Care Home: Welbeck House

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What the care home does well Welbeck House is of a size that helps it to be homely and part of the local neighbourhood.People who live at Welbeck House like living there and in most cases can decide what they want to do and when they want to do it.People who use the service are supported by staff that have a good understanding of their needs and want to improve the quality of the service. Checks are carried out with people to ensure staff know how they want to be supported, with detailed care plans summarising this information.Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in people`s health care needs well and seek help from others where necessary (such as community nurses, doctors and such like). What has improved since the last inspection? Care plans are now more detailed and better reflect people’s involvement in deciding how they want to be supported.People now feel more involved in making decisions about their day to day life at the home.Information about the home and care plans are now available in easier to read formats.The house is safer, with new radiator covers, removal of unsafe aids and the fitting of a shower screen to reduce the risk of water pooling on the floor (as this was a possible slipping hazard).Some people have had their bedroom decorated in a way they have chosen.The home now has a manager that is registered with CQC, this providing the home with more stability in respect of its management. What the care home could do better: To consider use of a nutritional check record to illustrate how input in health action plans, in respect of any individual`s nutrition is agreed. To consider the allocation of additional resources so that it is easier to source training for staff, this so they can better support people living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Welbeck House 42 Welbeck Avenue Bushbury Wolverhampton West Midlands WV10 9LS 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: Jonathan Potts Date: 2 9 0 4 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 35 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Welbeck House 42 Welbeck Avenue Bushbury Wolverhampton West Midlands WV10 9LS 01902681909 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Arcare (West Midlands) Ltd Name of registered manager (if applicable) Mrs Sarah Elizabeth Fitzsimmons Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Date of last inspection 1 0 0 6 2 0 0 9 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 35 Welbeck House is registered with the Care Quality Commission to provide accommodation and personal care for a maximum of three adults with a learning disability. Arcare (West Midlands) Limited is the registered provider and the responsible individual is Dr Raj Sharma. The registered manager is Mrs Sarah Fitzsimmons. The property is a traditional semidetached house and is situated in an urban area of Bushbury, providing access to local amenities and public transport. The building is in keeping with the local community. Accommodation is provided over two floors comprising: Two single bedrooms with a bathroom on the first Care Homes for Adults (18-65 years) Page 5 of 35 floor and one single bedroom with en-suite facility on the ground floor. Communal areas include a lounge, dining room and kitchen. Disabled access from the front of the property is enabled through the availability of a ramp and handrails. There is a small enclosed garden to the rear of the house. The homes stated philosophy is to Maintain a high standard of care, respecting individuality, privacy, residents dignity and independence at all times. First and foremost a happy and secure environment within the home. Care Homes for Adults (18-65 years) Page 6 of 35 The home has books available that tell people what the service is and how it is provided. These state that the current range of fees for the service are between 447.78 pounds to 728.17 pounds per week. The cost of hairdressing, chiropody, activities and travel expenses are not included in this charge. Care Homes for Adults (18-65 years) Page 7 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 8 of 35 How we did our inspection: CQC This is what the inspector did when they were at the care home Our surprise visit to Welbeck House was carried out on the 29th April 2010. We arrived at 9.20am and left at 4.20pm. Prior to our visits we looked at all the information we have received about the service over the 12 months since the last main inspection. This included information sent to us every year by the care provider and from different organizations. We have checked the homes performance against key standards and looked at outcomes for people living at the home. This was carried out by us talking to the people using the service, and asking staff about these peoples needs. We also looked at care plans, medical records and daily notes for two people. Care Homes for Adults (18-65 years) Page 9 of 35 We also looked around the house, looked at a number of management records and talked to management and staff. We received two completed survey forms from people living at the home and one from a staff member. CQC People What the care home does well Welbeck House is of a size that helps it to be homely and part of the local neighbourhood. People who live at Welbeck House like living there and in most cases can decide what they want to do and when they want to do it. Care Homes for Adults (18-65 years) Page 10 of 35 People who use the service are supported by staff that have a good understanding of their needs and want to improve the quality of the service. Checks are carried out with people to ensure staff know how they want to be supported, with detailed care plans summarising this information. Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in peoples health care needs well and seek help from others where necessary (such as community nurses, doctors and such like). What has got better from the last inspection Care Homes for Adults (18-65 years) Page 11 of 35 Care plans are now more detailed and better reflect people’s involvement in deciding how they want to be supported. People now feel more involved in making decisions about their day to day life at the home. Information about the home and care plans are now available in easier to read formats. The house is safer, with new radiator covers, removal of unsafe aids and the fitting of a shower screen to reduce the risk of water pooling on the floor (as this was a possible slipping hazard). Care Homes for Adults (18-65 years) Page 12 of 35 Some people have had their bedroom decorated in a way they have chosen. The home now has a manager that is registered with CQC, this providing the home with more stability in respect of its management. What the care home could do better To consider use of a nutritional check record to illustrate how input in health action plans, in respect of any individuals nutrition is agreed. To