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Inspection on 26/01/10 for Hunters Green

Also see our care home review for Hunters Green for more information

This is the latest available inspection report for this service, carried out on 26th January 2010.

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

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

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

What the care home does well

The manager at Hunters Green has a commitment, empathy and a caring approach in wishing to provide a good quality service at the home, ensuring that individuals, their relatives and staff are consulted. The manager and her staff team know people who live at the home well and have been supporting them for a number of years providing consistency and continuity of care. There are clear lines of accountability within the home. The manager has ensured that no individual is admitted into the home unless there has been a full assessment of their needs and that the home is confident that it is able to support them and meet their needs. The home is comfortable, homely and generally well maintained. The house is well furnished and those living at the home have personalised their rooms. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individual`s needs and the service is tailored accordingly.

What has improved since the last inspection?

The home has ensured that unnecessary risks to the health and safety of those who live at Hunters Green are identified and so far as possible eliminated. Since our last visit to the service undertaken by us in March 2007 the home completed a full range of risk assessments as appropriate in respect of a service user who had recently moved into the home. Staff have received training appropriate to the work performed, such as training in safe moving and handling, the manager confirmed to us that training in respect of first aid for staff had been arranged for February 2010.

What the care home could do better:

No requirements were made as a result of this visit to the service.

Key inspection report Care homes for adults (18-65 years) Name: Address: Hunters Green 12 Crifty Craft Lane Churchdown Gloucester Gloucestershire GL3 2LH     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: Odette Coveney     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Hunters Green 12 Crifty Craft Lane Churchdown Gloucester Gloucestershire GL3 2LH 01452859096 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.brandontrust.org The Brandon Trust care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number service users who can be accommodated is 4. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender 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 Hunters Green is a bungalow in a quiet residential area of Churchdown, Gloucestershire. The home provides care and accommodation for up to four service users with learning and physical disabilities. Service users are accommodated in single bedrooms. There is a lounge, dining room and adapted bathroom. The home also has a sensory room. A specialised vehicle is available for transportation. Prospective service users and people involved in their care are offered information Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 4 Brief description of the care home about the service including copies of the Statement of Purpose and Service Users Guide. Up to date information about fees was not obtained during this inspection. Care Homes for Adults (18-65 years) Page 5 of 31 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 inspection took place in January 2010 by one inspector and involved two visits to the home on 26th and 28th January. The manager was present briefly on the first visit and for all of the the second visit. Time was spent informally observing and listening to the care being provided to all people living in the home and talking to two members of staff. People living in the home have complex needs. All people have a physical disability and learning disability. They have complex communication needs and so time was spent observing them and their interactions with staff and others in the home. The manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing some information about the service and plans for further improvement. It also provided numerical information about the service (Dataset). Care Homes for Adults (18-65 years) Page 6 of 31 A selection of records were examined including care plans, medication records, health action plans, risk assessments, staff files, fire records and health and safety systems. A walk around the environment was also conducted. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? 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 8 of 31 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 9 of 31 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. People move into the home with enough information about the services and faciltities provided at Hunters Green in order to help them make this decision. As part of the pre admission process staff become aware of what support people need so that this can be successfully given once they are admitted. Contracts are in place, these provide clear information about the terms and conditions of the placement. Evidence: Hunters Green provides a service for four people. All of the people who live at the home have a high level of complex support needs, which include physical disability, learning disability and people who are not able to use verbal language in order to communicate with others. There are currently four ladies living at the home, all of whom have lived at the home for sometime. There are currently no vacancies at the home. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: At this visit we reviewed the homes Statement of Purpose, within this we saw that there was a photograph of the outside of the house. Information was provided within this document in order to inform people about the staffing structure within the home as well as the structure of the organisation. This provides people with an understanding of the size of the service and the organisation who it is responsible to. The document provides information about the range of needs the home is intended to meet in order that people can decide if the home is suitable for them. The Statement of Purpose also provides some other information that people may be interested in, in respect of the homes complaints and fire policy and some other associated procedures. At this visit we also reviewed the homes service users guide. This document has been produced in order to provide prospective residents into the home with information about the services and facilities that are provided. This document made good use of photographs and some pictures and symbols in order to assist people who may not be able to read. These aids provide people with a visual prompt about what was available at Hunters Green. We found that this document had not been reviewed since 2006 and it was clear that this was needed as some of the information contained within it was out of date, for example; The home has a new mini bus for the residents, however, a photograph within the guide was of the old bus. We also found that within the guide it informs people how they can raise issues of concern or complaint and directs them to the National Care Standards Commission (now known as The Care Quality Commission (CQC) and to an office for The Commission is located in Brockworth, which no longer exists. A review of the Service users guide is recommend. Within the service users guide and within individuals files we saw that agreements had been developed. These had been produced in a pictorial format and outlined the terms and conditions of the placement, these were in place for all residents and contained details which pertained to individuals placements at Hunters Green. We saw that there is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the Statement of Purpose and full assessments of needs were undertaken for those who live at the home. We reported within our last inspection report that the organisations admission policy was in need of review. At this visit we found that the policy was dated 2000, with no review. The manager informed us that she had raised this with her senior manager yet no action has yet been taken. It is recommended by us that The Brandon Trust should review its admission policy to ensure it is relevant and in line with current good practice and individuals Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: expectations. Within individuals care files we saw that the home had in place a comprehensive care management assessment in order to make a decision on whether the home and the skills of the staff team are able to meet the individuals needs. We also saw that the home had developed comprehensive care plans, that had been based in the homes initial pre admission assessment and also through information obtained through observation, building a relationship and getting to know people, their likes, dislikes and choices since their admission into the home. Within the completed Annual Quality Assurance Assessment (AQAA), that had been completed by the home and returned to us prior to our visit, the home had recorded that its plans for improvement for the forthcoming twelve months are; To review the service users guide to give a greater understanding to future individuals who may wish to be a resident at Hunters Green. Care Homes for Adults (18-65 years) Page 12 of 31 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. There are systems in place to effectively plan peoples care in a way that recognises their preferences and right to privacy and dignity. Evidence: It was very evident from talking with staff and the observation of individuals living in the home that people receiving a care service at Hunters Green can choose when to get up and retire to bed. On both of the days we visited there were people who were being assisted to get dressed and supported with their personal care, this was done at a time and pace suited to them and within their preferred routine. Staff work well to ensure that the service provided is tailored around the individual needs of those who live there and that the people who live at the home come first. We observed staff sitting with individuals and supporting them in a caring manner, supporting them with their breakfast, making sure that people were comfortable and at ease. During our time at the home we observed how people were supported within their Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: daily life at the home. We saw staff engaging with people at a manner and pace that was suitable to the individual in order to promote communication. It was clear that staff know the people who live at the home well and assistance given is at the level, pace and manner preferred by the individual. Staff were seen to be attentive and very supportive with a genuine caring, warm approach. We noticed that staff spoke to people in a very polite manner. We observed staff knocking on bedroom doors before entering and any personal care was carried out behind closed doors, thus maintaining peoples privacy. We did not witness any personal care being delivered so cannot comment on how privacy and dignity is actually maintained during the time that someones care is being delivered, although we did see that individual preferences in this area were being acknowledged within the care planning. For example the planning for life documents provided clear guidance for staff on how people wished to be supported with many aspects of their life such as care to be given with personal support, managing health needs, encouraging choice and decision making processes as well as practical information such as maintaining a safe environment and management of individuals finances. we saw that the home completes a monthly summary, this report captures all of the events and information pertaining to the individual for the previous four weeks, these reports were well written and included information about how people have been within themselves in areas such as their health, communication and social interaction. We did note that care files contained a great deal of information, some of which was out dated and no longer required. We would recommend that the home completes an audit of the care files and removes any unnecessary, un required information in order that the contents of each file are up to date and reflect the support given. During our last visit to the service that was undertaken in March 2007 a requirement was made by us that the home must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The purpose of this was in order for the home to undertake risk assessments as appropriate in respect of the service user who had most recently moved in. At this visit we looked at the care files for two of the people who live at the home in depth, for the others we sampled and reviewed certain areas of the files including risk assessments. We