Inspection on 20/04/10 for 13 Greenway Park

This is the latest available inspection report for this service, carried out on 20th April 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

13 Greenway Park 10/01/06

13 Greenway Park 30/06/05

13 Greenway Park 04/02/05

13 Greenway Park 30/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 13 Greenway Park 13 Greenway Park Chippenham Wiltshire SN15 1QG     The quality rating for this care home is:   three star excellent 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: Pauline Lintern     Date: 2 0 0 4 2 0 1 0 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 36 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: 13 Greenway Park 13 Greenway Park Chippenham Wiltshire SN15 1QG 01249443965 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Philip Taylor & Mrs Rhianydd Taylor Name of registered manager (if applicable) Mr Philip Taylor Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 13 Greenway Park provides care and accommodation for eight adults with a learning disability. Service users receive support with a range of social and behavioural needs. The majority of the current group have lived in the home for over ten years. Respite care and short-term placements are not available. The service is one of a group of three care homes in Chippenham, which together are known as the Cocklebury Farmhouse Homes . This is a private organisation. The ownermanagers founded the company in the late 1980s. They remain closely involved in all aspects of its daily operation. This includes regularly working in each of the services. The property is close to the centre of Chippenham. The town offers various amenities, including shops, bars, restaurants, parks, a leisure centre with swimming pool, and a cinema. Rail and road links to Bath and Bristol are available. Service users regularly access a wide range of local amenities. This is a key feature of the programme within this organisation s Care Homes for Adults (18-65 years) Page 4 of 36 8 Over 65 0 Brief description of the care home homes. The home is a detached and well maintained property. It stands in its own grounds, opposite a public park. There is a large garden to the rear, and a car parking area at the front. The accommodation is on two floors. There are six single bedrooms. One room is shared by two service users. Care Homes for Adults (18-65 years) Page 5 of 36 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: three star excellent 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 last inspection took place on June 13th 2007. The home was rated as Excellent. The unannounced inspection took place on April 20th 2010. The registered manager/providers were available throughout the day to assist us. The remaining senior team were also present throughout the day. We were able to meet with all of the people who live at 13 Greenway Park, including the most recent person to have moved into the home. We met with two long standing staff members and the most recently recruited member of staff. Prior to our visit we asked the home to complete an Annual Quality Assurance Assessment (AQAA). This provided us with information about the home. This included areas where they felt they do well, areas where there have been improvements, areas where they could do better and their plans for the future. Care Homes for Adults (18-65 years) Page 6 of 36 We canvassed the views of the people living at the home and staff members by sending out surveys to be distributed by the home. We received responses from eight people using the service and six members of staff. Service users were supported to complete their forms. Many of the policies and procedures are generic and therefore where relevant, the findings have also been included from the inspection on April 8th 2010 of one of the organisations other homes. This visit, conducted by the same inspector, considered some issues which apply across both homes, such as staff training, monitoring of quality assurance and health and safety checks. As part of the inspection process we looked at documentation relating to the most recently recruited member of staff, the admission process for the most recent person to move into the home, care plans and risk assessments. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: Any potential new people to the service or their representatives have access to information about the service within the Statement of Purpose. People living at the home are also provided with an individual service user guide. This document is in an easy to read format and is supported by pictures. It informs the reader of what they can expect from the service, their individual room, information about staff members and how to raise a concern if they need to. Systems are in place to ensure that any new admissions to the service are fully assessed. This ensures that the home is suitable for the person and that their needs can be fully met. Consideration is given to the existing group of people already living at the home and compatibility of the potential new person. Individual plans are person centred and kept under regular review. Plans are updated to reflect any changing needs. Files are well ordered and important information is easy to locate. People using the service have access to health care professionals as and when it is needed. People are supported to attend appointments. Evidence demonstrates that the people living at the home enjoy a wide and varied social life and are offered many life opportunities. Links with family and friends are encouraged and maintained. The people who use this service are treated with respect and their privacy is maintained. This is a service which is rarely complained about. People living at the home benefit from a pleasant environment, which is comfortable, clean and well furnished. There is evidence that staff have been recruited following the correct procedure. Structures