Care Home: Tramways

Similar services:

• Trevaylor Manor
• Stallcombe House
• Stroud Lodge
• The Woodmill
• Woodland Vale
• Bolealler House
• Claremont Nursing Home
• Althea Park House

What the care home does well Tramways provide a safe environment for individuals to live which is in close proximity to local amenities. Individuals have a wide range of activities available to them. Staff have opportunities for training and are knowledgeable about the people they support. Individuals are involved in the planning of their care. What has improved since the last inspection? There were nine requirements from the last visit, these have been followed up during this visit and the service has demonstrated compliance. Individuals now have up to date information in the statement of purpose and the service user guide enabling individuals to make an informed decision on whether to move to Tramways.TramwaysDS0000026641.V376958.R01.S.docVersion 5.2Care planning and associated documentation has been developed and individuals are being provided with a more person centred approach. Care documentation now includes the individual’s likes and dislikes and their preferred routine. Individuals are consulted about what was included in their plan of care. Individuals can be confident that there are clear guidelines for staff in the use of as and when required medication. Individuals can be confident that the organisation and the manager ensures that newly appointed staff have been through a thorough recruitment process including obtaining a criminal record bureau check. Individuals can be confident that fire risk assessments have been reviewed. Individuals can be assured that the quality of the service is being reviewed and that they are included in the process. What the care home could do better: Care plans should continue to evolve with the individual, ensuring a person centred approach is fostered. A review of the present medication system should be completed to ensure that it fully protects the individuals, including the storage of medication that requires refrigeration. Key inspection report CARE HOME ADULTS 18-65 Tramways Tramway Road Brislington Bristol BS4 3DS Lead Inspector Paula Cordell Key Unannounced Inspection 5th August 2009 09:15 Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 2 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 Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tramways Address Tramway Road Brislington Bristol BS4 3DS 0117 3009637 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) tramways@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Julie Elizabeth Oliver Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 14. Date of last inspection Brief Description of the Service: Tramways is registered to accommodate up to fourteen adults with mental health nursing needs and operated by Aspects and Milestones Trust. The provider is Aspects and Milestones and the registered manager is Mrs Julie Oliver. The property was purpose built and arranged on one level, designed into two separate units accommodating seven people, linked by a passage, with a shared kitchen. It is situated in an industrial estate close to the Bath Road and within walking distance of shops, amenities and bus routes. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of a key inspection process. The visit was conducted over a period of six hours. The purpose of the visit was to review the requirements and recommendations from the visit in September 2008 and monitor the care provided to the individuals living at Tramways. Prior to the visit some time was spent examining documentation accumulated since the previous visit including notifications of incidents that affect the wellbeing of individuals living in the home, surveys from people who use the service (6) and staff (3) and correspondence. The annual quality assurance assessment was not due until September 2009. During the visit an opportunity was taken to review records relating to the care of the individuals and the running of the care home, health and safety documentation and a tour of the home was conducted. During the visit opportunities were taken to speak with people receiving a service and the staff team. Structured feedback was given to the manager at the end of the visit. What the service does well: What has improved since the last inspection? There were nine requirements from the last visit, these have been followed up during this visit and the service has demonstrated compliance. Individuals now have up to date information in the statement of purpose and the service user guide enabling individuals to make an informed decision on whether to move to Tramways. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 6 Care planning and associated documentation has been developed and individuals are being provided with a more person centred approach. Care documentation now includes the individual’s likes and dislikes and their preferred routine. Individuals are consulted about what was included in their plan of care. Individuals can be confident that there are clear guidelines for staff in the use of as and when required medication. Individuals can be confident that the organisation and the manager ensures that newly appointed staff have been through a thorough recruitment process including obtaining a criminal record bureau check. Individuals can be confident that fire risk assessments have been reviewed. Individuals can be assured that the quality of the service is being reviewed and that they are included in the process. 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. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be assured that the home can meet their care needs and a comprehensive assessment is completed. Individuals have sufficient information available to them to make a decision on whether to move to Tramways. EVIDENCE: The statement of purpose and the service user guide have been reviewed and amended in response to a requirement from the visit in September 2008. The documentation clearly describes the service provided, who can live in the home and the age range. The complaint procedure and information relating to privacy and dignity is now included. The documentation was available in large print and included photographs making it accessible to some individuals. Staff said that this was suitable for the people living at Tramways. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 9 Six surveys were received from people living in the home. Five individuals confirmed that they had sufficient information about the service being provided. One person said that they did not have information and were not consulted on whether they wanted to move to Tramways. The individual later commented in the survey that nothing could improve and they liked living there. Five of the individuals had moved from a home that had closed. Individuals spoken with indicated that the transition had gone smoothly and they liked living in Tramways. One person said it was easy to move around as there was no stairs. Comments seen in the home’s own quality audit provided further evidence that the individuals liked living in Tramways and were generally satisfied with the care provided. The home has one vacancy. The admission policy and procedure is included in the statement of purpose. Individuals are encouraged to visit the home prior to making a decision to move to Tramways. The home completes an assessment of need which then informs the plan of care. Assessments and care plans are obtained from the placing authority as part of the home’s assessment process. Contracts were seen and clearly described the expectations of the service including the fees and what was not included in the cost of the placement. Individuals had signed the contract along with the manager. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported by staff that know them well. The gaps in the care planning processes could mean that care is not provided in a consistent manner or areas of need could be overlooked. EVIDENCE: Four people’s care was looked at, as a means to determine the outcomes for the people living in the home. Care files have been reviewed since the last visit and updated. It was still work in progress but the comments made during the last visit have been addressed. During the last visit it was noted that some care documentation related to previous placements. The manager said that this has now been addressed. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 11 Care files included personal history, what you need to do to support me, personal profiles, risk assessments, routines and likes and dislikes. From reading the care documentation individuals had been consulted on what was important to them and how they would like to be supported. Some of the information had been evidently written by the person themselves and used unusual words that described how they wanted to be supported. It may be beneficial to document some of the words as a dictionary so that new staff can have a better understanding of what is being said. Some of the care plans in place lacked detail in respect of frequency which could mean that they are not being followed consistently and would in fact be difficult to review in a quantifiable way. One person’s plan of care in relation to support when they are anxious gave conflicting advice by stating “offer support” and in the next sentence it said “to give space to be alone”. It would be beneficial to describe how the staff could support them to reduce their anxieties for example relaxation, chatting or having a cup of tea so that it is person centred and tailored to the individual. The manager said that they were in the process of exploring how care plans can be more accessible to individuals by including photographs of what they are interested in etc. Individuals had a care plan in respect of their mental health including their relapse indicators. These again could benefit from more information again linking with risk assessments in respect of some of the behaviours that may be exhibited. Care plans include guidelines and the expectations for those individuals that live in the home that are under section of the mental health act. From talking with staff it was evident that they were knowledgeable about the individuals living in the home. Staff described how they monitored individuals well being and worked closely with the mental health team. The frequency of reviews varies depending on the individual from six monthly to annually. It was clear from talking with staff and the manager that they had a good awareness of the Mental Capacity Act and the Deprivation of Liberty and the rights of the individuals living in the home. The manager said that where care is conflicting best interest meetings are organised involving the appropriate professionals. The home has accessed input from independent advocates. A visiting professional said “the home has an open approach with staff actively seeking advice and working alongside the individuals”. They said that it was a well managed home and they had no concerns about placing individuals at Tramways. The completed surveys from people living in the home indicated that staff treat them with respect and listen and act upon what is being said with four people Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 12 saying always and two people said usually. Three people were consulted about how the staff supported them. Two said they liked living at Tramways and the staff were ok, one person said that it depends on my mood whether staff are responsive and there were times when more support would be good. The latter was discussed with the manager who has agreed to sit with the individual and their key worker to determine exactly when the individual would like more support. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have available meaningful activities both in the home and the community. Individuals are encouraged to maintain relationships with friends and family. EVIDENCE: Since the last visit the home has employed an activity coordinator and an assistant. There is a wide range of activities being organised in the home and the community. Activities include games, cooking, gardening, pamper sessions, creative writing and garden skittles to name a few. There was a list of trips organised throughout the month to places further afeild. Individuals are consulted on what they would like to do on an individual basis and at the weekly meetings. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 14 Care staff said that they discuss with individuals as part of the key worker role on a regular basis activities that they would like to complete. From talking with staff it was evident that some of the individuals liked their own company and did not want to participate in group activities so one to one activities are organised. Each person has an activity profile detailing how they would like to be supported, what they are interested in doing and relevant risk assessments. All surveys received from people who use the service said they could choose what to do during the day, in the evenings and at weekends. One person said that they no longer go out on their own but staff regular support them to go out locally and they can always go on the trips if they wanted. Some of the individuals attend planned activities in the local community including dance voice, a drop in centre, voluntary employment and college. One person said they were planning to do a course on gardening in September. Another person said that the staff are helping them with cooking skills and that they will be making their own lunch on a Monday and a Friday. A member of staff on duty said that individuals are supported to be as independent as possible and if a person expressed a wish to move to more independent living this would be promoted. A member of staff said that at least 70 of the people living in Tramways can go out without staff support. From talking with staff it was evident that the individuals would be supported in any activity that they choose. One person attends church on a regular basis. Cultural needs are discussed in the care plan with details how to support the individual. Holidays are planned on an annual basis. Individuals are involved in the planning. Six people have chosen to go to Cornwall in September. Some of the others have chosen to go on holiday on a one to one basis. It was evident that holidays are tailored to the individual. The manager said that everyone is offered a holiday but some prefer to go on day trips. The home has an open visitor’s policy and maintains a record of visitors to the home. One individuals spoken with said that they regular visit family and they in turn visit the home. The home organises social events whereby the individuals can invite friends and family. Individuals have an opportunity to attend weekly meetings about the service that is being provided including activities and menu planning. It was noted that the individuals are in the process of devising a list of rules. This was discussed during the last visit as it was noted that the kitchen door was locked. The Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 15 manager said that this is no longer the case as individuals have asked for this to be kept open. When the individuals have compiled the list of rules it is recommended that this is included in the statement of purpose and the service user guide. Menus were viewed. A member of staff said that these are currently being reviewed to ensure that a healthier balanced diet is being provided. The home employs a cook to assist with the catering. Comments from individuals about the food ranged from “ok” to good. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual’s personal and health care needs are being met. Care staff are exploring how the medication system can be more robust this would be beneficial to ensure that individuals are better protected. EVIDENCE: Care plans included how the individual liked to be supported with personal care and by whom. From talking with staff this is an area that is monitored closely as an indicator that a person’s mental health may have relapsed. Information is recorded in daily records where individuals have refused personal care support so that this can be monitored. The manager said that where relevant advice would be sought from the appropriate professionals. Documentation was in place to evidence that individuals have access to a doctor, dentist, optician, chiropodist and annual health checks. Where Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 17 individuals have refused to attend appointments this is recorded and again discussed at reviews with the appropriate professional. The registered nurse on duty at the time of the visit said that the medication system is under review and the home is considering going to a blister system. The home presently administers the medication from the original packaging. Medications are ordered on a monthly basis and any medication remaining at the end of the month is returned to the chemist for disposal. It was noted from the disposal record that medication was being returned on a regular basis. Whilst the record stated surplus stock this could of been a medication error where by the prescribed medication was not administered. It would have been difficult to account for the error unless a daily stock record was maintained. If the home introduced a blister system as they were suggesting the risk of omissions is reduced and auditing of the system would improve. It was noted that medication was being stored in the kitchen fridge. This was not locked and individuals had access to the kitchen. Whilst individuals are stable staff said there is no risk but this could change on a day to day basis. The registered nurse provided evidence that this has recently been discussed at a staff meeting and a fridge was being purchased. No requirement was made on this occasion. Medication records were clear in respect of medication entering the home, administration and disposal. The registered nurses are responsible for the administration of medication. From discussions with a registered nurse it was evident that they were regularly re-dispensing medication into blister packs so that one person can go home. This practice should be reviewed as it is the pharmacy’s role to dispense and not that of the carer. The home has responded to a requirement to provide documentation on the use of as and when required medication and this corresponded with the risk assessment in relation to behaviours that challenge where relevant. A requirement was made during the last visit to review the practice of crushing medication and clearly document the rationale for doing it including seeking advice from the pharmacist and the prescribing doctor. The manager and a registered nurse said that it was the individual’s choice to do this but since the last visit this practice has stopped. The manager had a good awareness of the guidelines in respect of covert medication. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems are in place to protect the people living in Tramways ensuring that they are safe and protected from abuse. Most of the individuals were aware of how to complain and have systems in place to raise concerns and make suggestions for improvement. EVIDENCE: There is a detailed complaints procedure which values feedback from individuals that use the service. The policy is included in the statement of purpose. A record of complaints was maintained. It was evident that the individuals living in the home were confident in raising concerns about the care they receive and the relationships within the home. Where relevant the home has instigated safeguarding referrals where the relationships have impacted on others or where an allegation of abuse has been made. This evidenced a good understanding how the organisational complaints procedure and “No Secrets” link together. The record of complaint is kept in the hallway of the home for both individuals and visitors to view. A concern is raised that the actions taken to address the concern and the outcome is recorded and some of the information was Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 19 personal and confidential. It would be beneficial to review how information is recorded and whether the records could be kept in the office. It was also noted that pages had been torn out. Four individuals were consulted about how safe they felt living in the home. Three said they felt safe with one person saying not always at night when agency staff are working as they do not know them. All said they knew how to complain and would speak with staff, the manager or their social worker. Of the six surveys one person said they did not know how to complain. The staff in the home organise regular meetings for the individuals to comment about the service being provided including raising concerns and making suggestions for improvement. It was evident from talking with the manager and the staff that where suggestions are made this is actively encouraged and promoted. Training records provided evidence that staff have recently attended safeguarding training. Polices and procedures were in place relating to the protection of vulnerable adults including “Do the right thing”, whistle blowing, Equal Opportunities, Financial and Safeguarding Adults. A copy of the Bristol Safeguarding policy was made available to staff. Finances were checked for a random selection of people. Good records were maintained of money entering the home and expenditure including receipts. Records included signatures of staff less apparent was that of the person who lived in the home. Finances were checked by staff at the start and finish of every shift as part of the handover. Care planning documentation included information about how the person was supported with their finances and the control that they had. This was tailored to the individual’s abilities and wishes. Lockable storage is provided to individuals to keep their money and other possessions safe. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tramways provides a comfortable, homely, clean and safe environment for the people who live there. EVIDENCE: Tramways is purpose built and provides accommodation for fourteen people. The property is sited within an industrial estate with close access to local shops, bus routes and other amenities. The accommodation is arranged on the same level with bedrooms sited at each end of the property. There are two communal lounges, a dining room, art and craft area, a separate smoking area and a large kitchen sited in the centre. Areas seen were clean, homely and free from odour. Pictures and art work were displayed throughout the home enhancing the homely feel to Tramways. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 21 The office is sited by the front door. During the visit two visiting professionals walked straight into the home. This was discussed with staff who said this happens often as people who use the service leave the front door open. It may be beneficial to discuss this with individuals in relation to security and put a sign to remind visitors that Tramways is a home. Adequate bathing facilities are in place. Specialist equipment is available to assist individuals with personal care where required. Documentation in care files provided evidence that where individuals needs have changed in respect of mobility or skills advice is sought from the appropriate professional. Aids are in place for individuals who have a hearing disability including lights that indicate that there is a fire and door bells that flash a light in the individual’s bedroom. The kitchen was well organised, with a combination of domestic and industrial equipment. Cupboards were well stocked. Cleaning schedules are in place. The home was well maintained with routine health and safety checks being completed on the building. A maintenance person visits the home on a monthly basis to complete repairs with good response times for emergencies. The home employs two domestics to assist with the cleaning. One of these posts is presently being advertised. Individuals are encouraged as part of their activities to assist with the cleaning of their bedrooms. The laundry is sited adjacent from the dining room. There are three washing machines, two are industrial with sluicing facilities and a tumble dryer. Individuals have access to a large garden surrounding the property. It was well maintained with pleasant areas to sit and relax. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient and competent staff support the individuals living in Tramways. Good mechanisms are in place to support the staff ensuring a consistent approach is provided to the individuals living in the home. EVIDENCE: Tramways is staffed by a minimum of four staff in the mornings and three staff in the afternoon/evenings and two waking staff at night. There is a registered nurse working in the home at all times. In addition the home employs an activity co-ordinator and assistant, domestic and catering staff to compliment the care staff. Staff spoken with said that the staffing was adequate to meet the needs of the individuals and additional staff are employed to enable individuals to go on trips and places of interest. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 23 Records relating to recruitment were viewed for the one member of staff that has recently been employed. All documentation was in place demonstrating a robust recruitment process had been followed including obtaining a criminal record disclosure. From talking with staff and the manager it was evident that there is a good retention of staff. Once a member of staff commences employment a full and comprehensive induction is completed including attending statutory health and safety training and a values course. Once staff have completed their induction and probationary period, staff are then supported to complete a National Vocational Award in care. The manager said that many of the staff have worked in the service for many years and team training days have been organised to recap on some of the values training given to new staff including dignity and respect. From talking with staff it was evident that the training has been impacting on the way that they are working and supporting the individuals. All staff spoken with described the people in a positive way and how they were supporting them as individuals. The manager said that monthly training sessions are being organised on the needs of the people living in the home focusing on topics relating to mental health. This is good practice. Records provided evidence that staff have attended first aid, manual handling, and fire and food hygiene training with periodic updates. Staff complete a mental health awareness course as part of their induction. Regular meetings are organised enabling staff to share knowledge, review practices and address any issues. This was confirmed in conversations with staff and the records seen of the meetings. Records were seen that demonstrated that the manager ensures that the registered nurses continue with their registration with the Nursing and Midwifery Council. Staff described a positive working environment with good support mechanisms in place including supervision, team working, good communication and a supportive manager. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a home that is well managed. There are good levels of involvement. Individuals are involved in the home’s quality monitoring processes. Individual’s health and safety is promoted. EVIDENCE: Mrs Julie Oliver is the registered manager of Tramways. She has supported people with mental health both in the community and hospital settings. Mrs Oliver has supported some of the individuals for many years and transferred to Tramways from a home that had closed along with the people that lived there. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 25 Mrs Oliver is a registered mental health nurse. From talking with staff and the people that live in Tramways it is evident that the manager is approachable and has an open door policy. From talking with staff it was evident that they were empowered to make decisions and make suggestions for improvement. Good systems are in place to review the quality of the care provided including meeting with placing social workers on a regular basis, audits on the environment, medication, training, supervisions and health and safety to name a few. In addition to the internal audits the operation manager visits and compiles a report on the conduct of the home once a month in accordance with regulation 26 of the Care Home Regulations. Periodic reviews are completed by another home manager who will measure the quality of the service based on the National Minimum Standards. This was completed in July 2009 and it was evident that the manager has devised an action plan to address the areas identified for improvement. Two areas were identified which was to develop care planning processes in respect of including individual’s personal routine and likes and dislikes and expand on the statement of purpose. The latter has been completed and the care planning is work in progress as discussed earlier in this report. Individuals living in the home are consulted through meetings, care reviews and an annual survey. The manager said that this has been twice in the last twelve months to assess how individuals have felt about the closure of the previous home and the transition to Tramways. Comments from the surveys have been taken into account and an action plan has been devised to address the issues. This is good practice. Good systems are in place in respect of health and safety including routine checks on electrical equipment, health and safety training and policies and procedures to guide staff. Fire equipment was being routinely checked by the staff and an external contractor. Fire training was provided annually by an external trainer and staff have recently watched a video. Less apparent was staff participation in a fire drill once in a six month period. Only seven staff have participated in a fire drill since December 2008. The manager said that she was of the understanding that this should be annually and has agreed to address this. Polices are in place in respect of infection control and sufficient gloves and protective clothing was seen. Hand gel is provided to visitors as they enter the home. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 26 Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 X X 3 X Version 5.2 Page 28 Tramways DS0000026641.V376958.R01.S.doc yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 23 (4) Requirement For staff to participate in a fire drill once in a six month period. Timescale for action 05/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Review the medication system ensuring that it fully protects the individuals. Consider introducing a blister pack system. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Tramways DS0000026641.V376958.R01.S.doc Version 5.2 Page 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!