Care Home: Wood Lane, 135

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What the care home does well People have a nice home to live in that has a nice garden where they can help staff to grow things.The people living in the home are given information about the home and it tells them how much it costs to live there.The people living in the home can choose what they want to do. They go out with the staff.Each person has a care plan. This tells staff how to help the personThe staff help the people living in the home to get washed and dressed in clothes that they like to wear.The people living in the home are helped to learn how to do things around the home so that they are involved in the running of the homeThe staff help the people living in the home to see the doctor, or go to the hospital when they are not well.The food is varied with fresh fruit available to help keep them healthy. What has improved since the last inspection? The complaints procedure is easier to understand with pictures and a copy has been given to the people living in the home.The people living in the home are supported to keep in touch with families and advocates where necessary. What the care home could do better: Staff and other people who know the individuals living in the home should involve them in making decisions about their care and find out if they are happy at the home.The people living in the home should be helped to do the things they like to do.The home must make sure that peoples` belongings are safe.The home should be decorated and made homely and comfortable throughout.The home must make sure that there are always enough staff on duty to help the people living there to do the things they want.Staff should have all the training they need to do their jobs.The home must have a manager who will make sure that the home gets better and the people who live there are happy. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wood Lane, 135 Wood Lane, 135 Handsworth Birmingham West Midlands B20 2AQ The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman Date: 0 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 42 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: Wood Lane, 135 Wood Lane, 135 Handsworth Birmingham West Midlands B20 2AQ 01215235547 01215235547 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) : Milbury Care Services Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered person may provide personal care (excluding nursing) and accommodation for service users whose primary care needs on admission to the home are within the following categories:- learning disability, LD, 3. The maximum number of service users to be accommodated is 3. Date of last inspection 1 3 0 6 2 0 0 8 A bit about the care home 135 Wood Lane is registered to provide accommodation, Care Homes for Adults (18-65 years) Page 4 of 42 care and support for three people with learning disabilities. The house is a two-storey semi-detached property and is located in a pleasant and wellestablished residential area in the Handsworth district of Birmingham. Accommodation is provided in three single bedrooms. One of the single rooms is on the ground floor. There are two bathrooms in the house, one on each floor. Care Homes for Adults (18-65 years) Page 5 of 42 Downstairs there is also a lounge, separate dining room, kitchen and laundry. Upstairs, in addition to the bedrooms, there is a small office. There is an attractive enclosed garden to the rear of the property, and this has a lawn, planted borders and a small patio area. At the front of the house is a paved area with limited off-road parking. There are local shopping facilities within walking distance, and main bus routes also run close by. Care Homes for Adults (18-65 years) Page 6 of 42 Copies of reports from the CSCI are on display in the hallway of the home. The reader should ask the manager how much it costs to live here as it may be different for each person depending on the person’s needs. Care Homes for Adults (18-65 years) Page 7 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: 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 42 How we did our inspection: This is what the inspector did when they were at the care home This inspection was carried out by one inspector during June 2009. The home did not know we were going to visit. We tried to find out what it was like for people to live there. Because people could not tell us what they were thinking we watched for signs to see if they were happy living there. Care Homes for Adults (18-65 years) Page 9 of 42 We looked at how the home meets the law. We looked at how the home can do things better. Before this visit we looked at all the things we had been told about the home. This included things that had happened in the home. The home sent us the Annual Quality Assurance Assessment (AQQA). This tells us how they think they are meeting the needs of the people who live there. Care Homes for Adults (18-65 years) Page 10 of 42 Two people living in the home were case tracked. Tracking peoples care helps us understand what it is like to live there. We did this by meeting and observing them and talking to the staff about their care. We looked at their care files and some policies and procedures. Policies are rules about how to do things. Procedures tell people how to follow the rules. We looked around the home and records about staff and health and safety. Care Homes for Adults (18-65 years) Page 11 of 42 We sent three Have Your Say surveys to the home for the people living there and some to people involved in their care. We did not get any back. The home told us that they did not receive any. We spoke to someone who had been involved in making sure one person was given a choice about moving and their relative by telephone. We also talked to the manager and staff at the home. What the care home does well Care Homes for Adults (18-65 years) Page 12 of 42 People have a nice home to live in that has a nice garden where they can help staff to grow things. The people living in the home are given information about the home and it tells them how much it costs to live there. The people living in the home can choose what they want to do. They go out with the staff. Care Homes for Adults (18-65 years) Page 13 of 42 Each person has a care plan. This tells staff how to help the person The staff help the people living in the home to get washed and dressed in clothes that they like to wear. The people living in the home are helped to learn how to do things around the home so that they are involved in