Care Home: Westley Brook Close

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well People are supported to keep in contact with family and friends so they can maintain relationships that are important to them.People are supported to take part in interesting activities and to go on holiday so they live fulfilled lives.The interaction between people and the staff supporting them was respectful and sensitive and showed a good understanding of individual needs and abilities. What has improved since the last inspection? There is a new manager in post who is just starting to make improvements to the Home so it is better for the people living there.The rota is better managed so people get support from a consistent staff team.Support from health care professionals has been improved so people`s health care needs are met. What the care home could do better: Peoples health care needs should be properly monitored and planned for so these needs can be met in full.Page 15 of 44Care Homes for Adults (18-65 years)Care plans should clearly state how people`s current needs will be met by staff.Problems to do with the water pressure and the conditions of the bathrooms should be improved so people live in a safe and comfortable environment.Medication management must improve so that people receive their medication as required. Key inspection report Care homes for adults (18-65 years) Name: Address: Westley Brook Close 5,12,14 Westley Brook Close Sheldon Birmingham West Midlands B26 3TW The quality rating for this care home is: one star adequate 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: Donna Ahern Date: 0 9 0 6 2 0 0 9 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 44 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 44 Information about the care home Name of care home: Address: Westley Brook Close 5,12,14 Westley Brook Close Sheldon Birmingham West Midlands B26 3TW 01217432436 F/P01217432436 h6021@mencap.org.uk www.mencap.org.uk Royal Mencap Society care home 12 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 Over 65 12 0 learning disability Additional conditions: 12 residents with a learning disability under the age of 65 years. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 44 A bit about the care home Westley Brook Close is made up of three individually designed modern houses situated in a quiet cul-de-sac in Sheldon.The houses can accommodate 12 people with learning and physical disabilities, and some people have behaviour that can be challenging. The premises are situated close to a wide range of amenities, including local shops, library, health centre, Sheldon Country Park and churches of various denominations. There is limited parking available in the cul-de-sac. Each of Care Homes for Adults (18-65 years) Page 5 of 44 the houses has single bedrooms, dining and living rooms. Some bathrooms have been adapted to meet the physical needs of people living there. The last inspection report is available in house 12 for people to read if they choose to. The fee level for the Home ranges from Two hundred and sixty four pounds to One thousand and ninety seven pounds per week. Extra charges are made for the use of the homes transport and Care Homes for Adults (18-65 years) Page 6 of 44 is charged to people per mile. Fees do not include personal toiletries or clothing. Care Homes for Adults (18-65 years) Page 7 of 44 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: one star adequate 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 44 How we did our inspection: This is what the inspector did when they were at the care home The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. One inspector carried out this inspection over one day; the home did not know we, the commission were going to visit. The previous inspection to this Home took place on 23rd June 2008. Eight people were living at the home at the time of our visit. We case tracked three peoples care this involves establishing individual’s experience of living in the care home by meeting or Care Homes for Adults (18-65 years) Page 9 of 44 observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Time was spent observing care practices, interactions and support from staff. Some of the people who live at the home were not able to tell us their views because of their communication needs. We met and spoke to four staff members, the manager and deputy. We looked around some parts of the Home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think Care Homes for Adults (18-65 years) Page 10 of 44 they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the Home must tell us about. What the care home does well People are supported to keep in contact with family and friends so they can maintain relationships that are important to them. Care Homes for Adults (18-65 years) Page 11 of 44 People are supported to take part in interesting activities and to go on holiday so they live fulfilled lives. The interaction between people and the staff supporting them was respectful and sensitive and showed a good understanding of individual needs and abilities. Care Homes for Adults (18-65 years) Page 12 of 44 What has got better from the last inspection There is a new manager in post who is just starting to make improvements to the Home so it is better for the people living there. Care Homes for Adults (18-65 years) Page 13 of 44 The rota is better managed so people get support from a consistent staff team. Support from health care professionals has been improved so people’s health care needs are met. Care Homes for Adults (18-65 years) Page 14 of 44 What the care home could do better Peoples health care needs should be properly monitored and planned for so these needs can be met in full. Page 15 of 44 Care Homes for Adults (18-65 years) Care plans should clearly state how people’s current needs will be met by staff. Problems to do with the water pressure and the conditions of the bathrooms should be improved so people live in a safe and comfortable environment. Care Homes for Adults (18-65 years) Page 16 of 44 Medication management must improve so that people receive their medication as required. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 17 of 44 If you want to speak to the inspector please contact Donna Ahern 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 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 18 of 44 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 19 of 44 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to know so they can make an informed decision about whether they would like to live at the Home. Evidence: We saw the certificate of registration on display on the office wall in House 12. It still displays the name of a previous manager from over three years ago. This should be up dated to alleviate any potential confusion for people living there, their relatives or visitors to the Home. Eight people were living there and had done so for many years so it was not possible to assess the pre admission process. We saw that a detailed pre admission procedure is in place and if followed should ensure that full assessments are completed prior to any future admissions. The service user guide and statement of purpose tell people what they can expect from the home and had been written in a style that is easier for the people living there to understand. The service user guide needs some updating to include management, staffing changes and fee details so people have all the information they need. Care Homes for Adults (18-65 years) Page 20 of 44 Evidence: Care Homes for Adults (18-65 years) Page 21 of 44 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments do not give staff all the information they need to support people consistently. Evidence: We looked at three peoples care plan, one in each of the houses. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. The files looked at had lots of information about how to meet peoples individual needs in relation to personal care, communication, health care, social activities, likes and dislikes. However care plans looked at for people who needs had changed were very confusing. Several changes had been added in dating back two years and in some incidents it was difficult to track what the current care needs are. This may mean that people could receive inconsistencies in their care. For example one of the people has specific guidance in place about meeting there needs due to specific health reasons. Several entries had been made and then crossed out and then added to and was very confusing to follow. Although there is a specific system in place for reviewing and updating care plans this had not been properly followed. Care Homes for Adults (18-65 years) Page 22 of 44 Evidence: When we spoke to staff about the care plans they recognised that these do need to be updated so there is clear information available for staff to follow about meeting peoples current needs. We saw a number of risk assessments in place. Most had been reviewed recently but some required reviewing. We noted that when a review of a persons risk assessment takes place there was no evidence that any incidents in relation to the risk assessment had been considered. This may mean that control factors in place are no longer relevant but still being imposed. New daily records sheets have recently been introduced which should ensure that the right information is recorded. We looked at these for the last week. Recording do not include peoples response to care or decisions they have made themselves, or decisions made by staff in the persons best interest. This information should be recorded so it is clear what decisions have been made and that staff are following peoples care plans and supporting people in a way they prefer. Care Homes for Adults (18-65 years) Page 23 of 44 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 are supported to take part in a range of activities so they experience a meaningful life style. People are offered a choice of meals which meet any dietary or cultural needs and preferences Evidence: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to four staff members and observed care and support on the day. People are provided with opportunities to attend structured day centres and colleges. It was pleasing that some people are offered a more individual personalised option and are supported by staff during the day to do activities of their choosing. One of the people told us I like to go out on the bus, sometimes I go to Solihull and do some shopping. Another person told us I will go out when I want with X I like to do some shopping. One of the people has two staff employed to support them to take part in activities during the day. However their activity plan was not consistent with what they were currently doing. Care Homes for Adults (18-65 years) Page 24 of 44 Evidence: This should be updated to ensure consistencies with their care. We saw people being supported to help with daily routines and to maintain their independence. One of the people was busy sorting out their clothes that had just been taken out of the washing machine. Later we saw them putting their washing away in their room. Another person was well supported to do the washing up after their breakfast. They have a physical disability and cannot access the sink in the kitchen. Staff provided all the facilities so that they could do this task from a washing up bowl on the dining room table. People told us I go to the supermarket up the road each week to get the food shopping I look after my room and I keep it clean and make the bed. People seemed relaxed in their home environment. In house 12 and 5 we saw that people freely accessed all areas of their Home. In house 14 restrictions are in place and the kitchen and bathroom are kept locked. These practices should be kept under review and alternatives sought to minimise the restrictions in place for people. We were told that people are being supported to go on holidays or day trips. One person is going Spain and three people are going to Blackpool. One of the people told us she likes to go to the theatre to see different shows and she is going to the ballet we one of the staff. We saw that tickets had been purchased for a day at