consider the allocation of additional resources so that it is easier to source training for staff, this so they can better support people living at the home. Care Homes for Adults (18-65 years) Page 13 of 35 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 Jon Potts 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT Jon - CQC 01216005300 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 14 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 15 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. Individuals that maybe looking to move into the home have their needs thoroughly checked and are able to test drive the service. Information is available to help people make decisions about living at the Welbeck House. Evidence: We saw that the home has books that tell people who the service is for and how the service works (called the statement of purpose/service user’s guide). These have been updated since the time of our last main inspection. From sight of this document we noted that this is now easier to read (with use of pictures) and the information in it is up to date, this including the range of fees people pay to live at Welbeck House. We also saw that this guide is available to people living at the home, with one in each of their bedrooms. We saw that individuals are given copies of contracts with the home. These we saw have been reviewed although still do not detail what additional charges people need to pay in addition to the cost of residency at the home. We did see that there is a clear statement Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: about additional charges now available in the homes information book though. These contracts are only at present available in written format, and it maybe beneficial to consider other formats dependent on peoples communication needs. The manager told us in the information that she sent us that people only move into the home after comprehensive checks, during which the individual has chance to test drive the service. The last person that moved into the home did so prior to our last main inspection. At the time we saw that the home had undertaken thorough checks drawing on information from other involved agencies. We noted that the introduction to the home was gradual, and the individuals visits took place over a period of time that involved them stopping for a meal, progressing to an overnight stay. We saw that the individual was involved in meetings with agencies involved in their care, including staff from Welbeck House, this to check that they wanted to move into the home, and that Welbeck House could meet their needs. We saw that there was a multi agency review about a month after the individual moved into the home, this to check the success of the placement based on the individuals, representatives and staff views. We did note that whilst the admission process did consider the ability of the home to meet the individuals needs in some depth, this was not confirmed in writing (pre admission) by the home to the individual (or representative). The manager has now developed a letter to confirm that that the home can meet peoples needs based on checks. We saw from two survey forms that people living at the home returned to us that they did wish to move to Welbeck, and at the time they did so they had sufficient information to help them make this decision. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and are encouraged to play an active role in contributing to the planning of their care and support. Evidence: We looked at the care plans for two people living at the home. We saw that the manager has continued development of the care plans so as to make them more accessible, with easy to understand formats, and more detail so that the full range of an individuals needs are presented as an informative tool for staff. These documents are available in easy to read formats that assist people to understand what staff need do to support their needs and expressed preferences. It was clear from the checks (assessments) that we saw that individuals and significant others have been involved with these, and through this process have contributed to the care plans that we saw. The plans we looked at contained detailed information as to the individuals communication needs. They also make clear reference to what is important for the individual, this summarized in sections titled all about me that include numerous pictures. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: We have seen a noted improvement in the clarity and range of the individual plans at the home, these covering a far wider range of needs and drawing from suitable checks. We spoke to people about what was important to them and saw that this information is reflected in their individual plans. We also looked at records of recent reviews with the individual, social services and significant others and saw that the conclusions within these are also reflected in the care plans. We looked at the risk checks relating to individual plans and these again we saw have improved, with areas of risk identified through checks which supported the individual plan of care. We saw that developments in the individuals day to day life have been used to inform planning. Examples of this include how observation of behaviours has led to improved risk checks and behaviour plans, these identifying triggers and the factors staff need to be aware of when working with the people. We have seen that the manager has developed care plans as she told us she would at the time of our last visit to the home, these now easier to understand and reflecting areas of importance for the individuals living at the home in respect of how they want to be supported. We discussed the use of pictorial plans, and the acting manager stated that she had discussed such with one individual who had said they did not want this as they felt it was not appropriate for them as an adult. For others the acting manager stated that she was looking at on going communication with people about their care as the way forward, this as we saw was the case through regular meetings, reviews and checks. The two individuals that completed our questionnaires stated that they can always or usually made their own decisions. We saw that staff have explored the views of people living at the home in respect of a number of areas including how their post is handled and staff access to their bedrooms as examples. Individuals views we saw to be clearly recorded and these records signed by the individual living at the home. 