within the home provide a high and consistent level of management and support. Quality assurance systems are in place to ensure that people using the service and their representatives are able to share their views. Policies and procedures are in place relating to the health, safety and welfare of the people living there and members of staff. This home continues to provide excellent outcomes for the people who live there. As a result of this inspection, no statutory requirements have been made. Within our surveys we asked, what does the home does well? Comments included; We have a lot of activities available i.e. swimming, bike riding, horse riding, bowling, other activities weather depending is the beach, Lego land and they all do a college course, cooking, woodwork and gardening. There is a lot of independence and choice Care Homes for Adults (18-65 years) Page 8 of 36 whether it is with their food, where they would like to go etc. They also go on holiday for a week once a year, which I have been on twice. The home is very welcoming with a happy friendly atmosphere. It is decorated to a high standard, making it feel very homely. Each bedroom is decorated to the individuals taste that lives there. The food is top quality and to a standard of the best restaurants. Service users are kept active with lots of daily group activities and even individual evening outings to concerts, theatres, Indian and Chinese restaurants etc. If I were to fit the criteria for the home, this is where I would love to live. It gives you a sense of a homely atmosphere. The enjoyment the service users get from all the outings they attend and holidays that they go on. The organisational, day to day running of the home. Person centred comprehensive assessments and care plans always completed. What has improved since the last inspection? What they could do better: Within our surveys we asked, what could the home do better? We received the following comments; Not really, our home is well run. We have routines that are well structured, which is why our home runs extremely well and management are always there at anytime and are open to changes, which may arise for the good of the home in a positive role. No I feel that the home could not do any better; this is the best care home that I have Care Homes for Adults (18-65 years) Page 9 of 36 worked in. Sorry, I cant think of anything. I feel a great job is being done and will continue to be done. 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 10 of 36 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 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to the service. Information given to people helps them to make a decision about using the service and it is on an easy to read format. People benefit from having a detailed assessment of their care and support needs before they move in. Evidence: The service has information available within the home for any prospective new person to access. There is the more detailed Statement of Purpose and an individual service user guide for each person living at the home. The guide provides information on what the service provision includes. It provides information on the ethos, management and staff support within the home. It tells the person about their individual room and the opportunities available to them. A copy of the complaints procedure is within each Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: document. Since our last visit to the home there has been one new admission during April 2010. We looked at documentation relating to the individuals assessment and the process leading up to the transition. We saw that chronological records had been kept of all interactions prior to the person moving into the home. The manager explained that he had visited the person in their home in the first instance. As the person was interested in cars the home arranged for a manager to take the person to Castle Combe racing track for the day, then returned later to the home for a meal. The person had also visited the home with their relatives and they had helped X move in. It is evident that a great deal of thought had given to ensuring that the move went smoothly for the person. Staff told us that the person has settled in well and is already undertaking trips and activities and feeling more confident interacting with his peers. X showed us his bedroom and confirmed that he was happy. During our visit we observed that everyone using the service appeared happy in their environment and comfortable with their peers. Care Homes for Adults (18-65 years) Page 13 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to the service. Peoples needs are reflected within their care plan and therefore staff have accurate, up to date information to support people effectively. Systems to support people with decision making are in place. People are supported to take risks, which are fully reflected in the care plan. Evidence: As part of the inspection process we looked at the care records of two people living at the home. We saw that files were well ordered and information was easily accessible. Plans were person centred and individual, detailing all aspects of the persons life. This included information about me, communication, personal care, occupation and leisure, personality and relationships, any identified restrictions and medication and Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: health. In addition to this the records state the amount of staff support/interaction is needed to meet the persons needs. Evidence shows that plans are kept under review. The manager reported that review meetings are held every six months. One is an internal review and the other one with the care manager attending. The manager confirmed that most of the people receiving a service choose to attend their own review; however some people do not stay for the duration of the meeting. We saw one file where the persons health needs