Key inspection report
Care homes for adults (18-65 years)
Name: Address: Fearnley House 86 Straight Road Old Windsor Berkshire SL4 2RX The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Dickens
Date: 1 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years)
Page 2 of 29 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 29 Information about the care home
Name of care home: Address: Fearnley House 86 Straight Road Old Windsor Berkshire SL4 2RX 01753863752 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Choice Ltd Name of registered manager (if applicable) Mrs Sarah Rainey Type of registration: Number of places registered: care home 4 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: 4 The registered person may provide the following category of service only:Care home only - 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 Date of last inspection Brief description of the care home The home is owned and run by Choice Ltd and provides care for people with learning disabilities. The home is in a bungalow on a main road, with shops nearby. The house is set in a medium size garden with a tarmac car park in the front. The rear is a grassed area with an annexe for an office. There is a summerhouse for use as an educational facility. The premises has a spacious L-shaped lounge and dining room, with a kitchen, four bedrooms and suitable bathrooms and toilets. Fees range from £1800-£2200 per week. Care Homes for Adults (18-65 years)
Page 4 of 29 Over 65 0 4 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection was unannounced and took place over 6.5 hours. The shift leader assisted during the morning, and the registered manager represented the establishment during the afternoon. A partial tour of the premises took place and a number of documents were sampled including two residents care plans, two staff files, and quality assurance information including the Annual Quality Assurance Assessment (AQAA) which was completed by the manager and returned to CQC prior to this inspection. Four service user surveys were distributed prior to this inspection and returned to the Commission by parents and staff, as no service user is able to complete a survey without support. Information from these surveys, and from interviews with the manager, staff and the assistant psychologist, are included in this report. Care Homes for Adults (18-65 years) Page 5 of 29 What the care home does well: What has improved since the last inspection? The homes Statement of Purpose and Service User Guide have been updated, and the majority of staff have done Makaton training with new staff already booked to do this. An audit has been carried out by the Choice head office and recommendations for improvement have been received. Service users have now started going out to buy the weekly shopping and have more input into food choices. All relevant staff have received medication training, and specialist appointment sheet records have been introduced. Concerns and complaints have now been added to the agenda for service users meetings. Care Homes for Adults (18-65 years) Page 6 of 29 More staff have completed NVQs and the home now exceeds the recommended minimum of 50 of staff holding a qualification in care. What they could do better: 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 7 of 29 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 8 of 29 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed prior to them moving in to Fearnley House. Evidence: The AQAA returned to CQC prior to this inspection stated that the company have a team who carry out initial assessments, and then the manager outlined the process of admission. There is a policy in place for assessing potential new residents, and there has been one new resident who has moved into the home since the last inspection; their file was looked at in some depth. This person had had a Choice assessment, by the assessment team, and also an assessment from the in house psychology service. The assistant psychologist who carried out this assessment was in the home on the day of the inspection and outlined in detail how this resident should be supported by staff. A written behavioural support plan was on the residents file, and all staff had signed to say they had read and understood this. There was also evidence that information from this residents previous placement had been brought across and used in drawing up their care plan etc. There was no assessment from this residents care manager on
Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: file, and the home manager was asked to follow this up. A survey returned from the family of the new resident showed that they felt they had been given a choice of home, and had had enough information prior to their relative moving in. They had a number of positive comments about the home including that they were satisfied with how things had gone so far. Care Homes for Adults (18-65 years) Page 10 of 29 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know their assessed and changing needs will be reflected in their individual plans, and they are encouraged to be involved in all aspects of life in the home, and to make decisions about their own day to day activities. People who live at this home are supported to take risks as part of an independent lifestyle. Evidence: The AQAA stated that people are enabled to be independent and to make their own decisions. Care plans are person centred and a variety of communication tools are used. Two service user files were looked at in depth during this inspection, and all four service users behaviour plans were discussed with the assistant psychologist. The home tries to involve service users and their families, in the planning of their care. Preferred communication styles are noted and staff were seen to communicate with residents using a variety of communication styles including sign language. Care plans are written in plain language and addressed each persons needs in relation to
Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: personal support, and maintaining privacy and dignity. It was noted that the actual care plan had only brief reference to how people like their personal care delivered, though there are other references to this in other parts of their file. The manager said she would bring the information together, and ensure there was sufficient detail on how each resident would like their personal support to be delivered. A key worker system is in place at this home. Information on how to support each resident to keep safe, and promote their independence is documented, and each resident has individual guidelines on their file relating to their behaviour. The assistant psychologist talked about how positive behaviour is reinforced and there are strategies in place for avoiding or minimizing more challenging behaviours. As noted in the previous section, the care plan for the new resident was generated from the Choice assessment, and from information from their previous placement, though their care manager assessment was not on file. The manager was going to follow this up. Care plans were reviewed regularly and staff had signed to say they had read and understood these. Comments from the surveys returned to CQC made some positive comments on care planning including (with help from a parent) I am well looked after....and staff seem warm and caring, and tuned in to my needs. One parent stated that they were impressed by the homes response to their relatives changing needs. Another parent, under What could the home do better? noted: Make services more personalised. Long term keyworker needs to be identified. These comments were passed to the manager who said she had already had discussions with this family following their concerns being raised with her. Additional communication aids are one way that a home can promote the inclusion of residents and at this home, examples included the board in the kitchen with todays menu and the weather, and a board in the hall with photos of all the staff on duty. These boards were up to date and had been changed to reflect that days weather, and the members of staff who were on shift. There was plenty of evidence that residents were encouraged to make decisions and choices, for example during service user meetings. One set of meeting notes was sampled and found to contain a detailed agenda, notes about the discussions, and any actions that came from this. The record of the meeting was in a user friendly format with plain words, and symbols. The agenda contained issues of interest to the residents for example the choice of meals. The manager had also used the easy read version of the new Registration arrangements received from CQC to highlight the new system to residents. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: Two service user surveys showed residents (with help) had ticked that they Always made decisions about what they did each day; one ticked Sometimes; and one left this blank. Several comments were made about activities being restricted due to lack of drivers, and one clients file which was sampled during the inspection showed that they had apparently missed a regular activity on several occasions due to either staff or driver shortage. This was discussed with the manager who said that the situation with drivers had improved since the surveys were returned to CQC, and she made a note to check back and find out why a service user may have missed their regular activity. Residents benefit form the support of the Choice in-house psychology team which ensures all residents have up to date behavioural risk assessments. All four residents had these and the assistant psychologist who was present during the inspection was very knowledgeable on residents behavioural needs and had worked with residents to draw up plans to maintain their safety and minimise any risks. There were a few issues relating to the safety of residents in general, which were highlighted during this inspection, and these are discussed in the final section of this report. Care Homes for Adults (18-65 years) Page 13 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a range of interesting activities available to them, and are encouraged to be part of the local community. Family and friendship links are encouraged, and residents are treated respectfully by staff. Residents are offered a healthy diet and are involved in menu planning to ensure they have a say in the meals provided at the home. Evidence: The AQAA outlined the current arrangements for residents activities including individual timetables, and stated they had meaningful daytime activities and that family contact is encouraged. It also noted that service users are involved in menu planning and menu pictures are displayed in the kitchen. During the inspection it was seen that each person has an individual timetable of activities both in the home and out in the community and the home has its own
Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: vehicle to enable service users to go out. There are a variety of interesting leisure pursuits available to residents including sensory sessions, horseriding, trampolining and eating out. There is a computer available for use by residents, and a summerhouse for in-house day care activities such as arts and crafts. On the day of the inspection two residents went out for a drive in the morning as it was half term so their regular classes were not available in the community. The manager had an activities budget to pay for refreshments when staff and residents went out, for example on the afternoon of the inspection two residents were going to Windsor Great Park for a drive and then for tea. Two residents bedrooms were visited and found to contain their own personal TVs and access to music, as well as evidence of their hobbies and interests, providing a pleasant space to spend time on their own. The living room had a large flatscreen TV and was spacious and comfortable for those who wished to be with other residents and staff. One parent commented commented that their relative liked to people watch and this was the ideal place and had a lively atmosphere. One parent commented that they were pleased their relative was supported to have a daily walk which helped to maintain their mobility. Records of activities are kept on residents files including any activities of daily living they had participated in, for example