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 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 involved in decisions about their lifestyle and can develop life skills. People told us that they are happy with their life at Welbeck house and the opportunities they have access to for occupation and stimulation. Evidence: We saw that the manager has developed clear information as to the preferred routines of people living at the home. This is available in their care files and supports their individual care plans. These records set out in clear detail as to how a person wants to be supported throughout the day, and night, this so that staff are in no doubt as to what their preferences are in respect of such as when they want to get up, how they are to be supported with personal hygiene and what they like to eat. Checks (assessments) of individuals daily living skills and risk checks also provide clear information as to when people need support and when they dont. The individuals living at the home are all involved in supported activities through day Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: training centres where they take part in various occupational activities. People living at the home either use public transport or taxis to travel to the training centres, this dependent on their individual abilities. We saw that the individuals are encouraged to be as independent as possible when travelling. The manager told us of ways in which communication between the home and training centres is maintained, this supported by records that we saw. Funding for transport is through appropriate mobility allowances which we saw are recorded separately so that it can be seen it is spent appropriately. The staff have discussed what community activities individuals would like to pursue, although where there is a wish to attend such as football matches an individuals limited funds do impact upon their choices, beyond which transport and available staff (as an escort) are an issue. We discussed this with the manager who has identified that it is possible to get concessions for access to the local football ground, this to be applied for next season. The manager told us that agreement has been given by the provider to double up staffing levels on a Saturday so that they can take people out, with Sunday as a chill out day. We saw that meetings with people living at the home involve them in planning activities for the forthcoming month, these then recorded on planning sheets. The manager told us that an activities board is on order so these can be better displayed in the home in place of the fixed activity planner currently used. We spoke to the people living at the home and they told us that they are happy with the current levels of activity, confirming that if they go out they all like to go together as a group rather than on a 1 to 1 basis. One did tell us that they do go out to the local shop independently. We saw that the way the staff are recording the daily activities people are involved with, this including housework and food preparation, has improved. These records are now far clearer. We saw that the home supports individuals in maintaining contact with family and friends, this contact summarised in individuals records. We saw that people living at the home are able to move around freely, and are able to participate in household tasks if they wish (we saw people making themselves drinks). People told us that they can make decisions about what they do in the home and we saw that the manager consults people on a regular basis through meetings, this to discuss such as meals, activities, and any matters that may impact of people. We also saw that keys to bedroom doors are available to individuals. We saw that the staff have explored peoples dietary preferences in checks and these we saw are also discussed in regular meetings with people. The home was seen to have a planned menu, although this maybe open to change dependent on individual choices. The manager told us how this had been planned with use of menus provided from training centres, this to help with the reduction of repetition, balancing of healthy diets and such like. We spoke to people living at the home during the course of our visit and they told us that they are happy with the food and confirmed that they are offered choices, this as we saw was the case prior to teatime. The manager has involved people living at the home in the homes food shopping since Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: out last main inspection, this as people living at the home confirmed. Care Homes for Adults (18-65 years) Page 22 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. Individual’s health care needs are promoted and there is prompt follow up on any areas which compromise a persons well being. Medication management has improved meaning people at the home are safer. Evidence: Two of the individuals living at the home told us through survey forms that staff treat them well. The people living at the home told us in conversation that they are happy with the care and support that is provided. Interaction that we observed between the individuals and staff was seen to be appropriate, positive and relaxed. We saw that it was clear in care plans what personal support staff are to provide, and how this was to be provided, with the staff we spoke to clear as to what they should do. We saw that there has been involvement from specialist support services where required (such as occupational therapy) and the outcomes have informed the way personal care is provided. We saw from records that individuals health care needs are clearly identified in revised, and easy to read health action plans. These showed us that support to access community health care services is enabled, this including community nurses, dentists, opticians and such like. We saw that the home has checked the individual health care needs of people Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: and we saw clear evidence of follow up seen. An example of this is that staff made sure any risk of skin break down is checked and suitable aids used to prevent this happening. What we saw supported what the manager said about the ways the staff support the promotion of good health, this on the day and within the information she sent us before our visit to the home. Recording and risk checks also showed that the home has identified areas where there may be concerns in respect of individual health, these a sign for staff as to what to be aware of. We noted that the health action plans contained clear information as to how staff are to support people with nutrition, by promoting healthy diets, taking weights and such like, but it was sometimes unclear as to how these actions are decided upon. The manager was able to give good verbal accounts of the reasoning but we did advise the use of a short nutritional assessment may help illustrate the process by which health action points are agreed. We saw that people living at the home have access their health checks through their G.P., with one exception where an individual has made a clear choice not to have this review. This individuals preferences in respect of access to health services we saw to be clearly documented, and social services are well aware of the individuals views. We looked at the homes medication procedures, these reviewed and expanded since our last visit to the