Care Home: The Malvern Nursing Home

Similar services:

• Whiteley House
• Tyndale Avenue
• 2-10 Norfolk Road
• Bennfield House Nursing Home
• Eastfield Residential Home
• Sign Health
• Springwood
• Fairburn Mews

What the care home does well We asked people what the home does well and these are some of the comments we received from people who live there - "good food, good activities", "good dinner", "I like how the staff respond to my needs and take me to all appointments I have to attend, I like the fact that residents` meetings are encouraged", "arranges day trips". People`s needs are assessed before they move in and people are encouraged to visit the home to experience what the service is like before they make a decision about moving in. This helps people to be sure the home is the right one for them. The care records are kept up to date and provide clear information for staff on how to support people in meeting their needs and goals. There is a clear complaints procedure and people are encouraged to share their concerns. Complaints are taken seriously and acted on. During the visit we saw staff carrying out their duties in a quiet and organised way. They responded quickly and appropriately to people. Staff spent time with people, sometimes chatting and sometimes playing games such as dominoes. We saw people going out, some alone and others with staff. What has improved since the last inspection? Earlier this year the home was temporarily closed for approximately three months and people moved to alternative accommodation. This was because of a fire in the basement which caused smoke damage throughout the building. The home was redecorated and people returned to The Malvern at the end of March 2009. There were seven requirements following the last inspection. The home has made progress on dealing with the majority of these despite the disruption caused by the fire. The one requirement that remains outstanding relates to staff training. The home has started to deal with this and has booked some training courses but very little training had actually taken place when we visited. We will carry this forward with a new timescale and will follow it up with the home to make sure staff get the training they need. Improvements have been made to all areas of the service. The home has improved the way people`s needs are identified and recorded. This helps to make sure people are getting the right support to meet their needs and goals. Improvements have been made to the range of social and leisure activities offered to people and the home is continuing to develop this aspect of the service. For example, by working with people to draw up a weekly activities plan. The home is continuing to look at ways they can support people to be more independent, for example by putting flasks of hot drinks in the dining room so that people can help themselves rather than having to ask every time they want a drink. The home has improved the way they deal with safeguarding (adult protection) matters. The correct reporting procedures are followed and concerns are looked into. This helps to make sure people are protected. People`s capacity to make decisions is assessed and recorded and where restrictions are in place these are clearly recorded. The home has good systems in place to make sure they are working in accordance with the Mental Capacity Act and Deprivation of Liberty legislation and this helps to make sure people`s rights are protected and promoted. Hand washing facilities have been provided in all bedrooms and this will help to reduce the risk of cross infection. What the care home could do better: Some people living in the home told us they would like to see more in-house activities, others said they would like more variety in the food offered to people of Asian origin. The home must make sure that the plans they have for staff training are put into practice so that staff have the knowledge and skills they need to meet people`s needs. Further improvements to the environment should be made to create a more comfortable and homely place for people to live. In particular attention should be given to the heating, standards of cleanliness and the designated smoking area. More attention should be given to how people`s personal clothing is dealt with to make sure people always have their own clothes. In their self-assessment the home identified areas where they plan to continue to make improvements to the service and told us how they plan to make these improvements. They have made good progress in the last 12 months and should continue to build on what they have achieved. Key inspection report Care homes for adults (18-65 years) Name: Address: The Malvern Nursing Home 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN     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: Mary Bentley     Date: 0 5 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: The Malvern Nursing Home 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN 01274492643 01274499557 rachel@malvernuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rachel Halsall care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The Malvern is a 28-bedded care home with nursing, specialising in the care of adults with mental illness. The home takes both males and females and was established 20 years ago. The house is a late 19th century detached residential building situated on a main road approximately 3 miles from the centre of Bradford, served by a good bus route. There is a parking area to the side of the building and a small patio area situated on the other side of the building. Access to the home is gained through the conservatory at the front and a ramp is provided for people with mobility difficulties. There are 16 single bedrooms and 6 double rooms on two floors, accessible for those with mobility difficulties by a stair lift to the first floor. