Care Home: Walsall Road, 804

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What the care home does well Staff spend time talking to the people living in the home so that they feel valued.Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals.The people living there go out and do things they enjoy.Staff help the people living there to keep in contact with their families and the people that are important to them.People have a choice of meals that they enjoy.Staff make sure that people get the medication they need when they need it to help to meet their health needs.Staff have training to help them understand how to protect the people living there from harm.Each person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there.Checks of equipment are done to make sure it is safe for people to use. What has improved since the last inspection? Installation of the new adapted bath has been completed so that people with mobility difficulties have the opportunity to have a relaxing bath.A new dining table and floor covering has been purchased for the lounge and dining area making this a more pleasant place to spend time. The manager has attended training on Deprivation of Liberty Safeguards so that she is aware the procedure to follow when people`s freedom may need to be restricted.Staff have had more training so they know how to help people to meet their individual needs. What the care home could do better: People should be consulted about their preferences of the gender of staff that support them with their personal care. So that people can be supported in the way they prefer. Plans to obtain a new medication cabinet need to be followed through so that medication is stored in a more secure cabinet.Look at ways of reducing the impact of staff sickness so that people are supported by people they know well and the general routines of the home are not disrupted. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Walsall Road, 804 Walsall Road, 804 Great Barr Birmingham West Midlands B42 1EU The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kerry Coulter Date: 0 5 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Walsall Road, 804 Walsall Road, 804 Great Barr Birmingham West Midlands B42 1EU 01213580412 F/P01213580412 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) : www.milburycare.com Milbury Care Services Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The maximum number of service users to be accommodated is: 3. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs ona dmission to the home are within the following categories: - Learning Disability (LD 3). Date of last inspection 2 3 0 8 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home 804 Walsall Road is registered to provide accommodation, care and support for three people with learning disabilities. The property is a detached bungalow, located on the main Birmingham to Walsall road in the Great Barr area of Birmingham. The Scott Arms Shopping Centre is within walking distance, and the home is well situated for local amenities including public transport and local shops. The accommodation includes a through lounge and dining area, a domestic scale kitchen, and separate laundry. The bathroom offers assisted bathing facilities, and there is a separate toilet available also. One of the Care Homes for Adults (18-65 years) Page 5 of 34 three bedrooms has ensuite facilities. There is also a small office. To the rear of the property is an attractive private garden, which is accessible for wheelchair users via a ramp. The home is comfortably furnished and well maintained. There is off-road parking for several vehicles on the drive at the front of the house. Care Homes for Adults (18-65 years) Page 6 of 34 The service user guide states the weekly cost is £1094, this does not include aromatherapy, music therapy, hairdressing or transport costs. Copies of the homes previous reports are available in the home for people to read. Care Homes for Adults (18-65 years) Page 7 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 Care Homes for Adults (18-65 years) Page 8 of 34 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home to carry out the homes main inspection. We visited the home over one day, the home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We talked to both people using the service but only one was able to tell us about the home. We asked staff about peoples needs. Care Homes for Adults (18-65 years) Page 9 of 34 We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at all areas of the home, staff and health and safety records. We sent surveys to people who live at the home, their relatives, staff and care professionals so they could tell us what they thought about the home. What the care home does well Staff spend time talking to the people living in the home so that they feel valued. Care Homes for Adults (18-65 years) Page 10 of 34 Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals. The people living there go out and do things they enjoy. Staff help the people living there to keep in contact with their families and the people that are important to them. People have a choice of meals that they enjoy. Care Homes for Adults (18-65 years) Page 11 of 34 Staff make sure that people get the medication they need when they need it to help to meet their health needs. Staff have training to help them understand how to protect the people living there from harm. Each person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there. Checks of equipment are done to make sure it is safe for people to use. Care Homes for Adults (18-65 years) Page 12 of 34 What has got better from the last inspection Installation of the new adapted bath has been completed so that people with mobility difficulties have the opportunity to have a relaxing bath. A new dining table and floor covering has been purchased for the lounge and dining area making this a more pleasant place to spend time. The manager has attended training on Deprivation of Liberty Safeguards so that she is aware the procedure to follow when peoples freedom may need to be restricted. Care Homes for Adults (18-65 years) Page 13 of 34 Staff have had more training so they know how to help people to meet their individual needs. What the care home could do better People should be consulted about their preferences of the gender of staff that support them with their personal care. So that people can be supported in the way they prefer. Plans to obtain a new medication cabinet need to be followed through so that medication is stored in a more secure cabinet. Care Homes for Adults (18-65 years) Page 14 of 34 Look at ways of reducing the impact of staff sickness so that people are supported by people they know well and the general routines of the home are not disrupted. 