the running of the home Care Homes for Adults (18-65 years) Page 14 of 42 The staff help the people living in the home to see the doctor, or go to the hospital when they are not well. The food is varied with fresh fruit available to help keep them healthy. What has got better from the last inspection The complaints procedure is easier to understand with pictures and a copy has been given to the people living in the home. Care Homes for Adults (18-65 years) Page 15 of 42 The people living in the home are supported to keep in touch with families and advocates where necessary. What the care home could do better Staff and other people who know the individuals living in the home should involve them in making decisions about their care and find out if they are happy at the home. The people living in the home should be helped to do the things they like to do. Care Homes for Adults (18-65 years) Page 16 of 42 The home must make sure that peoples belongings are safe. The home should be decorated and made homely and comfortable throughout. The home must make sure that there are always enough staff on duty to help the people living there to do the things they want. Staff should have all the training they need to do their jobs. Care Homes for Adults (18-65 years) Page 17 of 42 The home must have a manager who will make sure that the home gets better and the people who live there are happy. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kulwant Ghuman Care Quality Commission 77 Paradise Circus Queensway Birmingham Telephone: 0121 600 5300 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 42 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 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There was information available for people thinking of moving into the home or their representatives to help them decide if the home could meet their needs. Evidence: The admission process was not assessed at this key inspection as the people currently living in the home were there at the time of the last key inspection. At the time of the last key inspection the admission process was found to be good ensuring that an assessment was being carried out regarding the physical, social, medical and psychological needs of people before they moved into the home. It was also apparent that individuals were able to visit the home to see if they liked it and to help the home decide if their needs could be met at the home. As at the last inspection there was a service user guide available to the people living in the home on their files. The service user guide included information about the fees that the individual would pay to live in the home. The home had made efforts to make these accessible to the people living in the home Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: by using pictures and symbols. There were also service agreements and residency agreements in place. These documents helped the individuals and their representatives know what services they could expect to receive from the home and how much the organisation would pay towards a holiday for the individual. The service user guide included information about the fees that the individual would pay to live in the home. The home still needed to evidence that the representatives of the people living in the home were aware of what was included in the assessments and the contracts. The day to day needs of the people living in the home were being met. The people living in the home had very limited verbal communication and used some gestures and some use was made of Makaton with the individuals. There was little use observed during the day of any other communication tools. Care Homes for Adults (18-65 years) Page 21 of 42 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 . The care plans did have all the necessary information included in them. This could mean that new or temporary staff would not have access to information they needed to safely care for the people living in the home. There was little evidence available to show how the people living in the home had been supported to make decisions. Evidence: We case tracked one person fully and looked at some aspects of care for another person who was living in the home. At the previous inspection it was identified that comprehensive care plans had been developed and they included long and short term goals. The plans were in the process of being updated. It was important to ensure that these plans were updated as they were over a year old and some information was out of date or not available, for example, one stated that an individual attended college but this was no longer the case. This would ensure individuals received the support that they needed. Plans in place included: helping people make snacks, undertaking domestic tasks, daily Care Homes for Adults (18-65 years) Page 22 of 42 Evidence: routines, accessing bedrooms, behaviour management, oral hygiene, finances and restrictions on them. There were risk assessments and management plans in place relating to these plans and this would help to keep the individuals safe. The risk assessments and care plans were last reviewed in October 2008. The files stated that these should have been reviewed every three months. This meant that any changes had not been recorded and staff who were working at the home on an irregular basis may not be aware of the changes. There was a care plan in place on how individuals were assisted to make choices. This stated that key worker meetings would be held four weekly to help the individual make choices or for choices to be made on his behalf including if any money was to be spent on his behalf. These would be recorded with a reason as to why the choice was made. Any serious choices would be made by a multi disciplinary team. There was no evidence that these meetings were being held and we were told that they were not taking place. Therefore it could not be evidenced how the person was helped to make choices. When we looked through one individuals care file it was not until we looked at the statutory review at the end of the file that we learnt that the individual suffered from epilepsy. It was important that this information was available to the staff so that they knew what to do, and how to recognise the individual was having a seizure. Another individual who had reduced mobility and for whom we observed a wheelchair being brought into the home when they returned from college did not have a moving and handling assessment in place. This was needed to ensure that the staff knew how to safely assist