Care Home: Trittiford Road Nursing Home

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What the care home does well The people living there are asked what things they like and do not like.Each person has a care plan. This tells staff how to help the person.People living in the home can choose what they eat and drink. Their diet helps to keeps them healthy.Staff keep records so that they can check how well each person is. Staff help people to go to the doctors if they are not well.People have the things they like in their bedroom.Staff have training so they know how to help the people living there.Relatives said, `Staff provide excellent care.` `I am happy with the home, I cannot think of anything they could do better.` `The care that staff give the people living there is superb.` `All staff are kind and caring.` `My relative is well cared for and happy.`Equipment is provided so that people can be safely moved from one place to another.Staff help people to go to church if they want to.Staff do health and safety checks so that the home is safe for the people who live there. What has improved since the last inspection? Care plans told staff a lot about the person so they know more about how to help them.Some rooms had been redecorated and new flooring had been put down. The home is more comfortable for the people who live there.Staff had written down what medication they had given to people. This helps people to be well.There were more fire drills. This helps staff and the people living there to know what to do if there is a fire. What the care home could do better: Staff should write down what and how much each person has eaten. This will make sure they are getting the food they need to be well.Staff should meet with their manager more often so they know how to help the people living there.The fire risk assessment should be updated as things change. This will make sure that all risks of there being a fire are as small as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: Trittiford Road Nursing Home 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES three star excellent service The quality rating for this care home is: 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: Sarah Bennett Date: 2 7 0 5 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Information about the care home Name of care home: Address: Trittiford Road Nursing Home 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES 01214415646 F/P 01214415646 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Accord Housing Association care home 11 Number of places (if applicable): Under 65 Over 65 11 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 11 Date of last inspection 0 7 0 6 2 0 0 7 A bit about the care home The home is two bungalows, five people live in one and six people live in the other. Since we last visited the people who own the home have changed. Accord are now the owners. The bungalows have been adapted to meet the needs of the people living there. Each person has their own bedroom. There is a large garden at the back. All the people who live there can use this. In each bungalow there is a lounge, kitchen diner and small sensory room. Our reports are in the home for visitors to read if they want to. The reader should ask the manager how much it is to live there. This may be different for each person as it depends on the needs of the individual. 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: three star excellent 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 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home and did the inspection in one day. The home did not know we were going to visit. We looked at what it is like to live there. We asked the people living there what they think of their home. Before we visited we looked at things we had been told about the home. We looked at information that the home sent us about things that have happened there. We looked at the records of two of the people who live there. We sent surveys to relatives asking them about the home. Four surveys were sent back to us and what they said is written in this report. We looked around the home and at records about staff and health and safety. We talked to the people living there, the manager and staff. What the care home does well The people living there are asked what things they like and do not like. Each person has a care plan. This tells staff how to help the person. People living in the home can choose what they eat and drink. Their diet helps to keeps them healthy. Staff keep records so that they can check how well each person is. Staff help people to go to the doctors if they are not well. People have the things they like in their bedroom. Staff have training so they know how to help the people living there. Relatives said, Staff provide excellent care. I am happy with the home, I cannot think of anything they could do better. The care that staff give the people living there is superb. All staff are kind and caring. My relative is well cared for and happy. Equipment is provided so that people can be safely moved from one place to another. Staff help people to go to church if they want to. Staff do health and safety checks so that the home is safe for the people who live there. What has got better from the last inspection Care plans told staff a lot about the person so they know more about how to help them. Some rooms had been redecorated and new flooring had been put down. The home is more comfortable for the people who live there. Staff had written down what medication they had given to people. This helps people to be well. There were more fire drills. This helps staff and the people living there to know what to do if there is a fire. What the care home could do better Staff should write down what and how much each person has eaten. This will make sure they are getting the food they need to be well. Staff should meet with their manager more often so they know how to help the people living there. The fire risk assessment should be updated as things change. This will make sure that all risks of there being a fire are as small as possible. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Bennett 77 Paradise Circus Queensway Birmingham West Midlands B1 2DT 0121 600 5300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need about the home so they can make a choice as to whether or not they want to live there. Individuals needs are assessed before they move in to ensure they can be met there. Evidence: The statement of purpose and service users guide had been updated to include the relevant and required information about the home. They included photographs and pictures making them easier to understand. This ensures that people have the information they need so they can make a choice about whether or not they want to live there. Since we last visited two people had been admitted to the home and their records were looked at. They included a completed assessment of their needs before they moved in to ensure they could be met at the home. After they had lived at the home for a short time further assessments were completed to ensure their needs could still be met there. Staff said and records showed that they had settled in well and their needs were being met. Records sampled for one person showed that they and their advocate visited the home before they moved in to meet the staff and the other people living there. Staff also visited them where they were living. The other person was in hospital and not able to visit the home. Their community nurse visited on their behalf and staff from the home visited them in hospital a few times so they could get to know the person and what they needed. Their records showed that staff had been sensitive to their need to settle into the home and had ensured that they felt secure in their new environment. 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. Staff have the information they need so they know how to support the people living there to meet their needs and be safe so ensuring their well being. Evidence: Two of the people living there were case tracked and some of the records of another person were looked at. Records included an individual care plan. Staff had recently updated care plans and were still doing this for some people. Care plans that had been updated were very detailed and centred on the individual. They included photographs and pictures making them easier to understand. Each person has a named nurse and a key worker for during the day and then others for during the night. Care plans were separated into how the person likes to be supported during the day, the evening and during the night. This shows that staff recognise that peoples needs may differ depending on the time and that night staff have a responsibility to ensure they are supporting people appropriately. Regular meetings had been held with the people living there. Night staff had led these and minutes showed that they were informal so trying to encourage people to take part. People talked about activities, changes to the home and what colours they would like the home to be decorated in. Several of the people who live there are unable to communicate verbally so staff had observed their reactions by facial expressions and using pictures to get their views. Records indicated that named nurses and key workers also spent time with individuals to seek their views about what they want and how they want the home to be run. Evidence: Assessments had been completed as to how much at risk people are of having sore skin. One persons stated in March this year that it needed reviewing monthly but had not been. The other person was assessed as being at high risk but some factors such as their medical condition had not been considered. If these had been, the assessment would have shown they were at very high risk. Care plans had been put in place to ensure that staff took action to reduce the risks. Individual risk assessments were in place that stated how staff are to support individuals to take risks whilst ensuring their safety as much as possible. These were detailed and generally regularly reviewed and updated where there were any changes. Some risks for some people had not yet been assessed, such as using the minibus but staff were working on risk assessments during the day to ensure they were all in place. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there experience a meaningful lifestyle so ensuring their well being. Evidence: The manager said that there have been several problems with children from the local community, as they do not accept or understand the needs of the people who live at the home. The manager has responded to this by working with the local police community support officers and going to local schools to raise awareness of people who have disabilities. They have also organised a party in a local park with a barbecue and local children will be invited to spend time with the people who live there. A party was arranged at Easter in the home where local people were invited and attended and met the people who live there. Records sampled showed and it was observed that people go out often in the local community and further a field. People go shopping, to parks, to pubs, restaurants and for drives in the country. The manager said that since the change of provider there is now only one minibus between the two bungalows. However, staff work together to ensure that people can use this as much as possible and this was observed during the day. One person goes to a local day centre and staff provide the transport for them. Regular coffee mornings are held in the home where people who live in local homes managed by Accord are invited. Staff said these were well attended and one person who regularly attends would like to be a volunteer working in the home. This gives people an opportunity to meet old friends and make new ones. The two bungalows have in the past been run very separately and people living in each did not often mix with the people