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 Kerry Coulter 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 15 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 16 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 have the information they need so they can make a choice as to whether or not they want to live there. Arrangements help to ensure that the needs of people would be assessed before they move in to ensure they can be met there. Evidence: The home has a service user guide in place that was last reviewed in June 2008. The guide is in an easy read format that includes pictures making it easier for people to understand. The guide tells people about the home and the services it provides. The guide was informative but should be amended to reflect the current night time staffing arrangements. No new people have moved into the home since we last visited but the home does have one vacancy. Information from the homes Annual Quality Assurance Assessment indicates that a full assessment would be completed before any new person is admitted. This will help people to be sure the home can meet their needs. People would also be offered the opportunity to visit the home to see if they would like to live there. Care Homes for Adults (18-65 years) Page 17 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 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 can support individuals to meet their needs safely so ensuring their well being. Evidence: We looked at the care plans of both people who live at the home. Care plans had been regularly reviewed and detailed how staff are to support the person to meet their needs and achieve their goals. The plan centred on the person and detailed how they should be supported, the things important to them, the things they like and the things they do not like. One health professional who returned a survey to us commented that the home has good care plans. Staff told us that they have up to date information about peoples needs. Care plans gave details of how the staff can communicate with the person for example what Makaton signs the person knows and objects of reference that they use, for example car keys to show the person they are going out. Discussions with staff and observations showed that staff were aware of the information in the plans and were working in the way the care plan said they should. Reviews are held with people at the home to review their care needs and their Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: relatives and involved care professionals are invited to attend these. Key workers also undertake regular support meetings with people. Staff told us that one persons relative usually attended these meetings as the person themselves were unable to communicate their views. Peoples care plans had information about how people need to be supported to make their own choices. Records sampled showed that people are given choices about what they do. Direct observation of staff showed that they supported people to make decisions, for example, what they wanted to eat or drink. All care plans were accompanied by a risk assessment. These included personal care, health care needs, activities within the home and going out into the community. This is viewed as being good practice in minimising the risks of accidents and injuries. Care Homes for Adults (18-65 years) Page 19 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 good 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 that meets their individual needs. Evidence: One person who lives at the home told us it was a nice home and they enjoy living here. Records sampled showed that people are supported to do the activities they enjoy. One persons care plan said they liked going to a local pub, they were going there with staff for lunch on the day we visited. Each person has their own activity plan based on the things they like to do. However one care professional told us that sometimes the timetables were not always followed. We saw that the manager was trying to improve this and had reminded staff at a recent meeting that the plans needed to be followed. Records showed that activities on offer include going out for lunch, going for walks, aromatherapy, shopping, massages and using the foot spa. During the afternoon a music activity was being undertaken facilitated by an external musician. People Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: seemed to be enjoy this activity. It is good that reviews are undertaken of the activities people participate in to make sure people are doing the activities they like. One persons activity planner set aside times for their favourite television programmes and we saw that staff changed the television channels so that people could watch their chosen programme. One persons planner had time set aside for daily leg exercises due to a health condition. We spoke with the person who told us they do they do their exercises and had last done them the day before. The home appeared to have an open policy in respect of visiting. Files contained information about maintaining relationships with families and friends. As stated earlier in this report peoples families are involved in reviews of their care. One person is supported by staff to write to one of their relatives regularly. Records showed that the home was organizing a summer barbecue and inviting families to attend. The home also has a record of the dates of birthdays of close relatives so that people can be supported to send a card. Where possible people are involved in choosing items for the shopping list and the next weeks menu. For people who find it difficult to make their choices known staff have good information about their food likes and dislikes. Food records sampled showed that people have a culturally appropriate, varied and nutritious diet that includes fruit and vegetables. We saw plentiful supplies of fresh fruit were available. The Annual Quality Assurance Assessment told us that healthy eating training was being organised for staff. One person told us that they get food they enjoy and they were aware of what was on the menu for the evening meal. Care Homes for Adults (18-65 years) Page 21 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. Arrangements usually ensure that individuals personal care and health needs are met so ensuring their well being. Evidence: The people living there were well dressed in individual styles that reflected their age, gender, cultural background and the activities they were doing. Attention had been given to individuals personal care so helping to ensure their well being. Peoples care plans gave detailed information about peoples personal care needs and how they liked to be supported. One persons plan had recently been updated to reflect that they had been consulted about their preferences for the gender of staff who supports them. We saw that for the other person their plan did not have this information despite the fact that are often supported by