found that assessments were in place, these contained sufficient information and had been kept under review. The assessments covered areas such as; access to the garden, risks of choking and the use of aids and equipment. Risks are evaluated every three/six months and staff make up a decision making group whereby overall objectives and sub goal objectives are discussed, within these assessments it is recorded if the client is capable of expressing an opinion in achieving the goals. What steps are taken to Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: minimise risks are also recorded. We found that the requirement which had been set at our previous key visit to the service had been met. We saw that in the front of each care file there was a Residents record keeping statement. This reminded staff of their responsibly in respect of confidentiality and respecting the rights of people in their care to access their own records. individuals rights and privacy, these are underpinned by the homes policies and procedures in this area. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home they had recorded that their plans for improvement for the forthcoming twelve months are; To improve electronic documentation of care plans in order for those who live at the home to have ownership of these documents. Care Homes for Adults (18-65 years) Page 15 of 31 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. Those living at Hunters Green are enabled to maintain contact with families, friends and local communities. Choices are provided to people in respect of meals and mealtimes. The home provides those who live there with structured and meaningful activities both inside and out of the home and people are able to choose whether they wish to participate or not. Evidence: Due to the good staffing levels at the home the routines of daily living and activities are flexible and varied to suit the expectations, preferences and abilities of individuals. At our last visit to the service in March 2007 a recommendation was made by us for the home to consider whether it may be beneficial to those who live at the home to Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: obtain a replacement vehicle which is able to carry more than one wheelchair at a time. At this visit we were pleased to find that the home has recently gained a new vehicle to support the residents in the community, the design of the new vehicle allows more flexibility and ease of access for residents. The home has two pet house cats these also provide residents with the opportunity for interaction within their own home. Information within individuals monthly summarys and information seen in care plans and daily records show that all individuals at the home have been supported to participate in a variety of social and leisure activities based on their abilities and choices. Recorded in notes was evidence that individuals receive one to one support to attend reflexology, go shopping, swimming, holiday, hydrotherapy, go out with family, visiting the pub and meals out. The home has its own snoozlen area which is located within a converted garage, this area has appropriate lighting and stimulus for people to relax and enjoy. The kitchen was seen to be clean and tidy. Many of the meals at the home are home made. During this visit we saw that individuals likes and dislikes were well recorded and at breakfast individuals had a different meal based on their preferences. At our last visit to the service in March 2007 we recommended that the home takes forward plans to create a pictorial menu, we saw that since our last visit these had been implemented, providing an additional tool in which to aid communication with those who live at the home. Within the completed Annual Quality Assurance Assessment (AQAA), which had been completed by the home they had recorded that their plans for improvement for the forthcoming twelve months are; To encourage greater neighbourly relationships within the community. Care Homes for Adults (18-65 years) Page 17 of 31 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. Individuals receive the support they prefer with individuals physical and emotional needs being well met. Systems of medication administration, recording and storage are well managed. Evidence: Information seen in care records, interactions observed between staff and those who live at the home, information seen by us which had been recorded in daily records and risk assessments showed us that clear guidance and support regarding personal hygiene and care is given when required and at a level and pace appropriate to the individual concerned. At our last visit to the service it was recommended by us that the home keeps existing health action plans under review. At this visit we found that health action plans were in place for all individuals, these were comprehensive and outlined staff responsibilities in specific areas such as record keeping and review of health needs and appointments, these plans evidenced that individuals are supported well in aspects of both their physical and emotional care. The plans are kept under review Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: and are updated as and when needed. People living in the home are registered with a local doctors practice. Other specialist services are accessed for people when is has been identified for areas of their heath such as speech and eating therapists and continence care. From discussions with the manager and information seen in care records it was evident that people at the home are supported to attend health appointments and records are completed after each visit. This ensures a consistent approach to meeting individual needs. We spoke to a member of staff about their role and responsibility in respect of medication practices within the home, they were able to speak with confidence and were able to demonstrate a sound understanding of the importance of safe administration and recording of medications. Medicines are supplied to the home using a weekly blister pack system. All the medicines used in the home are given by staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines were given from the labelled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. Within the completed Annual Quality Assurance Assessment (AQAA) which had been completed by the home they had recorded what their improvement over the previous twelve months had been, these were/are; We are currently in the process of reviewing the residents health action