Evidence: living in the other bungalow. There are more opportunities now for people to mix so helping to improve their social networks. Records sampled showed that when people are at home they watch TV, listen to music, spend time in the garden, do art activities, spend time in the sensory room, have hand massages and look at books and magazines. Some people had started to create their own photo diary, which had photos of activities they had done so providing a means to tell other people about them and what they do. Staff had recorded with the photo what the person had done and whether or not they had enjoyed this. People are supported to meet their spiritual needs. If people want to they are supported to attend church. One persons records showed that before they moved there they had not had the opportunity to attend church although this had been stated as something they would like to do. They now attend at least monthly at a church of their choice. Nuns from a local convent visit the home regularly and spend time with people who want a visit from them. They visited during the morning and it was obvious that this was beneficial to some people living there. A local priest visits on request. One persons records indicated that they had been very poorly the weekend before but had been supported by a visit from a local priest. Staff spend time sitting with one person and reading to them from their prayer book, which appears to give them comfort and meet their spiritual needs. The manager said that some people would like to go on holiday and these are being arranged. One person has asked to go to an Elvis weekend in Blackpool and this is being arranged, possibly with another person living there who may also be interested in this. Staff know that some people do not enjoy going away on holiday or are not well enough so day trips are being arranged so that people can experience different things and see different places. Records sampled showed that people are supported to keep in contact with their family and friends. This is through visits, telephone calls and sending cards and presents for special occasions. Relatives said, When we visit staff make us welcome. Records sampled showed that staff encouraged individuals to help out with household chores, as much as they are able to, so encouraging people to be as independent as possible. Care plans showed that people were to be supported to do as much for themselves as they could. Food records sampled generally showed that people had a healthy and varied diet. Not all food records had been completed and the manager said that the provider had asked that staff only record if a person has what differs from the menu. Records sampled showed that the dietician was involved with some people and there were concerns about their weight. Therefore, it is essential that staff record what a person has eaten and how much they have eaten so it is clear that they are being offered a healthy diet that meets their individual nutritional needs. Evidence: Staff had taken photos of individual food items. These were going to be printed and used to help people make more choice about what they want to eat. People were asked by staff what they wanted to drink and how they liked their drink, for example, with or without sugar and how much sugar. 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. Arrangements ensure that the personal care and health needs of the people living there are met so ensuring their well being. Evidence: Records sampled included individual care plans that detailed how staff are to support the person to meet their personal care and health needs. We observed that the people living there were well dressed in individual styles that were appropriate to their age, gender, the weather and the activities they were doing. Attention had been given to individuals personal care so they were comfortable. Staff were observed to take people to get changed if a person had spilt something on their clothes so they did not have to stay in dirty clothes. Relatives said, The care that the people living there get is superb. My relative is well cared for and happy. In our opinion the staff do very well in caring for my relative. Staff always keep me informed of how well my relative is. Some people needed assistance to move using a hoist. Throughout the day staff were observed assisting people safely and talking to them about what was happening so they felt secure. Some of the people living there have complex health needs and sometimes this is associated with their physical disabilities. Records showed that staff involve other health professionals in the care of individuals. Where necessary staff advocate on individuals behalf to ensure they get the healthcare they need. For one person an Independent Mental Capacity Advocate is involved to ensure that any investigations done or treatment needed is in their best interests. Records sampled included an individual health action plan. This is a personal plan about the persons health needs and what support they need to meet them. These detailed the persons health needs and recorded health appointments the person had attended with Evidence: the outcome and any advice that staff needed to follow. Plans included an assessment called a OK Health Check, this enables staff to identify the health needs of the person and is relevant to the needs of the people living there. Some people have health conditions that cause them to be in pain. Assessments of their pain had been completed and staff had responded to their needs so giving them increased pain relief when needed to make them comfortable. Medication is stored in a locked cabinet in the bungalow where the person lives. The qualified nurses that work there give the medication to people. Staff had signed each persons Medication Administration Record (MAR) appropriately indicating that medication had been given as prescribed. Staff record on the MAR how much of each medication is received. This makes it easier to check that medication is being given appropriately and audits showed that it was. Some people have swallowing difficulties making it difficult to take the medication they need to be well. Speech and Language Therapists had been involved in writing protocols to ensure that staff knew how to give people their medication whilst reducing the risk of them choking. Some people are prescribed Controlled Drugs. These have to be stored and recorded differently to make sure they are not misused. We found that these had been stored and recorded appropriately and were being given as prescribed to the person they were prescribed for. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are kept safe from harm. Evidence: The complaints procedure was in the service users guide, which each person had a copy of. It included our contact details so that people would know how to contact us if they needed to. It stated that it was available in other formats if required so making it easier to understand. The home had not received any complaints and we have not received any complaints about the home since our last visit. Staff said and records sampled showed that all staff had received training in safeguarding. This helps to ensure that they know how to keep the people living there safe from abuse. We visited the home in April last year to do an inspection that focused on safeguarding. We found that staff had good knowledge of how to safeguard the people living there from abuse, neglect and self harm. The manager said and staff records sampled showed that all staff had received training in the Mental Capacity Act and the Deprivation of Liberty Safeguards. The Mental Capacity Act came into force in April 2007. It requires an assessment of a persons capacity to be done if there is any doubt that they lack the capacity to make a decision about their health or welfare. The Deprivation of Liberty Safeguards are part of this legislation and ensure that people living in care homes are not receiving care or treatment that deprive them of their liberty. It is good that all staff are aware of this legislation and how it may affect the people living there. The manager has visited the local GP surgery to make the GPs more aware of this legislation and how it may affect the people who live at the home. The manager said this has given the GPs a better understanding of how the people living there can be involved in issues about consenting to treatment with the assistance, where needed, of Independent Mental Capacity Advocates. The money and valuables of the people living there are kept securely in the home. Staff check these at the handover of each shift to ensure they are being kept safely. Finance Evidence: records sampled matched the money held for the person. Receipts are kept of all purchases and put in a clear photo album so it is easier to track what the person has spent and what on. Records showed that people had spent their money on personal items and not on things that should be provided as part of the fees they pay. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, safe, clean and comfortable home that meets their individual needs. Evidence: The home was decorated to a good standard and well maintained. Some rooms had been redecorated recently and other rooms were planned to be redecorated. The decoration was of a contemporary style reflecting the ages of many of the people living there. Both bungalows have a small lounge off the main lounge. These have been converted to sensory rooms so providing a relaxing environment for people to spend time in. Sensory lighting, mobiles, beanbags and cushions are provided so that peoples senses can be stimulated but in an atmosphere that helps them to relax. This is important for many of the people living there who due to their disabilities need to spend a lot of time sitting in their wheelchair to help their posture. Bedrooms seen were personalised and reflected the tastes and interests of the individual. People had been involved in choosing the colours that their room was to be decorated in. Several aids and adaptations were available in the home to help people to be as independent as possible and help staff to be able to move people safely. Ceiling track hoists are available in bathrooms and several bedrooms. Baths are adapted so that people can get in and out of them. A new shower trolley has been provided so that people who are unable to sit in a shower chair or stand can still have a shower. New weighing scales that people can be hoisted onto have been provided. This ensures that people can be weighed regularly so that staff can monitor this and the individuals health needs. The home was clean and free from offensive odours throughout making it pleasant for Evidence: people to live in. Care staff are expected to do the cleaning as part of their role. Relatives said, Staff keep the home tidy and clean. Staff have training in infection control so helping to ensure that the risks of cross infection are minimised. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the people living there are supported by an effective and competent staff team who can meet their individual needs so ensuring their well being. Evidence: All care staff except one have completed National Vocational Qualification (NVQ) level 2 in Care. Five staff who have completed level 2 have asked to do level 3 and the manager said this had been agreed. This will help to develop their skills and knowledge. This exceeds the standard that at least half of the care staff have achieved this qualification so ensuring they have the skills and qualifications to meet the needs of the people living there. The manager said that there is a stable staff team and the sickness levels are very low. This helps to maintain a consistent staff team so that people are supported by staff who know them well. Rotas showed and the manager said that agency staff are rarely used. Any vacant shifts are covered by staff working extra hours as bank or by bank staff that work there regularly and know the people living there. When we last visited staff only worked in one bungalow so they only knew the people living in there. Now staff rotate between the two bungalows so they get to know all the people living in the home. Staff said this was good. Staff said there had not been many changes since the change of provider except the paperwork that they complete. Relatives said, All staff are kind and caring. Staff are very friendly, polite and helpful. Staff provide excellent care. Staff meeting minutes showed that regular meetings were held so that staff can keep updated with best practice and how to meet the needs of the people living there. There is a handover between each shift. This was observed to be informative to staff in how to ensure they knew how to meet the needs of the people living there. Evidence: The records of three of the staff that work there were looked at. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. This ensures that suitable staff are employed to work with the people living there. The records of qualified nurses showed that they had up to date registration with the Nursing and Midwifery Council (NMC) to ensure they are fit to practice. Staff records sampled showed that staff completed an induction when they first started working there so they knew how to meet individuals needs. Student nurses are often on placement at the home and one was on placement when we visited. This helps staff keep updated with current practice. Training records showed that staff have regular training so they know how to meet the needs of the people living there and how to keep them safe from harm. The manager said that nineteen staff had recently completed training in Palliative Care so they know how to meet individuals specific needs and support them appropriately. Records sampled showed that staff did not have regular, recorded supervision sessions with their manager to ensure they are supported in their role. The manager was aware of this and said she hoped that when the new deputy started soon this would improve. The managers line manager is not a nurse so she receives her clinical supervision at a local university to keep her updated with nursing practices. 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. The management arrangements ensure that the health and welfare of the people living there is promoted and protected so ensuring their well being. Evidence: The manager is registered with us and has several years experience of managing homes for people who have a learning disability. She has a Degree in Management and is currently doing a management course with Accord. The manager keeps updated with current practice and regularly undertakes research in her own time relating to people who have a learning disability. When we last visited the home was managed and staffed by South Birmingham Primary Care Trust and owned by Accord. Since then Accord have registered as the sole provider of the home. A representative of the provider visits monthly as required and does an audit of how the home is meeting the standards and regulations. This includes seeking the views of the people who live there and ensuring their needs are being met. A relative said, I am happy with the service and cannot think of anything they could do better. Fire records in bungalow 21 showed that until March this year staff had tested the fire alarm weekly to make sure it was working. Since then they had tested this monthly. The fire risk assessment stated that this should be tested weekly. The manager said that one person who had recently moved in, became very distressed when this was tested and they were not always well enough to be out of the home so that staff could do weekly testing. The manager said that when updating the environmental risk assessments recently they had assessed that, as records from recent years showed that the alarm had Evidence: never not worked, they could take the risk of doing this monthly to avoid distress to this person. The fire risk assessment should be updated to include this. An engineer regularly services the fire equipment to ensure it is well maintained. Fire drills are held about every six months so that staff and the people living there can practice what to do if there is a fire. Staff are also reminded of the fire procedures during fire drills. Staff have yearly updates in fire safety so they know how to minimise the risks of this. Individual plans are in place as to how the person should be evacuated if there was an emergency. The manager said more work needs to be done on these as they are looking at appropriate equipment that they can use to move people safely in an emergency. The manager and records showed that an Environmental Health Officer visited in November last year and the home was awarded five Hs for food hygiene practices. This is the highest award that can be given. Records showed that staff test the water temperatures regularly. These were within the recommended safe temperatures to ensure that people are not at risk of being scalded. Records showed that an engineer completed the annual test of the gas equipment in September last year and stated that it was safe to use. Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Assessments should be reviewed as stated and consider all the risks to individuals to ensure that all action can be taken to reduce them so ensuring the persons well being. Staff should record what a person has eaten and how much. This will ensure that peoples nutritional needs are being met so ensuring their well being. Staff should have at least six formal, recorded supervision sessions a year to ensure they are supported in their role to meet the needs of the people living there. The fire risk assessment should be updated with the current risks stated to ensure action is taken to minimise the risks so that if there were a fire people would be as safe as possible. 2 17 3 36 4 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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