Wolverhampton races. People are supported to maintain close links with their family. We could see that family contact is discussed with people. On the care files we looked at there was good detail about how staff should support people to maintain these links. We spoke to staff about this and they recognise the importance of maintaining links with peoples family and friends. Mencap have a family charter in place and this aims at sharing information with people important with them to help them to make choices. Different arrangements are in place in each house for meal planning. In House 12 one of the people told us they plan and write their own menu. We saw the menu displayed on the fridge in the kitchen. In house 5 people told us we all plan the menu We are having a take away tonight not sure what I am going to have yet. In house 14 people have very limited verbal communication so staff are more involved in planning the menu around what they know people like. It would be positive if more work could be done with using pictures and photographs to involve people more in such fundamental decisions. We saw lots of fresh fruit available in each house and tinned, dried, frozen and fresh supplies of food were available in each kitchen. Menus seen do not include details of fruit and vegetables and we advised that menus are monitored to ensure people are getting the recommended five portions a day to ensure people maintain a healthy diet. Care Homes for Adults (18-65 years) Page 25 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place do not always ensure that peoples health care needs are properly monitored which may lead to health care needs not being met. Evidence: Care plans looked at had information about how to meet peoples personal care needs. However for some people this information was due to be up dated to reflect their current needs. We saw lots of adding in of information, which sometimes was difficult to follow. One of the peoples care plan said they go to bed around 19.30- 22.00. We asked staff about this who told us the person goes to bed when they choose and recordings in the daily records indicated that this person does have flexible times for going to bed. We saw that people were dressed in age appropriate clothing and people were well groomed. One of the people told us I go shopping with X and choose all my clothes. Another person we were talking to was wearing earrings, a bracelet and neckless she told us she likes to look nice and wear her jewellery every day. This indicates that people are supported to maintain a good self-image. We saw that each person has a Health Action Plan in place. The format is in a booklet layout. These had been completed for each person but lacked detail and had not been Care Homes for Adults (18-65 years) Page 26 of 44 Evidence: dated. It is unfortunate that the format of the booklets is produced in a way that doesnt allow for it to be an active ongoing document of peoples health care needs, which is the intention of a health action plan. We saw an entry on one persons plan under I am allergic to the information recorded underneath this heading had been blanked out with correction fluid. We therefore didnt know what the person was allegic to and what action staff should take. The health action plan then went on to say my reaction is skin allergy. Other parts of the plan were incomplete. We read in this persons care plan some very specific information about a health care concerns but no information about this was recorded in their health action plan. Another health action plan looked at said the person should have their food liquidised. Staff told us that the information recorded in the health action plan is now out of date and the persons food should be cut up. We looked at recent health care appointments and we could see from the records that people have in put from a range of health care professionals. Two of the people case tracked had very recent appointments. One was with a consultant psychologist and one was an appointment at the continence clinic. Staff confirmed that both appointments had gone ahead as planned. We asked to see the outcome of these appointments so we could read what follow up action was taking place to meet these very specific health care needs. The outcome of both appointments had not been recorded. Poor recording of the outcome of peoples health appointments has the potential to cause significant difficulties when monitoring their health care needs. When we looked at medication management we had some concerns about medication storage and practice so we asked for a specialist pharmacy inspector to visit. They visited a week after out visit their report is as follows. The pharmacist inspection lasted just over two hours. The medicine management was assessed in each of the three units. Four people, who use the service, medicines, Medicine Administration Record (MAR) charts, care plans and daily records were looked at. The practice of one care assistant was observed, to see how she prepared and recorded the medication given. The deputy manager was present throughout the inspection and all feedback was given to him at the end of the inspection. Staff do not see the prescriptions prior to dispensing, so no copies were taken to check the medicines and MAR charts received into the home. Due to the poor ordering and checking in systems staff were routinely ordering and receiving four ampoules of one medicine every two months for one person even though the person only had one ampoule administered by the district nurse every four weeks. They had not recognised that the dose on the MAR chart was incorrect as this said it should be administered every three weeks but from recent correspondence this had been reduced to every four weeks. The majority of the quantities of medication had been recorded as received on the MAR charts, but not all. Staff carried over some balances of medicines from previous cycles but again this was not routine practice for all medication. As the start quantity for each MAR chart had not been accurately recorded for some medicines, it was not possible to Care Homes for