the individual and prevent any injuries to him or themselves. As stated earlier the care plans were in the process of being updated. It was important that relatives, advocates and other people involved in the care of the people living in the home were involved in this process and that this was recorded. In view of the limited verbal communication skills of the people living in the home the files needed to include detailed information about how the staff should communicate with them. For example, do they use any sign language, do they use pictures or any elctronic aids, how do they express whether they want to do something or how they feel. It was pleasing to note that the photographs of the key workers for individuals were included in their files so that the individuals knew who their key workers were. One of the individuals living in the home had some challenging behaviours that meant that their bedroom was very bare and most of their belongings kept elsewhere. The reasons for this were recorded. The behaviours of this individual did have some impact on the other people living in the home but this was generally well managed. The individuals initial assessment stated that they needed one to one support in the community and when travelling however, it was not possible to know how much one to one support was available through the funding arrangements and how much was Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: actually provided. Observations during the day showed that people could make their wishes known. For example, we were told that the staff had planned to take the two individuals in the home out shopping to return some items of clothing but one of them had indicated that he did not want to go. The staff brought some nail varnishes to paint the nails of one of the people living in the home and showed her the different colours available however she walked out of the room indicating that she did not want them done. On another occasion she chose to have some mints and she made choices at lunch time. One of the people living in the home made a cup of tea for the other person in the home during the day and made himself a sandwich at lunchtime. People were observed to move around the home freely and although bedrooms were kept locked they were opened when people wanted to access them. Care Homes for Adults (18-65 years) Page 24 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people living in the home were supported to undertake some activities but it could not be determined that these are what they wanted to do. The activity plans were very basic. Evidence: One of the individuals living in the home was attending college on the day of the inspection the other two were in the home. The people living in the home were assisted to develop daily living skills such as making drinks, setting the table for meals, making snacks and cleaning around the home. We were told that they also helped the staff to maintain the garden. Activities planners were in place however, they tended to be dominated by tasks such as cleaning, making snacks, baking, shopping and occasionally going out for meals or to the cinema. There was no way of determining who had decided that these activities Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: were to take place. The planners seen did not indicate that the individuals would be occupied in a meaningful way for a large proportion of the day for example, there was only one activity such as making a snack in the morning or afternoon. The key worker meetings that consulted with people on the activities were not taking place so it could not be determined who had decided on these. During discussions with the staff and looking at the records it was evident that activities did take place such as shopping, rides on buses or in taxis. The activities planners needed to be more closely aligned to the interests and goals of the individuals living in the home. For example, one of the individuals was very interested in motorbikes and during the day brought a magazine to show us some pictures. The activities plan should incorporate this by organising visits to libraries, purchase magazines, visit places that would be of interest, identify television programmes that may be of interest and so on. If the individual refused to take part this should be recorded. We were told that one person did not like going out in the community with the other people living in the home but there were no records or plans for how this was to be managed to enable each of the individuals needs to be met. One of the relatives of the people living in the home told us that they were kept informed of how the person living in the home was. They were pleased that their relative had been able to continue living in the home after a deterioration in their health as the individual considered Wood Lane to be his home and he was happy there. An independent advocate had been involved with this individual at that time to ensure that his wishes were taken into account. More use of independent advocacy services should be made in the home. There was evidence that where people wanted to they were supported to attend church services. Staff had been requested to ask the people living in the home where they wanted to go on holiday this year. This had not yet been decided. Due to the behaviour of one of the people living in the home the bedroom doors and kitchen cupboards were kept locked. Staff were seen to make the bedrooms and kitchen facilities available when people wanted them. It was noted that the plug for the bathroom was kept in one of the bedrooms to prevent one individual throwing it down the toilet. However, this had the effect that staff would need to enter a particular bedroom when the plug was needed and this could have an impact on the individuals privacy. The staff had not taken this into consideration and needed to find an alternative place to keep the bath plug. We were told that the staff were due to go and do the shopping for the home and that Care Homes for Adults (18-65 years) Page 26 of 42 Evidence: that was the reason for food stocks being low at the time of the inspection. There were some sausages and pies in the freezer along with some frozen vegetables and fresh potatoes in the kitchen however, during the afternoon staff had bought some food so that the meal identified on the menu was provided. We were told that fresh fruit was available although it had run out. There were very few snacks such as biscuits or crisps available in the home. It was recommended that the shopping