Inspection on 13/03/09 for Hoffmann Foundation for Autism 45a Langham Gardens

This is the latest available inspection report for this service, carried out on 13th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hoffmann Foundation for Autism... 28/06/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hoffmann Foundation for Autism 45a Langham Gardens 45a Langham Gardens Sudbury Court Estate Wembley Middlesex HA0 3RG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Schofield     Date: 1 7 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Hoffmann Foundation for Autism 45a Langham Gardens 45a Langham Gardens Sudbury Court Estate Wembley Middlesex HA0 3RG 02089089403 02089089403 LanghamGardens@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hoffmann Foundation for Autism care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 45a Langham Gardens is a registered care home for 6 adults with learning disabilities. Residents are accepted on a permanent or on a respite care basis. At the time of the inspection there were 4 residents accommodated in the home. 45a Langham Gardens is an extended semi-detached house in a quiet residential road close to East Lane. It is within walking distance of bus routes and there are 2 underground railway stations close by. The area to the front of the house has been paved over to provide off street parking and parking is available in the street. At the rear of the property is a garden with a lawn and decking area. Access to the garden is through the lounge or the conservatory. The property consists of ground, first and second floors. The ground Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home floor consists of a laundry, communal toilet, shower room, open plan kitchen and dining room, lounge and 3 single bedrooms (1 of which has access to the garden). There is a lift that connects the ground and first floor. On the first floor there are three single bedrooms, a dining room, a lounge, a bathroom (including toilet) and a medication room. The office, which includes a sleeping in facility for staff members, and a shower room (including toilet) are on the second floor. Information regarding the fees charged for the service may be obtained, on request, from the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 33 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: The inspection took place over 2 days in March 2009. Two visits were made to the home. The first visit was made on the 13th March when the deputy manager was on duty. We returned on the 17th March when the manager was on duty. During the inspection we spoke with members of staff. We met and spoke with the residents. Records were examined and the care of residents was case tracked. With the permission of residents a tour of the building took place. We sent survey forms to residents, members of staff, health care professionals and stakeholders and at the time of writing the report we had received replies from 2 health care professionals and from 6 members of staff. We would like to thank everyone for their assistance and for their comments during the Care Homes for Adults (18-65 years) Page 6 of 33 inspection. What the care home does well: What has improved since the last inspection? What they could do better: During the inspection 8 statutory requirements have been identified. The savings account book for one resident needs the names of signatories updating so that withdrawals can be made. Redecoration is needed in communal areas and residents bedrooms to improve the environment and also the interior of the conservatory needs some finishing. Items being stored near a stairwell need removing as they are a hazard. The temperature in the medication room must be monitored to ensure that action is taken if it exceeds the recommended temperature for the safe storage of Care Homes for Adults (18-65 years) Page 8 of 33 medication. The recruitment process needs to be thorough so that 2 satisfactory references are on file to demonstrate that suitable applicants have been appointed. Staff files must also contain training certificates so that the need for specific training and the need for refresher training is identified. The certificate for the inspection of the electrical installation must be forwarded to the CQC so that the home can demonstrate that systems are in good working order. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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. A comprehensive assessment of the needs of the resident, prior to admission to the home for respite care, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. Evidence: The residents living in the care home at the time of the inspection had been present during the last key inspection. However, residents have been admitted during the period between inspections for respite care placements and we looked at the case file of one person that has had several respite care placements. We saw that the case file contained a Care Plan drawn up by the funding authority, support guidelines for carers working with the resident, a medical history, manual handling risk assessment, important information about the medication being taken because of seizures and a care plan drawn up by the Hoffmann Foundation for Autism. The manager confirmed that prior to the start of respite care placements the resident had visited the care home on 2 occasions and had been accompanied by their care Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: manager from the funding authority and by a college worker. This gave the resident the opportunity to meet the existing residents and the members of staff, to view the accommodation and to decide whether they would like to stay in the care home for respite care. The pre admission process had included an assessment carried out by the psychology manager employed by the Hoffmann Foundation for Autism to determine whether the care home could provide a service that would meet the needs of the prospective resident. Care Homes for Adults (18-65 years) Page 12 of 33 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. Comprehensive care plans, reviewed on a regular basis, assure residents that the home will continues to meet their changing needs. Residents have the opportunity to exercise choice in their daily lives. Responsible risk taking contributes towards the resident leading an independent lifestyle. Evidence: Two case files were examined. Each file contained a needs assessment, a diagnostic assessment and a support plan. The plan identifies needs and sets out how these will be met. There is also a care plan and a