Care Home: Walsall Road, 836

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What the care home does well Information about what the service provides is available in an easy read format so that it is easier for people to understand.Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals.Staff know the people living there well and understand how they need to support them.The people living there enjoy their food. They can choose what they want, so that they can have the things they like to eat.People are supported to attend health checks to help them to stay well. 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.Proper checks are carried out on staff before they start work at the home. This is to ensure that they are fit for the job.Checks of equipment are done to make sure it is safe for people to use. What has improved since the last inspection? The lounge has been decorated and new carpets fitted making this a more pleasant place to spend time.One person attends an exercise class to help them stay healthy.The manager has attended training on Deprivation of Liberty Safeguards so that she knows what to do 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.There are more staff to meet people`s needs. What the care home could do better: Care plans should be developed to include more information about how people need to be supported with their epilepsy. This will help them get the care they need should they have a seizure.Review the arrangements for activities and holidays to make sure people can do the things they enjoy.The guidance in place for giving people as required medication should be reviewed to make sure it is up to date so that people receive the medication they need safely.Review the number of staff on duty to make sure there are enough staff to meet people`s needs.Improve the arrangements in place for health and safety audits of the home so that health and safety issues are identified and acted on. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Walsall Road, 836 Walsall Road, 836 Great Barr Birmingham West Midlands B42 1JN 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: 1 5 0 9 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 35 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 35 Information about the care home Name of care home: Address: Walsall Road, 836 Walsall Road, 836 Great Barr Birmingham West Midlands B42 1JN 01213580009 F/P01213580009 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 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The maximum number of service users to be accommodated is : 4. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: - Learning Disability (LD 4). Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home 836 Walsall Road provides accommodation, care and support for four adults with learning disabilities. It is run by Milbury Care Services. The house is a detached bungalow. It is on the main A34 Birmingham to Walsall road, being accessed via a good service road. It is in the Great Barr area of Birmingham, a short walk from the Scott Arms shopping centre. There is good public transport. There are shops, pubs, food outlets, libraries, places of worship and park nearby. Care Homes for Adults (18-65 years) Page 5 of 35 People all have single bedrooms containing wash hand basins. There is a bathroom with facilities for assisted bathing, and a separate w.c. The lounge / dining room is at the front of the house. There is a small office, kitchen and separate laundry room. Both the front and rear of the property is accessible to wheelchair users. The pleasant rear garden is enclosed and private. There is parking at the front of the property, both on and off road. Fees range from £1453 to £1553 and do not include aromatherapy, music therapy, hairdressing, visits to the barbers and transport. Copies of previous reports are available in the home for people to read. Care Homes for Adults (18-65 years) Page 6 of 35 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 7 of 35 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 people living there but they were not all able to tell us about the home. We asked staff about these peoples needs. Care Homes for Adults (18-65 years) Page 8 of 35 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. Not everyone returned a survey to us. What the care home does well Information about what the service provides is available in an easy read format so that it is easier for people to understand. Care Homes for Adults (18-65 years) Page 9 of 35 Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals. Staff know the people living there well and understand how they need to support them. The people living there enjoy their food. They can choose what they want, so that they can have the things they like to eat. People are supported to attend health checks to help them to stay well. Staff have training to help them understand how to protect the people living there from harm. Care Homes for Adults (18-65 years) Page 10 of 35 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. Proper checks are carried out on staff before they start work at the home. This is to ensure that they are fit for the job. Checks of equipment are done to make sure it is safe for people to use. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 11 of 35 The lounge has been decorated and new carpets fitted making this a more pleasant place to spend time. One person attends an exercise class to help them stay healthy. The manager has attended training on Deprivation of Liberty Safeguards so that she knows what to do when peoples freedom may need to be restricted. Staff have had more training so they know how to help people to meet their individual needs. There are more staff to meet peoples needs. Care Homes for Adults (18-65 years) Page 12 of 35 What the care home could do better Care plans should be developed to include more information about how people need to be supported with their epilepsy. This will help them get the care they need should they have a seizure. Review the arrangements for activities and holidays to make sure people can do the things they enjoy. Care Homes for Adults (18-65 years) Page 13 of 35 The guidance in place for giving people as required medication should be reviewed to make sure it is up to date so that people receive the medication they need safely. Review the number of staff on duty to make sure there are enough staff to meet peoples needs. Improve the arrangements in place for health and safety audits of the home so that health and safety issues are identified and acted on. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 14 of 35 If you want to speak to the inspector please contact Kerry Coulter West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel 0300 616161 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 35 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 35 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. Arrangements in place should ensure that people can be confident their needs will be met on admission to the home. Evidence: The home has an up to date service user guide in place. The guide is in an easy read format and includes pictures making it easier for people to understand. The guide tells people about the home and the services it provides. A statement of purpose is also available to people, this is in both a written and audio format. No new people have moved into the home since we last visited and the home does not have any vacancies. 