Care Home: York Street (32)

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What the care home does well The commission have not received any complaint about York street following our last visit. The staff have developed communication records called, "Communication Passports". These records are developed over time by staff who get to know each persons needs and help to identify how they express their choices in how they live their life. The communication records are a good example of the time taken by staff to produce records that help everyone to be kept updated in how each person communicates their likes, dislikes, choices and emotions. What has improved since the last inspection? We received two survey from people living at the home who were overall very positive about living at York street. The people we met told us they were happy at the home and had most things that they needed. We received 1 staff survey which overall was positive about their experiences at working at York street. Staff comments included,eg, "Extremely good provision of services for users to access and good flexibility of daytime activities..." Staff were happy working at York street and felt they had a good home with longstanding staff that offered good stability to people living there. Each persons has a file that shows how they are supported by staff to plan social events and activities and they carry out risk assessments to help make activities as safe as possible. Recent trips and holidays have included, holidays to the society`s own holiday lodges, trips to south Wales and trips on a narrow boat. People had assessments called, "My health action plan" and "Health passports." Both documents were good examples of staff identifying the health care needs and the support needed to keep each person healthy and safe. Information about how to raise a concern or complaint is made available to the people living at York street in a pictorial format. This is good practice as it helps to increase the opportunities for people to have a better understanding of the ways in which they can raise concerns. We have received 2 surveys from people living at the home and they both indicated they knew who to speak to if they were not happy. What the care home could do better: Full feed back was given to senior managers both during and on conclusion of our visit. To make sure that all precautions are taken to keep people safe against the risk of fire. To have an updated fire risk assessment with the right details and information. This will make sure that people are kept safe and that the management of fire safety at the home is up to date and gives people the right information and training to help take the right precautions against the risk of fire. All staff must be suitably qualified and experienced to support the health and welfare of people at York street. All staff must have updated training in fire awareness and in drug administration. This will ensure that all staff have the right skills and experience to safely support everyone at the home. The training records of staff should be reviewed to enable good management of their training needs to ensure they are always kept up to date in their practices especially in,eg, health and safety, food hygiene and non violent crisis intervention. To update the statement of purpose and service user guide and make sure its accessible to people so they have the most up to date information available to them to help them make decisions and choices about the home. To consider the use of bringing in the services of an independent advocate to help support people in making their requests and choices known about were they would like to live. This will help people to have information and feedback as to what support and help they can expect with their future plans. To review the comments made in this report with people at the home so they can be given feedback regarding their requests and suggestions. To review the need of more staff meetings, EG every 2 months, and ways for staff to discuss their comments and concerns To have updated financial records, support plans in place. These records must be clear and accessible to everyone residing at York street and their representatives and should show that finances are being managed in each persons best interest and with their consent. To keep everyone informed and up to date with the developments of their home including any suggestions regarding what people would like to improve their home such as when they can have eg, sky television, a new kitchen, new garden furniture, a treadmill and completion of the bathroom. To provide a maintenance and development plan for the home so that people are included and kept up to date with developments planned for their home including repairs of windows, bathroom area and weeds in the garden. To review the cleaning standards within the home and to provide the right input and review to make sure the home is always kept clean and of a good standard to promote peoples rights and dignity. To make sure that basic facilities such as soap and towels are provided to prevent any risks to people. Key inspection report Care homes for adults (18-65 years) Name: Address: York Street (32) 32 York Street Bromborough Pool Wirral CH62 4TY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 1 6 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: York Street (32) 32 York Street Bromborough Pool Wirral CH62 4TY 01516439196 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: pat.hood@was.demon.co.uk Wirral Autistic Society care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 2 Date of last inspection Brief description of the care home 32 York Street is registered to provide personal care for two adults with a learning disability. The home is a two storey terraced property located in a residential area. On the ground floor there is a lounge, dining room and a kitchen. On the first floor there are two single bedrooms, an office/staff sleep in room and a bathroom. There is a patio and a garden to the rear of the home. Parking is available on the road at the front and side of the home. York Street is close to local shops and to public transport services. The home is run by Wirral Autistic Society who have several care homes for adults with a learning disability in the area. Fees are negotiated at the time of placement and are dependent upon a number of factors including the amount of staff cover required. At the time of the inspection the fees were 1960.00 pounds per week. A copy of the Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 2 Brief description of the care home statement of purpose, which describes the services offered at York Street, is made available to relatives and social workers. The service users guide to the home is made available before a prospective resident comes to live at the home and the content is discussed with them, where possible, to ensure their understanding. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is 2 star. This means that people who use the service experience good quality outcomes. This unannounced visit took place on the 16 th September 2009 over a period of 4.5 hours. This was carried out with the help of senior managers from head office as the manager was on leave. Every body was at out during our visit so we met people on their return home in the evening. We gathered information for this visit in a number of ways. We sent surveys to staff, and to 2 people who live there and to 2 health professional. We (the commission) looked at records and included comments made in comment cards returned to us and surveys carried out by Wirral Autistic Society. We also sent comment cards to relatives so they could offer their opinions about the home. Care Homes for Adults (18-65 years) Page 6 of 33 Case tracking was used as part of the visit to the service. This involves looking at the support and care a person gets from the staff as recorded in their support plans, including information on medication, money, daily life and their living conditions. The manager completed a questionnaire called an aqaa that we sent before our visit. The information from this was used by us to plan this visit and in writing this report. The document was completed and was returned to the commission before this visit took place. It gave alot of information to show how the service was managed. It gave various details of how the manager is continuing to develop the service for the benefits of people living there. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Full feed back was given to senior managers both during and on conclusion of our visit. To make sure that all precautions are taken to keep people safe against the risk of fire. To have an updated fire risk assessment with the right details and information. This will make sure that people are kept safe and that the management of fire safety at the home is up to date and gives people the right information and training to help take the right precautions against the risk of fire. All staff must be suitably qualified and experienced to support the health and welfare of Care Homes for Adults (18-65 years) Page 8 of 33 people at York street. All staff must have updated training in fire awareness and in drug administration. This will ensure that all staff have the right skills and experience to safely support everyone at the home. The training records of staff should be reviewed to enable good management of their training needs to ensure they are always kept up to date in their practices especially in,eg, health and safety, food hygiene and non violent crisis intervention. To update the statement of purpose and service user guide and make sure its accessible to people so they have the most up to date information available to them to help them make decisions and choices about the home. To consider the use of bringing in the services of an independent advocate to help support people in making their requests and choices known about were they would like to live. This will help people to have information and feedback as to what support and help they can expect with their future plans. To review the comments made in this report with people at the home so they can be given feedback regarding their requests and suggestions. To review the need of more staff meetings, EG every 2 months, and ways for staff to discuss their comments and concerns To have updated financial records, support plans in place. These records must be clear and accessible to everyone residing at York street and their representatives and should show that finances are being managed in each persons best interest and with their consent. To keep everyone informed and up to date with the developments of their home including any suggestions regarding what people would like to improve their home such as when they can have eg, sky television, a new kitchen, new garden furniture, a treadmill and completion of the bathroom. To provide a maintenance and development plan for the home so that people are included and kept up to date with developments planned for their home including repairs of windows, bathroom area and weeds in the garden. To review the cleaning standards within the home and to provide the right input and review to make sure the home is always kept clean and of a good standard to promote peoples rights and dignity. To make sure that basic facilities such as soap and towels are provided to prevent any risks to people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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. Information is given to people about the home which helps them to make decisions about York street. Evidence: The statement of purpose and service user guide includes good information on the purpose of the home and the facilities on offer and includes visual pictures which may help some people understand the information given. We noted that these documents still referred to the old address and name of the commission and previous manager and would benefit from being updated in case anybody wanted to contact our department and needed help in making choices and decisions about the home. Although there are currently no vacancies at York street, the company do have good procedures which help people to choose were they want to go and helps them to gradually move into a home and get to know the people they would be sharing with. Staff complete assessments called, internal move assessment plans, although we did not see any of these assessments during our visit. When these assessments are completed they help to show how people are supported to gradually choose and make Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: the move to live at a home. We received two survey from people living at the home who were overall very positive about living at York street. However they both indicated that they were not asked if they wanted to live at York Street. One person felt they were given alot of information about the home before they moved in and another person felt they had not been given alot of information about the home. Some people made comments in their surveys saying, I feel a little bit pressured into making a choice about were I would like to live.... ..I would like to live by myself. The house