Personal Planning Booklet (PPB). The PPB is in a user friendly format. The home has a system of evaluating progress towards meeting targets. This is carried out on a monthly basis and the last report was dated February in one file and January in another. The manager said that the funding authority had reviewed the placement of each of the permanent residents in February 2009, and had just received copies of the minutes of the meeting. Relatives of residents are invited to attend review meetings, to support the residents, if the residents wish. The home also Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: holds internal review meetings on a regular basis. We noted that each file contained a copy of a completed Deprivation of Liberty Scoping Form that the home had sent to the local authority. When asked on the survey form members of staff ticked that they were always given up to date information about the needs of the residents they supported. One member of staff commented that any changes regarding the resident are added to the care plan so that members of staff can give the right care. One survey form contained a comment on the importance of following the guidelines when supporting residents. It was noted that residents are encouraged to make decisions about their day-to-day lives although none of the residents are able to independently manage their finances and the financial records of the 2 residents that were case tracked were examined. A change is needed to the names on the account belonging to one of the residents as one of the people named has now left the company and there is a system of loaning money to the resident until this matter is resolved. Records for the other resident included record sheets and included details of income and expenditure and the running total after transactions. Residents have a savings account in his or her own name. Residents exercise choice and examples given included what clothes the residents wear, what they eat, whether they take part in activities, whether they socialise with other residents and what time they go to bed at night and get up in the morning. Case files contained risk assessments tailored to the individual needs of the resident. Risk assessments included using facilities in the community and going on holiday. Risk assessments are reviewed on a regular basis and this is usually when the care plan is reviewed. Risk assessments include an identification of the risk setting, the risk factors, frequency of occurrence and measures to minimise the risk (risk management strategies). Care Homes for Adults (18-65 years) Page 14 of 33 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. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships. Residents are encouraged to make decisions and their wishes are respected. Residents are offered a varied and wholesome diet. Evidence: Since the last inspection the 3 residents that had been attending a day centre have stopped attending due to the closure of the centre. All of the 4 residents now have the a day care programme developed by the home. We discussed these with the deputy manager. Three residents have programmes that include activities taking place inside the home and in the community. The fourth resident is reluctant to take part in activities outside the home, although the members of staff on duty continue to Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: encourage the resident to go out for a walk when the weather permits. Activities arranged include shopping, having a meal out, going to a tea dance, swimming and an art class. A person comes into the home to offer massage sessions. There is also a karaoke session held in the care home on a monthly basis. It was noted during the inspection that residents made use of services and facilities in the community including shops, pubs, restaurants, the cinema and leisure centres. The care home is able to provide residents with transport as the home has a mini van. Residents also use taxis, dial a ride and public transport. However, the manager and a part time support worker are the only approved drivers for the home. There was a record on the case files that residents names have been entered on the electoral roll. There are board games for residents to use while they are at home and one of the residents has their own computer. Three of the residents went on holiday to Spain for a week in January this year and the manager said that they were going to arrange a holiday for the fourth resident that preferred a more quiet environment, if they wished to travel. a resident told us that they had enjoyed the holiday in Spain and that while they were there they had been swimming. Outings have not taken place since summer 2008. Residents enjoy varying levels of contact with their relatives and the home supports residents to maintain these links. Some relatives keep in touch with the home by telephone or email for an update on the welfare of the resident. Plans have been made for three of the residents to meet their family in the summer when the resident is on holiday, near by. They will be supported by members of staff. This continues a practice of enabling residents to see members of their family that are unable to visit the home. However, some residents have received visits from their relatives and relatives are invited to attend birthday parties and celebrations that take place at Langham Gardens. If a resident receives a visitor they can entertain them in their room or in one of the lounge areas, without intruding on the privacy of other residents. It was noted that residents privacy is respected and that members of staff knock on bedroom doors, waiting to be invited in where appropriate, before entering. The residents right to choose to be on their own is respected and we saw that residents moved between their personal space and the communal areas, as they wished. Residents are encouraged to take part in the day to day routine in the home and on the day of the inspection a resident helped with the food shopping for the home. With support from a member of staff, and according to the ability of the resident, they may help with their laundry, set and clear the table, load the dishwasher, keep their room tidy and make a drink. They are also involved in menu planning. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Menu sheets were available and they demonstrated a varied and wholesome diet. The home has a 6 week rolling menu which is due to be reviewed soon. One of the residents follows a gluten free diet. The home has received advice from the dietician regarding what the resident can and cant eat and members of staff are aware of how to adapt meals on the menu to make them suitable. If the resident does not like or want the meal on the menu, or any part of the meal, an alternative is served. Records are kept of what residents consume. Residents have access to fresh fruit. Residents said that they liked the meals served in the home and one of the residents said that the members of staff were good cooks. Care Homes for Adults (18-65 years) Page 17 of 33 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. Residents receive assistance with or prompting with personal care in a manner, which respects their dignity. Residents health care needs are met through access to health care services in the community. Residents general health and well being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the residents GP. Evidence: It was noted during the inspection that assistance with personal care was offered discreetly and took place in private. The level of assistance varies and is according to the individual needs of the resident. The deputy manager said that it was important to speak to the resident before offering assistance so that the resident was comfortable with what was happening. He also confirmed that a female member of staff provides assistance to female residents. We saw that residents were clean and tidy and noted that advice was given in a friendly and helpful manner about dressing appropriately for the weather conditions. There was evidence on case files of access to health care facilities in the community. Residents had appointments with the GP. There were records of appointments with the chiropodist, psychiatrist, dentist and optician. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Specialist support was requested when needed and included support from the physiotherapist and the Speech and Language therapist. Residents were able to have flu jab, if they wished. Residents were supported to attend out patient appointments and these included appointments at the rheumatology and gastroenterology clinics. Training is provided to staff in respect of epilepsy. Case files included comprehensive information about the residents medical history. It was noted that medication was stored in a locked room. However, the room appeared to be warm and when the thermometer was checked the temperature was around 25 degrees Celsius. The room did not have a window. The home uses a system of weekly dosette boxes, supplied by the pharmacist, and the compartments that were empty corresponded with the time of day and the day of the week that the inspection took place. Medication records were inspected and were up to date. Medication training forms part of the calendar of mandatory training for members of staff in 2009. One of the health care professionals that completed a survey form ticked that the home always seeks advice and acts on it to manage and improve the residents health care needs. They also ticked that the service always supports individuals to administer their own medication or manage it correctly, where this is not possible. Both people completing the survey form agreed that the residents health care needs are met by the service and that the residents privacy and dignity were respected. When members of staff were asked on the survey form about meeting the individual needs of residents one person added that if they have a problem they can seek advice from the company psychologists about how best to support a resident and that the psychologists keep in touch to follow up how things are working. Care Homes for Adults (18-65 years) Page 19 of 33 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. A complaints procedure is in place to protect the rights of the residents. An adult protection procedure and training in protection of vulnerable adults procedures help to promote and protect the welfare and safety of residents. Evidence: The home has a complaints procedure in place, which has timescales for each stage of the process. If a complaint cannot be resolved locally a senior manager within the company deals with the complaint. The policy advises the complainant of their right to contact other agencies that are involved in the process and names the CSCI, the local authority and the Ombudsman. The manager said that no complaints have been recorded since the one that was made known to the CSCI in August 2008. A visitor to the home had raised concerns regarding the condition of a room used for respite care. When we carried out a random inspection we were satisfied that the minor problems had been dealt with appropriately and that the room was now suitable to be used. One of the health care professionals that completed a survey form ticked that the service has always responded appropriately if they had raised concerns. The members of staff that completed a survey form all ticked that they knew what to do if a resident, relative or advocate had concerns about the home. A resident said that they would tell someone if they were unhappy. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: The home has an adult protection procedure in place and has a copy of interagency guidelines, which are produced by the local authority. In the office a copy of the portection of vulnerable adults leaflet is on diplay. Induction training held at head office includes protection of vulnerable adults training. Staff on duty confirmed that they had received protection of vulnerable adults training and were confident when discussing how they would deal with an incident of abuse. When we looked at a sampled staff files we saw that attendance certificates for adult protection training were kept on file and that there was evidence that this training was refreshed on a regular basis. The manager said that no incidents or allegations have occurred since the previous inspection. She confirmed that restraint is not practiced in the home. There are policies and procedures for supporting residents that are showing signs of aggression towards members of staff and other residents. Care Homes for Adults (18-65 years) Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a well furnished and homely environment although some redecoration is needed. Single bedrooms provide residents with privacy and a room in which to relax. Residents live in a home where standards of cleanliness are good. Evidence: During the inspection a site visit took place. The home is situated in a quiet residential road with transport facilities close by. Inside, the house was comfortably furnished and the standard of upkeep was good although