plan formats and ensuring that information re emergency hospital admissions is readily available if required to support a resident in an emergency hospital admission. We have reviewed our documentation regarding residents consent and best interest wishes to respond to new legislation. Care Homes for Adults (18-65 years) Page 19 of 31 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. People live in a home where the homes staff are aware of the policies and procedures that help prevent abuse and where the manager and staff have received updated information on peoples rights. Evidence: The Home has appropriate procedures in place for the management of complaints. The home has a complaints policy and procedure. These documents contains information about how people can raise concerns within the home and also within the organisation. This is to enable individuals to contact the appropriate people if they were not satisfied with the outcome of their complaint to the home. The home has in place a complaints logbook and it was seen that issues have been dealt with effectively and fairly. There is a copy of the Gloucestershires Councils policy on The Protection of Safeguarding Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included two satisfactory references, record of previous employment, and satisfactory Criminal Record Bureau disclosures. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who live at the home had been reported to the Commission. Care Homes for Adults (18-65 years) Page 21 of 31 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. People benefit from living in a home that can be adapted for their needs and which is comfortable, clean and safe. Evidence: Hunters Green is located in a semi rural area of Churchdown in Gloucester. The house is a large bungalow with parking to the front of the home and gardens for residents use to the side of the house, gardens are accessible to those who live at Hunters Green. The home is very domestic in style and gives the impression of being a comfortable place to live. The two main communal rooms and entrance hall are large with plenty of natural light. The lounge and the dining room allow people to relax and look out to the neighborhood and views across the hills. Within these rooms we saw photographs and pictures. Carpets and furnishings were of a good quality. With the permission of those who live at Hunters Green we were able to view all of the bedrooms. We could see that people had been encouraged to bring some of their favorite pieces of furniture and other cherished belongings with them. Where this has been done and rooms have been personalised, they have been made to look very attractive and homely. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: There are adaptations in place throughout the Home and specialist equipment including hoists, bathing aids, mobility aids, sensory aids and bed rails. All equipment is serviced and checked for safety as required in order that it is fit for use. Toilets are situated in readily accessible parts of the home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimise risk from cross infection in the home. The home was found to be clean, tidy and odour free in those areas viewed by us. At our last visit to the service some recommendations were made in respect of the environment, these were that the extractor fan/vent in the toilet to be cleaned, it was seen to be clean by us at this visit. Also that the home should replace the broken knobs on some of the furniture in the lounge, these were all seen to be in place during our visit. The remaining recommendation was the the home should progress and make the car park more even, this has not taken place and this element of the recommendation remains. the manager informed us that a risk assessment was completed which concluded that those who live at the home should access the homes vehicle from the main road, this is not acceptable and further consideration to this should be given by the organisation. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home it had recorded that its plans for improvement for the forthcoming twelve months are; The homes internal decoration requires refreshing and requests have been made to the housing association. We would comment that whilst decor in the home was of an acceptable standard the house and those who live at the home would benefit from some redecoration for those who live at the home. Care Homes for Adults (18-65 years) Page 23 of 31 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. Those who live at Hunters Green can have confidence in the staff that care for them. All staff are clear regarding their role and what is expected of them. Recruitment practices safeguard individuals who live at the home. Evidence: During the time we spent at the home there was a friendly and interactive atmosphere. Individuals looked well cared for and were noted to appear relaxed and at ease in their home. Staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individuals. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective communicators and were interested and motivated in meeting the needs of those living at the home. At this visit the staff records for three staff members were fully reviewed and two staff members, a volunteer at the home and the manager were spoken with as part of the inspection process. Staff spoke with a sound understanding of the diverse and individualised needs of those within their care, staff provided good examples of Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: effective relationships with those who live at th home and the positive impact that this has for those who live and work at the home. Staff spoke with a sense of pride about their role and demonstrated a committment to supporting those at the home in a caring and sensitive manner. At our last visit to the service it was recommended that the role of the volunteer could be documented in order that it is clearly defined, at this visit we spoke to the manager about this and we saw guidelines which had been developed by the manager, these were clear and well written. Through examination of staff records we found that the manager operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of residents. We saw that each staff member had a job description which outlined the job purpose and the qualities and skills required for the position. Written references, protection of vulnerable adults checks and Criminal Record Bureau checks (CRB) had been undertaken for staff prior to