reviewed in 2007 or 08. The organisation has a quality assurance system that includes regular audits in the home. They have recently conducted an anti institutionalisation audit. There are plans to involve people more in the quality auditing process. They circulate feedback questionnaires annually and as mentioned residents meetings are held each month. The AQAA showed that there is an action plan for 2009. It is not clear if residents and staff have been involved in developing the action plan. The plan includes developing a new policy on equality in service delivery. This is positive, however, if equality is a genuine aim then the decision making process about issues such as providing a wheelchair accessible vehicle need to be taken more quickly. The delay has meant one resident has received an unequal service to his peers. People living in the home gave us positive feedback about the service they receive. An occupational therapist told us that it is a delight to visit and work with this service. The financial records for one person were checked. They showed the person is being supported to spend his money on personal items for himself such as cigarettes and clothes. Receipts are kept and numbered and money tins and keys are kept secure. His inventory has been kept up to date with a recent entry. Safety management systems are in place and records seen showed the safety routines are being followed, such as fridge temperature checks. The records connected to fire safety checks were examined. A clear structure was in place for checking equipment and there has been a full system inspection in January 2009. There are organised practice evacuation drills every three months. The records for 2008 showed these were carried out. Keyworkers also go through the fire procedure with people and a record of this was seen in the care plans sampled. The fire evacuation procedure needs to be clearer. Two examples were found and both gave different assembly points. There is Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: no mention of who of the three staff on duty at night should call 999 and a senior said she was unsure. There are currently no specific arrangements for waking night staff to take part in drills or training that includes a night time scenario. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 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 Develop an Easy Read version of the Service Users Guide. Include in the Service Users Guide details of what is and is not included in the fees. 2 4 During the assessment process ensure people visit several times to help them make an informed choice about where to live and to give current residents the opportunity to decide if they want to live with the person. Always report on how peoples emotional and behavioural needs are being met along with a review of the use of As Required medication at care reviews. 3 6 4 6 For those who would benefit develop their care plans into a format that makes it easier for people to understand what has been written about them. Where people are assessed as not having the mental capacity to make decisions in an area of their life develop a care plan to show how they will be as involved or who will be consulted to make best interest decisions for them. Consider providing information to people in the home in Page 32 of 35 5 9 6 11 Care Homes for Adults (18-65 years) more accessible formats to help their understanding or memory about things that affect them. 7 14 Review outing arrangements and ensure all residents are being offered regular outings to places of interest to them. Provide a suitable vehicle for the people who have physical disabilities. 8 17 Review how meals are planned to see if the level of resident involvement can be increased. Consider offering taster sessions as an enjoyable activity and to see if people widen their preferences. Provide staff with training on epilepsy and pressure area care. All staff who administer medicines should complete an accredited course. Consult one persons district nurse team about their involvement in assessing the risk of developing pressure sores and any preventative action that they would recommend. Ensure that a protocol is in place for all as required prescribed medicines to guide staff about when these should be administered. Provide storage for controlled drugs that meets the required legal standard as referred to in the Royal Pharmaceutical Society Guidance for care and nursing homes 2008. 12 13 14 23 24 32 Ensure all staff attend safeguarding training. Hold periodic refresher training. Review the use of the premises and consider operating smaller more personalised services in two units. Include training on acquired brain injury as part of the induction as this is a specialist service. Review the Buddy system. Try to provide more consistent support for new staff as they learn their role. 15 33 Monitor the effects of long working hours as these can have a negative effect on staffs ability to respond appropriately when challenged. Review staffing levels in consultation with staff and residents and keep a record of the review process. Consider if staffing hours are being deployed the most effectively, in light of everyone mixing together downstairs. And, if there is a need to provide additional hours to ensure all residents have equal opportunities for outings and activities. 9 19 10 19 11 20 16 33 Care Homes for Adults (18-65 years) Page 33 of 35 17 34 Make efforts to recruit more male staff to better reflect the mix of residents. Review recruitment practices and ensure gaps are explored and the most applicable references are obtained. 18 19 35 35 Provide regular updates on Studio 3 techniques. Review training needs within the team and plan accordingly. Courses covering health conditions and risks residents have should be included such as pressure care, epilepsy and diabetes. The owners should facilitate for the seniors to be trained promptly to take on delegated responsibilities to support the deputy. Provide additional management support for the deputy in a timely manner. Give more examples of evidence in future AQAAs that demonstrate how individuals have benefited directly from the service, particularly if there is not an inspection due that year. Identify areas to improve in year ahead for all areas of the service. The fire evacuation procedure should be reviewed and make it clear who at night is responsible for calling the fire brigade. Waking night staff should be included in fire drills or take part in training that relates specifically to night time arrangements. 20 37 21 39 22 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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