Adults (18-65 years) Page 27 of 44 Evidence: demonstrate whether they had been administered as prescribed. Where the balances recorded were accurate, audits indicated that some medicines had not been administered as prescribed and some were unaccounted for. This was of concern due to the nature of the medication and the persons underlying clinical conditions. People are encouraged to leave the home and the community pharmacist dispensed a separate supply for them to take out with them. Care staff though had not recorded what had been taken out of the home, so it was not possible to ascertain exactly what had occurred at all times. The care plans were comprehensive and included information about the prescribed medication. This though had not been regularly updated and some information was out of date. Information from consultants regarding changes in drug regimes had not been followed exactly and the management had no system to identify this. There were good supporting information about all the prescribed medication including well written protocols detailing when a medicine should be administered on a when required basis for example in an emergency. There was no quality assurance system to assess individual staff practice in their handling of medication. One care assistant prepared the medication to be administered from the dispensed containers and then left these in the kitchen unattended whilst she administered them to one of the people in their own room. People living there, staff and any visitor to the home had access to these medicines. The home had purchased a vast array of homely remedies to administer to people for common ailments. The doctor had written a list of medicines the resident could take but there were no supporting protocols detailing their use. Their administration was recorded in a small notepad, which often did not include the persons name or time of administration. Information was not recorded on the persons individual MAR chart. It was not possible to audit exactly how many homely remedies should have been on the premise at any one time. The manager had purchased three new controlled drug cabinets and was awaiting their delivery. These were to be used to safely store any controlled drugs prescribed and received into the home in line with current regulations. Care Homes for Adults (18-65 years) Page 28 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to listen to and respond to complaints about the service. Arrangements in place do not fully ensure that people will be protected from harm. Evidence: The complaints procedure was available on display in the office. We have not received any complaints about this Home and no complaints have been made directly to the service since our last visit. Staff spoken with demonstrated a general understanding of their duty to safeguard people and how to report concerns on to senior managers. Safeguarding guidelines were available in the office. The whistle blowing procedures were available on the Homes intranet, we advised that a hard copy was made available for staff to read and this was dealt with during the visit. We looked at training records to determine that training in safeguarding vulnerable adults had been provided the matrix indicated that over half the staff had not completed the training. Staff should have this training and consideration should be given to discussing safeguarding and whistle blowing procedures in staff meetings to ensure that knowledge and understanding in this area is constantly checked. We saw arrangements are in place for supporting people to manage their personal money. Records seen detailed expenditure and a running balance.Receipts are kept for Care Homes for Adults (18-65 years) Page 29 of 44 Evidence: items purchased. Care Homes for Adults (18-65 years) Page 30 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in comfortable home that generally meets their needs. Maintenance work is not always done to a good standard. Evidence: Wesley Brook Close consists of three individual houses located in a quite cul de sac setting. House 12 and 14 are linked by a connecting door which is only used in an emergency. House 5 is located a few doors away. None of the houses are identifiable as care homes. There are lots of personal touches added in the communal areas and in peoples bedrooms to make the homes more welcoming and comfortable for the people living there. In the previous inspection report we were worried about people being placed at risk of harm from water borne infection due to low water temperatures. We were told and saw records to confirm that water temperatures are now being adequately maintained. However the manager and deputy said there still seems to be ongoing problems with maintaining water pressure levels and they were still in discussion with the housing association about these. We found no hot running water in the bathroom of house 5. We tried the tap several times. We told the deputy manager and staff about this. When we tried the tap again several hours later, there was running water. No one was able to Care Homes for Adults (18-65 years) Page 31 of 44 Evidence: explain why this had happened and we were told that the tap had not been disconnected. We were told that Mencap rent all three houses from a housing association who are responsible for repair work. When we were talking to the manager they told us there is a lack of clarity about what the housing association is directly responsible for. This could impact on peoples well being with work not being carried out as required. The bathrooms in all three houses are in need of refurbishment. When repair work has been done the quality and standard of work is poor. In one bathroom there is now three different types of tiles patched up over the bath which is poor in appearance and shows a disregard for the people living there. We looked at the bedrooms of the people whose care we case tracked. Bedrooms were lovely and comfortable with lots of personal possessions and there was evidence that people had been supported by staff to personalise their room. People told us I love my bedroom and