was done before the food stocks got so low to ensure that people living in the home continued to have choices available at all times. The food records showed that there were a variety of meals provided in the home. One of the people living in the home was on a low cholesterol diet and although low fat milk and spread was available in the fridge there was no other evidence to show that specific low fat foods had been purchased for him. The daily records, where the food eaten is recorded, menus and care plans should indicate how specific dietary needs are being met. It was seen that people ate their meals where they wanted. Some ate in the dining room and one had their meal on a tray in the lounge. Care Homes for Adults (18-65 years) Page 27 of 42 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 . The people living in the home are supported with their personal and health care needs in a person centred way. Evidence: There was a daily routine section in the care plans that indicated how the people living in the home were to be supported with personal care. These showed that personal care was being provided in a person centred way. For example, the way in which the hair of one individual was to be washed to ensure that they did not get upset or frightened by water going onto their face. The people living in the home were all dressed in clothing that seemed to match their ages and needs. One person had her nails painted, there were a choice of colours available but she was able to indicate if she did not want them painted. As stated earlier, one of the individuals suffered from epilepsy however, their were no guidelines available on the file for the staff to refer to. One of the staff spoken to was well aware of the condition however, bank and agency staff may not be aware of this and need the information to refer to. Care Homes for Adults (18-65 years) Page 28 of 42 Evidence: One of the individuals had problems with swallowing and advice had been sought from the Speech and Language Therapist and information was available to the staff. A behavioural therapist was being consulted to advise on the management of some challenging behaviour of one of the people living in the home. Peoples weight were being monitored however the last recorded weight seen during the inspection were Jan and February 2009. It was important to monitor individuals weights as an indicator of whether they were eating sufficient or too much, or as an indicator of any problems with their health. The management of medicines was found to be good. The people living in the home were having regular medication reviews. One person was having some of their medicines crushed or in liquid form due to their swallowing problems. They were however, receiving one medicine in capsule form and it was advised that this should be checked for safety with the pharmacist. There were no controlled medicines in the home. There were some PRN (as and when required) medicines but there were protocols in place for their use. It was noted that the wrong code was being used on the medication records for these. The code used indicated that the individual was being offered but refused. On some occasions there was no code at all. This shows that the staff are not consistent in recording. Usually, an entry would only be made if PRN medication had been administered. The medical files of the people living in the home included good detail of the appointments attended and what the outcomes were. There was evidence that people were seen as required and choices such has whether to have the flu injection or not. Care Homes for Adults (18-65 years) Page 29 of 42 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 . The people living in the home have access to a complaints procedure however, the actions identified in their care plans to ensure that they are supported to express any concerns or for any concerns to be raised on their behalf are not undertaken. Procedures in the home do not always protect the individuals from the loss of personal belongings. Evidence: No complaints had been lodged with us since the last inspection and none had been recorded in the home. Just before this inspection we were informed that the personal photographic camera of one of the people living in the home had gone missing from the safe to which only staff had access. The matter had been referred to the police. Procedures were in place in respect of handovers however, it was obvious that these were not being fully implemented. There were complaints procedures in place that were accessible to the people living in the home. They were available in a format that would be easier for them to understand however, it was unlikely that they would be able to raise issues independently. Keyworkers should be meeting monthly to ensure that the individuals needs were being met as they were dependent on the staff to voice any issues. These meetings were not taking place. There were inventories of belongings available on the files to track if things went Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: missing. There were records kept of any expenditure made on behalf of the people living in the home. Monies were withdrawn for individuals from a bank account and a record kept of the amounts withdrawn. It is recommended that there are two people who check the amounts entered onto the financial records sheets with the receipts so that any mistakes can be identified and rectified. An incidence of where this would have been picked up was discussed during the inspection. We were informed that financial records were audited during regulation 26 visits. This would ensure that money was being spent appropriately for the people living in the home. Care Homes for Adults (18-65 years) Page 31 of 42 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 . The people living in the home have access to accommodation that meets their needs. Some aspects of the home need improving to make it more homely and comfortable. Evidence: As at the last inspection the front and rear gardens of the home were very well maintained. The rear garden was very private with a green house with some very colourful flowers growing in it. The garden would be difficult to access for one of the people living in the home but we were told that with support he could be assisted out into the garden. At the last inspection we were informed that a request for ramped access into the garden had been made. This was not yet in place. Having ramped access would support easy access to the garden area and enable the individual