had changed and this had been fully reflected within their plan of care. The plan identified that the persons health needs may benefit from having some changes made to their environment in the future. This has been discussed with the appropriate people and documented. Staff members we spoke to told us that the senior staff members take responsibility for making changes, reviewing and updating care plans and risk assessments. We asked how this information is cascaded to the care staff. Staff confirmed that communication within the home is good and that changes are discussed during handovers and staff meetings. One member of staff told us the managers complete the care plans and risk assessments, however we are able to input into them. All staff sign to confirm that they have read and understood care documents. Staff members told us that having such a well structured management team accessible daily ensures that information is communicated between the team. We noted that care plans record whether a person living at the home has specific ethnic or cultural needs. The manager explained that one person living at the home regularly meets up with a person of the same sex and ethnicity to ensure that they have access to people of their own culture. We observed people making decisions about the way they live their lives. Through discussion we saw that people made choices about the food they ate and activities and holidays they wish to participate in. This is a service which is clearly structured around the wishes and needs of the people living there. The home holds monthly group discussions. Within these forums, discussions take place relating to activities, food, fire procedures and how to make a complaint if necessary. One member of staff told us that sometimes a service user will raise a concern, for example, it may be they feel that another person is being too noisy. This enables the person to raise the concern directly with their peers and the matter is rectified quickly. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: It was evident during our visit that the people living at Greenway Park feel confident and relaxed within the management team enabling them to raise any issues directly, if they choose to do so. If there are any restrictions in place these are clearly linked to the individuals assessed needs and are documented within their care plan. For example one persons care plan states that they are able to walk to and from college independently, however it was noted that following an assessment of risk, all other outings should be supervised by staff members. Within their care plan it states, I walk to college unsupervised as I have good road sense, as proved by a successful risk assessment carried out for my benefit. Within the AQAA under the heading our evidence to show we do it well it states, The Service User Plan addresses various topics and areas of the persons life giving details on the areas of support needed and how the staff of 13 Greenway Park will meet these needs. The Service User Plan clearly details any factors, which may pose restrictions in the service users lives. These are discussed as part of the review process and consent of the service users is recorded where appropriate. Detailed Risk assessments are in place and are linked to any restrictions necessary. There are many general and service user specific risk assessments. Risk taking is promoted where it is of benefit to the service user to enhance their quality of life. For example there are many risks associated with riding a bike, but procedures are in place to reduce the hazards. The enjoyment and skills learnt far outweigh these risks. There are detailed preventative measures to reduce or eliminate the risk involved. There are effective systems to manage risks so that service users can benefit from social and leisure opportunities which they enjoy. As changes arise, risk assessments are reviewed and updated. Care Homes for Adults (18-65 years) Page 16 of 36 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. This judgement has been made using available evidence including a visit to the service. People are provided with a range of activities and opportunities, offering them full engagement with their local community. People are encouraged to spend their time as they wish. Visitors are welcomed and important relationships promoted. Meal provision is of an excellent standard and based on fresh produce and peoples preferences. Fresh fruit is readily available to people. Evidence: It is evident from observation and discussion with people using the service, staff members and views canvassed within our surveys that this is an outcome area where the home excel. People have an opportunity to attend colleges and partake in Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: activities/hobbies of their choice. The home has a positive approach to getting the people they support out and about in the local and wider community. As mentioned previously in the report, one new person to the service has already attended day trips and activities, which in the past they had declined. During our visit to the home we saw various activities taking place. The manager explained that one person they support enjoys cleaning cars, for which he receives a payment. The person confirmed that this was an activity they enjoyed. Another person using the service is interested in gardening and he is fully involved in that area. The manager reported that he is very conscientious and even during recent ill health has still insisted in tending to the garden. They also receive remuneration for this activity. We had the opportunity during our visit to meet and talk to all of the people living at the home. It was evident that daily activities play an important part of the running of the home. People told us that their hobbies and interests are encouraged and supported by staff members. One person has a very large car