Inspection on 05/01/10 for 1a White Ladies Close

This is the latest available inspection report for this service, carried out on 5th January 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

1a White Ladies Close 11/01/06

1a White Ladies Close 11/10/05

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 1a White Ladies Close 1a White Ladies Close Little London Worcester Worcestershire WR1 1PZ     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: Emily White     Date: 0 5 0 1 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 32 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 32 Information about the care home Name of care home: Address: 1a White Ladies Close 1a White Ladies Close Little London Worcester Worcestershire WR1 1PZ 0190527271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.macintyrecharity.org MacIntyre Care care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Date of last inspection Brief description of the care home 1a, White Ladies Close is registered to provide residential care for up to 5 adults who have mild to moderate learning disabilities. The premises is a large, detached, purpose built house, situated in a residential area, close to the centre of the city of Worcester, and with easy access to various amenities and facilities. The Registered Provider is MacIntyre Care. The property is leased from the Sanctuary Housing Association. The stated purpose of the organisation is, to be recommended and respected as the best provider of services for people with learning disabilities throughout the United Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 5 Brief description of the care home Kingdom. The main aim of the home is to encourage people who live there to achieve optimal personal independence in their lives, both within and outside the home, with supervision, support and assistance from staff where needed. Please contact the home for informatiom about fees. Care Homes for Adults (18-65 years) Page 5 of 32 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: We looked at all the information that we have received, or asked for, since the last annual service review. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are Care Homes for Adults (18-65 years) Page 6 of 32 called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. What other people have told us about the service. We visited on a week day and the manager, staff and people who live at the home were there to help us. We spoke to everyone there, observed life in the home and looked at records such as care plans and staff files. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Where people do not have family or representatives outside of the home, it would be good practice for outside advocates to be invited to attend annual reviews of care plans. Peoples person centred plans or scrapbooks should be kept up to date and the person involved in this as far as possible. The service should consider the use of technology to bring the facilities of the home more up to date, for example access to computers and the internet. If appropriate this may improve peoples opportunities for leisure and personal development. Visits with all health professionals should be recorded in the health action plan so that outcomes can be recorded and so the home can keep a record of when the next appointments are due. This will ensure that peoples health is maintained and monitored regularly. Incidents involving peoples behaviour which lead to the administration of medications as needed should be recorded in detail. This will ensure that peoples emotional and physical well being is monitored and ensure that medications are being used Care Homes for Adults (18-65 years) Page 8 of 32 appropriately. It would be good practice for staff to have thorough and ongoing training in the Mental Capacity Act and Deprivation of Liberty Standards which will ensure they have a full understanding of how to safeguard people in their care. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. People are confident that the care home can support them. This is because there is an accurate and regularly updated 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. Evidence: The three people who currently live at Whiteladies Close have lived there for several years. No new people have moved to the house. In the past year two people have moved out to more suitable accommodation for their needs. One person moved to more independent supporting living accommodation and another to a nursing home. The home is proactive at seeking regular and up to date assessments for people to ensure that the home continues to be the right place for people as they grow older or their needs change. We saw from care plans that people who currently live at the home have regular assessments from social services and an annual review with the home manager and other staff and representatives as needed. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The AQAA provides detail of the assessment process which is thorough and fully involves the persons circle of support, visits to the home and consideration of compatibility with people who live at the home. At present there are no new people planning to move in but there is room for up to five people. The AQAA tells us that the home may consider whether Supported Living: Would be of greater benefit to those we support. It would enable the people who use the service to have more control over their lives, they would have their own tenancy agreements with the housing association providing greater security and would financially be considerably better off. This shows that the home is able to consider areas for improvement and development which may benefit people using the service. There is a clear statement of purpose, service guide and everyone living at the home has a contract or agreement and that they understand. Care Homes for Adults (18-65 years) Page 12 of 32 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. Peoples 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. Evidence: The AQAA tells us that: Everyone who lives at Whiteladies close is supported to make decisions- if the decisions involve big changes eg buying a new carpet, major expenditure or a life changing decsiosn such as a move then a best interests meeting would be held under the Mental Capacity Act, this is to ensure that the decision made is in the persons best interest. There are risk assessments in place for each person these cover household jobs, and leisure activities each person is encouraged to have as normal a life as possible within the limitations of their skills. Staff support the people at Whiteladies close with their finances, each transaction is recorded and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: checked people are encouraged as much as possible to be involved with their monies within their limitations. People living at the home sent us some surveys. People told us that they always or usually make decisions about what they do each day and can do what they want to. On the day of our inspection everyone was at home. We met and talked to everyone who lives at the home and observed staff working with them throughout the day. We saw that staff work with people in a supportive way, for example when they show distress or difficulty