Inspection on 09/11/09 for The Mariners

This is the latest available inspection report for this service, carried out on 9th November 2009.

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

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

Other inspections for this house

The Mariners 15/11/05

The Mariners 02/06/05

The Mariners 01/02/05

The Mariners 14/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Mariners 15 High Street Rye East Sussex TN31 7JF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Gill     Date: 0 9 1 1 2 0 0 9 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 30 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 30 Information about the care home Name of care home: Address: The Mariners 15 High Street Rye East Sussex TN31 7JF 01797223503 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.canterburyoasttrust.org.uk Canterbury Oast Trust care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The Mariners is registered to provide care and accommodation for up to ten adults with a learning disability and admits people with mild to moderate needs. The Canterbury Oast Trust (COT) owns the home and others in the area. The registered manager Frances Swain has day to day control. Accommodation is over four floors. The home is not suitable for those with mobility problems. All bedrooms are singles and eight have ensuite (shower or bath, toilet and wash hand basin) facilities. One has an ensuite (toilet and wash hand basin) and this room shares a bathroom with one other. Service users have access to a lounge, kitchen/diner, another bathroom and a laundry. At the rear of the premises there is a Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 10 Brief description of the care home large garden with lawn and decking, summer house, water features, shrubs, trees and flower pots. The Mariners is a listed building situated on the high street and includes a tea rooms open to the public. The town with all it amenities are within walking distance including train and bus stations. The home has its own vehicle which is used for service users. The staff compliment consists of a registered manager, team leader and support staff. The team leader and support staff work a rota that includes a minimum of two staff on duty during the day and two sleeping in at night. At the time of the visit fees charged were £802.48 per week. Additional costs would include toiletries, chiropody, hairdressing, newspapers and magazines. Previous inspection reports are available from the home or can be viewed and downloaded from www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection took place on 6th February 2007 and annual service reviews were undertaken on 13th February 2008 and 5th February 2009. This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.10am and 4.50pm. The manager and staff assisted during the visit. People that live in the home, a relative and staff were spoken with. Observations were made throughout the day. Ten people were living at the home on the day of the visit. Surveys were sent to the home for the manager to distribute to residents, staff and health and social care professionals. Eight were returned from services users, two of which were completed with help. Six surveys were received from staff and one from a health and social care professional all of which were very positive about the care and support received. Collective comments were received separately from a team of Care Homes for Adults (18-65 years) Page 6 of 30 professionals who have some concerns about the service. These were not positive although it was noted that most of the team had not been actively involved with the home in the last twelve months so things may have changed. Their comments have been incorporated into this report. Due to the negative comments from this team telephone contact was made with two care managers who has had recent and/or past contact with the home. They were generally positive about the home and their comments are also incorporated into the report. The care of two people was tracked to help gain evidence as to what its like to live at The Mariners. Various records were viewed during the inspection and a part tour of the home undertaken. The home sent their annual quality assurance assessment (AQAA) to the Commission within a very short agreed timescale. The AQAA is a self-assessment picture of how the manager thinks they are doing against the national minimum standards. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: No requirements or recommendation have been made at this inspection. Some areas for improvement are included in the text of this report. One staff commented the service functions above adequately to meet the needs of the service users and staff team. However the company (Canterbury Oast Trust) could ensure that services such as maintenance could operate more efficiently. Another said Care Homes for Adults (18-65 years) Page 8 of 30 The home does well in supporting the service users who live there. There are always financial restraints which the home has to work within. Two staff commented about staff terms and conditions. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to choose a home that will meet their assessed needs. Evidence: People have the information they need in order to make an informed choice as to whether this home is right for them. Most people surveyed confirmed they were asked if they want to move into this home, one answered yes and no and another indicated they were not asked. People surveyed indicated they they got enough information about the home before they moved in to decide if it was right for them. A statement of purpose and service user guide is in place. The statement of purpose is in written format and was last reviewed in August 2009. This document needs review as minor information is not quite accurate. The format for the service user guide is written and photographs or written, pictures and photographs and each individual has a copy. A copy of the service user guide is also displayed within the home as is the latest inspection report. In addition to the service user guide the home has also produced a small welcome booklet which is given to people thinking of moving in. The booklet is in picture, photograph and word format and contains information about life Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: at The Mariners. A copy is given to people to look through and keep during one their pre-admission visits and read later at their leisure. One relative spoken to felt they had sufficient information about the home prior to their family member moving in. People have their needs assessed. The home undertakes their own assessment and for the last two admissions this has been during a trail visit stay at the home. The assessment is a coded list type format plus comments and covers all areas of care and support. Copies of care management assessments and/or care plan had been obtained and held on file. In one case the home had also obtained a report of care and support from the previous placement. One professional surveyed indicated the care services assessments arrangements always ensures that accurate information is gathered and that the right service is planned for people. Another professional spoken with talked about a recent admission where a lot of planning including a couple of meetings between all parties had been part of the admission process. They said the initially feedback from the individual was that they were well and truly settled and had come on in a short space of time with a positive approach by staff. People are able to test-drive the home before moving in. The manager told us the arrangements which had taken place for the last two people moving into The Mariners. These had included short visits, staying for meals and a weekend or four day stay. A relative spoken with confirmed these arrangements had taken place. The relatives and a care manager also looked round. People are protected by contracts in place with the home. Most people had agreed a contract of terms and conditions. A copy of which is held on their file. Both recent admissions had not yet signed or agreed their terms and conditions. The manager told us this was completed with one individual the following day. Good practise would be to agree terms and conditions on admission. Increases in fees and allowances are advised in writing annually. These are then explained and agreed (signed by both parties) as an appendix to the contract and again copies are held on file. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive. Evidence: Peoples know their assessed needs and wishes are reflected in their individual care plan. Two care plans were examined in detail, one was in the process of being built up following the individuals admission a week earlier. Care plans are detailed and clearly reflect the way people wish to be supported or their independent skills. Care plans were reviewed regularly and there was clear evidence of changes and updates. Not all updates had been dated which would be good practise. Care plans contain a health action plan. A key worker system is in place. Care plans are produced in a meaningful format to people living in the home and evidence their involvement and who else they would like involved. Staff surveyed indicated they are always given up to date information about the needs of the people they support for example in the care plan. A formal review is held annually. Paperwork is in place to prepare for the review and Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: ensure the whole process is driven by the individual. For example who I wish to attend, where I want to hold my review and what I want to discuss. Professional team comments indicated the service is parental biased and can side with parents rather than support individuals and this was discussed with the manager. The manager told us about one individual where they do not feel confident in broaching a subject during their review. Notes have been made and the individual has asked the manager to broach the subject and then help them put their opinions forward. This clearly shows support for an individuals choice. Records evidenced that any goals would be discussed at the review. The manager told us that not all individuals have goals in place as they feel they have achieved the development they want to. Goals should also be about wishes and aspirations and an example of going to a concert was discussed. The home should look to develop this further. Developmental goals that are in place such as cooking and budgeting are clearly recorded along with progress to date. People are able to make decisions about their day-to-day lives. People surveyed indicated they are always able to make decisions about what to do each day. Regular house meetings are held with individuals chairing the meetings and staff on duty attending. Minutes and discussions with people confirmed they are asked if they have any concerns and are happy with the support they receive, staff, other individuals in the home, planned activities and the maintenance of the house. Records showed meetings are held once or twice a month. When issues do come up at the meetings the minutes show clearly action taken by management to resolve or move on the problem. The manager told us about an example of where an advocate had been accessed for one individual and another recent referral has been made for a second individual. The manager told people are involved in the recruitment of staff. Most recently one individual was part of the interview panel and asked their own questions. A professional surveyed indicated the home always support people to live the life they choose wherever possible. People are supported to take appropriate risks to aid an independent lifestyle. Where there is a risk this is clearly recorded together with any actions to reduce the risk, which was evidenced as reviewed regularly. The manager told us risk assessments for the individual who has recently moved in were in place but these were not examined. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational and recreational activities meet individuals expectations. Evidence: People have opportunities for personal development. During the visit it was apparent that people have had many opportunities to develop their skills and abilities. The location of the home is ideal for people to be able access the community easily as well as public transport. Individuals confirmed they are able to travel independently on the train and it was evident in the care plan another individual is being supported to achieve this. Peoples skills have been developed and to varying degrees and they are involved or independent in menu planning, shopping, preparation and cooking, laundry and other household chores. All individuals are undertaking a City and Guilds recognised practical daily skills qualification, which will be assessed by trained Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: member of staff. The manager told us the home has been approached and three individuals plan to get involved in an allotment within the town. People have opportunities for appropriate education and work activities. Two people undertake volunteer work within the town in three different outside locations. Others attend work or training opportunities organised by the Trust. These include working in the tearooms, craft, computer skills, numeracy, music sessions, working on the farm and horticulture. It is planned that the tea rooms will also introduce a National Vocational Qualification (NVQ) for individuals. One individual attends an outside horticulture workshop in New Romney. One professional spoken with felt sourcing more outside opportunities for individuals was an area the home still needs to develop further. People are actively involved in the local community and enjoy leisure activities. Records and discussions confirmed that people visit the local pubs and the leisure centre for swimming or gym. Two people regularly attend different local church services and one is a member of a local sewing/knitting club. Recent trips and activities have included a trip to see Take That in London and stay overnight, a Tom Jones in concert in Brighton, Wisley gardens in Surrey, cinema to see the Micheal Jackson film in Ashford, horse riding and Saturn disco. In house leisure pursuits include television, DVDs, music, laptop, music/dancing nights and craft and games nights, Surveys confirmed that people feel they can do what they want in the day, in the evening and at weekends. This year people chose to go on a coach holiday to the Isle of White as a group. One individual said it was a lovely holiday. People are supported to have appropriate personal and family relationships. The manager told us most individuals go home once or twice a month on visits. People also have holidays with family members. One relative called into the home during the visit and was very positive about the home. All individuals have a mobile phone to stay in contact with friends and family. Some individuals are involved in relationships and have their own aspirations which are being supported by staff. Professional team comments felt the home is not always supportive or only supportive to a point of clients relationships. This was discussed with the manager and support arrangements at present do seem to support long term developing relationships and individuals that want to take relationships a step further. One individual spoke about their X friend and confirmed they get to see them enough. The manager told us professionals have been involved to offer advice and guidance in this area, some individuals have also attended a college course and the home also has a DVD which was made by people with learning disabilities regarding sexual education and relationships. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Peoples responsibilities are recognised in their daily lives. Daily routines promote independence and choice. Everyone has a key to their room and a key to the front door. Professional team comments felt that the clients are expected to fit into the house rules and must have a house day (when people do their chores) on a set day with no give or take. Records confirm some people have more than one house day and at times this is only half a day due to preferred activity such as horse riding. House meeting minutes confirmed people are asked at each meeting if they are happy with their planned timetables and minutes seen confirmed there are no problems noted. One individual talked about past hobbies such as riding their bike and horse riding but are happy with what they do now. People were observed to have a choice in what they did through the day and plans in place were flexible. People treat the home as their own, people were observed to come and go freely as they pleased throughout the visit. Although people have activities planned into their week there is plenty of free time so people are able to choose other activities, just pop into town or chill. Staff interactions with individuals was patient, relaxed and