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Inspection on 02/09/09 for 10 The Crescent

Also see our care home review for 10 The Crescent for more information

This is the latest available inspection report for this service, carried out on 2nd September 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People have key workers. This means they have someone especially for them, to make sure they get the support they need and that other staff members know about their needs. The staff at the home have a very good understanding of the people they support. People choose how they want to use their time. They can be on their own when they want, or join in with others. People enjoy lots of activities. They go fruit picking, walking, visiting friends and food shopping locally, and go on trips to the coast or forest. People have the things they want in their bedrooms. There was a safe garden, and one of the people living there had planned and helped to make more of the garden. People were enjoying learning things, like how to use computers, at the activity suite in Marlborough. People help keep the house clean andtidy. They go shopping. They choose what they want to eat. There is lots of fresh food in the home. The home is clean and it is looked after. When people are not well they are helped to get the help they need from people like nurses and doctors. Staff know how to give people their medicines. They have training in how to support people with epilepsy. They work well with the community nurses. The staff have lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. They get regular one-to-one supervision. The people that run Innovations visit the home often. They know the people that live there. When they visit they make sure things are being done how they have been agreed. They find out what people think about the home, so they can decide how to make it work even better for the people that live there. They make sure things are done safely, and people know what to do if there is an emergency.

What has improved since the last inspection?

They have better information to give to people, to tell them about the home. People`s support plans include goals to aim for, which we suggested last time we visited. They have designed a better way of writing people`s support plans, using computers.The home had been provided with new dining furniture and carpets. When the managers find something is not right, they make sure everyone knows who has to make it better, so they can check later.

What the care home could do better:

People`s support plans include goals to aim for, but key workers do not always show how goals are being met, or the difficulties they may find in trying to meet them. This should always be part of key worker meeting records. Although medicines records were kept to a good standard, we found a hand written entry that had not been checked by a second member of staff. It is important to show that a second person has checked the details that have been written in, as errors can arise.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 10 The Crescent 10 The Crescent Pewsey Wiltshire SN9 5DP two star good service The quality rating for this care home is: 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: Roy Gregory Date: 0 4 0 9 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 Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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 Information about the care home Name of care home: Address: 10 The Crescent 10 The Crescent Pewsey Wiltshire SN9 5DP 01672562266 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) : nanettelance@btinternet.com Innovations Wiltshire Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Date of last inspection 1 1 0 9 2 0 0 7 A bit about the care home 10 The Crescent accommodates four adults with a learning disability. It is one of four care homes owned by Innovations Wiltshire Ltd. Mrs Nan Lance is the responsible individual and registered manager. The home is in a residential area of Pewsey, within walking distance of shops, doctors surgery and other amenities. Two of the other Innovations homes are also nearby. The home is a semi-detached house, furnished to a good standard. People have single rooms, with toilets and bathrooms nearby [one room has en suite facilities]. They share a living room, kitchen-diner and garden. The home has two members of staff on duty throughout the waking day ,and sleeping-in cover is provided at night. Fees for living in the home are based on individual need. 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 How we did our inspection: This is what the inspector did when they were at the care home We visited 10 The Crescent on Wednesday 2nd September 2009 between 2:40 p.m. and 5:10 p.m. We then visited the Innovations office in Marlborough on Friday 3rd September. We met both people that were living in the home. They showed us their bedrooms, the garden and the rooms they share. We talked with one person in his private room. He spoke about how he spent his time and what it meant to him to live at 10 The Crescent. We looked at the papers in the home, that explain what support people need and how staff work with people to keep them safe. We could also read about activities people did. We saw how medicines were kept. The members of staff on duty spoke to us about the work they do, and how they are trained and supported. When we visited Innovations company office in Marlborough we looked at how staff training is organised. We checked how Innovations appointed new staff, to make sure people could not start working until their background had been checked. We also saw the new activities suite, including the computers provided for people that use Innovations services. We were able to discuss how the office supports the home, with Nan Lance the registered manager and others from the management team. We sent out survey forms to the people