their commencement at work. Confirmation was in place that CRB checks were clear prior to people commencing work at the home. Each individual has a key worker to support them with the manager being involved with the overall monitoring of individual care. It was clear that staff have developed relationships with individuals and have worked together with them and others in order to identify the needs of residents and then support the person appropriately. There was information in individual care plans that provided information to guide staff to the appropriate level of support that individuals require. Regular staff meetings are held at the home and appropriate subjects are covered in respect of the service provided at the home and in line with the needs of those living at the home. The training records of staff were reviewed and staff are well supported in this area. At our last key visit to the service in March 2007 a requirement was made by us that staff must receive training appropriate to the work they are to perform such as training in first aid and moving and handling. Records seen by us evidenced that staff have undertaken training in the following areas: Fire safety, manual handling, food hygiene, mental capacity act legislation and equality and diversity. All staff have also completed safeguarding of vulnerable adults training. The achievement of a National Vocational Qualification (NVQ) is well promoted within the home, there are seven staff who have obtained an NVQ at level two or above in Care. The manager confirmed to us that staff would be completing training in first aid skills during February 2010. Care Homes for Adults (18-65 years) Page 25 of 31 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 benefits from good leadership and management, its practices have offered protection to the health and safety of residents. The home is run in the best interests of the residents. The home is well managed ensuring that individuals interests and rights are promoted and protected by a committed staff team. Evidence: The manager Mrs Jacqueline John has been employed at the home for over 16 years and she informed us during our visit that she would be retiring within the next few months. The manager, throughout our visit, was able to demonstrate a sound understanding of her role and responsibility. It was clear that she and her staff team knew the people who live at the home well and relationships based on trust and understanding had been built up. Mrs John has a National Vocational Qualification in Care/Management at Level 4, she also has obtained the Registered Managers Award and is an assessor for NVQ candidates who are working towards their award. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The home has a number of methods in which to monitor and review the quality of service provided at the home and to also establish the levels of satisfaction for the people who live at the home. These include observation and review of the care of people who live at the home, good record keeping, care planning reviews, staff supervision, staff meetings and training. We also saw that monthly visits are undertaken to the home on behalf of the registered provider, these visits are unannounced and cover areas such as a review of the service being provided to people who live at the home, a review of staffing, records and the premises. Reports pertaining to these visits were well written and available to us during our visit. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place. There was evidence that the home ensures so far as is reasonably practicable. the health and safety of service users staff and visitors. The home has robust policies and procedures in relation to aspects of health and safety. Accidents were recorded appropriately and reviewed as required. The home is completing the appropriate checks on the fire equipment and recording of training and testing of equipment was satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. The home has a fire risk assessment in place, this was reviewed by the manager in September 2009, no areas of concern were identified. We did find that the fire logbook contained a great deal of information, with some of this being irrelevant as it was outdated and no longer required, for example historical contractors reports. it is recommended that the home completes an audit of the fire information folder/logbook, and removes any unnecessary, outdated information in order to make the required information more accessible. We saw that there are people living at the home who have bed rails fitted to their bed, for their safety. We asked to view the risk assessments for these. We saw that the home had these in place, these were generic risk assessments to cover all people who use them. It is recommended, by us, that the risk assessments pertaining to the use of bed rails should be tailored and based upon the needs of the individual rather than a generic assessment which covers all. This visit did not focus on the financial viability of the home. There was no evidence Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: that the financial viability of the service was threatened in any way. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home they had recorded that their plans for improvement for the forthcoming twelve months are; To improve record keeping methods to improve the efficiency of the service and to support staff to develop management skills. Care Homes for Adults (18-65 years) Page 28 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 1 The home should review its service users guide in order to ensure that it contains accurate information. The Brandon Trust should review its admission policy to ensure it is relevant and in line with current good practice and individuals expectations. We would recommend that the homes complete an audit of the care files and removes any unnecessary, unrequired information in order that the contents of each file are up to date and reflect the support given. Progress the plans to make the car park more even. The home should complete an audit of the fire information folder, and remove any unnecessary, outdated information in order to make the required information more accessible. Risk assessments pertaining to the use of bed rails should be tailored and based upon the needs of the individual rather than a generic assessment which covers all. 3 7 4 5 24 38 6 38 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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