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 35 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 most of 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 two 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. Staff told us that they have up to date information about peoples needs. One persons care plan told us that they had epilepsy, however there was no information in their plan about the support they needed if they had a seizure. Information is also needed as to how often they should be checked by staff during the night. This information will help to keep the person safe. However staff spoken with during the inspection were able to describe the action they would take to keep the person safe should a seizure occur. Care plans gave details of how the staff can communicate with the person for example by their body language. Discussions with staff and observations showed that staff were aware of the information in the plans Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: 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 relatives and involved care professionals are invited to attend these. Key workers also undertake regular support meetings with people. Surveys from people indicate they can make decisions. 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. Care plans were accompanied by a risk assessment. These included personal care, health care needs, skin care, use of bedrails, 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. One person told us I am looked after really well. Comments from relatives included I am satisfied with the care and Im happy with the service that my relative receives. Care Homes for Adults (18-65 years) Page 19 of 35 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. The lifestyle experienced by people may not always match their expectations. Evidence: Records showed that activities on offer include board games, ball games, going out for lunch, going for walks, aromatherapy, shopping, massages, helping with domestic tasks and music sessions. Some people attend a day centre and one person has recently started to attend an exercise class. It is good that reviews are undertaken of the activities people participate in to make sure people are doing the activities they like. Each person has their own activity plan based on the things they like to do. Records sampled showed that people are supported to do the activities they enjoy but sometimes they do not get the opportunity. For example on the day of our visit some people did not get to do their planned activities due to staff having to support other people to attend appointments or escort them to the day centre. Staff told us that when there are two staff on duty sometimes people do miss out on planned activities. One person who was due to go out spent their morning in the lounge holding a Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: tambourine. They had very little interaction from staff during the morning as staff were either out with other people or assisting other people with personal care. Discussion with the manager indicates that people have not had the chance of an annual holiday this year due to staffing issues. Usually people receive a 200 pounds contribution towards this. The manager said that as holidays had not taken place the money had been used to fund trips out, for example to the theatre. One person at the home told us they were going to the theatre that weekend and that they were looking forward to it. The home appeared to have an open policy in respect of visiting. The homes annual quality assurance assessment told us that people are supported to maintain contact with their relatives. One person is supported by staff to write to their relative who lives abroad. Relatives are invited to attend peoples review meetings. One persons care plan recorded that they had no family involvement. They have previously had support from a befriending service but this has now stopped. The manager told us that it is intended to source a new befriender for the person. We looked at this persons care plan. There was little information about how the home was supporting the person to establish and maintain friendships. For people who find it difficult to make their choices known staff have good information about their food likes and dislikes. Records in the home showed that staff have received training on healthy eating. 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. During our visit people were supported by staff to choose what they would like for their breakfast and lunch. One person at the home has swallowing difficulties and so has to have a special diet. Staff spoken with were aware of this persons needs. Food records sampled indicate that the person has their meals in line with guidance from health professionals. Care Homes for Adults (18-65 years) Page 21 of 35 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. Care plans gave detailed information about peoples personal care needs and how they liked to be supported. During our visit one person asked for assistance to go to the toilet, staff gave immediate assistance in a discreet manner. 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. Records showed that each person has an annual health check with 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. As stated earlier in this report one person has recently started to attend exercise classes, this will help them to lead a Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: more healthy lifestyle. 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. Records sampled show that staff have received training on peoples health needs, for example epilepsy, dementia and dysphagia (swallowing difficulties). One person at the home has dysphagia and has had some recent chest infections. As this may be connected the home had arranged for their needs to be reviewed by a health professional. 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. 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. However some of these needed to be reviewed to make sure the information was up to date. The Medication 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. Care Homes for Adults (18-65 years) Page 23 of 35 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 about this home in the last twelve months. 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. Two people who live at the home told us they knew how to make a complaint. One person told us staff listen. 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. There has been one safeguarding incident at the home. The manager reported this to the local authority under safeguarding procedures and also made sure we were notified. The incident has been investigated by the provider who has reported their findings on the matter to the local authority. At the time of writing this report we are awaiting the investigation report of the incident. 