supported by the home. We received these before our visit; they were filled in by support workers. We received survey forms from three staff, and from a community learning disabilities specialist nurse. The service provided us with an Annual Quality Assurance Assessment [AQAA] when we asked for it. This told us what Innovations have planned, to make sure the home goes on providing support how people want them to. What the care home does well People have key workers. This means they have someone especially for them, to make sure they get the support they need and that other staff members know about their needs. The staff at the home have a very good understanding of the people they support. People choose how they want to use their time. They can be on their own when they want, or join in with others. People enjoy lots of activities. They go fruit picking, walking, visiting friends and food shopping locally, and go on trips to the coast or forest. People have the things they want in their bedrooms. There was a safe garden, and one of the people living there had planned and helped to make more of the garden. People were enjoying learning things, like how to use computers, at the activity suite in Marlborough. People help keep the house clean and tidy. They go shopping. They choose what they want to eat. There is lots of fresh food in the home. The home is clean and it is looked after. When people are not well they are helped to get the help they need from people like nurses and doctors. Staff know how to give people their medicines. They have training in how to support people with epilepsy. They work well with the community nurses. The staff have lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. They get regular one-to-one supervision. The people that run Innovations visit the home often. They know the people that live there. When they visit they make sure things are being done how they have been agreed. They find out what people think about the home, so they can decide how to make it work even better for the people that live there. They make sure things are done safely, and people know what to do if there is an emergency. What has got better from the last inspection They have better information to give to people, to tell them about the home. Peoples support plans include goals to aim for, which we suggested last time we visited. They have designed a better way of writing peoples support plans, using computers. The home had been provided with new dining furniture and carpets. When the managers find something is not right, they make sure everyone knows who has to make it better, so they can check later. What the care home could do better 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 Roy Gregory CQC South West Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA Tel: 03000 616161 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 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 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. Peoples aspirations and care needs are assessed prior to them being offered a service, taking into account the needs of people already supported by the home. Good information is made available. Evidence: The home has been under-occupied for some months, following the re-assessment of need of two people who formerly lived in the home. The service was pro-active in liaising with other authorities, to support the two people concerned to move out to a more independent way of living. They have continued to review how best to meet the needs of the two remaining people being supported, as a priority over admitting new people. We have seen that an admission at a nearby home, also provided by Innovations, was based on a full assessment and was followed six months later by a full review, showing the company has sound procedures for assessment and admissions. The needs of existing residents are considered. The home had a pictorial combined service user guide and statement of purpose, produced in an easy read format, which contained the necessary information. There was evidence at the company office that there was ongoing review of how best to produce information of use to people living in the home, their relatives, and people considering placement. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs and goals are assessed and reviewed through a planning system that promotes recognition of rights and abilities to make choices. Risks are recognised and minimised to enable participation in every day life experiences. Evidence: There was a support plan for each person living at the home. These were dated earlier in the year and had review dates set. They showed peoples preferred routines, and contained good detail to guide staff on how to provide individual support. The plans were written in the first person. There was good guidance about communication needs and styles, and this was linked to how to support people to make choices. As good practice, plans showed how a persons abilities fluctuated, and gave guidance on how to recognise and work with changes. We saw at the providers office that work was in hand developing a support plan format on computer, which people being supported could directly input to. This allowed for inclusion of pictures. People living at Innovations homes were already engaged in this. There was a key worker assigned to each person living at the home. Their role was to take primary responsibility for the persons care planning, to ensure appointments were followed up, to identify and support personal shopping needs and to advocate for resource needs. The home has responded to our recommendation at the previous inspection, that support plans should include goals, which can then be evaluated. Key workers carried out key worker meetings periodically, as a means of checking that support plans remained valid and were being followed. The records of these meetings Evidence: could give better evidence that peoples