could do with a new kitchen... Enables to promote independent living, generally alright but sometimes a little hemmed, its a nice place to live. We also received one survey from a member of staff who also raised comments about peoples requests in were they wanted to live saying, Services user has continually asked for own house/ flat, I understand the difficulty of this issue but Services User has consistently asked this and yet been denied. These comments and requests should be reviewed with everyone at York street so that peoples opinions and requests are valued and reviewed on a regular basis. The organisation may need to include an advocate in gaining the opinions and requests of people living at the home. This could help support them in knowing what is happening with their comments about living at York street and other houses. Care Homes for Adults (18-65 years) Page 12 of 33 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 individual needs of the people living at York Street are identified by staff and in support plans so staff can support them to meet those needs. Evidence: Individual support plans were available for each person. Each person has a person centred plan in place. We looked at them both. The plans were detailed in part and mostly reviewed and updated in parts helping to give enough information to show how their personal, health and social needs would be met and covered a diverse range of needs and requests. People were supported to keep in touch with their family and friends and alot of work and support was offered to help people with their requests and choices to keep in touch with people important to them. Some plans had recent reviews, other plans which identified various risks had last reviewed dates of 2008. This was discussed with senior managers present who agreed that reviews were needed of both plans to make sure they were all consistently updated and made clear what support was in place to safeguard each person especially were risks had been identified. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: The staff have developed communication records called, Communication Passports. These records are developed over time by staff who get to know each persons needs and help to identify how they express their choices in how they live their life. The communication records are a good example of the time taken by staff to produce records that help everyone to be kept updated in how each person communicates their likes, dislikes, choices and emotions. In discussions with the staff on duty they were able to explain the way in which people living at York Street make decisions and how they are supported to make those decisions. They felt this was helped by the fact they have the continuity of staff who have worked there along time and have got to know the people they support really well. When everyone returned home that evening there was a friendly atmosphere were each person did their own thing on their return home. We noticed a friendly atmosphere throughout our visit were everyone was included and made to feel welcome. Everyone seemed to have a good rapport with each other. We looked at a sample of financial records kept at the service of personal allowances which were well kept and accurate and in good order of the monies managed by them. Staff had developed records called, Me and My money were they had tried to show were people were being supported with their finances. Staff had worked hard in developing capacity assessments to show why various decisions were made to support some people with the management of their finances. The service and staff help each person to manage small amounts of money were its identified they may need some support. We discussed how the financial procedures were carried out and how they were maintained at York Street to help safe guard the financial affairs of each person. However in looking at each persons financial records there was no information, procedure or update on why or how some of their money was managed and stored at head office. The staff and people living at York Street had no details of were their monies were stored at head home. They had no details of the name of the account , or details of any savings or updated statements. There was no information regarding what benefits each person had stored at head office or the name of an agreed appointee. We were told that people contribute to the communal transport and the costs are taken from peoples monies stored at head office. However we could not see any clear information or consent given by people living at York Street or their representatives for their monies to be stored and managed at head office. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: One assessment showed that they were contributing money each week from their money stored at head office for the use of a communal car thats shared between 3 houses. However their support plan had no evidence that they had consented to this being done and there was no evidence to show they were getting value for money for this financial contribution. We noted that at times they are unable to use the car as other homes were using it and they were having to additional pay out for the use of public transport and taxis when the communal car wasnt available. We had previously discussed this with senior managers within the society. Following our visit we have met senior managers and have been told that various reviews and developments are taking place regarding the current procedures for managing and supporting people with their finances. They are hoping to have more person centred procedures in place by the end of December which they are confident will give better and improved methods of supporting people in managing their finances. The service did not have a policy or procedures to describe the current processes offered to people to support them with their money and to explain the procedures of how their money was managed at head office. Updated support plans will help to show were people are supported in giving their consent in choosing how they want their support or management of their finances. Care Homes for Adults (18-65 years) Page 15 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at York Street are supported so they can live a lifestyle of their choice. Evidence: In discussions with the staff and in looking at records, they showed that the people living there always receive the support they need to get out and about regularly in their local community. During our visit everyone was out in the day and they were being supported with their weekly activity of choice and some