some redecoration is needed in communal areas and in some of the bedrooms. We discussed the use of the conservatory with the manager. Since the last inspection they have tried to attach a special film to the glass panels of the roof so that a suitable temperature can be maintained during the summer. The film has become detached from most panels so the home is now getting quotes for ceiling blinds. Some finishing off is required in the conservatory as there are free standing breeze blocks on the floor below the windows. There are 3 single bedrooms on the ground floor. Two of these rooms are close to the lounge and have a bathroom in between. These rooms are used when respite care clients are accommodated. One of these rooms is suitable if a resident uses a wheelchair. The third bedroom on the ground floor is used by a resident that has Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: problems with mobility. Ground floor facilities are accessible to all residents and there is level access to the property. Recent modifications to the porch area and inner door have facilitated this. Within the home each resident has their own single bedroom. Four of the bedrooms have ensuite facilities. We noted that there were bags of what appeared to be bedding items stored on the top landing, adjacent to the staircase. The manager said that when members of staff carry out sleeping in duties they use their own bedding and that duvets and pillows are left in the home while sheets and pillow cases are taken away to be laundered. All areas in the home were clean and tidy and the building was free from any offensive odours. There is a laundry room on the ground floor. The washing machine has a sluicing facility. Members of staff have received food hygiene and infection control training. Care Homes for Adults (18-65 years) Page 23 of 33 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. A programme of NVQ training for members of staff assures residents that care practices are based on an understanding of the residents needs. Staffing levels in the home assure residents that there are sufficient members of staff on duty each day to support the residents and to meet their needs. Recruitment practices promote the welfare of residents. Residents benefit from support given by members of staff that are skilled and trained. Evidence: We looked at a copy of the staffing rota and noted the names of people working in the care home, both on a permanent basis and through the care bank. We discussed whether they were studying for or had completed an NVQ qualification. The deputy manager confirmed that of the 16 support workers, 2 have completed an NVQ level 3, 1 is studying for a level 3 and 7 have completed a level 2 qualification. A newer member of staff told us that they are being enrolled on an NVQ level 2 course. The deputy manager confirmed that he had completed his level 4 qualification. The home has met the target of a minimum of 50 per cent of support workers achieving an NVQ level 2 or 3 qualification. We discussed staffing levels and saw that there were a large number of staff working Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: at Langham Gardens that are placed there through the companys care bank. Of the 16 members of staff on the rota only 6 were employed on a permanent basis. The manager explained that 2 of the 6 beds in the home were vacant. When these vacancies are filled recruitment will take place for permanent staff. At the time of the inspection, when 4 permanent residents were living in the home, there were 2 support workers on duty during the day and at night there is one member of staff on waking night duties and 1 member of staff on sleeping in duties. This was sufficient to meet their needs. When residents are admitted on a respite care basis the manager said that staffing levels are increased, according to the individual needs of the resident receiving respite care. When asked on the survey form about staffing levels in the home 2 members of staff said that there always enough staff to meet the individual needs of the residents, 3 ticked usually and 1 person ticked sometimes. It is recommended that staffing levels are reviewed to assess their sufficiency both when respite care residents are living in the home and when only permanent residents are there. Three staff files were examined. It was noted that each file contained an application form. The application form included a health declaration and a declaration in respect of any cautions or convictions that the applicant may have. Two of the files contained 2 satisfactory references but the third file only contained 1 satisfactory reference. This member of staff had previously been a bank worker and the manager confirmed that 2 further references are held at head office. Each file contained evidence of an enhanced CRB disclosure being obtained. Files contained photographic evidence of the identity of the member of staff, which were passport details. Where necessary, files also contained evidence of right to reside and to work in the UK. Staff files contained an induction checklist and attendance certificates for training courses attended. However, some attendance certificates were not on file although there was other evidence of members of staff attending training courses. A programme of training has been arranged for staff to enable them to support the residents. The programme includes mandatory training including autism, first aid, medication and person centred planning. There are also courses that are linked to the individual needs of the residents including epilepsy, communication techniques and challenging behaviour. The home has a training budget, which can be used to purchase external training. A record is kept of when training is undertaken so that the need for refresher training can be monitored. The company sends out an annual list of the most recent date for the training courses attended by each member of staff so that the home can check the training record of members of staff working in the home on a care bank basis. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: When asked on the survey form whether their induction covered everything they needed to know to do the job when they started 3 members of staff ticked very well and 3 members of staff ticked mostly. It is recommended that after completing induction training the content of the course is reviewed with the new member of staff to determine whether there are any areas that may not have been covered. All of the members of staff that completed a survey form agreed that they receive training that is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. Two of the members of staff commented that they would like more training. Care Homes for Adults (18-65 years) Page 26 of 33 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 manager demonstrates her competence and commitment to a quality service by continuing to develop her understanding, skills and knowledge through further training. Systems are in place to gather feedback on the quality of the service provided to enable the service to develop in ways that meet the changing needs of the residents. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Evidence: Prior to becoming the manager of Langham Gardens the manager had worked as a deputy manager and as a manager in other Hoffmann Foundation for Autism care homes for approximately 3 years. She holds an NVQ level 4 qualification, after completing this course in June 2008. Since the last inspection she has undertaken a number of short training courses including Mental Capacity Act training and updates for Autism, health and safety and epilepsy. She is supported by a deputy manager that Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: has completed his NVQ level 4 training. When asked on the survey form whether the manager met with members of staff to give them support and to discuss how the member of staff was working 4 people ticked regularly and 2 people ticked often. Examples given of when this happened included during supervision, team meetings and one off conversations. We discussed quality assurance systems in place both within the home and within the company with the manager and with the deputy manager. This is a relatively small home, accommodating a maximum of 6 residents, and family contact with the current permanent residents is limited. However, residents are encouraged to give feedback on the quality of the care received during discussion with their key worker, during residents meetings and on a day to day basis to the manager or to members of staff on duty. Their views and the views of the funding authority are also sort when review meetings are held. Family members are able to give feedback during review meetings or when they visit Langham Gardens. A member of staff from Langham Gardens represents the members of staff working in the care home at a staff consultation meeting that is held at the companys head office. In addition the company sends out a quality assurance questionnaire to stake holders and the manager said that questionnaires had been sent out recently to the families of residents that had stayed in the home on a respite care basis. A representative of the company carries out the Regulation 26 visits to the home and a copy of the report of the last visit was available. The visit took place on the 11th March. The person conducting the visit speaks with members of staff and also talks with residents. There was evidence that the fire alarm system was tested on a weekly basis and that fire drills were carried out on a regular basis and the records of these were up to date. Valid certificates were available for the servicing/checking of the fire alarm system and emergency lighting, the fire extinguishers, the lift, the portable electrical appliances and the landlords gas safety record. We noted that the certificate for the checking of the electrical installation had expired in August 2008. There were recorded risk assessments for all safe working practice topics. Staff on duty confirmed that they had undertaken training in safe working practice topics i.e. first aid, fire safety, infection control, manual handling and food hygiene. We saw that attendance certificates for these training courses were kept on staff files. There was evidence that the training was refreshed at regular intervals. A copy of a valid employers liability insurance certificate was on display in the office. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 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 7 12 The names recorded on the account book belonging to a resident needs updating as one of the 2 people listed has left the company. To enable the resident to have access to their account and for withdrawals to be made. 01/06/2009 2 20 13 Arrangements must be made to ensure that the temperature in the medication room does not exceed 25 degrees Celsius This will ensure that medication is stored according to the guidance that accompanies the medication. 01/05/2009 3 24 23 The wall underneath the 01/08/2009 windows of the conservatory must be finished off. This will enhance the overall appearance of the inside of the conservatory. Care Homes for Adults (18-65 years) Page 30 of 33 4 24 23 Redecoration in the communal areas and in some of the bedrooms is needed where paintwork is scratched, scuffed, chipped or marked. This will enable residents to enjoy surroundings that are in a good state of decoration. 01/08/2009 5 30 13 Bags containing items of bedding currently stored on the landing adjacent to a stairwell need to be moved to a safe place. This will ensure that hazards to the health and safety of everyone living, working and visiting the home are minimised. 20/04/2009 6 35 35 After completing a training course a copy of the certificate of attendance must be placed on the member of staffs file. This will enable the home to maintain up to date and readily accessible training records that can be used when monitoring the need for further training. 01/05/2009 7 42 13 When the checking of the electrical installation is carried out a copy of the certificate must be forwarded to the CQC. 01/08/2009 Care Homes for Adults (18-65 years) Page 31 of 33 This will enable the home to demonstrate that servicing and checking is carried out at the required intervals. 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 2 6 13 That the monthly evaluation of the care plan is kept up to date. That the number of people authorised to drive the company vehicle increases to give more flexibility regarding the timing of activities outside the home. That a programme of outings to take place in 2009 is drawn up, with the help of residents, and is implemented. That staffing levels are reviewed to assess their sufficiency both when respite care residents are living in the home and when only permanent residents are there. That after completing induction training the content of the course is reviewed with the new member of staff to determine whether there are any areas that may not have been covered. 3 4 14 33 5 35 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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