goals and expressed likes and dislikes are being revisited. However, we saw some examples of good practice. For example, one person had agreed a way of improving communication with a relative, as a goal. The key worker had identified how the goal had been met, and a commitment had been made to ensure the communication would be continued. We saw that people in the home were able to make decisions about how they spent their time and which parts of the home they used. One person told us that at different times of day they liked to use their own room or the shared rooms. They felt they could do what they wanted, when they wanted, except staff availability to support them going outside could be a limiting factor. They understood this was to do with current specific staffing support requirements to the other person that lived in the home. All staff who responded to our survey put emphasis on promoting choices as central to what the home does well, involving people in choices about meals, what to do and where to go, whilst also giving encouragement to try new experiences and places to go. A learning disabilities community nurse responded to our survey. She identified that there was more emphasis on the rights of individuals and respecting their wishes than previously, whilst seeing scope for further improvement in this area. Risk assessments seen were specific to individual needs, designed to facilitate participation. For example, we saw risk assessments about community access, bathing, making hot drinks, and cleaning in the house. The assessments were completed to a good standard, in an effective format. Some had been amended, showing they were working documents that were reviewed. They were checked as part of monthly management audits. 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. Varied activities give people access to the community and opportunities to maintain leisure interests within the home, local community and wider area. Significant relationships are supported. Menus are varied and service users can choose the food they prefer. Evidence: We saw that the people supported by the home enjoyed a range of planned and more spontaneous activities. Records showed people had done fruit picking, walks, visiting friends and food shopping locally, whilst there had been trips to the New Forest and the coast. The home provided a car and also made use of public transport. Both people in the home had been on a caravan holiday together in 2009. People were supported to make use of entertainments and hobbies within their bedrooms as they wanted to. One person had extensive provision of his own audiovisual equipment and books, and was actively involved with an interest in trains. He had been supported to make train journeys, and an advocate was working with him on plans to undertake a trip of a lifetime abroad. This person returned to the home during our visit, having attended a music and movement outreach session in the village. The staff on duty gave him a lot of time to unwind and talk about his day over a drink. They also talked about a college course and how that was going. Some use was made of an external resource centre, but Innovations had started up an activities suite of their own, within the company offices in Marlborough, which we saw. Evidence: Here there were a number of computers for the use of people supported by all Innovations services. People were learning to use e-mail and webcams, and were involved in designing their own support plans. There were also music and arts and crafts resources. There were plans to recruit an activities worker and to offer a service to people outside Innovations services. Both people living in the home were actively involved in choosing their meals, including breakfast cereals, sandwich fillings and the ingredients for main meals. They had agreed how they would help with household chores such as cleaning and washing. One person told us he liked to know he was helping, and also to know there were definite times when these jobs needed doing. The same person had been able to develop a gardening interest. House meeting records showed how this had been taken on board. The person was involved in planning what kinds of plants to use and where to put them. Both people in the home enjoyed frequent use of the garden. There were plans to obtain a greenhouse to develop the interest further. People in the home were included in conversations with staff members. They were invited to assist with meal preparation and to have drinks whenever they wanted. The menu was varied and the home was well supplied with fresh fruit and vegetables. The dining area provided a welcoming environment for people to enjoy meals. 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 receive personal care in ways they prefer. Peoples health needs are assessed and monitored, with close liaison with health professionals as necessary. People are protected by the services policies and procedures for handling medicines, providing these are followed completely. Evidence: Peoples support plans gave detailed guidance on what support people needed with personal care, and the people had indicated their agreement to their plan contents. For one person there was a behaviour protocol. This reflected extensive inter-agency planning and agreement. Staff had been able to contribute their observations of behaviours exhibited and measures that alleviated them. They were maintaining an hourly monitoring record, using a written scoring system. This showed that staff worked with the person in line with agreed procedures, and gave good information to assist further review of the persons needs. Linked to the behaviour protocol was another for the use of as needed medication. This described what had been agreed as low and high agitation levels. A flow chart directed staff on when and how to offer the as needed medication. One person had an epilepsy profile. All staff received annual