home and as a result improved. We looked at medication records and found these to be well documented and in good order. The home was audited by the contracted Pharmacy and the only issue at the time was the need for appropriate controlled drug storage. This is now in place as is a controlled drugs record. We saw that staff have or are completing medication training and we saw that the manager carries out regular checks on the medication. She also carries out competency checks on the staff in respect of how they manage medication. We saw that there has been some minor issues with recording in respect of medication since our last visit, these identified by the manager who has taken appropriate steps to ensure they do not reoccur. Care Homes for Adults (18-65 years) Page 24 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. People who live at the home are able to express concerns and have confidence that their concerns will be listened to and dealt with. Staff practices protect individuals from abuse. Evidence: We saw that the home has an appropriate complaints procedure available on display in the home, this supplemented by a pictorial procedure found in individuals case files. From two surveys from people living at the home we received one told us that they are aware of the homes complaints procedure. One also stated that staff listened and acted on what they said, the other said this was sometimes the case. When we spoke to people at the home they told us that they would speak to the manager or staff if they were unhappy. We are also aware that the individuals living at the home also have regular contact with social care and health staff outside the home (such as community nurse, adult training centre staff and such like) whom they could raise concerns with if not comfortable with the homes staff. We looked at the homes complaints records and found that any issues raised are well recorded, with any investigation or findings from these clearly documented. We saw that the home has a safeguarding procedure in place as well as the local multiagency procedures. We did discuss the procedure for referral of suspected abuse and how the home promotes the safety of the individuals living at the home with the manager, who showed a good understanding of what her responsibilities are. We have seen from Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: the homes practices that they respond appropriately to matters that may put people living at the home at risk, taking steps to ensure people are protected from abuse. We saw that the home has training materials and guidance in respect of the mental capacity, this obtained for staff reference since out last inspection. The manager told us that the staff would benefit from training in challenging behaviour, this something which she told us she is trying to source, this hampered by waiting lists for training not funded by the home. We saw that individual plans are supplemented by very clear guidance as to how staff must respond to possible challenges from people living at the home, although the incidence of actually challenges from records we noted to be very low. Provision of training for staff to develop their skills in managing challenges would be beneficial, especially as they all work many shifts without the on site support of other staff. The manager did tell us that she is due to attend training on the implications of the Deprivation of Liberty Legislation, this so she will be in a better position to update staff. We saw that the home has appropriate procedures in place in respect of the handling of individual’s monies, although these are overseen by peoples representatives. We saw that any moneys kept by the home on behalf of the individual are appropriately recorded and balanced with the monies kept. We also saw that the staff are now maintaining inventories of peoples property in the home, this ensuring there is no doubt as to what the individual owns and what is the property of the home. Care Homes for Adults (18-65 years) Page 26 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. The overall physical design and layout of the home is suitable in meeting the needs of the individuals that live there and meets with their expectations. Evidence: Welbeck House is in an established residential area, blending in with other properties around it. The size of the home also lends itself to the creation of a homely environment. The last visit by the Fire Prevention Officer was in December 2008, the only point identified the need to ensure there is a regular review of the homes fire risk assessment, this now completed by the manager following her undertaking fire risk assessment training. The home has also received a visit from Environmental Health in the last 12 months and has followed advice they have been given on food safety matters. We saw that the home has a plan for redecoration and refurbishment in place and we saw that there has been some redecoration in the home. The manager carries out regular audits, these fully recorded. We saw that the works identified are prioritised (in regard to urgency and safety) and most we saw to have been addressed from looking around the house. We spoke to people that live at the home and they told us that they are happy with their rooms and the house in general. Whilst there is scope to improve the decor, and update furniture which is of an age, although functional, this is not an issue that Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: those living at the home expressed any concerns about. Some refurbishment of the exterior could make the house more inviting though, as well as protecting such as the exterior woodwork. We noted the front of the house does have ramped access that is suitable for a wheelchair. We saw that servicing certificates relating to the safety of the house are all up to date (these relating to such as the buildings electrics and gas safety). We did see that bedrooms are personalized and some have been redecorated, this in accordance with the occupants choices and preferences, as they told us. The manager told us that the home now has a digital aerial although there are still issues with reception to the one bedroom, this a matter that the manager is looking at progressing. We noted that the radiators around the home have now been covered with guards and now protect people from access to possible hot surfaces. We saw that overall the home was clean and there were no unpleasant smells. Most staff have received training in infection control. We saw that the home has liquid soap and paper towels available. The manager stated in the information that she sent us that staff are working toward good infection control and are supporting individuals living at the home to achieve this, evidence of this seen in their case files. Care Homes for Adults (18-65 years) Page 28 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. Staff in the home are at present reasonably well trained, skilled and usually