had been out shopping. The records showed a variety of activities that each person had been involved in, such as recent holidays to the societys own holiday lodges, trips to south Wales and trips on a narrow boat. Each persons file showed that staff do try to plan social events and activities and also carry out risk assessments to help make activities as safe as Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: possible. People told us they use the societys communal car for transport to go out. Staff had completed a financial assessment called, Me and my money for each person. There was no evidence in the files to show if people had given their permission for their money to be withdrawn to pay for these transport costs. The records around the management and funding of the communal vehicle wasnt clear. This needs to be reviewed to show that everyone is included and in agreement to the current arrangements regarding who manages, maintains and funds this service. People should be supported in getting value for money and should be given the opportunity to choose how they want their support with the management of their finances. However some people are supported with their own car and staff helped to make sure this was managed for their use only to have greater freedom to plan their trips out and about. People are involved with all aspects of planning and choosing what they want to eat. We noted that everyone was looking forward to their evening meal and the atmosphere was relaxed and friendly with everyone relaxing after getting home in the evening. The house has one lounge accessible to everyone. The staff explained that they are hoping to have a new kitchen and further decoration of the bathroom but they were not sure when this will be done. One person said they had regularly asked for sky television to be installed however there was no evidence of any consideration to this ongoing suggestion. This request was also suggested in a survey form submitted to our department from one person living at the home. Care Homes for Adults (18-65 years) Page 17 of 33 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. People living at York Street are supported to stay healthy and safe. Evidence: Support plans were available for each person we looked at two of them. The plans had been recently updated in parts and revised and gave enough information to show how their personal care and support would be met. The plans provided staff with guidance and were appropriate instructions as to the support each person needed with their health care needs and personal support. Some records were able to give details and advice for non violent crisis intervention. However we noticed that the traff training record had various dates for some staff of last having this training in 2006. Staff should expect to have updated training to ensure they always have the right skills and inofrmation to meet the assessed needs of the people they support. The records showed that people are supported in accessing health care services if it was needed, especially any hospital or specialist appointment and included regular visits to the doctor. We noticed that some records were offering the same information in different formats which might benefit from being revised to make it easier to identify updated needs in one document. One Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: persons file had good practice documents called, My health action plan and they also had another health needs document called a Health passport. Both documents were good examples of staff identifying the health care needs and the support needed to keep each person healthy and safe. We discussed this with senior managers present during are visit who advised that various records would be looked at to see what developments could be made to improve upon them. The company and staff have also managed to deal sensitively with one subject that is often difficult to discuss. They have produced a sensitive document requesting information regarding bereavement. The questionnaire helps identify personal wishes such as, are there any instructions or requests that effect how the individual should be treated after death. One plan had information with details of their personal wishes and requests and their family had helped to fill in the necessary details to help staff with their wishes. We looked at the storage and procedures of managing medications at the service and they were found to be well maintained and safely managed. The medications records were detailed and offered accurate and up to date medication records, providing a safe system of supporting people with the administration and storage of their medications. We noticed from reviewing staff training records that some staff may not have received updated training and guidance on the management and administration of medications. This must be updated so that all staff responsible for supporting people with their medications are up to date in their practice to safely administer medications. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes procedure for responding to concerns and complaints. Evidence: Information about how to raise a concern or complaint is made available to the people living at York street in a pictorial format. This is good practice as it helps to increase the opportunities for people to have a better understanding of the ways in which they can raise concerns. We did not see any recent complaints at the home and we have not received any to the commission. We have received 2 surveys from people living at the home and they both indicated they knew who to speak to if they were not happy. One staff survey suggested, Respond better to individual choices, concerns raised by service users, however this has improved considerably. Staff had started to complete capacity assessments which helped identify if a person needed any type of support in managing their money. In looking at each persons financial records there was no information, procedure or update on why or how their money was managed and stored at head office. We have already identified these issues in outcome area 2 and 3. We have recently met senior managers of the organisation who have advised us that they have completely reviewed the processes for supporting people with the management of their finances. They have developed pictorial assessments which they Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: plan to use in every establishment and have various plans to show how they will support people individually with their finances. These new records records are examples of good practice to help