collection, which they add to by making purchases at local charity shops and rallies. One person has a large structured train set in their bedroom. They told us that staff members support them when they wish to make additional purchases to add to the train set. One person is particularly interested in arts and crafts and there were various pieces of work they had completed in their bedroom. Staff told us that the person was currently doing a woodwork course at Lackham College. They had previously attended a painting and drawing course. Staff members told us that some people had chosen to go to St Ives this summer. Other people had chosen to go to Butlins. One staff member told us that it was an 80s theme, when they go to Butlins and that they were all planning to dress up for the occasion. Some people at the home have bicycles and they regularly ride along the cycle path to Calne. People living at the other organisations homes also join them. Swimming is another regular activity that takes place. Staff reported that the homes do interact with each other regularly and join each other for various activities and events. This enables people to meet up with friends and acquaintances other than their own peers. At the time of our visit two people who live at another of the Cocklebury Farmhouse Homes, came for lunch before joining people from Greenway Park to attend horse riding. On a Wednesday night the two managers carry out sleeping in duties in two of the houses. They use this as an Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: opportunity to take service users from both homes to the pub for a social evening. Service users are supported to attend concerts, the theatre and to watch tribute bands. To celebrate one persons birthday plans have been made to take them to a club in Bath to see a tribute band. People have the opportunity to go to restaurants and discos run by the Gateway club if they wish to do so. Staff members present people with the opportunity to take on new experiences and try new foods such as Indian and Chinese. When it was one of the managers birthday, he treated everyone to an Indian meal at a local restaurant, which staff reported was a great success. The home is located near to the park, which has a bandstand. Staff told us that some people they support enjoy going to the park and listening to the band on a Sunday. During our visit one person played their guitar and sang for us after lunch. Within our surveys we asked the people living at the home what they felt the home does well. Comments included; Taken on trips to London to see Mum and Dad. All the trips and outings we go on. Nice meals. Bedroom has lots of things I am interested in (tractors, diggers, farm animals) I am always dressed nicely. Going out and buying clothes. Going out with my friends. Outings, car, shows, steam rallies and concerts. Help us go out. College, trips and holidays. Pub night, home swap and holidays. Links with families and friends are encouraged and supported. People benefit from being able to access and interact with service users living at other Cocklebury Farmhouse homes. One persons care plan states staff to encourage X to maintain contact with their family. Staff are to assist X in writing letters and sending family birthday cards etc. Peoples preferred routines are respected however people living at Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: the home are encouraged to access facilities and experience new opportunities available to them. One person told us that they had previously been water skiing. Some people go canoeing with staff support. The manager told us that some people choose to spend more time alone in their rooms than others. Some people prefer to watch the television for a while after their lunch. Choices are respected by the staff members. Within the home there is a rolling rota for helping at meal times. This includes clearing away plates and taking requests for drinks after lunch and helping prepare the meal at teatime. Care plans show that some people are happy to undertake small household tasks such as keeping their bedrooms tidy. The cook told us that one person living at the home has an ice cream maker, which they enjoy using. People are supported to make celebration cakes such as for their peers birthdays. We noted that staff and managers interacted positively with the people they support and they were never excluded from any discussion. We saw staff respecting peoples wishes and seeking their views. The people using the service take part in the weekly grocery shop. Meat and vegetables are purchased from a local farm shop and are of excellent quality. Members of staff confirmed that the quality of food provided is of a very high standard. The home has a cook working Monday to Friday. At the weekends care staff take over the responsibility of meal preparation. All staff receive food hygiene training. On the day of our visit the main meal was homemade cottage pie and vegetables. Fresh fruit is served as a dessert. During the course of the meal we noted that everyone interacted well with each other. Care staff and managers joined in the conversation. It was evident that meal times are a very important event within the home. At the time of our visit no specific dietary needs were recorded. However the cook had a list of individual likes and dislikes. Care Homes for Adults (18-65 years) Page 20 of 36 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. This judgement has been made using available evidence including a visit to the service. People are supported with areas of personal care if required. People have access to healthcare professionals as and when needed. People are protected by the homes policies and procedures for dealing with medicines. Evidence: The majority of the people living at Greenway Park require minimal support with their personal care. In some cases people may just need prompting or reminding to carry out certain tasks. For example one plan we sampled stated staff to prompt X to keep his clothing tidy throughout the day and encourage X to wear appropriate clothing. The plan also reminds staff that since their illness X now requires more time to undertake care routines. The plan identifies that X would benefit from having ensuite facilities in case their illness develops again. This was discussed further with the manager, who was able to demonstrate that any proposed changes would be in the best interests of the people involved. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: We saw documentation detailing when service users have attended hospitals and clinics with staff support. It was evident that with staff support and careful planning the staff team have been successful at ensuring the visits were as positive an experience as was possible. Their handling of the situation has been a credit to them. We saw records detailing appointments with dentists, consultant psychiatrists, opticians and doctors. During the day of our visit one person living at the home reported to staff that they had a toothache. Staff members immediately made a dental appointment for them. Within the AQAA under the heading what we do well it states The service user group has a wide range of individual personal care needs and these are detailed in the Service User Plans. Staff give the appropriate level of support, delivered in a dignified and sensitive manner, maintaining privacy and confidentiality. All service users have their own Health Action Plan detailing the healthcare support they receive and who helps them to access this professional support. Service users on prescribed medication are fully protected by the homes procedures and risk assessments. Physical exercise is promoted by the home to encourage healthy lifestyles. The health needs are very well catered for. All service users have annual routine health checks and whenever there is a suspected medical problem, appointments are made with the appropriate professional and a member of staff assigned to support them in this. Weight charts are updated weekly. Policies and procedures are in place for the safe handling of medicines. We sampled the medication administation record and noted that it had been completed properly with no unexplained gaps. Guidelines on the use of as required medication are included within the persons care plan. Only senior staff administer medication. They receive relevant training from the pharmacist that the home uses. Training has also been given to other carers, to promote their understanding of the topic. The assistant manager reported that one person using the service currently self administers their medication. They collect the medicine from the office in a dosage box. Staff then record that they have given X their medicine by drawing a red line through the appropraite record. When X takes the medicine staff sign G to indicate that the medicine has been taken. Another person administers their own hay fever tablets during the hay fever season. Care Homes for Adults (18-65 years) Page 22 of 36 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. This judgement has been made using available evidence including a visit to the service. People living at the home are safeguarded by the homes policies and procedures for complaints and protection. Evidence: Overall this is a service where residents are safe and listened to and a service rarely complained about. Within our surveys we asked if people knew how to make a complaint or raise a concern. All responded positively. One person commented that the service always responded appropriately when they have raised concerns. The home has a complaints log, which is kept within the home to enable them to monitor any patterns or emerging trends. The AQAA reports that there have been no complaints received about this service in the last twelve months. We noted that the home had received cards of thanks and appreciation. One was a letter from a care manager dated 15/2/10 expressing appreciation of the level of support provided by the home to their client. Another card was from an ex employee thanking the managers for letting them work for them for so long. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: Within the AQAA it states, Policies and procedures relating to abuse and adult protection are in place. These include the No Secrets policy from the local authority which describes the multi agency processes within Wiltshire for any such violation of rights. There is also a Service User Complaints procedure and a whistle blowing procedure. All these are aimed at ensuring the protection of vulnerable adults who reside at 13 Greenway Park. All service users are empowered to complain if they so desire and are free to discuss any matters with the managers or staff at any time. Challenging behaviour needs are individually addressed with effective management strategies. One member of staff we met with explained the procedure they would follow if they felt that a person they support was unhappy or concerned about anything. They said that they would first listen to what they wanted to tell me, I would explain that I may have to pass the information on to the manager They added that group discussion times were sometimes used to raise concerns. People we spoke to told us that they were happy living at the home and no one commented negatively. Staff members we spoke to confirmed that they had attended Protection of Vulnerable Adult (POVA) training . One person said that they had attended two weeks ago. They understood the No Secrets protocols and the Whistle blowing policy. They told us I know what to do, I would report any concerns straight away. Arrangements for protecting people from abuse are suitably in place, with staff being aware of the procedures to be followed. Staff impress as being protective of the people they support and wanting to provide a safe service. We noted that within a supervision a new member of staff had been reminded that until their full satisfactory check with the Criminal Records Beaurea (CRB) had been returned they could not work unsupervised. The member of staff had confirmed that they understood the reason for this and fully acknowledged this. Within the AQAA it states Physical intervention is required on occasion due to the nature of the service user group. This is performed as a last resort and the intervention used is the least restrictive possible. There is detailed information in the Service User Plans and as risk assessments and this utilises best practice principles. The managers consulted with relevant parties in deciding which techniques should be applied to a particular person and the risk assessments and procedures in place are extensive. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: Care Homes for Adults (18-65 years) Page 25 of 36 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. This judgement has been made using available evidence including a visit to the service. There is a commitment to ensure that people benefit from a well maintained environment. Evidence: Within the AQAA they identified areas where improvements have been made during the last twelve months, Building maintenance works are cyclical. Improvements this year include: New Emergency Light Units, replaced radiators for the central heating system, new bathroom suite in main bathroom and en-suite, new vanity units, new kitchen worktop and tiles, various light fittings, stained window frames and sills. Additionally painting and decorating has occurred in the dining room and some bedrooms. All flower borders have been tended and necessary trees trimmed. Hanging baskets were put up as usual in the summer. At the last inspection a good practice recommendation was made, which related to attention being given to the decor and cleanliness of the building used as a laundry facility. We observed that the building has now been re-tiled and new flooring has Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: been laid. As part of the inspection process we toured the premises. People using the service showed us around their bedrooms. We saw that all rooms were personalised with pictures, photographs and ornaments. People had televisions and music centres in their rooms. Furnishings and fittings were of a high standard. Currently there is one shared bedroom. As mentioned previously in this report, the managers are planning to alter the accommodation to enable each person living at the home to have a single bedroom. Documentation relating to the proposed changes has been provided to CQC. We saw that communal areas were comfortable and homely, well maintained and clean. There is a separate dining room and lounge area. Toilets and bathrooms were found to be clean and hygienic. Anti bacterial hand wash was available in all hand washing facilities. The home has large areas of garden at both the front and back of the property. The gardens are well maintained. There is also a patio area for people to access if they choose. The home employs a cleaner, who works weekdays. Care staff carry out these duties at other times. Toxic materials are generally locked in the laundry facility outside. Materials currently in regular use are then locked in a kitchen cupboard. Care Homes for Adults (18-65 years) Page 27 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to the service. People are supported by an effective staff team, who are appropriately recruited, inducted, trained, and supervised. Staff are competent and qualified to meet the needs of the people they support. Evidence: The home is staffed at all times. During the night a member of staff sleeps in to provide support if needed. The home operates an on call system for emergencies or advice. The manager told us this is rarely used. The majority of the staff team have worked within the Cocklebury homes for many years and have good relationships and knowledge of the people they support. The management structure is well established and appears to work very well. There are two managers/providers, a deputy manager and an assistant manager. There are also senior carers. Members of staff spoke highly of the management and the support they provide. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: Within our surveys we received the following comments I have worked in Cocklebury Farmhouse homes for nearly nine years and enjoy my job immensely. I look forward to coming into work and couldnt imagine working anywhere else. I would like to mention that I enjoy my work at Greenway Park. I work with a team of people who work together well and what I enjoy most about my place of work is it has a family atmosphere, which to me is quality. We spoke to the most recently recruited member of staff and sampled their recruitment records. They told us that they were currently waiting for their full CRB check to be returned and were currently working under an ISA First check. They understood that this did not enable them to work alone or unsupervised. We discussed their induction period. They told us things are really good so far, I have an induction folder to work through. I have been reading policies and procedures and care plans. They told us that they had attended some activities with another member of staff and were currently shadowing staff with the daily routines. The new member of staff is booked on training for Protection of Vulnerable people and physical intervention. We saw that all necessary recruitment checks, references, identification and declaration of physical and mental health were in place. A copy of their contract of employment was also in place. Within the AQAA it states, All four of the management team have earned the NVQ HSC Level 4 and RMA awards. The majority of the care and senior staff have a minimum of NVQ level 2 with some having the level 3. All staff are provided with clear and concise job descriptions, their own copy of the policies, procedures and risk assessments (except those specific to service users) as well as the GSCC Codes of conduct. All staff follow an intense period of induction which includes a pack to work through and a period of a few weeks where they are shadowed by another member of staff to ensure they know exactly what they should be doing. All staff have a training needs assessment and follow training courses led by an outside training company including manual handling, appointed persons first aid, health and safety, COSHH, Infection Control, POVA and Mental Capacity Act. All staff have a minimum of NVQ 2 in Health & Social Care (the newest member of staff will be completing this in the next few weeks). Some staff also have NVQ 3. 