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Inspection on 22/07/09 for Aldenham Road (122)

Also see our care home review for Aldenham Road (122) for more information

This is the latest available inspection report for this service, carried out on 22nd July 2009.

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

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

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

What the care home does well

The AQAA states: "The needs presented by the client group varies from moderate learning disabilities to complicated autistic tendencies with behavioural and other health needs. The service has staff well trained, knowledgeable and skilled staff who understand service users needs are able to provide them with the required support to meet these needs." All the people who we spoke to said that they are happy in their home. Everyone who completed Have Your Say surveys made positive responses to all the questions. The staff said that they feel well supported by the company and the management. The relative who completed a survey said, "The staff are always helpful and caring and look after my relative to the best of their ability. They are always available to me whenever I go to the home and open to any suggestions I might make." The care plans are well written with the involvement and the views of the people who live in the home, and they show that people are involved in making decisions about their care and their lives in the home. The ethos of the home is that it is the home of the residents, and the staff support them to live theirAldenham Road (122)DS0000019263.V376871.R01.S.docVersion 5.2lives as they wish to and to make their own decisions about every aspect of their lives in the home. People are encouraged and supported to take part in their choice of activities in the home and in the community, and to attend day care that meets their specific needs and interests. Funding has been agreed to provide waking night staff in the home, due to the risks of seizures for one person. The manager has negotiated funding for one to one staffing in the home for 16 hours a week, so that one person can do the things they like to do in the home and in the community on the days when they are not at the day centre. The staff are proactive in addressing any possible health concerns, and ensuring that each person receives the support and treatment that they need.

What has improved since the last inspection?

The health and safety concerns that we raised in the last inspection report have been addressed to make sure that there are no avoidable risks in the home for the people who live there. Several new staff have been employed in the home since the last inspection, and there is now a stable, enthusiastic staff team. The home is almost fully staffed, and the use of agency staff has reduced.

What the care home could do better:

The manager has shown through the Annual Quality Assurance Assessment and discussion during the inspection that she knows what improvements may be made in the home, and she has plans in place for them. One difficulty for both the staff and the manager is the lack of internet access in the house, so that they can manage and update care plans and other information on the computer. The manager would like to move the office fully into the house, and this was recorded as a required action in the proprietor`s monitoring report for May 2009. We noticed that the door to the first floor office was held open with a box of paper. This could be a fire hazard, as the door would not easily close in case of fire. The manager had also noticed this, and the box was removed immediately.Aldenham Road (122)DS0000019263.V376871.R01.S.docVersion 5.2