people understand how they can be supported with the management of their money. Care Homes for Adults (18-65 years) Page 21 of 33 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. York street offers a comfortable and adequate environment for people to live in. Evidence: We were shown around the home and looked at a sample of areas. Each person has their own bedroom were they are encouraged to have personal belongings and to individualise the room the way they want. The home was decorated to an adequate standard offering a homely environment to live in although we noticed there were various areas of wear and tear and build up of dirt and grime. There was no towels or soap in the communal bathroom. Cleaning schedules needed review to improve the standards of hygiene in the home. We noticed various areas of repair needing to take place including, eg, the build up of weeds in the garden patio area and dirt on the garden furniture, some wear and tear on the kitchen units, some of the sash windows couldnt be opened, the bathroom flooring was coming up on the edges and there was a build up of black grime? on some of the bathroom tiles. We saw no evidence of any maintenance schedule to tell people when they could expect the repairs and maintenance to take place. People had worked hard in being supported in painting their own bathroom. However Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: there was no information or plan shared with people to tell them when they could expect to receive further redecoration and investment to improve the bathroom. There was no information to say when they could have a new floor covering or new tiles to complete the refurbishment in their bathroom. The people we met told us they were happy at the home and had most things that they needed. However some people had asked repeated for sky television but still didnt have this facility and there was no evidence that they had received any feedback to their requests. We noticed one questionnaire completed by family members suggesting the use of an excercise bike and a treadmill but again there was no evidence of any response to these suggestions. The home would benefit from a review of its facilities to look at the possibility of modernizing the environment to meet younger adults opinions and requests. We looked at a sample of maintenance certificates which were mostly up to date and showed safe management of the home. However we were unable to find an updated fire risk assessment and some records indicated the homes staff had last had fire training in 2006. Senior managers present agreed to review this record as a matter of priority to make sure everyone was safe at the home and to improve the management of health and safety. However as a matter of good practice we noticed that staff had a list of staff and people living at York street displayed in the office. Staff explained that they completed this daily to make sure it was clear as to who was in the building at all times to help with any type of emergency or fire call. Care Homes for Adults (18-65 years) Page 23 of 33 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. People are supported and protected by the services recruitment and selection procedures Evidence: Senior managers contacted their head office and managed to obtain a list of training that staff had attended while working at York street. We looked at the list of staff training records and noted that some staff had received various updated training while employed by the home. However we also noticed that some details on the list provided, showed old dates for necessary training. This meant that some people may not have been provided with the necessary skills and training to always meet peoples needs. eg some staff had not received recent refresher training for necessary subjects such as health and safety, food hygiene, fire awareness, drug administration and non violent crisis intervention. Staff need updated training to help keep them up to date in their practices and help to appropriately support people. Staff had been given recent advice and updates regarding when they could expect certain training. eg. The organisation had decided that all staff would received updated refresher training in safeguarding every 12 months. This helps the staff and managers to be fully informed regarding how they will be supported with their training needs. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: We received 1 staff survey which overall was positive about their experiences at working at York street. Staff comments included,eg, Extremely good provision of services for users to access and good flexibility of daytime activities... This person also felt that staff had the right skills and experience to look after people in the right way. We met staff during our visit and it was obvious they had a good rapport with the people they supported. They were happy working at York street and felt they had a good home with longstanding staff that offered good stability to people living there. The manager meets with the staff on a 3 to 4 monthly basis. We looked at a sample of the most recent minutes of these meetings which showed information discussed on, training, activities, policies and procedures. Following comments and requests made during our visit these meetings may benefit from being reviewed to increase the frequency of the meetings to enable people to regularly voice their comments and concerns. As a matter of good practice the minutes of a recent staff consultation committee dated 16th July 09 was seen displayed in the office. This helps to keep everyone up to date in whats happening within the organisation and shows that this information is easily accessible. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was adequately managed and the health and safety of everyone at the home was promoted and protected. Evidence: York Street continues to benefit from an appropriately qualified manager. Due to a company review and reorganisation the manager has only recently been moved to York street and she is also responsible for the management of another service close by. The manager has is awaiting her application of registration with the commision. The focus of the home is on providing the best for people living there and responding to their needs. The manager had submitted a detailed pre inspection questionnaire (aqaa) which gave us alot of information about the work and development of York Street and was able to show alot of good practices with good outcomes for people living there. We could only find minutes of a house meeting including people living there dated 2006. Following various comments and suggestions made to us during our visit it did Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: highlight the need to look at how people are supported and consulted in the ongoing management of their home. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical installation and the gas supply. These checks help to make sure that the environment is well managed and is a safe place to live and work in. Senior managers present during our visit agreed to review the homes fire risk assessment and fire brigades most recent report to make sure their recommendations had been carried out . They acknowledged the need to update the homes fire risk assessment to comply with necessary safety checks to continue to keep everyone safe. As the home is part of a large organisation they have access to senior managers located at head office who offer expertise and plans to develop the homes further in terms of quality and development. Senior managers explained that various records such as, personnel files, training and financial records still remain stored at head office. Unfortunately the manager was on leave during our visit but senior managers present tried to locate necessary records and helped gain access to some records stored at head office. The homes policies and procedures still offered old dated policies that would benefit from being reviewed and updated. Managers advised that the organisation are in the process of developing all policies and procedures so that everyone will eventually have access to updated procedures necessary to their practices. They also advised that the organisation offer updates to some policies on their own company intranet however York Street do not have their own computer. This should be reviewed further with everyone at the home to see if they would benefit from having access to their own computer rather than having to access a computer outside their own home. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 All staff must be suitably qualified and experienced to support the health and welfare of people at York street. All staff must have updated training in Fire awareness. This will ensure that staff are up to date in their fire safety practices to enable them to keep people safe at York Street. 25/11/2009 2 18 All staff must be suitably qualified and experienced to support the health and welfare of people at York street. All staff must have updated training in drug administration. This will ensure that all staff have the right skills and experience to safely manage and administer medications to the people they support. 25/11/2009 Care Homes for Adults (18-65 years) Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 7 20 To have updated financial 04/01/2010 records, support plans in place. These records must be clear and accessible to everyone residing at York street and their representatives and should show that finances are being managed in each persons best interest and with their consent. To show clear and transparent records as to how each persons monies, benefits are managed and safeguarded. 4 24 23 To make sure that all 25/11/2009 precautions are taken to keep people safe against the risk of fire. To have an updated fire risk assessment with the right details and information to keep people safe. This will make sure that people are kept safe and that the management of fire safety at the home is up to date and gives people the right information and training to help take the right precautions against the risk of fire. Care Homes for Adults (18-65 years) Page 30 of 33 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 1 To update the statement of purpose and service user guide and make sure its accessible to people so they have the most up to date information available to them to help them make decisions and choices about the home. To consider the use of bringing in the services of an independent advocate to help people be supported in making their requests and choices known about were they would like to live. This will help people to have information and feedback as to what support and help they can expect with their future plans. To review the comments made in this report with people at the home so they can be given feedback regarding their requests and suggestions. The manager should have clear procedures and records to show how each persons finances are managed. To provide people with the name of their appointee and summaries of financial procedures. This will help to evidence they are kept in the best interest of everyone living at York street. People should be included in the procedures offered in managing their finances and clear records will help show they are managed in each persons best interest and with their consent and are person centred to meet their needs and requests. To keep everyone informed and up to date with the developments of their home including any suggestions regarding what people would like to improve their home such as when they can have eg, sky television, a new kitchen, new garden furniture, a treadmill and completion of the bathroom. To provide a maintenance and development plan for the home so that people are included and kept up to date with developments planned for their home including repairs of windows,bathroom area, and weeds in the garden. To review the cleaning standards within the home and to provide the right input and review to make sure the home is always kept clean and of a good standard to promote peoples rights and dignity. To make sure that basic facilities such as soap and towels are provided to prevent any risks to people. To review the need of more regular staff meetings, EG every 2 months, and ways for staff to discuss their comments and concerns 2 1 3 7 4 24 5 24 6 33 Care Homes for Adults (18-65 years) Page 31 of 33 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 7 34 The training records of staff should be reviewed to enable good management of their training needs to ensure they are always kept up to date in their practices especially in,eg, health and safety, food hygiene and non violent crisis intervention. The manager should always have evidence of updated training records for all staff working at York Street including bank staff, so that she can plan any necessary updates and refresher training. The manager should look at providing more house meetings for people living at the home and ways to engage people in voicing their comments and opinions so that they can be reviewed and approriate feedback given to them. 8 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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