I keep it clean myself. I like my bedroom I have everything I need. One of the people had been supported to rearrange their bedroom furniture. Their bed was next to a towel rail, this could cause an injury. Staff agreed at the time of the visit to make this safe, in agreement with the person. The gardens in house 12 and 14 have not been well attended and would benefit from some attention to make them more pleasant for the people living there. The garden furniture in house 12 was in a poor state of repair and unsafe for people to sit on. Care Homes for Adults (18-65 years) Page 32 of 44 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices are robust and protect the people who live there. Staff have not received all the training they need to do their job and meet peoples assessed needs. Evidence: We watched the way that people interacted with staff on duty, which indicated that good relationships exist between people living there and the staff supporting them. People told us staff are good” I like my key worker x”. We looked at the staffing rota for the week of the visit and the previous week. These showed different staffing levels in each house with either one or two staff on duty during the day in each house and one person in each house at night. Some people have additional staffing agreements for part of the week to enable them to do activities during the day. We did find the layout of the rota difficult to follow and it was difficult to assess who was on shift. Consideration should be given to having a clearer rota with the full names of all staff working in the Home. We spoke to four staff during this visit who demonstrated that they had a good understanding of peoples individual needs. They told us that they are due to have training up dates so they continue to have the skills and knowledge to do their job. Care Homes for Adults (18-65 years) Page 33 of 44 Evidence: We spoke to staff about the training they had received and looked at the staff training matrix to confirm what staff had done and when. The matrix was very confusing and we were not able to make an accurate assessment. We could see that health and safety training took place in April 2009 and infection control was planned for June 2009 but many areas showed gaps with up to 8 or 9 staff showing they had not completed required training. The manager told us she is due to do a staff training assessment so that she can determine what training is outstanding and make plans for staff to update their skills and knowledge where required. We could not see a date for when the last training on epilepsy had taken place. This training is crucial due to people having epilepsy and requiring staff to understand their needs and give them the support they need to be safe. Staff need other training specific to the needs of the people living there including communication and behaviour management. This training was raised as needed at the previous inspection and has still not been provided. Two staff had commenced employment recently. They were both in the process of completing the homes induction programme and were in the process of attending relevant training as part of their induction. The AQAA told us that 22 of the 24 staff have completed the induction training as recommended by skills for care and 22 staff have also completed NVQ level 2 or above. This should contribute towards ensuring that the staff team have effective knowledge of social care. We looked at staff recruitment records for the two most recently employed people. Criminal Records Bureau checks (CRB) had been made and written references received before employees began work. This should ensure that people are protected from the risk of having unsuitable staff work in the Home with them. Staff told us that since the new manager has been in post supervisions are taking place on a more regular basis. This should ensure staff have the opportunity to reflect on their practice and consider their individual training needs. Regular staff meetings now take place, which provide an opportunity for staff to discuss good practice and development issues. Care Homes for Adults (18-65 years) Page 34 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure the home is run in the best interest of the people living there. Evidence: The manager has only been in post for a few months. She has several years experience of working with people who have a learning disability. She has completed a CRB (criminal records bureau) check for the commission and told us she will then apply to be the registered manager. Staff told us The new manager is very good she is approachable The manager is excellent she gets things done. The Home has experienced a number of management changes in the last few years. There have been temporary arrangements in place with managers covering or acting as manager but not actually registering for the position. We found at this visit that many of the things that needed attention at previous visits still require attention now. The relationship between Mencap and their landlord needs attention so the home is maintained to a good standard for the people living there. Improvements should be made Care Homes for Adults (18-65 years) Page 35 of 44 Evidence: to peoples care plans so they are up to date and give clear information for staff to follow. Staff must have the required training to do their job. Medication management must improve so that people receive the medication they need. The providers senior manager carries out visit to the home to monitor and report on standards. Reports were available for visits in January and May 2009. These visits must be monthly so that the provider takes responsibility for monitoring the Home. We are unsure why some of the shortfalls we found at this inspection had not been picked up at the monthly visit and dealt with. A continuous improvement plan is displayed in the office for people to see. we were told that this provides a focus for improving standards across all areas of the Home. Quality assurance systems should include the views of the people living in the Home. Results of any surveys completed by