Care Home: Victoria House

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• 2 Perhaver Park
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What the care home does well People who may want to move to Victoria House are given good information about the service. There is plenty of good food. Each person has their own room just as they want it. The staff are friendly and safe to be with. People are reminded about what to do if they are unhappy about anything. People are helped to keep healthy, and staff will help them visit their doctor, dentist or optician. Staff will support people to keep in touch with their family and friends. People are encouraged to develop their skills and be as independent as possible. What has improved since the last inspection? The new manager has started to improve the information about people who live in the home. One person has had a new wet room installed in their bedroom to help make it easier for staff to support them with their personal care. The laundry facilities in house 2 have been moved from the kitchen area reducing the risk of infection. The new manager has started to look at the numbers of staff in the home, and has increased staffing levels on some of the days when people may want to go out. Staff now regularly meet with the manager to talk about their work and any training they may need. What the care home could do better: Some of the people living in the home need more staff to support them to do interesting things. Staff need to have clear written information about how they need to support people. People who use the service should be involved in writing these plans. All rooms in the house should smell fresh and clean. Any carpets that are worn or stained should be cleaned or replaced to ensure that the home is kept looking comfortable and in good condition for the people who live there. There is a risk of infection due to the current use of the toilet accessed through the kitchen area in house 2. Key inspection report Care homes for adults (18-65 years) Name: Address: Victoria House 1 Victoria Terrace Plymouth Devon PL4 6BL     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: Wendy Baines     Date: 1 3 0 7 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 34 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 34 Information about the care home Name of care home: Address: Victoria House 1 Victoria Terrace Plymouth Devon PL4 6BL 01752661171 01752661171 victoria_grenville@regard.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Regard Partnership Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Victoria House is the name of two adjacent terraced houses in Victoria Terrace. Each house has its own communal facilities, kitchen and staffing rota. No.1 Victoria Terrace has accommodation and communal facilities for six people and No.2 Victoria Terrace for four people. Accommodation is provided in single rooms on both the ground and first floors. A small patio area is provided at the rear of No2 and provides a pleasant seating area. The home is situated within walking distance of local shops and amenities and the City Centre of Plymouth. Neither house is suitable for people who have significant mobility difficulties as both are accessed by a short flight of steps. The home is owned by the Regard Partnership Limited. Both houses are registered for people aged between 18-65 years who have a moderate learning disability and may have behaviours that challenge services. There were nine people living at Victoria House at the time of this inspection. The weekly fees for this service are calculated on an individual basis depending upon the each person?s support needs. Information relating to the services provided by Victoria House can be obtained directly from the Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 10 Brief description of the care home home. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Inspection was unannounced and took place over two days on the 6th and 13th July 2009. Although the service did not at the time have a Registered Manager the homes acting manager was present throughout the Inspection. The Inspector was advised that the service was in the process of submitting an application to Register a manager with the Care Quality Commission. Significant time was spent with all of the people who live at the home, and observations were made of how people spend their day and their interaction with care staff. The Inspector was able to meet and talk to all staff on duty. Care Homes for Adults (18-65 years) Page 6 of 34 Records relating to the day to day running of the home, including health and safety records were examined. Prior to the inspection surveys were sent out to people who use the service and staff. A tour of the building was made and the records relating to the support needs of six people using the service were examined in detail, as well as the personal files for four staff members. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment sent by the Commission and which allows the Registered Manager to describe what the service does well and what areas for improvement have been identified. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Some of the people living in the home need more staff to support them to do interesting things. Staff need to have clear written information about how they need to support people. People who use the service should be involved in writing these plans. All rooms in the house should smell fresh and clean. Any carpets that are worn or stained should be cleaned or replaced to ensure that the home is kept looking comfortable and in good condition for the people who live there. There is a risk of infection due to the current use of the toilet accessed through the Care Homes for Adults (18-65 years) Page 8 of 34 kitchen area in house 2. 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 34 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 34 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 who may use the service and their representatives are provided with the information they need to help them make an informed choice about where they live. Visits to the home and pre-admission assessments ensure peoples needs are well known prior to deciding on the suitability of Victoria House. Evidence: People who may be wanting to move into Victoria House are provided with information about the service. A service user guide is available, which has details about the accommodation, the staff and different services available. This information is available in picture format for people who may not understand the written word. A new resident had moved into the home since the last key inspection. Records relating to this admission were examined and the inspector was also able to talk with a representative from Social Services to gather their views on the quality of the homes admissions process. The home also had vacancies and the manager was able to describe to the Inspector the organisations assessment and admissions process. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: When a request is received from someone wishing to move into the home a referral manager from the organisation and the homes manager would undertake an assessment of their needs. This would involve meeting the individual, their family or representative as well as others who know the person such as social workers. The person would be invited to visit the home over a period of time to become familiar with the surroundings, the staff and other people living in the home. The records seen for the recent admissions to the home demonstrated that these procedures had been followed. The new resident had been able to visit the home and choose the decor for their bedroom, which was completed before they moved in. Records confirmed that an advocate was also involved in the admissions process to support the person concerned and ensure that the move to Victoria House was in their best interest. A representative from Social Services said that the staff at Victoria Terrace had worked hard to support the new resident to move and settle into their new home The keyworker and staff asked for all the information they needed as part of the initial assessment and made appropriate requests for support in relation to staffing and the individuals health needs. Care Homes for Adults (18-65 years) Page 12 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Victoria House can be confident that they will be treated in a dignified and respectful manner by staff who have a good understanding of their needs. Low staffing levels could have a detrimental effect upon peoples choices and opportunities. Although there has been some improvement in care plans they are still not all written in a consistent format that covers all areas of care. This could result in inconsistencies in the way that care is delivered. Evidence: Many of the people living at Victoria House were, due to the level of their disability, unable to comment directly about the quality of the support they received. The Inspector was able to observe the care being provided by staff and spend time talking with some of the people who live in the home about their routines and plans for the day. In addition it was also possible to speak to management and staff about the Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: people who live at Victoria House and examine a sample of the records relating to their care. Staff expressed concern about on-going staff shortages in the part of the home supporting people with more complex care needs. Some of these people required more than one staff member to access opportunities in the community. Another person chose at times to stay in bed during the day, which meant that a staff had to remain in the house to provide support. The staff felt that some people were being restricted due to the needs of others. Whilst it was recognised that peoples personal care needs were being met, the days when there were fewer numbers of staff on duty, peoples opportunities to participate in leisure activities both in and out of the home were reduced. This continues to be a cause of concern amongst some of the staff team as they were aware that inactivity and boredom may lead to frustration that can cause a deterioration in a persons well being and behaviour. The manager said that staffing levels are being seen as a high priority in the home and additional staff are now on duty on set days during the week to assist with activities. The time spent observing the daily life in the home and staff practices found the staff were very patient and people were treated gently and with respect. Staff had a good understanding of peoples needs and were able to use their knowledge and skills to diffuse potentially difficult situations. Staff were observed knocking on peoples bedroom doors before entering. Where possible people were being encouraged and supported to partake in daily tasks within the home. The homes notice boards had a plan for the day in pictures and this included photographs of the staff on duty. Staff in the part of the home which supports people with more complex needs felt that the communication tools available to support people were not always appropriate. Staff did think that there was a plan to develop communication passports in liaison with the Speech and Languages department and they hoped that this would assist them to meet the communication needs of each individual. The Support plans and care records for six people were examined in detail. Support plans are the documents used to describe each persons needs and how these needs will be met by the home. All of the files seen contained a personal profile of the individual, which gave a brief description of their current needs and background. There was also a strengths and needs assessment, care plan and risk assessment relating to daily living and the environment. The strengths and needs assessment in some cases documented statements such as x needs help to maintain contact with family, however it was not clear in all cases how this support would be delivered. Although it Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: was evident that there had been some improvement to care plans since the last inspection some of those examined were not documented in a consistent format, did not cover all areas of care and did not demonstrate how people have been involved in this process. Guidelines were in place for some people who may display episodes of difficult behaviour. In some cases these guidelines had been provided and monitored by the specialist Learning Disability services. Staff spoken to were aware of these procedures and the importance of consistency when dealing with difficult situations in the home. People have a monthly meeting with their keyworker to look at their plan of care and discuss any important issues. Minutes of these meetings were seen as well as copies translated into pictures for those with communication difficulties. The home also organises a review each year for each person and invites their family and/or their representative. Care Homes for Adults (18-65 years) Page 15 of 34 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. Staff are aware of the need to support and encourage people where possible to develop their skills. People who use the service have the opportunity to develop and maintain important personal and family relationships. The opportunities for some people to partake in social and leisure opportunities are being restricted due to insufficient staffing levels to meet these needs. Evidence: Some of the people living in the home were able to partake in household tasks, such as laundry, washing dishes, shopping and preparing meals. One of the notice boards had pictures of different tasks for the week, and on the day of the inspection one person was pleased to show the inspector a picture of a cooking activity that they would be involved in. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: During the two day inspection visit the people who were more able were occupied doing planned community activities such as music and art groups. Two gentlemen also enjoyed a lunch out at a local pub. People were also seen relaxing in their bedrooms and assisting staff in the kitchen. As identified in a previous outcome group staff expressed concern about the amount of time they were able to spend with people who required higher levels of support. Staff did feel that although peoples personal care needs were being well met it was not always possible to take people out and meet their social and leisure needs. On the first day of the inspection there were two staff on duty to support the four residents with greater care needs. One of the residents required two staff to go out. However, this was not possible as one other resident had chosen to stay in bed during the day and a staff member would therefore need to remain in the house. The manager for the home recognised that staffing levels in the home still needed to be improved, and said that on some days during the week three staff are now on duty to help take people out. Monthly keyworker meetings take place and the minutes of these meetings confirmed that discussion takes place with each person about activities and an annual holiday. One gentleman was keen to tell the Inspector about his plans for a summer holiday and the staff were supporting him to make these arrangements. Daily records and discussion with staff confirmed that people are supported to maintain links with family and friends. The organisation also has several other services in the local area and people often visit friends and attend social events in the different homes. People said that the meals were good and nice. The main meal of the day was in the evening and those who were able were supported to assist with preparation, as well as helping to prepare their own breakfast and lunch. Picture menu plans and other symbols were available to assist people to make choices about their meals and snacks. In house No1 people were able to partake in shopping and meal preparation and each person had a day when they would be the duty chef. In house No2, people require more support at mealtimes but were being involved as much as possible. Due to the open plan layout in house No2 people were able to sit in the dining area and interact with the staff who were in the kitchen preparing food. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: The staff support people to make healthy choices about their meals and this was reflected in the menus. In the previous three inspection reports the home was commended for the quality of the food and the involvement of people in this area of daily life. Care Homes for Adults (18-65 years) Page 18 of 34 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 living at Victoria House receive support in a way, and at a time that they want and need. Staff respect peoples privacy and dignity and are sensitive to changing needs. People who use the service have access to healthcare services, and healthcare needs are addressed as soon as they are identified. Evidence: Records and discussion confirmed that people living in house 1 require some support with their daily personal care needs. This is usually in the form of prompts, encouragement and reminders by staff. The people living in house 2 have greater needs and require assistance with all aspects of daily personal care. The way this care should be delivered was described in the care plans seen during the visit. Throughout the inspection staff were observed assisting people in a respectful and supportive manner. Evidence was recorded that people had been supported to see their GP, dentist and Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: optician. Any medical conditions, such as Epilepsy were identified in support plans and a description provided to staff on how this condition affects the person and how they should be supported. One person was being screened for Dementia. The staff had recognised changes in the individuals behaviour and had made a referral to the Specialist Learning Disability Services with a request for Dementia screening. Although this diagnosis has been ruled out at present staff are now aware of the potential support needs for this individual in the future. A risk assessment had been completed for one person following a fall and a referral made to the Physiotherapy services for advice regarding equipment to prevent this happening again. Staff had identified concerns about the health needs of a person who had recently moved into the home. Advice had been sought from a specialist dietician and staff were encouraging the individual to have a healthy diet and take regular exercise. Medication was stored in both houses, and although no one was managing their own medication, should someone wish to do so and are assessed as safe they would be fully supported by staff to be as independent as possible. Since the last inspection a new Blister pack system had been introduced. This is a system where medication is delivered to the home from the pharmacist in sealed packs that separates each day and time of the day, and which reduces the risk of medication errors. All staff who have the responsibility to administer medication had received training in safe practices and certificates were available in staff files. Medication records were clear and neat. Each month a designated member of staff checked the administration records and balances of medication for accuracy. The Quality Assurance Manager who visited the home each month undertook spot checks to ensure medication practices and storage were safe and in line with the organisations policy. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure. Policies and Procedures regarding the safeguarding adults are available to staff and give them clear guidance about what action should be taken Evidence: Neither the home nor the Commission have received any complaints about this service since the previous Inspection. Those people spoken to and who were able to comment said the staff were very nice and kind to them and that they were able to talk to them if they were unhappy about anything. The Keyworker meetings and formal 3 monthly reviews allow people to comment about how they want to live their lives, what plans they have, and whether there were any issues of concern. Relatives and Social Workers were involved for those people who are unable to advocate for themselves. Minutes from the last residents meeting confirmed that people had been reminded about what they should do if they are unhappy about anything and a pictorial complaints procedure had been used to help explain this information. Pictorial information was also available for people who use the service regarding peoples rights, abuse and how to keep safe. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: Records confirmed that staff undertake training about issues relating to abuse and the protection of vulnerable Adults. However, one staff member spoken to was unclear about their responsibilities should they suspect someone is at risk, or if an incident of abuse has occurred in the home. Care Homes for Adults (18-65 years) Page 22 of 34 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. Victoria House provides a comfortable and homely place to live. The environment could be further improved by the replacement of carpets in House 2 and by addressing issues raised relating to infection control. Evidence: Victoria House offers a spacious and comfortable home to the people that live there. No1 has a large lounge room at the front of the house and large dining room and kitchen at the rear. The door from the kitchen led on to the patio area that was being used for parking, but access was available directly to the pleasant patio area of House No2. In House No2 the Lounge, dining room and kitchen are open plan, and this allows those living in the house, who are more dependent upon staff to be involved in the household activities taking place, either actively or just by watching from the seating areas. Office space was provided in each house that did not encroach upon the communal space. Both houses has large notice boards with pictures of staff and information about daily events in the home and local community. Bedrooms in both houses were on both floors and were all well personalised and nicely Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: decorated. One of the bedrooms in house 2 had, had a wet room installed, making it easier for the staff to assist with the individuals daily personal care needs. Both houses were found to be generally clean and hygienic throughout. However, it was noted that in House 2 one of the bedrooms had a strong odour and most of the carpets needed to be replaced. Since the last Inspection the laundry room in house No2 has been relocated away from the kitchen area. This had been previously recommended to reduce the risk of cross infection. However, a shower room and toilet, which has to be accessed through the kitchen area is still being used by one person. At the previous inspection the manager had advised that this would cease when an ensuite facility was available in the individuals bedroom. This facility is now available, therefore due to the continence needs of those living in the home use of the bathroom facilities located next to the kitchen area should now cease. Care Homes for Adults (18-65 years) Page 24 of 34 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. Staff are competent, motivated and committed to providing the people who live at Victoria House with the support they need to live fulfilling lives. Recruitment practices are safe. The opportunities of some people living in the home are reduced due to low staffing levels and the needs of others. Evidence: Throughout the Inspection staff were observed treating people in a dignified and respectful manner at all times. Staff knocked on peoples doors before entering and gave clear information about how they would be supporting them during the day or with a particular task. All staff spoken to were able to give a clear account of the needs of the people they support, and were able to demonstrate a good understanding of the way people communicate. This knowledge enabled staff to diffuse situations where an individuals behaviour may become difficult. The acting manager and staff spoke openly about the strains that long term sickness and absence of a Registered Manager had had upon the service. However, all staff said that there had been significant improvement since the new manager was Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: appointed three months ago and this had had a positive impact on staff moral. The manager said that since she has been in post she has looked at staffing levels as a matter of priority. She said that there has been some improvement with the use of Bank staff and increased staffing levels on some set days to allow people to go out for particular social activities. Referrals have also been made to Social Services to request additional funding for individuals with care needs that the home feels require additional staff support. There were concerns expressed by staff that staffing levels in house 2 were still at times insufficient to meet peoples assessed care needs. Staff felt that although peoples personal care needs were being met, some people had their social and leisure needs restricted due to the needs of others living in the home ( see Standards 14Lifestyle) Some of the staff felt that their support time could be better planned to ensure that peoples needs are being met. The personnel files for four staff were examined and these contained the necessary pre-employment checks, including two written references and a Criminal Record Bureau Disclosure, ensuring as far as possible only suitable staff are employed in the home. The organisation has its own training department to ensure staff remain up to date not only with the statutory training in first aid, Health and Safety, and Fire safety but also in issues relating to the needs of people with a Learning Disability, such as Autism, and dealing with behaviours that challenge. The local Learning Disability service