available in sufficient numbers to support individuals with their chosen lifestyles. Evidence: We looked at the homes staffing rota and found that this was consistent with the staff on duty. There is usually one staff member available to support the three individuals living at the home, with some doubling up at the point of staff handover. Based on the comments from individuals we spoke to this is usually sufficient to allow staff to meet their needs within the home. There is currently one staff vacancy that the manager has interviewed for and is looking to fill in the near future. Existing staff are working additional hours to cover any gaps in the rota, this the manager said with their full support. The home does not use agency staff which is positive in maintaining consistency, this as care plans have identified that some individuals do not like change, as would be the case with staff they are not used to. We saw from sight of the homes training plan that the staff at the home have a good level of training, this including vocational qualifications (this further evidenced by our sampling of certificates in staff files). The manager has clearly identified those areas where staff need further training or updates to qualifications they currently hold. She told us that training for staff in some areas has been hampered by waiting lists for courses Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: through Wolverhampton social services training department. When asked about purchasing training we have been made aware that the home has no dedicated training budget, which means that if not available through other sources that the home currently uses, some areas of training are not currently available. The provision of a dedicated budget is beyond the managers scope of responsibility and as such is a matter that the registered provider should address, as this will become a more critical issue as staff require updates (as some do for safe working practices) and training to equip them to deal with any changes in the need of those people living at the home. The home has had a very limited turn over of staff, with no new staff employed since the last main inspection. We looked at the records related to a potential staff member that has been interviewed and whilst incomplete (as checks are on going) this showed us that suitable and robust recruitment checks are in the process of completion before their employment at the home. This confirms that the home is still carrying out robust checks so as to protect people living at the home in accordance with their procedures. The manager also confirmed that she will not employ any staff until she has received a suitable enhanced disclosure. The manager showed us that staff support meetings (supervisions) now occur on a regular basis. We also saw evidence of regular staff meetings. Care Homes for Adults (18-65 years) Page 30 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. The management and administration of the home has shown improvement over the last year. The manager listens to the views of people living at the home and shapes the way the service is provided accordingly, in so far as she is able. Evidence: We looked the home certificate of registration which was on clear display in the front hallway of the house. This we saw is the current certificate and reflects the service that the provider states will be offered in the homes information. The manager of the home has completed her registration with us since the last main inspection. She has shown us that she has experience at a senior level in care homes over a number of years. She also showed us that she has appropriate qualifications and experience of working with people with a learning disability. She sent us the information we requested prior to our visit to the home and this showed us that she has a clear understanding of where the service needs to improve, and the barriers that may prevent this. We are aware that the manager is an integral part of the care team, this meaning Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: that she is very involved with direct support of the people that live there. This also means that allocated time available to undertake management tasks is sometimes limited. Despite this, based on what we have seen, we judge her to be managing the home well and in accordance with the wishes of the individuals living there. The provider told us that they are in discussion with the social services department that fund the homes current placements. The manager has concern that peoples changing needs due increasing physically dependence (as they become older) does require a review of funding. We have been told that funding levels do create barriers when looking at funding for holidays, training and activities. This is a matter that the manager and/or provider are to continue pursuing. We heard, and saw evidence of how the manager has gained the views of individuals living at the home, this through meetings and one to one discussion. This has enabled the manager to send us information that, based on other evidence we have gathered, is accurate and honest as to the homes performance. We have seen a commitment on the behalf of the home to address the requirements we raised at the last inspection, these now addressed. We saw that the providers representative visits the home at least monthly, these management checks appropriately recorded and available to the manager. We looked at how the home handles individuals monies, and have found that records relating to monies in safe keeping are well documented and balanced with monies that are safe kept. There are now also now records of individual’s property within the home. We saw that the home has procedures relating to safe working practices that are acceptable these supported by records of health and safety checks. Staff training records also show that most training within the scope of safe working practices is provided to the staff team although one needs to complete their food hygiene and all would benefit from fire training. Risk checks have been developed as have records, which have continued to improve since the last main inspection. We noted that policies and procedures are also in place, these reviewed and more accessible as they are now stored in a more logical order. We saw that the manager is pro-active in carrying out safety audits so as to identify potential risks and hazards to people living at the home and staff. Care Homes for Adults (18-65 years) Page 32 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 33 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 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 19 To consider use of a nutritional assessment to illustrate how health action points are decided and agreed in respect of any individuals nutrition. To provide a dedicated training budget for the home. 2 35 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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