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 28 28 0 6 1 1 2 0 0 8 Brief description of the care home In November 2009 the home told us the weekly fees vary depending on each persons assessed needs, the basic fee is 525.00 per week. Please contact the home for more detailed information about the fees. Information about the home, the Statement of Purpose, is available from the home on request. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This is what we used to write this report: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The results of any visits that we have made to the service since the last inspection in November 2009. Surveys returned to us by people using the service and people with an interest in the service. We received 11 surveys in total, 10 from people living in the home and one from a visiting health care professional. Information we have about how the service has managed any complaints. Care Homes for Adults (18-65 years) Page 6 of 30 What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Relevant information from other organisations. A site visit carried out by two inspectors between the hours of 9:20 am and 5:00 pm. The visit was unannounced. During that time we spoke to people living in the home, staff and management. We looked at various records including care records,looked at some parts of the home and observed staff as they carried out their duties. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Earlier this year the home was temporarily closed for approximately three months and people moved to alternative accommodation. This was because of a fire in the basement which caused smoke damage throughout the building. The home was redecorated and people returned to The Malvern at the end of March 2009. There were seven requirements following the last inspection. The home has made progress on dealing with the majority of these despite the disruption caused by the fire. The one requirement that remains outstanding relates to staff training. The home has started to deal with this and has booked some training courses but very little training had actually taken place when we visited. We will carry this forward with a new timescale and will follow it up with the home to make sure staff get the training they need. Improvements have been made to all areas of the service. The home has improved the way peoples needs are identified and recorded. This helps to make sure people are getting the right support to meet their needs and goals. Improvements have been made to the range of social and leisure activities offered to people and the home is continuing to develop this aspect of the service. For example, by working with people to draw up a weekly activities plan. The home is continuing to look at ways they can support people to be more independent, for example by putting flasks of hot drinks in the dining room so that people can help themselves rather than having to ask every time they want a drink. The home has improved the way they deal with safeguarding (adult protection) Care Homes for Adults (18-65 years) Page 8 of 30 matters. The correct reporting procedures are followed and concerns are looked into. This helps to make sure people are protected. Peoples capacity to make decisions is assessed and recorded and where restrictions are in place these are clearly recorded. The home has good systems in place to make sure they are working in accordance with the Mental Capacity Act and Deprivation of Liberty legislation and this helps to make sure peoples rights are protected and promoted. Hand washing facilities have been provided in all bedrooms and this will help to reduce the risk of cross infection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move in and whenever possible people or those close to them are involved in this assessment. This helps people to be sure the home will be able to meet their needs. Evidence: Ten people living in the home completed surveys for us. Six of them said they had received enough information about the home before moving in to help them decide if it was the right place for them. We saw completed pre-admission assessments in the care records. They had detailed information about peoples needs and showed that people are offered the opportunity to visit the home before making a decision about moving in. The pre-admission assessments have been updated to include information about equality and diversity to make sure peoples needs in these areas are not overlooked. The home told us they have improved their pre-admission assessment procedures and people are now given the opportunity to have an overnight stay so that they can Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: experience the service for themselves before making a decision about moving in. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and goals are identified and there are plans in place to show how people are supported in meeting their needs and goals. People are supported in making decisions about their lives. Evidence: During the visit we looked at three peoples care records, two of these in detail. Overall we found that the care records are up to date, accurate and provide detailed information about peoples needs and how these are to be met. Peoples needs are assessed and the assessments we looked at showed what people can and cannot do for themselves. When the assessments showed that people needed support in a particular area care plans were in place. The care plans clearly identified the needs, the goals and the action that staff should take to provide the right support. We saw that risks are clearly identified and that there are plans in place to show how the risks are managed. In one persons records we saw that the risk of aggression is Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: managed by staff providing one to one supervision. The plan tells staff how they should provide this supervision and what their role is. We talked to staff about this and they were clear about what they were required to do. We observed staff and saw that they followed the agreed plan and provided one to one supervision