people or their representative about the running of the home should be published. We looked at some health and safety records including Fire appliances and equipment we saw that these are checked and serviced regularly. The work place fire risk assessment must be up dated to ensure safeguards are in place to protect people. The AQAA informed us that moving and handling equipment and portable electrical equipment had been serviced as required. Care Homes for Adults (18-65 years) Page 36 of 44 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 37 of 44 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 19 12 Arrangements must be in 31/07/2009 place so that peoples health care needs are planned for and monitored. So health care needs are well met. 2 20 13 All homely remedies must be 31/07/2009 administered against a protocol detailing their use, side effects, cautions and warnings and dose including the maximum number of days they can be administered before a doctor is called. The system to record their administration must be improved so all administrations can be audited. This is to ensure that the administration of homely remedies is safe and Care Homes for Adults (18-65 years) Page 38 of 44 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 accurately recorded at all times. 3 20 13 The quantity of all medicines 31/07/2009 received and any balance carried over from previous cycles must be recorded. This is to ensure that audits can be undertaken to demonstrate the right medicine is administered to the right person at the right time and the right dose as prescribed and records reflect practice. 4 20 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. 31/07/2009 This is to ensure tat individual staff practice is assessed on a regular basis and appropriate action taken if audits indicate that they do not administer the medicines as prescribed. 5 20 13 A system must be installed to check the prescriptions prior to dispensing. All discrepancies must be 31/07/2009 Care Homes for Adults (18-65 years) Page 39 of 44 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 addressed with the healthcare professional. This is to ensure that all medicines are administered as prescribed at all times. 6 20 13 The medicine charts must record the current drug regime as prescribed by the clinician and checked by a second member of staff for accuracy. 31/07/2009 This is to ensure that all medicines are administered as prescribed at all times and audits can be undertaken to demonstrate this. 7 20 13 All medicines must be securely held in a locked facility at all times and not left unattended. 31/07/2009 This is to ensure that all medicines are safely held on the premise at all times. 8 23 13 Arrangements must be in place to ensure staff are suitably trained in safeguarding people. 30/07/2009 So people are protected from the risk of harm. 9 35 18 Staff must have the 30/09/2009 Page 40 of 44 Care Homes for Adults (18-65 years) 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 mandatory training to do their job. So peoples needs are met by appropriately trained staff. 10 39 26 The owner must carry out monthly visits to the home. 31/07/2009 So they can ensure that the Home is run in the best interest of the people living there. 11 42 23 The work place risk assessment must be updated. 30/07/2009 So peoples health and safety is well maintained. 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 2 3 1 6 7 The statement of purpose needs some more information so people have all the information they need about the home. Care plans should contain up to date information so people receive care in a way that they prefer. People’s daily records should include peoples response to care and how decisions have been made. So it is clear who has made the decisions and why. Risk assessments when up dated should detail why the 4 9 Care Homes for Adults (18-65 years) Page 41 of 44 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 control factors in place are still relevant. 5 16 Practices in place that restricts people should be reviewed and where possible alternatives considered so peoples rights are not denied. Menus should be monitored to make sure people are offered the recommended five portions of fruit and vegetables’ a day to ensure people eat a healthy diet. Menus should be developed so that people with limited verbal communication can be more involved in choosing what they would like to eat. Health action plans should be fully completed and health care needs should be planned for so that peoples needs are met in full. Consideration should be given to discussing whistle blowing and safeguarding procedures in team meetings so ensuring staff have the knowledge and understanding to protect people. Garden furniture that is unsafe to sit on should be removed so people are not put at risk. The water pressure problems should be rectified so people have facilities that are acceptable to them and do present any potential hazardous. Bathrooms in all three houses should be refurbished so they are hygienic and comfortable for people living there. Consideration should be given to redesigning the rota so staffs full names are included and the layout of the rota should be easy to follow. Staff should have communication and behaviour management training so they have the skills and knowledge to meet peoples specific needs. A manager should be registered so someone is responsible for the ongoing development of the home so that it meets the needs of the people living there. Quality assurance systems should include the views of the people living there. Page 42 of 44 6 17 7 17 8 19 9 23 10 11 24 24 12 13 24 33 14 35 15 37 16 39 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 17 42 Systems need to be in place between the provider and landlord so that problems such as the water pressure are dealt with in a timely manner. Care Homes for Adults (18-65 years) Page 43 of 44 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. 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. Care Homes for Adults (18-65 years) Page 44 of 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!