making a decision, and staff try to encourage independence in all the activities people do. Some examples of this include supporting someones choices about going out in the snow, getting involved in daily chores and making tea, encouraging people to find out information for themselves such as the date or what is in the freezer for dinner that night, and checking whether household chores have been done. We spoke to one persons key worker who has responsibility for knowing them well and making sure they have everything they need. We also spoke to other staff during the day. Staff show a good understanding of peoples personalities and needs, and observations show that staff have a good understanding of their role by supporting people instead of doing things for them. Monthly house meetings are recorded and kept in the dining room for everyone to look at. Everyones viewpoints are recorded, from concerns to discussion about holidays. The records show that the actions from previous meetings are taken up and acted on. Everyone living at the home has a care plan. We looked in detail at one persons plan, which includes profiles of their needs and abilities, for example communication, daily living, a behaviour support plan and risk assessments. These sections had been recently updated throughout the past year. People have monthly meetings with their key worker which include discussions about how they feel, complaints, and behaviour. People also have an annual review completed with the home manager, key worker and operations manager. The care plan provides information for staff to support people to be as independent as possible, for example with with making drinks, helping with lunch and dinner, and getting ready for bed. There is a section called What I can do on my own, which focuses on peoples abilities and strengths. One persons care plan had a behaviour support plan which focused on the positive ways to help them if they showed distressed behaviour. Headings include: Some things I might do when I am bothered about something Understanding why I get bothered and upset Being with me, every day good practice What you can do to Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: help me cope when I get upset How am I doing? How are we doing? These sections have detailed instructions for staff on how to diffuse incidents. Where necessary people have behaviour monitoring forms which staff record on a daily basis, which they use to provide information to health professionals and identify triggers and patterns in behaviour. A person with autism has some individual guidance for staff about autism in their file. This persons key worker has experience of working with children with autism and was able to show to us they had a good understanding of the persons care file and their needs. People have risk assessments that reflect their care plans, which enable them to lead as independent a life as possible. One person has easy to read health and safety guidelines for activities round the house, including use of domestic appliances. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can take part in activities that are appropriate to their age and culture and are part of their local community. People are supported to follow personal interests and activities. They are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal 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 Evidence: The AQAA describes in detail the full lives that people who live at the home lead. Examples include, one person works in a cafe, a garden fete was held at the home, people have joined the local library. The AQAA also tells us that: The people we support have regular gatherings with family and friends and we intend to roll out our Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: service newsletter again to ensure all friends and families who do not have regular contact with us for whatever reason are kept informed. We spoke to people during our visit and looked at records which showed that people living at the home are supported to see important people in their lives on a regular basis and encouraged to progress, such as getting a new job working in a cafe. We received surveys from people who live at the home. Comments include: They look after me I am well treated Good food We looked at one persons care plan in detail and daily diaries for the others to see what sort of lifestyle they are leading. People have a planner which covers what they are doing for the coming two weeks. This includes household tasks as well as day centres, work and social life. One persons care plan states that she likes going shopping, having coffee and going on day trips. The daily planners show that these activities are happening. The daily diaries show that people spend a large part of their week and day services but at weekends and on other days they are supported with a wide variety of activities. People told us they enjoy the day services and told us about other activities they had been taking part in, as well as planned holidays to Weston Super Mare and Hay on Wye. People have scrap books or person centred plans (PCP)which they are involved in making. These are made up of photographs and things that people enjoy doing. One persons PCP was set up in 2007 with a lot of photographs ad information. In the following two years we noted that there were fewer photographs and entries. During our visit this person asked her key worker if they could work on her PCP together. We observed staff working with this person to choose photographs of the recent Christmas party and laminate them for the scrap book. A large part of peoples lives at the home includes getting involved in household chores. We saw photographs of people doing daily tasks at home and staff who came to work during the day asked whether household tasks had been done. People are encouraged to make their own drinks and get involved in the cooking as far as possible. People choose their meals every week, and likes and dislikes are taken into account and alternatives offered. For example the evening we visited one person had chosen chicken pie, but the person who did not like chicken had something of their choice. We saw menu planners and books which showed a varied diet. The AQAA tells us: One lady chooses to eat on her own in the music room all people know and respect this. People are encouraged by staff to choose healthy options and we have loads of Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: cookery books to help choose different recipes, we also have a Polish member of staff and he has cooked some Polish food for people it has gone down really well. At the moment people like to eat at the same time. Care Homes for Adults (18-65 years) Page 18 of 32 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 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. The home supports people with their medication in a safe way. Evidence: Peoples care plans are very detailed and explain how staff can support them and what they are able to do for themselves, no matter how small the task. For example one person is able to turn on the taps for the bath. We spoke to staff who show a good understanding of how to support the individuals who live at the home. Staff have good ways of communicating with each other about peoples health