Care Home: West Street, 36

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What the care home does well Staff encourage people to be independent and to make their own decisions wherever that is possible. This enables people to have control over their lives.Staff are respectful to people and sensitive in meeting their needs.This helps in making sure people receive care in the way they prefer.The way in which information is gathered and kept about people means staff can provide support in a way that people need and prefer.It also means staff have in depth knowledge and understanding about each individual person and so encourage them to develop skills and experiences safely.Comments received from the people who live at the home were positive.People made comments such as, "Gorgeous living here,staff are excellent. I am settled here". Comments made from a relative that was visiting the home were,"Staff are lovely,can`t fault them, the manager is fantastic,my son is happy here". Positive comments were made by a visiting health care professional who said, "I think the home is `excellent` staff go out of their way, any suggestions they always listen". Surveys returned from other health care professionals also made positive comments such as:"I feel that they try their utmost to meet people`s needs and provide meaningful activity for people as the residents have diverse and at times quite challenging needs". A second professional said, "Adheres to care plans and uses the help appropriately from other services". What has improved since the last inspection? The requirements and most of the recommendations made at the last inspection have all been completed. There is a stock audit trail for all medications. People`s monies who live at the home are not used as a loan to the home`s petty cash system.The transport fees for people who live at the home have been changed. Any transport provided by the home is now included in the fees, which is included in the breakdown of the fees. This makes it clear about what people are paying for. The organisation when recruiting new members of staff now obtains a statement regarding their physical and mental health. What the care home could do better: The dishwasher at the home needs to be repaired.This makes sure that good hygiene standards are promoted for people who live at the home. The registered manager should make sure that all staff receive regular support and supervision they need to carry out their jobs. This makes sure that staff are working in the best interests of the people who are living at the home. The manager should obtain a management qualification in care.This would make sure that the manager maintains and updates her knowledge,skills and competence while managing the home.The registered manager should have access to and be up to date with relevant care information. For example the CQC and department of health website.This was a recommendation made at the last inspection. The organisation should review and improve their quality monitoring reports so that they provide clear and transparent information about the homes progress. This will benefit the people who live there because it will show where the home has identified areas for improvement and what action they take about it. Key inspection report Care homes for adults (18-65 years) Name: Address: West Street, 36 36 West Street Wombwell Barnsley S73 8LA     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: Irene Ward     Date: 3 0 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: West Street, 36 36 West Street Wombwell Barnsley S73 8LA 01226757269 01226759573 None www.milburycare.com Milbury Care Services Ltd care home 6 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) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: One service user as identified on the variation application dated 14.9.05 (who is over the age of 65 years) may be accommodated at the home. One specific service user over the age of 65, named on variation dated 8th December 2006 (V37181), may reside at the home. Date of last inspection Brief description of the care home 36 West Street is also known as Wellham House and is a new purpose built home set in its own grounds. It provides care and accommodation for people with learning disabilities. The lay out and equipment at the home is suitable for people with physical disabilities. There is a passenger lift providing access to both levels. On the ground floor there is a lounge, activities room, dining area and purpose built kitchen. The four bedrooms have direct access to a bathroom or shower area. On the first level floor there are two self-contained flats. The bedrooms and shared spaces exceed the National Minimum Standards for room sizes. There are good amenities, for example shops, pubs, a church and leisure facilities close to the home. Wombwell shopping Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 6 6 Brief description of the care home centre is a short walk from the home and there is public transport into Barnsley town. The manager provided the information about the homes fees at the time of the site visit. Fees range from 1,572 pounds to 1,772 pounds per week. Additional charges include hairdressing, toiletries, flowers, newspapers and magazines. There is a supplement charge for incontinence pants. Prospective residents and their families can get information about the home by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star good. This means that people who use the service experience good quality outcomes. The Commission for Quality Care inspects homes at a frequency determined by how the home has been risk assessed.The inspection process has now become a cycle of activity rather than a series of one-off events.Information is gathered from a variety of sources, one being a site visit.More information about the inspection process can be found on our website www.cqc.org.uk This is what we used to write this report:We looked at information we have received about the home since it was registered. We asked for information to be sent to us before the inspection, this is called an annual Care Homes for Adults (18-65 years) Page 6 of 29 quality assessment questionnaire (AQAA). We sent surveys to people who live at the home and to staff and Health Care professionals One inspector visited the agency unannounced. This visit lasted over four hours and included talking to the staff and the registered manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live at the home. We also spoke with one relative and a health care professional who were visiting the home. We looked at two peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people who use the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The site visit took place on the 30th April 2009.The registered manager was available to assist throughout the visit and available for feedback at the end of the day. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The dishwasher at the home needs to be repaired.This makes sure that good hygiene standards are promoted for people who live at the home. The registered manager should make sure that all staff receive regular support and supervision they need to carry out their jobs. This makes sure that staff are working in the best interests of the people who are living at the home. The manager should obtain a management qualification in care.This would make sure that the manager maintains and updates her knowledge,skills and competence while managing the home. Care Homes for Adults (18-65 years) Page 8 of 29 The registered manager should have access to and be up to date with relevant care information. For example the CQC and department of health website.This was a recommendation made at the last inspection. The organisation should review and improve their quality monitoring reports so that they provide clear and transparent information about the homes progress. This will benefit the people who live there because it will show where the home has identified areas for improvement and what action they take about it. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed prior to admission, this makes sure that 36 West Street is the right place for them to live. Evidence: The manager confirmed that information is made available to anyone interested in moving into the home in the form of the service user guide before they move in. There have been no new admissions since the last inspection.The manager said that if someone were considering moving into the home they would be given the opportunity to visit the home and stay for a meal,overnight or whatever they were comfortable with. The registered manager is aware however of the need for comprehensive preadmission assessments and explained that any such admission would be arranged via a planned introductory programme which would include visits to the home and a trial placement prior to this being made permanent.The organisation employs development officers who take the initial referrral.The manager said that she completes an easy care full assessment document, which is used by the Local Social Services and the Health Authority. This makes the referrral system more easier to access. The manager said that the assessment also makes sure that the person would fit in with people who Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: all ready live at the home, and if the home could meet their needs. Records of two people showed that the home carried out detailed pre-admission assessments when referrals were made to the home. People visit the home and the manager asks for information from relatives and other professionals to help them decide if they will be able to meet peoples needs before a place is offered. This is particularly useful for those people with complex needs. People living at the home have an individual contract/statement of terms and conditions that has been agreed between them where possible and the home.Copies were held on individual peoples file. Three surveys were returned from people who live at the home. They told us that they received enough information about the home before they moved in. One person said, You gave me that book ive still got. Care Homes for Adults (18-65 years) Page 12 of 29 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. The care provided is of a good standard and encourages people to make their own decisions where possible, about how they wanted to live their lives. Evidence: People living at the home looked well cared for and staff were seen supporting people during the day and it was clear that they understood individuals needs. They supported people sensitively and supported people to make choices. Each person has an individual care plan or an individual support plan, detailing their individual needs and the actions that staff needs to follow to meet these. The care plan focuses on the person and contained information about every aspect of the persons life, they focus on achievement and improving opportunities for individuals. The care plans were very detailed and covered daily routines and how people preferred their care to be provided. All areas of daily life such as peoples personal care, activities, living skills were covered in the plans.They also focused on special requirements such as peoples Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: dietary needs. Plans detailed such things as when people had begun to loose weight,what action the home was taking was recorded, such as making sure that people had high calorie food, plenty of snacks and dietary supplements were given. That food is cut up well and peoples likes and dislikes are recorded.It was clear that staff at the home had taken all the neccessary measures to make sure that people who had been losing weight, received both medical help and intervention in making sure that their health was not put at risk. The care plan/support plan provided the reader with very good information, was easy to understand and gave a sense of the person. The plans are reviewed regularly. Also present were a range of risk assessments with the purpose of supporting people to live as independently as possible with safeguards in place, these were also reviewed regularly.Some people have to wear protective clothing for self protection, risk assessments were in place, which were contained in care plans/support plans were being reveiwed six weekly. People spoken to on the day who live at the home made