in a discreet but effective way. Peoples capacity to make decisions is assessed and recorded and where restrictions are in place they are clearly recorded. The home supports some people in managing their money. One person told us they get their money every morning and walk to the local shop to buy cigarettes. When people have an agreement about a daily money allowance the money is prepared in individual envelopes and people sign for it as they receive it. There are suitable systems in place to make sure that any money held or spent on peoples behalf is properly accounted for. There are meetings where people in the home can share their views of the service. Meetings took place in May and October 2009. The notes of the October meeting showed that discussions had taken place about the new arrangements for people to make hot drinks whenever they want. The home has put flasks of tea and coffee in the dining room so that people do not have to ask when they want a drink. Some people had expressed concerns about this and were assured staff would still be available if people needed support. During the visit we saw people helping themselves to drinks and staff were nearby if people needed help. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the way people are supported to follow their personal interests and to the range of social and leisure activities offered to people. The home is continuing to develop this aspect of the service. Evidence: Most of the people who completed surveys for us said there are usually activities for them to take part in. One person said I am encouraged to do my own individual activities as and when I wish and another person said they like the day trips. One of the staff organises in house activities for people. One person told us they would like to see more in house activities. People go out for coffee, go to the pub, to the park and go shopping with staff. Generally people use public transport but if a few people are going the home arranges transport, a group of people recently went to Tropical World in Leeds. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The care records have information about peoples social and cultural needs and their current interests and hobbies. There are care plans in place to show how people are supported to meet these needs. The planned activities for the week when we visited included a coffee morning, an art group, Music for Health, shopping and baking. The Music for Health session is run by an outside organisation, they play music and encourage people to join in by playing musical instruments. Two people told us they really enjoy this. During the visit we saw some people going out alone and others going out with staff. In the home we saw staff sitting with people, chatting and playing games such as dominoes. Throughout the day we saw that staff were where they should be and they responded appropriately to people. Staff were attentive to what was going on and quick to respond, for example when someone commented that the dining room was cold staff quickly closed the window. However, there were times when opportunities to interact with people were missed and staff seemed reluctant to initiate conversation with people. There were occasions when staff were stood around the edges of the room observing rather than interacting with people. This was discussed as an issue that needs to be addressed through staff training. In their self-assessment the home told us they have improved the range of activities and are providing more support for people to follow their chosen faith. They have employed the services of a consultant to advise on how they can improve the way they address matters of equality and diversity. They said they want to continue to improve the way they support people to make the most of their abilities. For example, by supporting everyone to have a weekly activities programme. At lunchtime the tables were set with table cloths, cutlery and napkins. There were no condiments. People were offered a choice of meals which included chicken, omelette, curry, rice, chapattis and jacket potatoes. Most people said they enjoyed the food and were satisfied that there was enough variety. One person said there was not enough variety in the food offered to people of Asian origin. Another person said the food is all the same, he said weve had chicken twice this week already. We saw that food and meal times are discussed at the meetings held for people living in the home. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 in meeting their health care needs. Overall, peoples personal care needs are met however more attention should be given to peoples personal clothing. Evidence: People living in the home who completed surveys for us said they generally get the care and support they need. A health care professional who completed a survey for us said the home is good at meeting peoples health care needs. Peoples care plans have information about their personal and health care needs. There is information about the level of support people need and their preferences, for example whether they prefer baths or showers and whether they need help from staff or just prompting. During the visit we saw three staff helping someone to move from a chair to a wheelchair. They talked to him about what they were doing and asked him if he was comfortable throughout the process. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We saw two different members of staff discreetly prompt people about their personal appearance, on one occasion the offer of help was declined on the other the person was happy to let the member of staff help them. When we looked around we saw that some peoples clothing had been put in the wrong rooms. More care should be taken with peoples personal clothing to make sure people have their own clothes to wear. The records showed that peoples nutritional status is monitored, nutritional risk assessments are done and peoples weight is recorded. People are assessed for other potential areas of risk such as pressure sores. One person who has Diabetes is supported by staff to check their blood sugar levels and they have access to the Diabetic nurse specialist. People have access to a range of NHS and social care professionals such as community psychiatric nurses, psychiatrists and social workers. We looked at how peoples medicines are managed. Overall the systems in place are suitable to make sure people get their medicines as prescribed. One health care professional who completed a survey for us said the home is good at managing peoples medicines and making sure the records are up to date. One person administers some of their own medicine with support from staff. When we looked around we saw that some creams that are prescribed for individuals were being used for other people. This needs to be addressed and was discussed. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable systems in place to make sure that complaints are taken seriously and acted on and to make sure that people are protected. Evidence: Seven of the ten people living in the home who completed surveys for us said know who to talk to if they are not happy. Six people said they do not know how to make a formal complaint. The home has a complaints procedure. The notes of a meeting held for people living in the home in May 2009 showed that the complaints procedure was discussed and people were reminded about how to raise any concerns they might have. This is good practice and should be repeated at future meetings so that people are reminded that the home is open to comments which will help improve the service. The home has had four complaints in 2009. All of these were recorded with details of the complaint, the action taken and the outcome. The home also has a log where a summary of all complaints is recorded. During the visit we discussed how the system could be improved to reduce the need to duplicate information. At the last inspection we were concerned that the home was not always following the correct Adult Protection (safeguarding) procedures. This has improved significantly. The home is reporting concerns and taking appropriate action to follow up concerns and/or allegations. This has helped to make sure that people are properly protected. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: It was evident that senior staff understand the safeguarding procedures and their responsibilities in this area. However, some of the care staff we spoke to were not clear about this. More training is needed to make sure staff working at all levels are able to recognise abuse and know how to report any suspicions or allegations. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and improvements have been made; more could be done to create a more comfortable and homely place for people to live. Evidence: People living in the home who completed surveys for us said the home is usually clean and fresh. One person we spoke to during the visit was not happy with the standard of cleanliness in their room. They invited us to look at their room and we saw that it was not particularly clean. Earlier this year the home had a fire in the basement and this caused smoke damage throughout the home. People living in the home were temporarily moved to alternative accommodation and the home was redecorated. Overall, the home is now brighter and cleaner. Hand washing facilities have been improved and there are soap dispensers and paper towels in all the bedrooms. This will help to reduce the risks of cross infection. The bedrooms we looked at were adequately furnished. Some people told us they have keys to their bedroom doors and can go to their rooms when they choose. Risk assessments are done to decide if people can have keys to their bedrooms. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: With the exception of one bedroom where the person had lots of personal belongings around there was little evidence that people decorate or furnish their rooms to reflect their personal tastes and/or interests. People should be encouraged to personalise their bedrooms to help to create a more homely environment. We looked at the laundry which has been completely refurbished, it is suitably equipped and well organised with individual named boxes for peoples clothing. However, when looking around we found that some peoples clothing had been put in the wrong rooms. In many rooms peoples clothing had been stuffed into the drawers rather than being put away neatly. This suggests a lack of awareness and respect for peoples dignity and was discussed during the visit. Throughout the day we found that parts of the home were cold, apart from the main lounge which was very warm. This was discussed. One person told us their bedroom was cold, they said they had been given a mobile heater, they said its better but I was cold last night, I had to double the quilt over. Following the last inspection the home took advice from the Environmental Health department and created a new smoking area. This is an enclosed space next to the dining room. Several people complained about the smoking area, they said it is cold, uncomfortable and is letting in water which it is. This was discussed. The home told us they are planning to add an extension so that they can offer single rooms to everyone. It will also involve some changes to the communal areas. They do not intend to increase the overall number of places. There is one room on the ground floor which has almost no natural light and when planning the extension consideration should be given to changing the use of this room. The home has been given a 4 star (the highest is 5) rating by Environmental Health for its standards of food safety and hygiene. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually enough staff to meet peoples needs and people are protected because staff are properly checked before they start work. Staff training must be provided so that staff have the knowledge and skills they need to understand and meet peoples needs. Evidence: On the day we visited there were 5 care staff and 1 nurse on duty during the day. The home told us there are usually 6 care staff (including a nurse) on duty during the day and four staff overnight. The home also employs separate staff for activities, cooking and housekeeping. The deputy manager and registered manager are also on duty during the week. People told us staff are usually available when they need them, they said staff generally listen to them and take notice of what they say. During the visit we saw that staff carried out their duties quietly and in an organised way. When staff were allocated to one to one duties they stayed with the person they were supporting. There was always a member of staff with people in the lounge and dining room. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Staff told us they enjoy working at the home. They said they are kept informed about about peoples needs and changes in their condition and said it is a friendly place. The home told us that because of the disruption caused by the fire they have not been able to meet the requirements made at the last inspection regarding staff training. However, they told us they have started to deal with this and various training courses have been booked for the coming months. This includes induction training for new staff, infection control, food hygiene, moving and handling, the Mental Capacity Act and Deprivation of Liberty. We looked at the files of three newly appointed staff and they showed that all the required checks were completed before they started work. This included two written references, PoVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks. One new member of staff told us that when they started work they were shown around the home, told about health and safety and about peoples needs. They said they are booked on a full induction training programme. The home told us that over 50 of care staff have achieved an NVQ (National Vocational Qualification) at level 2 or above. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the outcomes experienced by people in all areas of the service. The management team are committed to making sure people using the service are supported in contributing to the ongoing development of the service. Evidence: The registered manager is also the home owner, she is a registered mental nurse and has many years experience caring for people with mental health needs. The assistant manager is an experienced business manager and his role is mainly dealing with general management and administrative duties. The home told us they are currently working with a management consultant and reviewing the management structure of the home with a view to creating a senior clinical role. The home completed the annual quality assurance assessment (AQAA) we asked for and sent it back in good time. It gave us all the information we asked for. The care records showed that peoples capacity to make decisions is assessed and recorded. There were Deprivation of Liberty Safeguards in place for two people living Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: in the home when we visited. The care records had detailed information about the reasons why the applications had been made, the decision making process, the restrictions that have been agreed and the actions that staff should take. The home is in the process of developing questionnaires to send to people to give them the opportunity to share their views of the service. Different questionnaires are being devised for people living in the home, relatives and health and social care professionals. They plan to have it ready to issue in the next two months. We saw examples of the draft questionnaires; the questions are focused on the outcomes experienced by people using the service. There are meetings for people living in the home where they can share their views of the service and make suggestions for changes and/or improvements. We saw evidence in various records, for example care records and staff meetings, that the home is working to develop a more person centred service where peoples views are central to how it is run. Information provided by the home showed that all the required maintenance and service records are up to date. This was confirmed by a selection of records seen during the visit. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 18 You must make sure all staff 02/02/2009 are provided with training to enable them to work with people with mental health problems. This training must include the mental capacity act. Also the nurses must up date their practices to be sure they are providing support staff with examples of good practice. This is to make sure the staff have the necessary skills to look after people properly. Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 18 Staff must be provided with 29/01/2010 training on safe working practices and training related to the needs of people living in the home. This must include training on the Mental Capacity Act, Deprivation of Liberty, adult protection, conflict resolution and challenging behaviour. To make sure staff have the knowledge and skills they need to care for and support people properly. 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 2 20 24 More care should be taken to make sure prescribed creams are only used by the people they have been prescribed for. The designated smoking area should be maintained in a reasonable condition and it should be at least Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations weatherproof. 3 24 The heating systems should be reviewed to make sure that all areas of the home are kept at a comfortable temperature. More could be done to support people to take ownership of their personal space for example by personalising their rooms to reflect their personal tastes and interests. More attention should be given to making sure that peoples bedrooms are kept clean. 4 24 5 30 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!