13 Greenway Park has a very high staff to service user ratio. At the busiest times of the week there are as many as 4 (or 5) care staff working, plus 2 of the 4 management team and in addition a cook and cleaner. This ensures that there can be multiple outings occurring at the same time to cover Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: the different needs and interests of the service user group, while still having staff to supervise the home. At evenings and weekends an on-call system is in place. This on call system ensures one of the managers or a senior member of staff will be available locally in case any incidents occur, although this is necessary only rarely. At evenings and weekends, managers are always available for assistance via the telephone. Employees who are new to the organisation often begin at Greenway Park. If they are felt suitable they may move to one of the other establishments that the group operates. Staff receive mandatory training in subjects such as manual handling, fire awareness, basic food hygiene, health and safety and safeguarding. Care Homes for Adults (18-65 years) Page 30 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to the service. People using this service benefit from a well run home, with clear leadership Systems are in place to monitor quality assurance. Health and safety policies and procedures are in place. Evidence: The home has been registered since 1988. As mentioned previously in the report there is an established senior management team, who have regular direct contact with the people they support and members of staff. It was evident from our visit that the people living at the home have good relationships with all of the management team and are used to having regular access to them. We saw senior managers spending time with individuals, sharing a joke and reassuring them when necessary. People are clearly benefiting from a well run home. Members of the management team attend training to ensure that they remain aware Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: of any changes in legislation. For example the assistant manager has been to workshops held by the local team on the Deprivation of Liberties Safeguards (DOLS) and there are training sessions to be held by professional providers in the coming weeks on the Mental Capacity Act to involve some of the other staff members. The management team have also produced a guide to the Mental Capacity Act and DoLS and what it means for Cocklebury Farmhouse, in addition to other information leaflets produced by the Department of Health. Within the AQAA they identified what they could do better Questionnaires should be redesigned to encourage more personal comments about the service. This will create more tangible feedback, which can be responded to. Quality assurance is taken very seriously and conscientiously. Service user satisfaction questionnaires are in a pictorial format. Questionnaires are sent out to service users, friends and families every two years. As a result of the surveys, actions and outcomes are documented and fed back to the appropriate people. People living at the service have regular group discussions to share ideas and views on the service provision. Due to the ethos of the home people are able to discuss issues, worries or ideas at anytime of the day. People we spoke to told us that they were happy living at Greenway Park and this was evident from our visit. The home has a development plan in place, which includes issues relating to each of its services. We saw that regular health and safety checks take place and records are kept. The home had a current fire risk assessment. The fire officer had recently carried out an inspection of the premises and discussed the proposed changes to the building. Within the AQAA under the heading what we do well it states Fire Safety at 13 Greenway Park is paramount. The risk assessment is extensive and has been updated to cover all aspects of the new Regulatory Reform (Fire Safety Order) 2005. The fire log book covers regular tests for the fire Alarm system as well as other checks such as enegency lights and fire doors. Fire procedure training is given to all staff every quarter to ensure they are aware of what to do in an emergency and clear evacuation procedures are recorded and regularly reviewed with staff and service users. A Community Safety Inspector from Wiltshire Fire & Rescue Service, visited 13 Greenway Park on 16.2.10 as part of their regular inspection. The officer said he was impressed with our Risk assessments and procedures and was happy with all our systems in place. He also commented that it would be nice if other homes followed the bespoke planning and organisation of systems and evacuation drills that is carried out Care Homes for Adults (18-65 years) Page 32 of 36 Evidence: in our homes. Environmental risk assessments are in place for all areas of the home. Care Homes for Adults (18-65 years) Page 33 of 36 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 34 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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