to be as independent as possible. To the front of the home there is parking for 2 to 3 vehicles. The home is a small domestic style property, similar to others in the area and there are two bedrooms, a bathroom and an office on the first floor and, one bedroom, a shower room, laundry, lounge, dining room and kitchen on the ground floor. People occupying the bedrooms on the first floor need to have full mobility to access them. Care Homes for Adults (18-65 years) Page 32 of 42 Evidence: The lounge is generally comfortable and homely with a leather suite and television in there. There are some ornaments and photographs of the people living in the home around the room. The lounge was in need of redecorating and the carpet needed to be either deep cleaned or replaced to improve the ambience of the room. There is a separate dining room containing a table and chairs. The room could be made more homely. All three bedrooms were seen. Two of the bedrooms were decorated according to the individual tastes and genders of the occupants and included personal possessions but were in need of being updated. We were told that plans were in place for this to happen. We were told that new wardrobes, vanity units and beds were to be purchased over the next few weeks. Records needed to be kept of how the individuals were involved in choosing items and colours for the rooms. The third bedroom was sparsely furnished. There were no curtains at the window. The care plan indicated that the window had tinted glass to promote privacy. The individual had behaviours that meant that items were regularly destroyed but efforts needed to be made to make the room more homely. The bathing facilities needed to be made more homely, especially the shower on the ground floor. The grouting around the tiles had become discoloured and the extractor fan was not in working order. The stair carpet was becoming worn and should be made part of any refurbishment programme for the home. The home was generally clean. There were hand washing facilities with hand dryers fitted in the bathroom and shower room. The home needs a general boost in decor to make it a pleasant place for people to live in. Care Homes for Adults (18-65 years) Page 33 of 42 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 . Staffing levels must ensure that the individual needs of the people living in the home can be met as they want. Most of the staff in the home have had the training needed to meet the needs of the people living there safely. Evidence: During the inspection staff were seen to interact with the people living in the home with respect and care. The people living in the home were of different genders and of white european backgrounds. The staff complement on the day of the inspection did not reflect this. The staff were all female and of either black or asian descent. The manager who was supporting the home in the absence of a registered manager was male and white european. The manager needed to be mindful of wherever possible the staff on duty reflect the genders and cultural background of the people living in the home. The staffing rotas showed that the staffing levels varied. On some occasions it was planned to have three staff on duty during the mornings and sometimes two. During the afternoons and weekends there were generally two staff and one during the night. We were told that although sometimes three staff were planned on rota there were only two on duty. They did try to get bank staff but there was not always someone Care Homes for Adults (18-65 years) Page 34 of 42 Evidence: available. At weekends there are normally two staff planned to be on duty. We were told that staffing levels were difficult to maintain because individuals were informing the home at the last moment that they would not be able to be on duty. We were also informed that this issue was being pursued with the individuals. These staffing levels do appear to be low particularly as the staff undertake cleaning, cooking and care tasks and all the individuals would need one to one support in the community or when undertaking activities. Where one to one funding is provided the rotas should indicate how and when these hours are provided. Agency staff should be accessed where there are no bank staff available to cover the shifts. We were told that on occasions due to the staffing levels people living in the home were not able to be taken out because one of the individuals did not want to go. We were told that two people had left the home recently and that they were unlikely to be replaced as the home had been overstaffed. The manager must ensure that the staffing levels meet the needs of the people living in the home and their lifestyles are not compromised due to low staffing levels. We were told that no new people had been appointed at the home since the last inspection so we did not look at the recruitment procedure at this inspection. We looked at the file of someone who had been employed before the last inspection. There was an induction checklist on the file but there was no evidence to show that the individual had undertaken an induction equivalent to Skills for Care or Learning Disabilities Qualification. There was no training matrix in place to show what training the staff had undertaken and the individual had no training certificates available on the file. The individual had not attended fire training but we were informed the day after the inspection that she had been booked on training to be undertaken on 18.6.09. Individual staff training records showed that the majority had had training in food hygiene, infection control, first aid and so on and that some had had some training about the specific needs of the people living in the home. It was important that all the staff had training regarding the needs of the people living in the home. Another area of training identified during the inspection was the wording used in some of the daily recordings, for example, has been good. The manager overseeing the home told us that training in communication had already been arranged. Moving and handling training for all the staff was needed as the mobility of one person had deteriorated. One member of staff told us that supervision had not taken place for several months. This meant that staff may not be aware of the changes in the needs of the people living in the home, their training needs were not being identified and updates on good practice may not be taking place. Care Homes for Adults (18-65 years) Page 35 of 42 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 . The home is showing the effects of not having a dedicated manager who can oversee the development of the home, the staff and the people living there. Evidence: The home had been without a registered manager for the past year. We were told that someone had been covering the home for some months but had left and the home was now being overseen by a manager who was registered at another home run by the organisation. The rota showed that he was at Wood Lane three days of the week. It was important that a person was appointed at the home quickly so that the people living in the home could be assured that someone who had day to day responsibility for the running of the home and ensuring their needs were met was in place. The lack of a registered manager at the home was showing in the way the home was operating. The care plans and risk assessments were not being reviewed on a regular basis. Four weekly key worker meetings were not taking place and the choices being made for, or, with the people living in the home were not being documented. Staff were not being supervised on a regular basis. Some documentation was difficult to locate during the inspection for example reports of the visits made to the home under Care Homes for Adults (18-65 years) Page 36 of 42 Evidence: Regulation 26, weekly fire alarm tests and monthly emergency lighting tests. Staff were not carrying out the hand over procedures effectively resulting in an item going missing. It is important that an individual is appointed as soon as possible so that they can ensure that the home is run for the benefits of the people living there and can advocate on behalf of the home to ensure its improvement and development The regulation 26 reports were forwarded to us following the inspection and showed that issues were picked up. There had been a service review of the home during January and February 2009. Health and safety appeared to be handled well and the servicing of equipment meant that it was maintained in good working order. Care Homes for Adults (18-65 years) Page 37 of 42 Are there any outstanding requirements from the last inspection? Yes No x 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 38 of 42 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 8 13 Moving and handling risk assessments and management plans must be in place. 31/07/2009 This will ensure that the people living in the home are supported safely. 2 19 15 A record and management plan for all an individuals medical needs must be maintained. 31/07/2009 This will ensure that the needs of the people living in the home are met consistently. 3 35 18 All new staff should undertake adequate induction training and ongoing training. 31/07/2009 This will ensure that the Care Homes for Adults (18-65 years) Page 39 of 42 people living in the home will be supported by people with the right skills and knowledge. 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 5 Ramped access into the garden should be provided. This would enable easy access for those with reduced mobility. There should be evidence that people living in the home and/or their representatives have been involved in the admission process to ensure that the individuals needs and rights are made aware to all parties. Care plans should show the exact methods of communication with the people living in the home. This will ensure that staff use the most appropriate methods to communicate with the people living in the home. Care plans should be updated at least every 6 months, with ithe nvolvement of relevant other people. This will ensure that the changing needs of the people living in the home are known and planned for. The decision making process should show how decisions are arrived at to ensure that they are in the best interests of the people living in the home and their choices implemented wherever possible. This will ensure that the people living in the home are enabled to make choices about their daily life. Activities should be in line with individual goals and interests and records kept when people did not want to take part. This would ensure that the people living in the home were provided with activities that met their needs. Individuals privacy and choice should be taken into consideration when making decisions about the running of the home. This will ensure that the people living in the home are assured of their privacy and dignity. Food stocks should be replenished to ensure choices are available at all times. Food records should how individual dietary needs have 3 6 4 6 5 7 6 14 7 16 8 9 17 17 Care Homes for Adults (18-65 years) Page 40 of 42 been catered for. 10 19 The weights of the people living in the should be regularly monitored to ensure that they receiving the correct nutrition. All medicines should be provided in a safe format according to the needs of the individual. This will ensure that the people living in the home are safe from any potential risks. Staff should ensure that the medication policy and procedures are applied consistently. This will ensure that the people living in the home receive a consistent service. Procedures in the home should be applied so that the people living in the home and their belongings are safeguarded. Care plans and staffing rotas should show where one to one support is being provided to the people living in the home. This will ensure that the people living there receive the individualised support they are entitled to. Numbers of staff on duty should not restrict the lifestyles of the people living in the home. This would ensure that individuals are able to do what they want despite the wishes of the other people living there. Evidence of efforts made to cover any shortages should be retained. Wherever possible the staff team on duty should reflect the background of the people living in the home. Staff should receive supervision a minimum of six times a year. This will show that they are supported with their development and that they provide care to the people living in the home in line within current good practice guidelines. A manager to oversee the home on a day to day basis should be put in place as soon as possible. This will ensure that the people living in the home know that there is someone responsible for the day to day management of the home. All areas of the home should be maintained to provide a welcoming and homely environment for people to live in. 11 20 12 20 13 23 14 33 15 33 16 17 18 33 33 36 19 37 20 37 Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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