and well being. There is a staff handover file which includes daily checklist to ensure all tasks relating health, personal care and safety are completed. The handover file also includes behaviour monitoring charts and everyones two-weekly planners. This ensures that staff know what is happening with everyones emotional, health and personal care needs. The AQAA tells us that peoples health action plans are to be updated and include as Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: much historical information and to be as accessible to the individual as possible. Recent audits have highlighted the need to improve these plans. We looked at the health action plan for one person and saw that these were up to date with the persons current needs, and their were regular records giving details about the persons psychiatric reviews. The health action plan also stated that this person should have annual trips to the dentist and regular visits to the home by the chiropodist. The health action plan did not record any of these visits. Staff confirmed that these visits had been happening and appointments are recorded in the homes diary. It is important that visits with all health professionals are recorded in the health action plan so that outcomes can be recorded and so the home can keep a record of when the next appointments are due. Everyone living at the home has a confidential file which records medical correspondence, details of strategies and interventions as per their care plan, and detailed house notes which are used to record more serious or confidential incidents or events. These notes are detailed and show staff have a good understanding of dealing with incidents and helping people to take responsibility for their actions. We looked at medications storage, recording and administration. All medications were accounted for and we observed some good practice for example recording dates of opening on loose medications, which makes auditing them easier. Guidance for each medication is included in the front of each administration record. One person had medications administered as needed. There is a protocol for these medications and staff showed a good understanding of what the medications are for and when they should be used. These medications had been used infrequently which shows that generally other methods are used before medication is considered. We saw on one occasion that the medications had been administered during the week before our visit. The record in this persons behavioural chart states X got very agitated abut 11 am had to administer PRN, X is fine now. No further records had been made, for example in the house notes which are used to record more serious incidents. We would expect a more detailed record to be made when an incident such as this occurs, to show what had happened, what other methods had been tried, and what the effect of the medications were on the person concerned. Care Homes for Adults (18-65 years) Page 20 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Evidence: The AQAA tells us that the home has: Clear policies and procedures on the Protecion of Vulnerable Adults, all staff have had training in abuse and are also working through a module on our e learning system. There are risk assessments in place for people with challenging behaviour and all staff have had training in this area. There are detailed Behavioural Support Plans in place for those who need them, developed by our Care Practice Advisor and Area Manager in conjunction with the whole team. There are policies and procedures regarding money and these are followed at Whiteladies Close. Macintyre has clear policies and procedures on recruitment and therefore no person can start at Macintyre without having had a CRB check and 2 references. We keep clear records detailing each member of staffs employment with us. We received surveys from people who live at the home who say they know how to complain and they know who to speak to if they are not happy. We looked at information sent to us from the home since the last key inspection and information in the complaints book at the home. This shows that people who live at Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: the home do complain and it is taken seriously when they do, no matter how small the concern. Safeguarding matters are referred appropriately and dealt with. The home has received one complaint from a relative of a person living at the home and records show that this too was dealt with appropriately, including the use of external advocates for the person concerned. Training records show that staff have up to date training in safeguarding and discussions with staff show they have a good understanding of the process. Observations of staff working show they understand how to work with peoples personalities and behaviours. The behaviour support plans in peoples care plans provide a lot of detail for staff to work with. It would be good practice for staff to have thorough and ongoing training in the Mental Capacity Act and Deprivation of Liberty Standards which will ensure they have a full understanding of how to safeguard people in their care. Care Homes for Adults (18-65 years) Page 22 of 32 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. People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. Peoples own rooms and the communal areas are personalised and homely. Evidence: Surveys from people who live at the home say that it is always fresh and clean. During our visit people showed us around their house and showed us their bedrooms. People showed a lot of pride in the things they had in their rooms. Peoples rooms and the house are very personalised with photographs and their hobbies and interests. There are photos up everywhere, for example photos of parties, and funny photos of people doing housework. The AQAA tells us that: The garden is looking better than ever as the people living here have decided to keep the gardners on throughout the winter. Friends and relatives have commented on how much better it is looking. All the people we support were involved in choosing the decor for the entire house when it was redecorated last year. The AQAA also tells us that the home aims to: Encourge people to understand that Whiteladies Close is their home and to encourage them to take responsibility for the Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: upkeep and cleanliness. We have developed better cleaning rotas, encouraged people to choose new carpets, furniture etc for their bedrooms, encouraged people to look after their home. During our visit we observed that the house is homely and clean, and feels as though it belongs to the people who live there. There are chickens in the garden and a rabbit in the house, and a staff member has a dog who comes to the house and people enjoy taking it for a walk. We noted that all health and safety and hygienic practices are observed by all staff. Care Homes for Adults (18-65 years) Page 24 of 32 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. 