helping in the kitchen, and outside activities such as attending sensory sessions at the leisure centre. A discussion took place about the activities arrangements on the day of the inspection when, due to a combination of factors, one resident was not able to take part in their usual activity. The manager said she would discuss this with staff as everyone knew that priority was given to ensuring residents had meaningful activities and were supported to follow their activities plan unless they actively chose not to. Family and friendship links are encouraged and staff were knowledgeable about residents family contacts; each resident has a list of important family dates at the front of their file. Three parents completed the service user surveys and many positive comments were made including Staff are meticulous with personal care and ...my parents are particularly pleased that I get a daily walk which is extremely important. Another parent stated they were pleased with the way the home addressed their relatives changing needs, and that activities were geared to specific needs and wishes. This parent noted that the home Liaise with parents and friends. One family noted therapeutic work and psychology services are not provided regularly. This was discussed with the assistant psychologist who said that residents may not necessarily be an active referral, but if new issues develop or more therapeutic work is needed, Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: then a new referral can be made, and this had now happened in the case of the resident whose family felt more input was needed. Residents are encouraged to be as independent as possible, and staff addressed residents respectfully throughout the inspection. There were no examples seen of staff speaking exclusively with eachother, and residents were seen to be included whenever they were present. Staff communicated well with residents, and in a variety of ways including using speech and sign language. Almost all staff at Fearnley House have done Makaton training. Residents have unrestricted access to the communal areas, except the kitchen where they need to be accompanied by a member of staff. Residents are consulted about menus and meals at Fearnley House and evidence of this was seen in the notes from residents monthly meetings. Lighter lunches are offered with the main meal in the evening. This home used to have a cook but since she left earlier in the year an extra member of staff is provided on shift so that one person is available to do the cooking. On the day of the inspection residents were offered three choices of light lunch, as per the menu. The menu was in a pictorial format on the board in the kitchen so residents could see what the options were. According to the up-dated training matrix forwarded to CQC following the inspection all but one staff member has had food handling and hygiene training, though some are due for a refresher course. Residents are weighed monthly and the manager could give a detailed account of the action being taken in regard to one resident with a fluctuating weight. Guidelines are in place on residents files in relation to any extra support that is needed relating to meals, for example special diets, or when food has to be cut up to avoid the risk of choking. Care Homes for Adults (18-65 years) Page 16 of 29 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. Service users receive personal support in the way they prefer and require, and their health needs are met. Arrangements for the safe administration of medication are satisfactory. Evidence: Two service user files were looked at in depth, including their care plans and arrangements for personal care. During the day, service users were seen to receive personal care in private, and an overview of residents preferences was noted on their care plan. Routines at the home appeared to be flexible to suit residents preferences. Each resident is encouraged to choose their own clothes etc and aids and equipment are provided to support independence, for example a shower chair and a chair for the bath, and all staff have had moving and handling training. Specialist advice is sought as needed and psychological assessments are offered to all Choice residents. Consistency of support is ensured by having a good liaison with family members, and good communication with individual residents; there is also a key worker system in place. A Recommendation is being made that the manager reviews the information about how each resident would like their personal support to
Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: be delivered to ensure there is sufficient detail available for staff. There were good records at the home relating to residents health needs, including notes on any referrals to specialists, and the outcomes. Residents are supported to attend appointments and the home has switched GPs and now have a better service which is able to give more specialist support to patients with learning disabilities. As noted earlier, all Choice residents are offered a psychological assessment and therapeutic interventions are arranged as necessary. On one file sampled it was clear that the staff and manager had pursued medical attention for a previously undiagnosed complaint and the resident was now receiving specialist support on this. Good comments were received from parents on surveys, including one who wrote (on behalf of their relative) I have needed to make several visits to the local GP and hospital, and both staff and medical professionals have treated me with sensitivity and consideration. Medication arrangements include a company policy and procedure, and the shift leader holds the keys to maintain security. The local GPs come to do an annual medication review and a health check for each resident. Staff who give medication are trained and also have competency assessments. Two staff give medication together, as one acts as a witness. One member of staff is responsible for ordering medication and stocktaking, and during the inspection one medication was checked against the previous stock take, and the correct number were found to be in the cabinet. Two medication records were sampled and there were no unexplained gaps. There are no Controlled drugs at the home. The manager was asked to follow up, as mentioned at the last inspection, about arranging advice and a visit from a local pharmacist regarding the medication arrangements at the home. The manager confirmed, before this report was released in draft, that the visit had been arranged for the coming week. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Services users complaints would be taken seriously and there are policies and procedures in place which should protect them from abuse. Evidence: The AQAA briefly outlined the complaints and safeguarding arrangements and noted, under planned improvements, that they could do more safeguarding training to ensure all staff are up to date. The AQAA also states that concerns and complaints are now included in the service user meetings. There is a complaints procedure in place including a pictorial version for service users Notes were sampled from service user meetings, and these did show that residents had been given the opportunity to raise any concerns. Residents files showed detailed guidance for staff about how to interpret various signs and mannerisms of residents, including specifically how they might express that they are unhappy. Observations in the home demonstrated that staff communicated well with residents and therefore would be likely to spot any concerns at an early stage. Of the four service user surveys returned to the Commission, two ticked they knew how to make a complaint, one ticked that they didnt know how to complain, and the fourth left it blank. There is a safeguarding adults policy in place at this home and on the up-dated
Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: training matrix, sent to the inspector on the day after the inspection, all staff had done safeguarding adults training, though two staff members would need a refresher course. The manager covered safeguarding adults as part of her NVQ Level 4 but had not attended a separate course and it was recommended she explore attending the course provided locally by Windsor and Maidenhead Council. A safeguarding adults matter was raised relating to a service user and has now been satisfactorily concluded. The manager and assistant psychologist were able to outline the changes they had put in place following this investigation. The issues relating to staff recruitment arrangements, which could impact on the safety of residents, are discussed under the section on Staffing. Care Homes for Adults (18-65 years) Page 20 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fearnley House offers a spacious, bright and homely environment , which is clean and pleasant throughout. Evidence: The AQAA outlines the arrangements for maintaining the environment which are satisfactory but states repairs could be quicker. It notes there are plans to improve some parts of the home including changing the bathroom to a wet room, and having a new kitchen. A tour of premises took place on the day of the inspection and included two bedrooms, a bathroom, the living/dining room, kitchen, office and summerhouse. The home was found to be spacious and bright, with colour co-ordinated soft furnishings and comfortable domestic style furniture and fittings. The manager confirmed that the main bathroom will be converted to a wet room in May, followed by work on the kitchen which is going to be completely renewed. Aids and adaptations are available to promote residents independence including for bathing and showering. The premises are in keeping with the local community and accessible to all service users. Bedrooms visited were personalised and comfortable and the home was clean and fresh throughout. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: There is a cleaning rota in place which is thorough and ensures that both day and night staff maintain the home to a high standard; staff sign to say when cleaning activities are completed. There were no unpleasant odours in any part of the building. There are good hand washing facilities throughout the home and antibacterial hand gel available for visitors and staff. The laundry was visited and found to be clean and had suitable facilities for laundering including a commercial washing machine and separate tumble dryer. The hand washing facility in the laundry is difficult to access and staff said they did not use it. This was highlighted to the manager for her attention. There were some concerns about the laundry in relation to health and safety and these are discussed under Standard 42 at the end of this report. Surveys received from service users showed that three had ticked Always in answer to the question about whether the home was fresh and clean; the fourth family did not use the tickboxes on the survey form, but neither did they make any negative comments about the environment or the cleanliness of the home, which they described as small and cosy. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by qualified and competent staff and there are good training arrangements in place. Recruitment procedures need further work to fully protect service users. Evidence: The AQAA states that NVQs completed or in progress have increased and during the inspection it was noted that out of 13 staff, 10 already have this qualification, which exceeds the minimum of 50 qualified staff recommended in the Standards. Staff observed and spoken with appeared to have the necessary qualities, and communicated well with residents, anticipating their needs. Behavioural support plans were being followed and staff were seen to be using the recommended techniques. There is a recruitment policy in place and two staff files were sampled during the inspection. Choice Ltd has an arrangement with CQC that recruitment records can be kept at head office and a proforma, confirming the correct checks have been made, is kept at the service. Of the two files sampled, both had been checked against the vulnerable adults list to ensure that they had not been deemed unsuitable to work with vulnerable people, and both had suitable references. One person had confirmation of a full employment history and full CRB plus evidence of their induction, and a training record.
Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The second person, who was new, had been given a start date without the full CRB being returned. Whilst Guidance allows this in exceptional circumstances, there did not appear to be any in this case, and the manager, who arrived in the afternoon, said there was no risk assessment. The service manager who joined the inspection for the feedback at the end said that Choice Ltd routinely started staff before the full CRB is back with other safeguards in place, such as a risk assessment. This will be highlighted to the CQC National Relationship Manager who liaises with Choice Ltd, as further discussions may be needed on this matter. A Recommendation will also be made to ensure their arrangements fit with Guidance on the CQC and CRB websites.The missing CRB did arrive at head office on the day of the inspection, and the manager said she would discuss with staff how they could have been deployed more appropriately on that morning. One person had two short gaps in their employment history and the manager said she would ensure these were followed up with the staff member and the records would be up-dated. There is a training and development plan in place and those staff spoken with said they had had the relevant training, e.g. those who administer medication had had relevant medication training. An up-dated training matrix, sent to CQC following the inspection showed that staff had had training in relevant areas including safeguarding adults, moving and handling, food handling and hygiene, and fire awareness. All staff had also had at least the introductory training in working with service users who may display challenging behaviours, SCIP (Strategies for Crisis Intervention and Prevention), and most had gone on to do the Foundation course. All but two staff have had Makaton training to help them communicate with those service users who prefer this method of interaction, and five staff have now had training in the mental illnesses which may affect people with learning disabilities. The manager was asked to keep staffing levels and staff deployment under review as there were some shortfalls on the day of the inspection, which have been discussed earlier under activities, and are noted later under health and safety. A number of positive comments were received about staff on surveys from parents, including: They provide ...the best care and support; Staff seem warm and caring; and one noted they were particularly impressed with the homes response to their relatives changing needs. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, and service users views are taken into account in the running of the home and in planning the service. Arrangements for maintaining health and safety should be kept under review to ensure risks to service users are minimised. Evidence: The AQAA states that the manager updates her own training, and she already has an NVQ 4 in care. She ensures staff have the relevant training, and that all health and safety regulations are met. This manager is new since the since last inspection. She has now been the manager for 18 months and is registered with CQC. She was on leave on the day of the inspection, but despite being a two hour drive away, came to Fearnley House and assisted with the inspection for the remainder of the day. She had a very positive attitude to the inspection process, and the few shortfalls that were identified were remedied by the manager as noted below. The home has a number of ways that it measures the quality of the service and
Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: receives feedback from service users. The AQAA states that there are service user meetings, key worker meetings, and annual reviews which are recorded in each persons preferred communication style. It also notes that quality assurance questionnaires are given to service users, families and staff, and the information is used for the annual development plan. Examples of changes made as a result of feedback included ensuring families are listened to and made to feel welcome, changing the meal times, and reviewing the menu. Audits are carried out on a regular basis, for example on medication and health and safety, and on an ad hoc basis, for example the AQAA states that head office carried out a day care audit. During the inspection the notes were sampled from the service user meetings. The manager and staff work hard to involve residents, and to make these occasions meaningful and enjoyable. The format and outcome were set out in a user friendly way to ensure maximum involvement from those service users who wished to take part. The AQAA states that there are a number of ways in which the home ensures health and safety regulations are met. For example records are kept relating to health and safety, fire checks and evaluations, and legionella. The company has a health and safety consortium, and there are six-monthly health and safety inspections. Staff had received relevant training, including fire awareness, health and safety, and correct moving and handling. However, on the day of the inspection there were some issues of concern relating to safety. To maintain confidentiality in relation to residents and staff, details were discussed with the manager but not included in this report. The manager confirmed to CQC the next day that these issues had been remedied, and that among other things, a new risk assessment relating to accessing the kitchen, and to the laundry, had been carried out and implemented. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 41 13 Arrangements for managing health and safety at this home must be reviewed. To minimise, as far as possible, risk of harm to residents. 12/05/2010 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 18 Guidelines on how to support people with personal care should be reviewed to ensure they contain sufficient detail about how that care should be delivered. The manager should review staffing levels, and the deployment of staff, to ensure service users quality of life is maximised. Recruitment arrangements should be reviewed to ensure they fit with the relevant Guidance from CQC, the CRB, and the Independent Safeguarding Authority. 2 33 3 34 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!