Key inspection report CARE HOME ADULTS 18-65 Aldenham Road (122) 122 Aldenham Road Bushey Hertfordshire WD23 2ET Lead Inspector Claire Farrier Key Unannounced Inspection 22nd July 2009 13:45 Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldenham Road (122) Address 122 Aldenham Road Bushey Hertfordshire WD23 2ET 01923 237770 01923 237770 FP aldenhamrd122@walsingham.com www.walsingham.com Walsingham Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Petrina Angeline Goodwin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd July 2008 Brief Description of the Service: 122 Aldenham Road is a two-storey, detached, family style house located in a residential area of Bushey. It is operated by Walsingham, which is a voluntary organisation. The home provides accommodation and support for six adults who have learning disabilities. All the bedrooms are single, and none have en-suite facilities. There is a mature garden to the rear of the property and a small garden with additional space for four cars to park at the front. The house is situated on a main road and has easy access to Watford town centre. There are also local shops that are within walking distance. The house provides a domestic environment and it is indistinguishable from the neighbouring houses. The Statement of Purpose and Service Users’ Guide provide information about the services provided by the home for prospective residents and social workers. The manager was not able to provide information on the fees charged. Please contact the manager for up to date information. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We (The Care Quality Commission) spent one afternoon at 122 Aldenham Road, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We looked around the home. We met most of the people who live in the home, and to the staff who were in the home during our visit. One person completed a Have Your Say survey before the inspection, two members of staff and one relative also completed Have Your Say surveys and we have used the information from these in this report. We talked to the manager about what we had seen during our visit. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CQC before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. We have also looked at the reports of the visits that a representative of Walsingham makes to the home. What the service does well: The AQAA states: “The needs presented by the client group varies from moderate learning disabilities to complicated autistic tendencies with behavioural and other health needs. The service has staff well trained, knowledgeable and skilled staff who understand service users needs are able to provide them with the required support to meet these needs.” All the people who we spoke to said that they are happy in their home. Everyone who completed Have Your Say surveys made positive responses to all the questions. The staff said that they feel well supported by the company and the management. The relative who completed a survey said, “The staff are always helpful and caring and look after my relative to the best of their ability. They are always available to me whenever I go to the home and open to any suggestions I might make.” The care plans are well written with the involvement and the views of the people who live in the home, and they show that people are involved in making decisions about their care and their lives in the home. The ethos of the home is that it is the home of the residents, and the staff support them to live their Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 6 lives as they wish to and to make their own decisions about every aspect of their lives in the home. People are encouraged and supported to take part in their choice of activities in the home and in the community, and to attend day care that meets their specific needs and interests. Funding has been agreed to provide waking night staff in the home, due to the risks of seizures for one person. The manager has negotiated funding for one to one staffing in the home for 16 hours a week, so that one person can do the things they like to do in the home and in the community on the days when they are not at the day centre. The staff are proactive in addressing any possible health concerns, and ensuring that each person receives the support and treatment that they need. What has improved since the last inspection? What they could do better: The manager has shown through the Annual Quality Assurance Assessment and discussion during the inspection that she knows what improvements may be made in the home, and she has plans in place for them. One difficulty for both the staff and the manager is the lack of internet access in the house, so that they can manage and update care plans and other information on the computer. The manager would like to move the office fully into the house, and this was recorded as a required action in the proprietor’s monitoring report for May 2009. We noticed that the door to the first floor office was held open with a box of paper. This could be a fire hazard, as the door would not easily close in case of fire. The manager had also noticed this, and the box was removed immediately. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 7 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. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each person’s care needs. EVIDENCE: Four people live in the home, and no one has moved into the home for several years. One person moved to another service shortly after the last key inspection. As no one has moved in recently, during this inspection we did not see any assessments that were carried out before people came to the home. However a new resident is preparing to move in. We looked at the information that the home has about this person, which includes the care plan from their current placement, and notes of their most recent CPA (Care Planning Approach Review). The assessment and admission process has included several visits and overnight stays in the home, to meet the other people who live there, and for the staff to get to know their needs. At the last residents’ meeting, the people who currently live in the home were asked whether they would like the new person to move in, and they all said that they like the Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 10 person and would like them to move in. The Annual Quality Assurance Assessment (AQAA) stated that in the last 12 months the Service User Guide and Statement of Purpose have been updated in pictorial format, so that people who plan to move to the home have information in a format that they can understand. The staff who we spoke to said that they have sufficient information and training to enable them to meet the needs of the people who live in the home. One of the staff surveys had the comment, “What the home does well is to meet people’s needs.” In the AQAA the manager wrote, “In the next 12 months we plan to ensure the home meets service users needs and support them to become more independent.” There are sufficient staff in the home, and the care plans have appropriate information so that the staff know how to support each person effectively (see Individual Needs and Choices). Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are actively involved in their own care planning and are consulted on every aspect of community life in the home. EVIDENCE: We looked at the files of two people, which show what care is provided for them and how it is recorded. The care plans are written in a person centred format, which shows that people are involved in making decisions about their care and their lives in the home. Entries are written in the first person and describe the person’s personal preferences, how they make decisions, and the support that they need with their daily activities (see Personal and Healthcare Support). The Annual Quality Assurance Assessment (AQAA) stated that in the last 12 months staff have all been trained in a person centred way, and there is a new format for goals that enables service users to have more control over Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 12 their home. We saw updated goals for each person, written with the involvement of each person and in a pictorial format. For example, one person said that they wanted to have a garden with flowers. They were supported to plan for this, with a goal for achieving it and the actions and steps that were needed to achieve it. The care plan records that this person has been supported by the staff to buy some plants for the garden, and they told us that they have done this. The care plans are reviewed regularly, and the information that we saw about each person was accurate and up to date. Each person has risk assessments for some activities where a decision has been made concerning their safety. The purpose of risk assessments is to ensure that the people who live in the home can take part in the activities that they wish to. The risk assessments that we saw covered all aspects of the person’s life in the home and in the community. For example, bowling, swimming, walking to the shops, social behaviour. There are also general assessments in each person’s file, for example for using the dishwasher and other activities in the house. The risk assessments are reviewed regularly to ensure that they are still relevant. The staff who we spoke to said that the care plans provide them with good information on each person’s needs, so that they are able to provide a good quality of care in the way that each person wishes. One member of staff, who had been new to care work, was very clear about how they support the people in the home to take their own decisions and to be as independent as possible. This person said that the care plans are used as working documents and provide clear information for both the person concerned and for the support workers. The residents are supported to be involved in the management of the home. Everyone has responsibility with support for tidying their rooms and doing their own laundry. One person has had training in health and safety, and with support from a member of staff they carry out all the weekly health and safety monitoring, such as testing the fire alarms and checking water temperatures. Each person has regular one to one meetings with their key worker to discuss what they want to do, and how they will do it. There are also regular meetings for the people who live in the home that are formally recorded. The minutes of the last meeting showed that each person chose the meals that they would like for the next week. They also discussed the person who has been visiting in preparation for moving into the home (see Choice of Home). Everyone was asked, “Do you like the person, and do you want them to live here?” and all said, “OK.” In previous residents’ meetings topics have included how to make a complaint and fire drills. The agenda is produced in a pictorial format so that everyone can understand it and be involved in the decisions about the home. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported to live full and active lifestyles. They are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states, “What the service does well is to promote lifestyles that portray individuals as valued citizens, and allow individuals to take reasonable risks. In the last 12 months we have encouraged one service user to take ownership of making their own breakfast and drinks. We have encouraged ownership of the home by encouraging individuals to be involved in maintain the cleanliness of it.” Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 14 Each person has an activities planner that shows their choice of what they would like to do each day in the home and in the community. All the residents attend day centres that provide activities that they are interested in. This means that they all attend different day centres. One person attends a local day centre on four days, and Earthworks, where they carry out horticultural activities, on one day. This person said that they wanted to have a garden with flowers at Aldenham Road. They were supported to plan for this (see Individual Needs and Choices), and they told us that they have bought and planted some flowers. One person attends a day centre on only two days a week, by their choice. The manager has negotiated and agreed funding for one to one staffing in the home for 16 hours a week, so that this person can do the things they like to do in the home and in the community on the days when they are not at the day centre. Their activity planner shows activities that include swimming, bowling, going to the library, feeding the ducks, lunch out. Everyone has families or friends who visit them or who they visit regularly. They are supported to contact their families by phone. The menus looked varied and nutritious, and they reflect each person’s individual choices. The menu is drawn up each week with the involvement of the people in the home using pictures of meals to help them to choose, and there is a choice of meals each mealtime. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is proactive in addressing any possible health needs. There is an experienced and enthusiastic team of staff who have the training and information to provide a good quality of care for the people who live in the home, and to ensure that their individual needs, choices and preferences are met at all times. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states, “The needs presented by the client group varies from moderate learning disabilities to complicated autistic tendencies with behavioural and other health needs. The service has staff well trained, knowledgeable and skilled staff who understand service users needs are able to provide them with the required support to meet these needs.” We received a survey from one relative, who siad, “The staff are always helpful and caring and look after my family member to the best of their ability.” One member of staff who returned a survey said, “What the home Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 16 does well is good and quality care. Up to date recording. Good sharing of information.” During the inspection everything we saw supported the information that is quoted above. The care plans contain good details of each persons care needs. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. The staff are proactive in addressing any possible health concerns, and ensuring that each person receives the support and treatment that they need. One person has a longstanding problem with their hand, and this has now been addressed with a referral for treatment. The staff have also persevered in ensuring that dental treatment is provided, when appointments were not made by the hospital. Funding has been agreed to provide waking night staff in the home, due to the risks of seizures for one person. Another person has regular reviews with the Community Support Unit for their mental health problems, and they have had support from the Intensive Support Team for behavioural difficulties. The guidelines for managing this person’s behaviour include a detailed protocol for when PRN (when required) medication should, and should not, be used. The staff who we spoke to were very clear on their understanding of this protocol, and the medication records and daily recording in the care plan show that it has been applied appropriately. The home has sound systems in place to manage peoples medication safely. We checked a sample of medication records, which were free of errors, with no signature gaps found on the MAR (medication administration record) charts. The MAR charts are colour coded as an aid to ensuring that the correct medication is given, and an audit is carried out every day to make sure that the MAR charts have been completed properly and there are no errors. The member of staff who assisted us with checking the medication was very knowledgeable on all the procedures and safeguards. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are encouraged and supported to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. EVIDENCE: The home has a satisfactory complaints procedure in place that is available to all residents and their relatives. The complaints procedure is in an easy read pictorial format for the people in the home. The staff encourage people to make any concerns known, and these are recorded. The Annual Quality Assurance Assessment last year stated, “We could more effectively record all aspects of bullying within the service and use evidence to better support service users who may feel bullied by other service users.” In this year’s AQAA the manager reported, “In the last 12 months we have encouraged service users to be more respectful of others by explaining when behaviours or comments are not appropriate.” The home has appropriate procedures for safeguarding vulnerable people. The staff who we spoke to were aware of the safeguarding procedures, and of their responsibilities for whistle blowing. Everyone has training on safeguarding vulnerable people. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The building is an ordinary detached house, furnished and decorated in domestic styles that produce a homely, comfortable environment, which allows the people who live there to relax and feel at home. Everyone has their own room, which is arranged and decorated to reflect their particular interests and tastes. The lounge and kitchen are domestic in style and are comfortably furnished and well equipped. Five bedrooms are on the first floor. There is one bedroom with an adjacent bathroom on the ground floor, which is suitable for a person with limited mobility. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 19 The home appeared to be clean and generally well maintained. The home has appropriate procedures to maintain hygiene and prevent the risk of infection within the home. Following the last inspection some areas of the home have been made safer for the people who live there. Window restrictors have been fitted to the first floor windows to prevent them opening wide, and the window of the laundry, which opens outwards, has yellow and black warning tape attached to it. The knife drawer in the kitchen is now kept locked, and risk assessments are in place to ensure that the risks that we observed are managed properly. On this occasion we noticed that the door to the first floor office was held open with a box of paper. This could be a fire hazard, as the door would not easily close in case of fire. The manager had also noticed this, and the box was removed immediately. The office is small, and an automatic door closer must be fitted if the manager and staff wish to use it with the door open. Since the last inspection the sister home next door has closed down. The manager’s office for both homes was in the gardens between the two houses. The manager would now like to move the office completely inside the house, but there is currently no internet access to the house, so updates to care plans and records cannot be completed there (See Conduct and Management of the Home). Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. EVIDENCE: Several new staff have been employed in the home since the last inspection, and there is now a stable, enthusiastic staff team. The Annual Quality Assurance Assessment (AQAA) stated that the home is now almost fully staffed, and in the next 12 months the plans are to complete this process and to train and skill up the staff team further. The AQAA stated that no agency staff were used during the previous three months. There was an agency member of staff in the home on the day of this inspection, but we were told that there is always a permanent member of staff on each shift. The staff rota shows that there are two support staff in the home throughout the day, and one at night. The staff no longer sleepover at night, which means that the hours that they work comply with the Working Time Directive. Funding has Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 21 been agreed to provide waking night staff in the home, due to the risks of seizures for one person. Also for one to one staffing in the home for 16 hours a week, so that one person can do the things they like to do in the home and in the community on the days when they are not at the day centre. Walsingham provides comprehensive training for staff that covers all mandatory training in first aid, moving and handling, fire safety, food hygiene, etc, and training to meet special needs the residents have such as epilepsy and challenging behaviour. The staff who we spoke to said that the training and support provided for them is very good. The AQAA states that three of the seven the full time support workers currently have a qualification at NVQ2 or above. All the staff have regular one to one supervision with either the manager or deputy manager, so that they can discuss their work and training. Walsingham has robust recruitment procedures that ensure that the staff in the home are fit to work with vulnerable people. The references, CRB (Criminal Record Bureau) disclosures, evidence of identity and full employment history are stored at Walsingham headquarters by agreement with us through the Provider Relationship Manager (PRM). The PRM checked the staff files including CRB forms held at Walsinghams Head Office in October 2008, and confirmed that these were satisfactory and in line with legal requirements. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, and the management actively seeks the views of the residents and other involved people in order to ensure that a good quality of care is provided. EVIDENCE: The Commission for Social Care Inspection completed the registration process for the manager shortly after the last key inspection, and since then the manager and the deputy manager have completed qualifications in leadership and management. The manager has worked in the caring profession since 1986, and was manager of another Walsingham home before moving to Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 23 Aldenham Road in February 2008. The sister home next door to 122 Aldenham Road has closed down, and the manager now manages only 122 Aldenham Road. The ethos of the home is that it is the home of the residents, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. The manager and deputy manager set the tone for the home, provide strong leadership to the team and enjoy good relationships with the residents. They lead by example, and support and encourage the staff. All the staff who we spoke to and who completed surveys for this inspection said that the manager is always available if they wish to speak to her. One new member of staff described the support that they had received from the manager so that they could complete their essential training. There is still an office in the garden between the two houses, and the office functions cannot be fully moved into the house until internet access is installed. This need was recorded as a required action in the proprietor’s monitoring report of May 2009. In the Annual Quality Assurance Assessment (AQAA) the manager stated, “We need all staff to be able to be able to produce easy info read documentation to have the tools to do so. Management will continue to push forward for our lap top or another computer to enable us to carry out this work.” One of the staff who completed a survey for this inspection said, “What the home could do better is to have enough equipment for recording information for example computers as we all have to use one computer for updating information which is not enough as there may be little time.” As the computer is in the office outside of the house, the manager and staff need to be out of the house, and away from the residents, in order to manage and update care plans and other information on the computer. Walsingham has a comprehensive system for quality assurance in its homes, which includes annual surveys of residents and their families. The company carries out regular service audits of the home and monthly Regulation 26 monitoring visits. These visits include discussions with staff and with the people who live in the home, and auditing of records and medication. The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. The Environmental Health Officer had carried out an inspection of the kitchen on the same day that we visited the home. The report showed that no actions were needed to improve food hygiene in the home. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. One of the people who live in the home has had training in health and safety, and with support from a member of staff he carries out all the weekly health and safety monitoring, such as testing the fire alarms and checking water temperatures. We found one health and safety concern, that the office door was held open by a box of paper (see Environment). The manager had also noticed this, and the box was removed immediately. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 X LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 X 3 4 3 X X 3 2 Version 5.2 Page 25 Aldenham Road (122) DS0000019263.V376871.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23(4) Requirement The registered person must ensure that adequate precautions are in place against the risk of fire, in particular with regard to holding doors open. Timescale for action 22/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA43 Good Practice Recommendations The Responsible Individual should ensure that facilities are in place, such as internet access, so that the manager and staff can complete and update records and care plans in the house. Aldenham Road (122) DS0000019263.V376871.R01.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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