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. Peoples needs are met and they are supported because staff get the right training, supervision and support they need from their managers. Evidence: The AQAA tells us that: Greater emphasis has been put on individual needs for example people are supported to go out on a one to one basis whenever possible, staffing levels have improved during the daytime when people are here so this goal is achievable. Rotas show that there always sufficient staff at work. The shifts are operated on a 9-5 basis so there is minimum disruption to the lives of people who live at the home. People have appropriate key workers to their needs for example taking into account gender and specific past experience of staff. Surveys from people who live at the home tell us that staff always treat them well and always or usually listen and act on what they say. We met and observed all three people who live at the home during our visit and observed that people have a good rapport with the staff. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: The AQAA tells us that: All staff to have or have had Mental Capacity Act training and supported living training, elearning and to make sure all staff have NVQs or NVQ in progress. Both our NVQ2 and NVQ3 candidates complete an intensive module on equality, diversity and rights, and it is included on our e learning system. We spoke to staff about their training and looked at the training matrix. The majority of the training is updated using e learning which staff say is effective and keeps them up to date. Training includes Challenging behaviour, Communication, Dementia and ageing, Epilepsy, Person Centred Planning, all the mandatory health and safety training, medications and safeguarding. We spoke to staff about their understanding of the Mental Capacity Act and Deprivation of Liberty Standards. Staff had an understanding of this through team meetings and some had been on some training including the manager. The AQAA tells us that: People have been involved in staff recruitment. All people at the service asked questions when we recently interviewed for the post of support worker and the two people who were at home on that day sat in on the interview and asked questions. Each has contributed to a recruitment wishlist for the service which helps appplicants decide if they are what people are looking for. Macintyre has clear policies and procedures on recruitment and therefore no person can start at Macintyre without having had a CRB check and two references. We keep clear records detailing each member of staffs employment with us. We saw peoples recruitment wish lists in their care files. There have not been any new staff at the home in the six months before the inspection. All recruitment records are kept up to date. Care Homes for Adults (18-65 years) Page 26 of 32 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. People have confidence in the home because it is run and managed appropriately. Peoples 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 good health and safety practices are carried out. Evidence: The manager of the home has taken over since the last key inspection but has maintained the high standards. She has implemented some improvements and the AQAA shows that she is aware of where there are still improvements to be made. We observed that the manager has a good rapport with people who live at the home and with staff. The AQAA tells us how the home seeks the views of people who live there so they can make improvements: People who live here have regular house meetings where they can voice any complaints and opinions, these are recorded in a way that people understand with photos and pictures. There are individual support plans in place for Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: each individual with photos so they can understand them, a pictorial complaints policy, each individual has had their complaints procedure explained to them in a way they understand, for example in pictures or talking to staff. We also hold regular person centered reviews for each individual. We also have a monthly Person Centred Planning meeting with each person and document this, it asks questions in every aspect of their lives and we act on answers through discussion in regular team meetings and house meetings. During our visit we saw records of all of the ways peoples views are sought. These records are easily accessible in the house. We saw that peoples views are acted on and changes are made to the house or the way things are done. People are also encouraged to try new things and develop, for example in taking a job which they enjoy. We also saw examples of the house newsletter which is very attractive with words and pictures, and examples of annual surveys which people living at the home complete. The AQAA tells us about a new quality improvement process that has been developed by MacIntyre. This involves asking the staff about what they do well and what is working less well so they can do it better. We saw the records of this process and some actions that have been developed to put into the service development plan. An example of this is considering changing peoples two weekly planners to something that shows more planning and decision making by people who live at the home. The service development plan shows that goals are being addressed throughout the year. The AQAA tells us that: All staff are required to have mandatory training before they can work on their own, they complete a detailed Personal Dvelopement Folder. The mandatory training consists of Fire Safety, First Aid, Moving and handling, and Food Hygiene. If satisfactory, they are signed off probation after six months. During our visit we observed appropriate health and safety practices being used by staff and people living at the home. Staff are responsible for recording health and safety monitoring such as food temperatures in the kitchen and water and fire safety records. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 1 6 Where people do not have family or representatives outside of the home, it would be good practice for outside advocates to be invited to attend annual reviews of care plans. Peoples person centred plans or scrapbooks should be kept up to date and the person involved in this as far as possible. The service should consider the use of technology to bring the facilities of the home more up todate, for example access to computers and the internet. If appropriate this may improve peoples opportunities for leisure and personal development. Visits with all health professionals should be recorded in the health action plan so that outcomes can be recorded and so the home can keep a record of when the next appointments are due. This will ensure that peoples health is maintained and monitored regularly. Incidents involving peoples behaviour which lead to the administration of medications as needed should be recorded in detail. This will ensure that peoples emotional Page 30 of 32 2 12 3 12 4 19 5 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and physical well being is monitored and ensure that medications are being used appropriately. 6 23 It would be good practice for staff to have thorough and ongoing training in the Mental Capacity Act and Deprivation of Liberty Standards which will ensure they have a full understanding of how to safeguard people in their care. Care Homes for Adults (18-65 years) Page 31 of 32 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. 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