calm. One professional spoken with was please with the way the home are working with an individual to promote their independence in the short space of time they have been at the home. People are offered a varied diet which they have planned. Individuals spoken with confirmed the menus have recently changed and the food is nice. They also confirmed they were asked their favourite meals. These were then incorporated into a four weekly menu which states individuals choices for each day. To ensure individuals have what they have asked for this can mean between one and three different meals are planned each day. Breakfast is cereals and toast. Lunch is a sandwich or snack and the main meal is in the evening. People confirmed they are involved in all aspects of meal shopping, preparation and cooking of the main meal and also prepare and cook their own individual meals. This can lead to difficulties with cooker and kitchen space and this has been over come with some individuals cooking their main meal at lunch time. Those spoken with confirmed they did not mind this. The manager told us she is looking at ways the cooking facilities can be improved to ensure individuals can cook their own meals when they choose. Care Homes for Adults (18-65 years) Page 17 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put in practise. Evidence: People receive support in a way that they prefer and require. A key worker system is in place and individuals were aware who their key worker is. A picture board of staff is in place. Care plans and discussions confirmed people are encouraged to be as independent as possible with their personal care. People routines and likes and dislikes are recorded in their care plan and these are also flexible. People have the luxury of an ensuite with shower or bath or the use of a bathroom with one other. Individuals undertake personal shopping during free time. People were dressed individually reflecting personalities. During the visit people were treated with respect and their rights to privacy upheld. Individuals spoken with confirmed they are able to get up, go to bed, have a bath or shower when they please. A professional survey indicated the home always respects peoples privacy and dignity and a professional spoken with also felt peoples privacy and dignity is absolutely respected. People have a health action plan in place. Records of appointments and concerns are Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: maintained including the outcome. Six people independently make their own appointments and attend check up appointments on their own. Others individuals and treatment appointments are supported by staff. Records and discussions confirmed access to health professionals such as well-person clinics, optician, dentist, chiropodist, GP and attend hospital appointments as required. One individual is current working with a speech and language therapist. A health professional surveyed indicated peoples social and health care care needs are always properly monitored, reviewed and met by the care service. They indicated the home always seeks advice and acts on it to meet peoples needs and improve their well being, this was not entirely echoed by the professional team comments. The professional surveyed also indicated the homes manager and staff always have the right skills and experience to support peoples social and health care needs. They commented the whole team always work well with our surgery regarding client care, prevention checks, prescriptions etc. well done. Professional team comments indicated that there had been communication problems when organising appointments with individuals via staff. This was discussed with the manager who told us all appointments are now recorded in the house diary and during the house meeting the diary is gone through and then individuals transfer these appointments to their own diaries so theres no confusion. People are encouraged to retain and manage their own medication and are protected by safe medication systems. The home has a medication policy in place. Storage for medication is safe and secure. The Medication Administration Record (MAR) charts were examined. These showed good use of codes and signatures for administration. Handwritten entries should be dated, signed and witnessed. Not all individuals had a list of their medication within their care plan and for those that did there were no start and end dates which would be good practise. There are some specific instructions for medications given as required. The manager agreed to check these to ensure they contain all the relevant information. Staff that administer medication have received training. The manager told us competency checks on medication administration are not generally in place for staff but she does during her working shift observed medication administration. Good practise would be to record these. It is commendable that five of the six people prescribed medication retain and manage their own medication. Appropriate risk assessments and audits are in place to ensure safety. A professional surveyed indicated the home usually supports people to administer their own medication or manages it correctly where this is not possible. Procedures to ensure peoples ageing and end of life are handled in line with their wishes are in place. A specific care plan detailing wishes for end of life has been developed with individuals and is contained within the care plan folder. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. Evidence: People feel their views are listened to and acted on. People spoken with confirmed who they would speak to should they have a concern which in all cases was a member of staff. Regular house meetings are held which are chaired by the individuals and staff on duty attend. People are asked specifically about any concerns they may have including with their support, staff, activities, other individuals in the home and maintenance of the home. People surveyed said they knew who to speak to if they are not happy and they know how to make a complaint. A complaints procedure is displayed on the homes notice board. The manager told us the home has received no complaints since the last visit. The Commission has received no complaints. A grumbles book is maintained. This details well any grumbles individuals may have voiced and what action has been taken and the outcome. No grumbles have been recorded since April 2009. The manager told us the home has also purchased a DVD which everyone has watched made by people who have a learning disability called would you complain. A relative felt confident that if they had any concerns these would be dealt with. A professional surveyed indicated the home has always responded appropriately if they or a person using the service or another person have raised any concerns. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: People are protected from abuse. People spoken with confirmed they feel safe living in the home. The home has procedures in place to manage any abuse. All staff have received training in safeguarding vulnerable adults. Training is updated every three years. Two staff spoken with were clear of the routes to report abuse within the Trust and outside. The manager told us a DVD has been purchased which explains the Mental Capacity Act. It was made by people with a learning disability and everyone has watched it. In addition staff have also attended recent Mental Capacity Act and dealing with challenging behaviour training. Care Homes for Adults (18-65 years) Page 21 of 30 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 have a home, which is well maintained, comfortable and enables them to live safely whilst encouraging community independence. Evidence: People live in a homely, comfortable and safe home. A part tour of the home was undertaken with the manager and some individuals showed the inspector their rooms. Three minor concerns was highlighted. In one bathroom a small amount of ceiling paper was hanging down and also there was a small line of tile grouting which was black. One individual showed me their toilet seat which needed replacing. The premise is a grade 2 listed building over four floors. People are involved in choosing colours for the decor. Recently two shower ensuites and bathroom have been refurbished, a wash hand basin installed in the kitchen and a new worktop fitted in the kitchen. The manager told us of ideas to try and improve the kitchen facilities for individuals. Peoples bedrooms are individual, personalised, very homely and promote their independence. All bedrooms viewed reflected peoples personalities, interests and hobbies. Individuals spoken with confirmed they are happy with their room and apart from the toilet seat highlighted above everything is in working order. One confirmed there is plenty of hot water for a shower. One individual confirmed they are responsible for keeping their room clean and tidy. Bedrooms are lockable everyone Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: has a key to their own room. Peoples ensuites provide privacy and meet individual needs, those viewed were very personalised and homely. There are eight ensuites with shower or bath, toilet and wash hand basin. There is another ensuite with toilet and wash handbasin. The other individual has a wash hand basin and shares a bathroom with the individual who has an ensuite wash hand basin and toilet. In addition there is another bathroom. There are also two cubicle type toilets on the ground floor which are not very homely. People have access to shared space which compliments their own room. There is a laundry room on the 1st floor. The ground floor has a side door where people can access the high street without going through the tea rooms. A lounge which is quite small for the size of the home and may benefit from a couple of large pictures to make it more homely. The basement houses a good kitchen/diner with a door onto the garden decking. The garden is well maintained with lawn, water feature, summer house and established shrubs and trees. The large decking area has flower pots and a water feature. The manager told us in the summer this would have table and chairs and is often used by individuals. The garden is maintained by individuals and staff. The home was clean and tidy throughout. People surveyed indicated the home is always clean and fresh. Liquid soap and paper towels are supplied as necessary to avoid infections. Care Homes for Adults (18-65 years) Page 23 of 30 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Recruitment practises should be tightened to fully protect people. Evidence: A qualified team supports people. There is a permanent staff team of five and the manager told us all are qualified to National Vocational Qualification (NVQ) level 2 or above. At the time of the visit three flexi staff were also regularly working in the home and the manager told us two of these are also qualified. This is commendable. There are sufficient staff to meet the needs of the people who live in the home. The manager told us that in addition to her there is a minimum of two people on duty 7am to 10.30pm. Two members of staff sleep in on the premises for emergencies. Staff surveyed indicated there is always sufficient staff on duty to meet the needs of people who use the service. The team is male and female. A small number of flexibank staff are used on a regular