comments such as, Gorgeous living here,staff are excellent. I am settled here. Comments made from a relative that was visiting the home were,Staff are lovely,cant fault them, the manager is fantastic,my son is happy here. Through discussions with the manager at the time of the visit and the contents of care plans it was clear that people are able to make choices wherever possible. Care Homes for Adults (18-65 years) Page 14 of 29 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 this service wherever possible, are encouraged to make choices about their lifestyle and are supported by staff to carry these out. Evidence: People who live at 36 West Street have the opportunity to attend various college courses. Some people who are more independent also have days at home to participate in personal shopping, laundry and household tasks. People continue to have opportunities to pursue other interests outside of the home such as going shopping,out for coffee, going dancing.Some people attend Barnsley College and do various courses such as cookery and gardening.Some people like to read newspapers and magazines or watch DVDs. Some people had been on holiday to Butlins.There was a large notice board in the office downstairs that showed what activities people were attending for that day. The manager said that this is updated by Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: the night staff each night as they look in the diaries and plan the next day activities for people. People spoken to on the day made positive comments such as, I get to go out. I like to go out for coffee or shopping and i go out for meals and go on holidays, i am settled here.One person confirmed that they were able to go to bed as and when they wanted and that they had their supper when they wanted. Some people have their own pets, especially when they are able to look after them and take responsibility for looking after animals. One person was spoken to through the manager who used makaton (a form of sign language). They were able to show me their flat. The person appeared to be happy. When asked by the manager they said that they were happy living at the home. Three surveys were returned from people who live at the home. Two people told us that they always make decisions about what they do during the day/evening and at weekend.One person said, You put it on the board for me. They also said,I like stopping in bed sometimes - sometimes i get up though.One person said they never make decisions about what they wanted to do during the day/evenings/weekends and said,Mum and Dad take me out when possible. Two surveys were returned from staff who work at the home. When asked,what does the service do well? they commented,Promote independence,choice and a variety of activities.Keeping the home clean and tidy. Sticking to clients preferred routines and their likes and dislikes. Arrange courses out in the community and up date care plans regularly. When asked,what could the service do better? staff said, More activities outside of the home,more one to one time.Holidays for all clients. Be able to keep more than 100.00 pounds for each client in the safe. The manager said that people where possible choose what they want to eat each day and some help to prepare snacks. Care Homes for Adults (18-65 years) Page 16 of 29 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. Peoples personal and healthcare is provided appropriately and sensitively according to individual needs. Evidence: Each person living at the home is registered with a General Practitioner. People receive support from staff in attending dentist and other health care service appointments. Peoples health needs were recorded in their individual care plans or support plans. Barnsley General Hospital is used for Accident and Emergency service and most out patients appointments.People have access to other health care professionals such as district nurses, chiropodist and dentist.The manager said that a chiropodist visits the home about every six weeks. The home operates a monitored dosage system. There is a policy in place for the storage and administration of medication for all staff working in the home to follow. Medication is kept in a locked safe in each persons room. The Medication Administration Records show that everyone receives their medication as prescribed. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Two peoples medication was checked with the manager and both were correct. Medication had been given out to people that morning. All drugs checked were accounted for and balanced. Any changes made to medication are verbally agreed and are recorded. Then records are faxed to the GP/consultant who agrees and signs the changes made to any medication which are then faxed back to the home. The home does hold some controlled drugs, which were appropriately and securley stored and records maintained. All staff who give out medication have received the appropriate training as necessary. A visiting health care professional was spoken at the time of the visit. They made positive comments such as: I think the home is excellent staff go out of their way, any suggestions they always listen. Two surveys were returned from health care professionals who were on the whole positive about the service. Some of the comments were: The staff are pro-active in seeking assistance from the Physio service.Regular feedback and arranges review meetings with relevant members. Staff always act on advice given.Flexible and willing to work with team. When in doubt they get in touch with us to seek clarification.When asked if the service supports people to live their life they choose. Both answered usually and one commented, this can be limited by staffing numbers given the occupancy group of clients that live in the property. When asked does the service respond to the different needs of individuals? one health care professional said, we have a range of people with different learning disability levels and the home looks after their care well in all cases. When asked what does the service do well? they said, I feel that they try their utmost to meet peoples needs and provide meaningful activity for people as the residents have diverse and at times quite challenging needs. A second professional said, Adheres to care plans and uses the help appropriately from other services. When asked, How do you think the service can improve? The health care professionals said,There seems to be a drive from the company to reduce numbers of staff at times. This is not always in the interest of the clients. A second professional said, Continuos training on observations recording and reporting of problem behaviours,effects and side effects of medication,epilepsy care and care of the people with learning disabilities and physical health care needs. When asked is there anything else you would like to tell us? one health care professional said, Satisfactory care and competant skilled staff . Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an effective complaints procedure and are protected from harm. Evidence: A comprehensive complaints procedure is followed and is made available to people and any other interested parties. The complaints procedure was on display in the home. Where individuals are unable to verbalize concerns, staff observe behaviours and body language to identify any dissatisfaction.There have been three complaints since the last inspection. One was regarding broken equipment in the home,another was an incident between a neighbour and a relative and the third was a dispute with a neighbour regarding noise. All complaints have been logged and records were held of the investigations carried out and of the outcomes to the complaints made. No complaints have been received by the Commision. People when asked were clear as to whom they would speak to if they had any concerns or worries. All said they would speak to either the manager or the staff.One person said,Mum and Dad act on my behalf. There is a policy and procedure with regard to safeguarding adults and the procedure to take if there is a suspicion of abuse and staff demonstrated a good awareness of this. Staff receive training in adult protection and safeguarding issues during induction training and further training when required. There has been one safeguarding referral Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: made since the last inspection,which is currently being investigated. Appropriate action had been taken by the home in making sure that people were protected. Appropriate recruitment procedures are followed, with references and Criminal Records Bureau (CRB) checks made to reduce the risk of unsuitable people working in the home. Peoples finances were discussed and checked with the manager.Monies checked all balanced and receipts are obtained for all purchases made. A requirement was made from the last inspection regarding staff not using peoples personal monies as a loan to the homes petty cash system.The manager explained that this had only happened because of the floods. Staff borrowed peoples monies to buy food provision for the home as they could not access the bank.This was not common practice. A further requirement was made regarding the arrangements for charging people for transport. It was felt that the system was unfair and not clear and transparent. The manager said that the system had ceased and the organisation had introduced a new system. Any transport provided by the home is now included in the fees, and is also included in the breakdown of the fees. This makes it clear what people are paying for. Care Homes for Adults (18-65 years) Page 20 of 29 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 clean, comfortable and safe home. Evidence: The home provides spacious accommodation for people. Communal areas and four bedrooms are on the ground floor.This includes a lounge, dining room, kitchen and a sensory/activity room. There are also a further two flats on the first floor for people who are more independent.Each flat has a lounge,kitchen/dining area,a separate bedroom and a bathroom.There is a passenger lift so people can access all areas of the home.There are a number of single toilets and a shower room. All bedrooms on the ground floor are single and have en-suite facilities that are a Jack and Jill style which means that the bathroom is shared between two bedrooms and is situated between the bedrooms. Doors at either side have locks on so that privacy is maintained for the person in the bathroom at all times. All areas including the lounge, dining room, kitchen and toilets were all clean, free from any odours and maintained to a good standard. Peoples bedrooms seen had been personalised with posters and their various possessions such as CD players, television and items they had collected and made. Rooms have been decorated and furnished appropriate for their age. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Surveys returned from people who live at the home told us that the home is always kept clean. One person commented, I look after my own room,i like it like this,you dont need to clean it A relative spoken to on the day of the visit said that it always took the organisation a long time to repair things and the example given was the dishwasher had been broken for 5 weeks.This was discussed with the manager who confimed that the dishwasher was broken and in need of repair. A range of maintenance checks is completed on a regular basis to make sure that the house is safe and secure. Care Homes for Adults (18-65 years) Page 22 of 29 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. Proper recruitment procedures are followed and good staff training meant that peoples needs were met and their interests were safeguarded. However the organisation needs to make sure that there are always sufficient staff on duty. This will ensure that management responsibilities are not neglected in areas such as staff supervision. Evidence: Staffing levels were sufficient for meeting the needs of people. The duty rota showed that there are usually four members of staff on duty both in a morning and afternoon. This did not include the managers hours.The manager works 9-5 for four days and is supernumary and then works one day hands on capacity. At night there are two staff on waking night duty each night.One of which is a senior staff member. The staff records of three staff one which was recently appointed were looked at.These showed that all the necessary pre- employment checks had been carried out prior to the new workers starting in post.All records showed completed application forms, two written references, CRB (Criminal Record Bureau) checks had been obtained.One requirement made at the last inspection regarding obtaining health statements when recruiting staff is now in place. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Records of staff supervision were seen. These were not up to date. Staff had last recieved supervision in October and November 2008.The manager said that she was aware of this. Supervisions had been scheduled to be done, however the manager said, there is not enough time to do it. The home provides all the mandatory training that is required.A range of other training has been completed by staff such as fire safety,challenging behaviour,health and safety,POVA,medication,emergency first aid,food hygiene,non violent crisis intervention,principles of care,abuse and neglect,communication and infection control are just some of the training staff have attended. Five staff have completed the National Vocational Qualification (NVQ) Level 2 and one staff holds NVQ Level 3 and one staff is working towards completing NVQ Level 3. The manager is a qualified (Registered Mental Nurse) RMN nurse, however she has not yet obtained a management qualification in care. Staff meetings are held regularly and minutes of meetings were seen at the site visit. Surveys returned from people who live at the home told us that they were treated well by staff.When asked if staff treat you well? Three people said, always and one told us that a member of staff takes them out to a cafe. When people were asked,do carers listen? all three people said always.One person spoken to who lives at the home said, Gorgeous living here,smashing,staff are nice. One relative who was visiting the home said that the manager was fantastic. However they did also say,The home needs more staff,there are staffing problems because of the pay,need an incentive for staff to stay,they also could do with employing a cleaner. A health care professional visiting the home said, I think the home is excellent staff go out of their way,any suggestions they always listen. Care Homes for Adults (18-65 years) Page 24 of 29 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. People benefit from a well managed home in which their needs and wishes are put first. However there are areas where improvements should be made as detailed in the report. Evidence: The manager of the home has worked at the home since the home first opened. She is a qualified registered mental health nurse (RMN), although she has not yet completed a management qualification in care. The home has a good and effective management team in place.The ethos of the home is open and positive.People who use the service,one relative,health care professionals and staff all commented highly about the home. Regular staff meetings are held and minutes are taken. There are Quality Assurance systems in place. Surveys were last sent to people who live at the home, relatives, health/social care professionals in September 2008. A Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: report regarding the outcome of the surveys has been completed. The report was not very clear as to what the result was. Such as what did people actually feel about the home. The report was not clear as whether an action plan needed to be developed or if there was any improvements needed to be made at the home.The organisations reporting format needs to be clearer so it can be understood by people who use the service,their representatives and other interested parties including the Commission. All accidents are recorded as required and an accident book is maintained in line with the requirements of Data Protection. Peoples personal finances were checked at this site visit.Monies checked at the time of the visit all balanced and receipts are obtained for all purchases made. A requirement was made from the last inspection regarding staff not using peoples personal monies as a loan to the homes petty cash system.This has been addressed.The charges for transport was also discussed with the manager. A requirement was made at the last inspection regarding the arrangements for charging people for transport. This matter has also been addressed by the organisation. The manager did not have Internet access at the home. This meant it was difficult for her to keep up to date with current events and information. For example there is frequent information on the Care Quality Commission and Department of Health websites about changing and good practice guidance. This recommendation was made at the last inspection and has not yet been completed. Information provided from the AQAA Annual Quality Assurance Assessment and the examination of selected health and safety documents show that regular checks to electricity and gas and fire safety equipment are regularly undertaken. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 24 The dishwasher at the home needs to be repaired.This makes sure that good hygiene standards are promoted for people who live at the home. Staff should receive regular support and supervision so that they carry out their jobs. This makes sure that staff are working in the best interests of the people who are living at the home. The manager should obtain a management qualification in care.This would make sure that the manager maintains and updates her knowledge,skills and competence while managing the home. The registered manager should have access to and be up to date with relevant care information. For example the CQC and department of health website. The organisation should review and improve their quality monitoring reports so that they provide clear and transparent information about the homes progress. This will benefit the people who live there because it will show where the home has identified areas for improvement and what action they take about it. Page 28 of 29 2 36 3 37 4 39 5 39 Care Homes for Adults (18-65 years) Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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