training about epilepsy. The persons support plan gave staff clear guidance on signs of and responses to seizures. There was good attention to maintaining routine medical appointments, and these were always well recorded. For example, one of the people in the home had been to the dentist during the morning prior to our visit. This had already been written up with an outcome and details of the next appointment. People were weighed monthly and Evidence: there was evidence that significant changes were acted on. Food and drink diaries were currently being kept as additional monitoring, as issues had been identified in respect of each of the people being supported. The community learning disabilities specialist nurse who responded to our postal survey wrote, There has been a huge improvement noted in the management of care for individuals living at number 10. The staff are working more consistently following advice and guidance. They have responded well to ensuring additional monitoring forms are being completed and passed on. Peoples medicines were kept in cabinets in their own rooms. This meant any medicines were given within peoples personal care routines. They had given their signed consent to receipt of medicines from staff. There were agreements signed by a GP about homely medicines that people could take. Members of staff undertook training in medicines administration. The supplying pharmacy provided workbooks for staff to complete. Senior support workers oversaw the process, and revisited assessment of competency within routine staff supervision. It was planned by Innovations to enrol at least one of the senior support workers in the company on a more advanced distance learning course in medications practice. Medicines Administration Records [MARs] were routinely checked by management. We found good record keeping. However, a medicine had been handwritten in the MAR, without the entry being counter-signed by a second person. It is important to show that a second person has checked the details that have been written in, as errors can arise. 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. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. Evidence: The home had not received any complaints since the previous inspection. The service had worked on improving the accessibility of the complaints procedure and explaining it to people living in the home. By holding regular house meetings and with the nature of staff interactions, and peoples access to external professionals, people in fact had many opportunities to voice any dissatisfaction. This meant that potential complaints by people receiving a service were likely to be recognised and resolved at an early stage. All staff received annual updating training about abuse awareness and safeguarding. There was provision for newly recruited staff to receive this quickly as part of induction. Staff were trained annually in managing difficult behaviours. They told us the emphasis in this training was on awareness of behavioural triggers, de-escalation techniques and self-protection. Physical intervention was not employed as a restraint. Innovations have demonstrated to us that any issues of concern are taken seriously and there is co-operation with local safeguarding procedures. Internal incident forms, and notifications to us, demonstrate that staff are observant and keep objective records. For a person with assessed behavioural difficulties, there was a behaviour management protocol written by a community-based learning disabilities nurse. This was subject of continuing review and drew on staff knowledge and observations. Staff members we met were familiar with the reasons for and content of the protocol. We observed their interactions with the person to reflect guidance in the protocol. Senior staff in the organisation had received training from Wiltshire Council about the Mental Capacity Act, including deprivation of liberties safeguards. A related information pack had been placed in each Innovations service, and it was intended that training Evidence: opportunities would be extended to more staff. People living in the home had signed agreement to receive support with how they managed money. There were good systems in place to show staff handled personal monies with security and transparency. There were routine management checks of records and balances for accuracy. There was a protocol to follow if a person should go missing. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 10 The Crescent provides a homely, safe and clean environment, suited to the needs of the people who live there. Evidence: All of the home presented as clean and homely. The sitting room had been fitted with new carpet. There was imaginative lighting and some wall decorations had been made by the people that live in the home. The kitchen-diner was also well appointed, with new furniture provided since our previous inspection. A separate utility room housed laundry appliances. The stairs and landing had been re-carpeted. The two bedrooms in use reflected peoples differing personalities and interests. They told us they had chosen their colour schemes. As the home was under-occupied, the people effectively had one bathroom each at the time. Outside was an enclosed garden. It included lawn, flower beds and raised productive vegetable beds. A person supported by the home told us of their involvement in planning and maintaining the garden with support. Both people showed they liked to make a lot of use of the outside space. Staff had daily, weekly and monthly cleaning schedules. These were used as a guide to ensure standards were upheld, rather than as a rigid framework. One person showed us they had a planning sheet in their room, to remind them about things like cleaning and changing their bed. They said they had reported a loose floorboard and it had been put right. There were good arrangements within Innovations for attending quickly to such issues as they arose. The company employed a gardener to cover all the homes in the group. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. Evidence: A minimum of two staff were being maintained on duty by day. Whilst this suggests a high ratio for two people, current issues agreed with outside agencies meant that this level of staffing was necessary in respect of one of the people being supported. The other person was supported appropriately within the home by this staff availability, but was restricted in his opportunities to go off the premises, as a third member of staff had to be arranged to allow support to do so. A regular team of staff was used by the home, with no agency use, to ensure continuity. This meant all staff were very familiar with the individual support requirements of both people. One member of staff slept in at night. A photo board in the home told people who was coming on duty at any time. All the staff group had obtained NVQ [National Vocational Qualification] in care to at least level two and we saw that for staff across the whole company, NVQ achievement was expected and was the norm. A training matrix at the company office showed that training was planned in advance and different training providers were considered, to ensure training met the particular needs of people being supported. One member of the administrative team at the company office had particular responsibility for identifying and booking training resources. Individual staff files held good evidence of training received. Bank staff were fully included in training events. Sampled recruitment records for Innovations staff as a whole showed new staff were appointed only after the necessary checks about their backgrounds were completed, and references obtained. Interviews were conducted in a consistent fashion and recorded in some detail. There was evidence of recent efforts to secure training for some people supported by Innovations services to be directly involved in the staff Evidence: recruitment process. We saw that staff were appointed only after receipt of references, and confirmation that there was no evidence that they were unsuitable to work with vulnerable people. Supervision records kept at the company offices in Marlborough showed staff received regular one-to-one supervision from a senior carer, approximately six-weekly. This included reference to direct observation of peoples working practices. The company had introduced annual appraisals for all staff. The four staff members that responded to our survey confirmed they received supervision regularly. Three considered there were always enough staff to meet the needs of people in the home, the other respondent said there usually were. People described their role as based on promoting independence and facilitating choices. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team provides leadership and direction so people benefit from a well run home. There are systems for monitoring and improving the service provided, based on direct feedback from people that have a stake in the service. There are a number of measures in place to promote and protect the health and safety of people that live and work in the home. Evidence: Whilst Innovations has a manager registered to each of its homes, in this case Nan Lance, there is very much a management team approach towards all the services provided by the company. All three service managers share in management monitoring and strategic development of all services, as does the operations director. The inhouse senior role at 10 The Crescent is undertaken by Bev Britten, who is also registered to manage other Innovations Services. Nan Lance was frequently at the home. The company undertook a staff team-building exercise during 2008, which led to a service development action plan. There was a record of monthly whole staff team meetings. Members of staff were expected to attend at least one in three of these, and to sign that they had read minutes of meetings. Therefore staff were in touch with the companys development aspirations, and new procedures were adopted across all services at the same time. The home received a monthly management monitoring visit. An extensive checklist ensured all areas of provision were looked at in some detail and showed how matters for action were delegated and followed up. Evidence: The company operated a quality assurance system based on questionnaires sent to people using the service and their supporters. There was evidence that responses were acted upon in order to tailor the service to peoples wishes and expectations, or to ensure people were aware of the reasons for certain decisions or practices. Key worker meeting forms included an action section so staff could demonstrate how feedback obtained directly from the people supported was used to make changes. All staff received regular training in food hygiene, first aid and manual handling. There were a number of environmental risk assessments, which staff had signed. Risk assessments were reviewed through routine management monitoring. There was safe storage of substances that could be harmful to health. There was evidence of regular testing of all fire equipment and of clear procedures to follow in the event of fire. Water, fridge and food temperatures were monitored consistently. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 20 13 Handwritten entries by staff 30/10/2009 in the Medicines Administration Record must always be counter-signed by a second member of staff. This is to show that the entry has been checked for accuracy. 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 6 Ensure key workers evaluations always refer to support plan aims, and to how peoples known likes and dislikes are being catered for. 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. 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. 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