basis. People surveyed said staff always treat them well. Most people surveyed indicated staff always listen and act on what they say two indicated they sometimes do. Good interactions were observed during the visit. One person spoken with said they liked all the staff who were nice. Another said the staff Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: are very good they look after us very well and help me sometimes when I need help and sometimes they dont they let us get on with it. People could be better protected by recruitment practises. Two staff files were examined of staff recruited since the last visit. These showed checks were in place such as completed application forms, references and Criminal Records Bureau (CRB) checks. For one staff member the information from the human resources department did not evidence that the CRB had included a Protection of Vulnerable Adults (POVA) check. The manager told us all staff have a POVA check. Good practise would be to evidence this. The manager agreed to follow this up with the human resources department. The other staff member had evidence of a POVA check on their file. The application forms for both staff highlighted there were gaps in their employment history. However these had not been explored and a written explanation made which is required by legislation. Staff surveyed indicated the Trust did carry out checks such as CRB and references before they started work. People are involved in the recruitment of staff. The manager told us of the most recent appointment where an individual had asked their own questions as part of the interview process. Staff receive training to develop their skills for the job. Records confirmed that all staff receive mandatory training (fire, first aid, infection control, moving and handling and food hygiene) and this is updated regularly. The home has an induction to Skills for Care specification which is completed when new staff join if they do not already have an NVQ in care. All staff undertake an orientation induction. Some staff have undertaken training in dealing with challenging behaviour, risk assessment and equality and diversity. Staff surveyed indicated their induction very well or mostly covered everything they needed to know to do the job when they started. They also indicated they are given up to date training which is relevant to their role. Staff feel very well supported. Staff spoken with feel they are well supported. Records examined for two staff confirmed that they receive regular formal supervision and also have annual appraisals. Staff surveyed indicated the manager gives them enough support and meets with them regularly or often to discuss how they are working. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. It has effective quality assurance systems. Peoples health and safety is protected. Evidence: People benefit from a well run home. The manager has twelve years experience working with learning disabilities in this home. She has obtained her Registered Managers Award (RMA) and an NVQ level 4 in care. Staff spoke highly of the manager. Comments included she doesnt mind being involved but pulls away when she needs to, she is an excellent manager, she comes across as an easy person but when things need to be said they are said, she has new ideas and is respected. She is supportive, fair and gets the best out of the staff, fun but fair, approachable, head of the helm but joins in as well and we respect her. One staff surveyed commented the manager works hard in supporting service users who live here. She supports her staff and values their input and efforts. One professional spoken with felt the manager is forward thinking. The manager demonstrated an openness to feedback regarding the home and showed a commitment and enthusiasm to exceeding the standards and improving outcomes for individuals. She is keen for the home to be seen as a Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: transition home where people move on within an approximate two year period to more independent living. The home has already had some success with individuals moving on in the last twelve months. The home will need to be sure this model suits the people already living at the home. People can be confident their views underpin the development of the home. People who use the service are asked to complete a quality assurance questionnaire each year usually around the time of their formal review. Good practise would be to collate these and give overall feedback to people living in the home. Relatives also complete annual questionnaires and these are collated by the Trust. Regular house meetings are held to give people the opportunity to voice their views. The area manager undertakes monthly visits to the home in order to assess the standard of care being provided. Copies of their reports were seen on file. The home completed their Annual Quality Assurance Assessment (AQAA) which was received by the Commission within a very short timescale agreed with the inspector. Information gave a good picture of the home although could have better represented the home with examples of how things are done. The home has an annual develop plan in place. The heath, safety and welfare of people is promoted and protected. The AQAA confirmed that equipment is regularly serviced and it is evident the home is well maintained. Some sampling of required tests were undertaken and confirmed tests are in place according to recommended timescales. Staff have undertaken mandatory training. Accidents are recorded and reported appropriate and did not warrant further investigation. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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