staff of the opposite gender at night. Records sampled included an individual health action plan. This is a personal plan about what support the person needs to meet their health needs and what healthcare services they need to use. A care professional told us that home usually seeks and acts on advice about peoples healthcare needs. Records showed that each person has an annual health check with Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: their GP to ensure that any underlying health needs can be detected so they can get the help needed to meet their health needs. Records showed that staff supported people to go to the GP when they are unwell and to have regular eye, hearing and dental checks. Where appropriate people had regular chiropody treatment. Records show that staff regularly monitor peoples weight as significant loss or gain of weight can be an indicator of an underlying health need. Staff spoken with during the visit had a good understanding about peoples health needs. One person at the home has epilepsy, staff were able to describe what they would do to keep them safe should they have a seizure. One person who lives at the home has recently been diagnosed with diabetes. The Annual Quality Assurance Assessment told us that three staff have received training about diabetes. When we visited we spoke with one staff who had not yet had any training, they told us this was being arranged by the manager. No one living at the home is able to administer their own medication. We saw staff administering medication during our visit and this was done is a safe manner. Medication is only given by staff trained to do so. Recently the home has had high levels of staff sickness and this has caused some difficulties in having staff who are medication trained on duty. On some occasions staff have had to come to the home from another Milbury home on the same road to administer medication. At the front of the persons Medication Administration Record (MAR) there is a photograph of them so that unfamiliar staff would know who to give the medication to. It also states how they take their medication so that staff know this. Some people are prescribed as required (PRN) medication and protocols were in place stating how, when and why this should be given so it is not misused. The Medical Administration Record (MAR) was examined and was found to be completed appropriately. There is a system in place for a second member of staff to check and sign that medication has been appropriately administered and recorded. During our visit staff had difficulty in opening and locking the wooden medication cabinet and had to call out the maintenance engineer to repair it. The wooden cabinet is not ideal for the storage of medication and does not have space for medication that is to be returned to the pharmacist. Medication to be returned is currently being stored in a cabinet that is not secure enough. We saw that the homes own quality assurance audit had identified that a new cabinet was needed and had a date for completion that had since passed. Staff told us that they had been promised a new cabinet but did not know when it would be obtained. Care Homes for Adults (18-65 years) Page 23 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. Arrangements ensure that the views of the people living there are listened to and they are protected from abuse and harm so ensuring their well being. Evidence: We have not received any complaints or allegations about this home in the last twelve months. The Annual Quality Assurance Assessment completed by the manager records that the home has not received any complaints directly. The home has a complaints procedure that has been made easier to understand with the use of pictures. People have a freepost addressed postcard that they can send to Milbury to let them know something at the home is worrying them. Due to their level of understanding not all people at the home would be able to do this. However their care plan has detailed information about their communication needs and staff would use the persons individual communication plan to determine when a person is unhappy. Staff records showed and the AQAA stated that staff have training in how to protect the people living there from abuse. Staff spoken with were aware of the different types of abuse that could happen and were able to describe the actions they would take to keep people safe. As people who live at the home have limited communication and understanding it is good that the home has sent their relatives information about how to complain and about the homes policy on protecting people from abuse. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Staff records showed that most staff have had training on the Mental Capacity Act. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. So that staff know about this the manager has tried to get staff on Deprivation of Liberty Safeguard training. Evidence shows that staff are on a waiting list to attend this training via Birmingham City Council. Money is held securely in the home and records showed that it is spent on personal items not on things that should be provided by the home. Receipts are kept of all purchases and these cross referenced with the persons records indicating that peoples money is being spent appropriately. Staff check peoples money at the shift change. We saw that a full and in depth audit of financial procedures in the home had been undertaken at the homes annual operational review. This helps to make sure peoples money is being well looked after. Care Homes for Adults (18-65 years) Page 25 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. People live in a safe, homely and comfortable environment that meets their individual needs. Evidence: The home is a specially adapted bungalow, which is well maintained. We looked at all areas of the home and found it provides a homely environment to live in. The home was generally in good decorative order but some communal rooms were starting to look a little worn in places and externally some windows needed repainting. However the Annual Quality Assurance Assessment has told us that redecoration of some communal areas and painting of the windows is already planned. It also told us that the home had a new dining room table and lounge flooring. Part of the garden wall had fallen down and had a temporary repair. The homes annual operational review recorded that it was intended to rebuild this. We saw that that the hallway carpet was worn in places, consideration will need to be given to replacing this in the near future. Each person has their own bedroom. Bedrooms looked at were decorated and furnished to suit the tastes, culture and interests of the individual. One person told us that they liked their bedroom. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: One person who has lives at the home has a sight impairment. At our last inspection we were told that the colour schemes, contrast and textures had been designed following a functional assessment of this persons needs. Grab rails are fitted in the hallway and bathroom and there is ramped access into the garden to assist people with mobility difficulties to move around the home safely. The home also benefits from having an adapted bath. The home was clean and free from offensive odours so it was a pleasant place for people. There were satisfactory hand washing facilities in the kitchen, bathroom and laundry to help minimise the risks of cross infection. Care Homes for Adults (18-65 years) Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development usually ensure that the needs of the people living there are met. Evidence: The Annual Quality Assurance Assessment recorded that seven out of the eight permanent staff had achieved a National Vocational Qualification in Care. This means that at least 50 of staff have achieved this qualification ensuring they have the skills and knowledge to meet the needs of the people living there. There were only two people living at the home when we visited. Staff rotas showed that during the day there are always at least two staff on duty and at night there is one staff. Staff told us that there were usually enough staff on duty. Recently the home has had some staffing difficulties as several staff have been on long term sick leave. As reported earlier in this report this has resulted on some occasions in staff from another Milbury home having to assist in administering medication. To ensure there are enough staff on duty to meet peoples needs staff have worked extra hours or bank staff have been used. When we visited the home a bank staff was on duty for part of the day. It was evident that they did not know peoples needs as well as the permanent staff. For example one person asked for a cup of tea. When it was made by the bank staff the person had to send it back as the bank staff did not know they liked sweeteners in their drinks. One permanent staff told us that it had been difficult at the home in last few weeks as bank staff do not know people as well. Discussions with staff indicate that the situation will hopefully soon improve as some staff on sick leave Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: were due to return to work. As the manager was not on duty when we visited we were not able to access the homes recruitment records. However we were told by staff and this was later confirmed by the manager that no new permanent staff had started work in the home since we last visited. At our last inspection we found that the home had a robust recruitment procedure. The Annual Quality Assurance Assessment completed by the manager indicates that the home still has good recruitment procedures in place. Staff surveys received and discussion with staff indicate that the majority of staff are satisfied with the training on offer. Some training undertaken by staff is by training packages accessed on a laptop. One staff did comment that sometimes it was difficult to find the time to do this as they had to fit this in as part of the two staff on duty. We looked at the training records of three members of staff. Records sampled showed that staff receive the training they need to be able to meet the needs of the people living there, this includes health and safety, manual handling, food hygiene, first aid and the prevention of abuse. Staff also had specific training in meeting the specific needs of individuals that live there to include sensory impairment, diabetes, epilepsy and dementia. Staff meeting minutes showed that regular meetings are held so that staff know about any changes to the needs of the people living there and within the organisation. The matrix for supervision indicated that staff have this regularly. Regular supervision is important for staff as it enables them to reflect on practice and identify their training and development needs. Care Homes for Adults (18-65 years) Page 29 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 management arrangements ensure that the home is well run so the health, safety and welfare Evidence: The current manager has worked with the organisation for several years. She currently manages another home, situated in close proximity. The manager is a qualified nurse and holds the Registered Managers Award and National Vocational Qualification Level four. At the time of our visit the manager was off work as she was unwell. As the deputy manager position in the home was vacant staff had support from a manager of another Milbury home. Staff told us that the manager is approachable. One staff told us the home is well run. The manager completed the Annual Quality Assurance Assessment and returned it when we asked for it. This told us what improvements the home had made and were intending to make in the future. A representative of the company monitors quality at regular intervals during monthly unannounced visits. We observed the reports produced as a result of these visits which show the visits look at a wide range of matters to ensure the service is operating well and that people are pleased with their care. An Annual Operational Review is also Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: undertaken of the home. As part of this surveys are sent to people at the home or their relatives and involved care professionals to seek their views of the home. Where areas for improvement are identified an action plan is completed stating what needs to be done. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. We looked at a selection of maintenance and servicing records, all were up to date and demonstrate that systems are in place to ensure the home and equipment is safe. We saw that staff have regular training in health and safety, which ensures they are provided with the knowledge and skills to help people keep safe. We saw that a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. Staff regularly test the fire equipment to make sure it is working. Care Homes for Adults (18-65 years) Page 31 of 34 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 Care Homes for Adults (18-65 years) Page 32 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 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 18 People should be consulted about their preferences of the gender of staff that support them with their personal care. So that people can be supported in the way they prefer. Plans to obtain a new medication cabinet need to be followed through so that medication is stored in a more secure cabinet. Look at ways of reducing the impact of staff sickness so that people are supported by people they know well and the general routines of the home are not disrupted. 2 20 3 33 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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