has also provided additional training in matters relating to disability. Since the last inspection the organisation has introduced a new system of on-line training. Some of the staff spoken to said that they did not enjoy this way of learning, and preferred face to face training rather than the use of a computer. Each staff member had their own training record, which enabled the Registered manager to identify when updates in training were needed or to plan training resulting from a review of each staff members development needs identified through supervision. Nine of the eleven staff employed at the home had achieved a National Vocational Qualification (NVQ). The NVQ is awarded by an external training provider demonstrating that staff have the knowledge and competence to support people with a Learning disability. Formal staff supervision sessions take place every six weeks. These meetings are used to monitor staff performance, identify training issues and deal with any concerns. All of the staff spoken to said that they felt well supported by the new manager and that recent improvements in the home had improved staff moral and team working. Three Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: of the staff who completed surveys said that they thought that the service could be improved by staff having more support and contact from senior/head office staff within the organisation. Although the majority of the standards in this outcome group have been met, a rating of adequate has been given due to the concerns raised about restrictions of people due to staffing levels in House 2. This rating was also given in the last key inspection but remains an area of concern. Care Homes for Adults (18-65 years) Page 27 of 34 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 appointment of a new manager has improved the way the home is run and improved staff moral. These changes are likely to have a positive outcome for people who use the service. The staff team strive to provide a stimulating, safe environment that respects and protects peoples rights. Evidence: Since the last inspection the home has had a long period of time without a Registered Manager. Staff spoken to were very honest and open about the strains that this and staff sickness has had on the service. However, all the staff who completed surveys and those spoken to said that their had been significant improvements since the appointment of a new manager at the end of April this year. Several staff members said that records and systems in the home had improved and that they felt more valued and supported. The new manager was present throughout the inspection and was aware of where Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: improvements needed to be made to further improve the quality of the service. The Inspector was informed that the Provider is in the process of submitting an application to the Commission to Register a manager for the service. Since being in post the new manager has started to review care plans, and is considering training for staff regarding person centered planning and the involvement of the individuals in their care arrangements. Staff supervision is now taking place on a regular basis, and staff said that they felt well supported. All of the homes policies and procedures have been reviewed and where required updated. The manager was aware of on-going issues relating to staffing levels of those people with greater care needs, and stated that this continues to addressed with the organisation. The organisation has a Quality assurance team with five managers covering each geographical area where the organisation has services. These managers report to a Quality assurance director responsible to the senior management team. The manager said that questionnaires are sent to people who use the service, their families and/or their representatives, asking for their views on the quality of the services provided. The results of keyworker meetings and the three monthly reviews also contributed to the overall review of the services. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 34 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 1 14 16 Staff must be employed in 21/10/2009 sufficient numbers to ensure that peoples social and leisure needs are met. People must not have their social and leisure opportunities restricted due to the needs of other people living in the home. 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 6 15 Care plans must cover all areas of need as set out in Standard 2 (needs assessment) and provide clear guidelines for staff about how any identified needs will be met. To ensure consistency in the way that care is delivered. 20/09/2009 2 7 12 The Registered provider must ensure that staffing levels are sufficient to enable people to make choices about their lifestyle and daily activities. People using the service must not have their needs 20/09/2009 Care Homes for Adults (18-65 years) Page 31 of 34 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 and choices restricted due to the needs of other people who live in the home. 3 30 13 The use of the toilet facility, 10/09/2009 which is accessed through the kitchen area must cease. The Registered Provider must take steps to reduce the risk of infection, from people with continence needs using the toilet, which is accessed through an area where food is prepared. 4 33 18 Staff must be employed in sufficient numbers to meet the assessed care needs of people living in the home. People must not have their opportunities restricted due to the needs of others living in the home. 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 10/11/2009 1 6 The Registered Provider should demonstrate that people are involved in planning their care and making choices and decisions about how care is delivered. The service should ensure that people are provided with information, assistance and communication support they need to make decisions about their lifestyle. The Provider must ensure that all staff are aware of their responsibilities and the procedures to follow should they Page 32 of 34 2 7 3 23 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations suspect an incident of abuse has occurred in the home. 4 24 Carpets in house No2, which are stained and in poor condition should be renewed to further improve the environment in which people live. The odour problem highlighted in one bedroom during the inspection should be addressed. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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