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 Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: home has sent their relatives information about how to complain and about the homes policy on protecting people from abuse. 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. The manager told us that training for staff about the new Deprivation of Liberty Safeguards Legislation was being arranged. 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 35 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 generally 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. Since we last visited the home the lounge has been redecorated and new flooring fitted in the lounge and kitchen. We saw that the hallway carpet was stained in places but evidence was available to show a new carpet was scheduled to be fitted the day after our visit. The homes annual quality assurance told us that new furniture was also planned for the dining room. 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 were happy with their bedroom. One person who has lives at the home has a sight impairment. Staff told us that due to this they do not change the position of furniture in the home as this could confuse them. We spoke with the person who told us they were able to find there way around the home. One person at the home has dementia and may forget where things are in the home. To help them remember there are pictures on the doors and also in the kitchen on the drawers and cupboards. This helps the person to know where things are. Grab rails are fitted where needed and Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: 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. One person also has a new electric bed that will help them to sit up more easily when they want to. 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. The home has been inspected by the Environmental Health Officer in regard to food hygiene practice, they were rated as having good procedures in place. Care Homes for Adults (18-65 years) Page 27 of 35 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: Half of the 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. The homes annual quality assessment told us that the home hopes to increase the number of staff that have this qualification. Records show that new staff are enrolled on the Learning Disability Qualification if they have not already achieved this. This helps staff to understand the needs of people at the home. Our last inspection of the home identified that the numbers of staff on duty may not be satisfactory due to one persons needs having changed. At this visit we found that staffing hours have been increased. There are now two staff on duty at night and two staff during the day with an additional thirty hours of one to one support for one person. However despite this increase in staffing there is evidence to suggest that staffing numbers still may not meet peoples needs. As stated earlier in this report some people in the home did not get to participate in their planned activities as staff were busy on other tasks. Some staff surveys and staff spoken with indicated that staff felt sometimes there was not enough staff on duty. One relative told us that the home needed more staff. Discussion with the manager indicates that the Local Authority has been approached for more funding for staff. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: The records of three of the staff that work there were looked at. These included the required recruitment records to ensure that suitable people are employed to work with the people living there. These included evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. Staff said and records sampled showed that they had an induction when they first started working there. 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. 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. Where there are gaps in staff training this has been identified and arrangements are being made for them to receive the training they need. 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 35 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. Management arrangements ensure that the people living there benefit from a safe and well run home. Evidence: The current manager has worked with the organisation for several years. She currently also 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. 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. They showed 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 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 Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: 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 that 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. Some people need support from staff when transferring from their wheelchair to chair. We saw that staff were doing this safely. When looking around the home we saw that the cupboard containing cleaning products had been left unlocked, staff locked this when this was brought to their attention. We also saw that three doors in the home needed repair. Each had a metal foot plate to protect the door but parts of the metal had bent outwards and could cause a cut or graze should someone walk or fall against them. The home does undertake regular health and safety audits but this issue had not been identified as part of the audit. The manager reported the doors for repair whilst we were at the home. Care Homes for Adults (18-65 years) Page 31 of 35 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 35 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 1 33 18 24/11/2009 A full review of the staffing arrangements of the home is needed. To ensure that there are enough staff on duty to meet peoples needs. 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 6 Care plans should be developed to include more information about peoples support needs in regards to epilepsy. This will help to ensure they get the care they need should they have a seizure. Review the arrangements in place for activities to help make sure people are able to participate in their planned activities, so having a lifestyle they enjoy. Review the arrangements in place so that people at the home can have an annual holiday if they choose to. This Page 33 of 35 2 12 3 14 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 will give people a chance to see different places and experience new things. 4 15 Update peoples care plans so that they inform staff about how people need to be supported to make and maintain friendships. So that people have the social contact they need to have an enjoyable lifestyle. The guidance in place for the administration of peoples as required medication should be reviewed to make sure it is up to date so that people receive the medication they need safely. Improve the arrangements in place for health and safety audits of the home so that health and safety issues are identified and acted on. 5 20 6 42 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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