Inspection on 08/06/10 for The Mount

This is the latest available inspection report for this service, carried out on 8th June 2010.

CQC found this care home to be providing an Adequate 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 Mount 26/02/08

The Mount 28/02/07

The Mount 18/01/06

The Mount 13/07/05

The Mount 21/01/05

The Mount 04/10/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Mount Faircrouch Lane Wadhurst East Sussex TN5 6PT     The quality rating for this care home is:   one star adequate 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 8 0 6 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Mount Faircrouch Lane Wadhurst East Sussex TN5 6PT 01892782025 01892782917 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Mount Camphill Community Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 39 The registered person may provide the following category of service only: Care home only (PC) to service users of the followinging gender: Either whose primary care needs on admission to the home are within the folowing category: Learning disability (LD) ) Date of last inspection Brief description of the care home The Mount Camphill Community is an independent specialist college that provides further education and training for residential and day students aged 16 to 25. The Community is a registered educational charity providing up to 39 residential places for young people with moderate learning disabilities, and is also inspected by Ofsted. The Camphill Movement, founded in 1940, works to create communities in which vulnerable children and adults can learn and work with respect. Camphill is inspired by Christian ideals as articulated by Rudolph Steiner and is based on the acceptance of Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 39 2 7 0 1 2 0 1 0 Brief description of the care home spiritual uniqueness of each human being, regardless of religious or racial background. The Mounts training programme extends over 4 years. An educational year is approximately 38 weeks divided into 4 terms, with students returning home or to other placements during the holidays. There are 5 community houses on-site, each with its own character. There are craft workshops for pottery, bakery, weaving, woodwork and catering. In the main house, which is a renovated monastery, are classrooms, a library and a community hall. There is a large vegetable garden and orchard, which provides the venue for a horticultural course and extensive grounds and woods where the estate and rural skills course are taught. There is also a sports hall on the site. The Mount is staffed by senior co-workers and co-workers. Senior co-workers and their families live on site and share accommodation with students and other co-workers. Most staff are volunteers and trainee co-workers are from a wide range of countries and usually work at The Mount for up to one year. Details of fees can be obtained from the college. There can be an additional charges for pocket money, and certain educational trips. A copy of the latest inspection report can be obtained from the college or down loaded from www.cqc.org.uk. The Mounts email address is office@mountcamphill.org and website is www.mountcamphill.org Care Homes for Adults (18-65 years) Page 5 of 32 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: one star adequate 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 key inspection took place on 27th January 2010. A random (short focused) inspection took place on 6th April 2010. The random inspection was to look at compliance of the Statutory Requirement Notice issued in relation to recruitment procedures. The college was found to be compliant. This inspection was carried out over a period of time and concluded with an unannounced visit to the college between 09.30am and 4.50pm. The manager and staff assisted during the visit. Students that live at the college and staff were spoken with. Observations were also made. Thirty-one students were living at the college on the day of the visit. The care of two people was tracked to help gain evidence as to what its like to live at The Mount. Various records were viewed during the inspection and some parts of the college observed. Care Homes for Adults (18-65 years) Page 6 of 32 In addition telephone calls were made to students and relatives to gain feedback about the college. The home was not asked to complete an annual quality assurance assessment (AQAA) for this inspection as they have completed one within the last twelve months. . Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? Work has gone into developing support plans, risk assessments and behavioural guidelines although further work is required to ensure staff have clear information about students needs and how to deliver support in a consistent way. Professionals have been or it is planned will be involved in assessments and providing advice and guidance to staff about best practise to meet needs. Assessments for prospective students are being undertaken using a more thorough process to ensure all needs are identified before judgements about meeting needs and moving in are made. One key area is still lacking detail. Care Homes for Adults (18-65 years) Page 8 of 32 Medication systems have improved and are now safer although minor improvements would fully protect students. Some of the shortfalls in staff training have been undertaken and formal supervision is gradually being introduced to ensure staff have knowledge of good procedures and best practise guidance. Recruitment procedure have been strengthened to ensure students are protected. Management have updated some polices and procedures to reflect best practise. A new manager has been appointed and a new balanced management team is in place with defined responsibilities and a better understanding of legislative requirements. Quality assurance and monitoring systems are being developed and introduced. Reporting and working with other professionals has improved. 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 9 of 32 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 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students who may move into the college and their representatives do not have the full written information they need to make an informed choice about whether this service is right for them. Students needs are assessed prior to moving in although better detail in relation to one key area is required before a sound judgement can be made that needs based on the assessment can be met. Evidence: Parents receive a brochure and details of the admission process before a three day assessment visit. On deciding the college can meet a students needs a student handbook is sent out with a copy of the terms and conditions for parents to sign. Previously parents stated that information received did not contain a copy of the full complaints procedure. A copy of the statement of purpose and service user guide (student handbook) was obtained. There are shortfalls in the information which is required by legislation and feedback has been given to the manager. The manager has agreed to address the shortfalls and send an updated version to the Commission. It is planned that new students will receive a copy of the student handbook which meets legislative requirements. A requirement is not made at this time. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: People have their needs assessed prior to moving in although in one key area more in depth exploration is needed before a sound judgement about meeting needs can be made. A requirement was made previously to ensure prospective students personal care and health needs are assessed prior to the college providing accommodation. As yet no new students have moved in. Although the assessment period for the annual intake at the start of the September term has begun. A new needs assessment format has been developed and introduced. A new admissions team now has responsibility for undertaking the assessments. One assessment which has been completed for a prospective student but not yet signed off was examined. The level of detail is a great improvement on previous assessments and in most areas gives a very good picture of the student, their skills and needs. However previous educational information for this individual highlighted some aggressive behaviours which had not been followed through and examined during the assessment process and as a consequence to the risk assessment developed for the three day assessment period. Not exploring this key area during assessment has resulting in safeguarding incidents in the past and staff undertaking the assessments must ensure such information is explored and recorded. The manager told us as this assessment has not yet been signed off by himself this would have been picked up before making a decision about admission. A copy of the contract of terms and conditions was obtained. There are shortfalls in the information required in this document and feedback has been given to the manager. The manager has agreed to address the shortfalls so a requirement is not made at this time. A file of contract terms and conditions was previously seen as part of the last inspection. This contained contracts all dated Summer 2009 and all were signed by parents. The manager told us these contract were still in place although agreed that some students do have the capacity to sign their own terms and conditions if the contract were in the right format. People have the opportunity to test drive the college. Students and their parents are invited to look round the college and meet people and then attend for an interview. One relative said we looked at others and there was no comparison to The Mount. After the interview students attend for an assessment visit usually over three days. During this time the student joins workshops and is observed in the house where they are staying. At the end of the assessment period staff give feedback. A final decision is then taken whether to offer a place on a three-month trial period. Care Homes for Adults (18-65 years) Page 12 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students are involved in decisions about their lives and play an active role in planning their care and support. But support plans and risk assessments must be further strengthened to fully protect students. Evidence: Previously a requirement was made in relation to care plans in that care plans must reflect all individual health, personal and social care needs. Also care plans must contain clear guidance to staff on the management of care and health needs. The plan must be kept up to date and regularly reviewed. A new format support plan has been developed and introduced for all students. Two were examined. The college has worked hard and the detail in support plans is considerably improved and well on the way to having an accurate working support plan in place. However this is still work in progress. Further improvements must be undertaken although further enforcement action is not taken at this time as it is expected the college will continue to address the remaining shortfalls. The level of detail of students skills varied between sections and support plans. In some cases it was good and in others it was not. For example Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: one support plan talked about a student brushing their teeth under personal care but there was no information about the rest of their personal hygiene routine i.e. whether they had a bath or shower, their morning or evening routine and whether they were independent or needed assistance. In another instance the support plan stated that a student would keep some money in their wallet (no detail as to how much) and would work on coin recognition but no detail about how or when. Where other documents such as risk assessments or behavioural guidelines contain information the support plan should be cross referenced to clearly direct staff. All students have signed their support plan and they contain under each section what I want to achieve. Students are involved in their reviews and complete an evaluation form. However one completed evaluation highlighted that the student wanted to work on having a shower on their own but there was no mention of showering in the support plan. The manager told us that over the last few months the college has contacted social workers to arrange reviews or had discussions on the telephone or sent them copies of the students new support plan and risk assessments. Students and parents spoken with are all happy with the care and support received. Relatives felt the college definitely meets the needs of their relative and they give the care and support that they expect and have agreed. One said they are getting stronger on care and support. Students spoken with confirm they are involved in decisions about their day to day lives. Students said they have opportunities to feedback and contribute to life at the college at weekly house meetings, the student forum and also meetings with their personal mentor. Relatives spoken with felt students are able to live the life they choose. Previously a requirement was made to ensure written risk assessments were in place which detailed all risks associated with care delivery and actions to reduce any such risks. Again the college has worked hard to progress this but it is still work in progress. Further enforcement action is not taken at this time as it is expected the college will continue to address the shortfalls. There is a generic risk assessment chart on which staff indicate risk levels (high, medium or low) and where there is a risk a separate specific risk assessment is recorded. This format has recently been reviewed and a new format will shortly be introduced. A new format has also been introduced for the specific risk assessment. Risk assessments for two students were examined. None contained clear actions for staff to reduce any risks. In one risk assessment it stated co-workers to be aware of strategies in place to assist but did not detail these strategies or cross reference to where they are recorded. Care Homes for Adults (18-65 years) Page 14 of 32 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 the service are able to make choices about their life and are supported to develop their skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: All students attend college workshops five days per week, which can include work experience. Ofsted inspects this side of the college. This is a large part of life at the college and workshops are integral to college life. All the college bread is made and baked in workshops. Most of the vegetables are produced in the very large vegetable garden and large greenhouse. Fruit is also harvested and used at the college. Students are able to access the local community. Discussions confirmed that students can go into the village or take the train to Tunbridge Wells, Eastbourne or Hastings. The college also has transport, which can be used to access the community. Further Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: independence has been achieved for some students to access the community independently. One relative spoken with felt there could be more links with the local community. Students and records confirm that there are plenty of opportunities for a good variety of leisure activities including walks, cycle riding, basketball and space ball, outside sports such as cricket, tennis and football, snooker, local pub, regular trips to Tunbridge Wells or into Wadhurst, a trip to Bodium castle, fish and chips on the beach, aerobics, theatre, swimming, sledging and the cinema. The college has a library, snooker area and sports hall. Organised leisure activities are held within the college such as dancing (disco, salsa, folk and ballroom), gardening and singing as well as time to read, listen to music, play card games or Scrabble, watch a film or DVD or socialise with friends and sleep overs. Students of other religions can be taken to worship. Students confirmed that activities for weekends are discussed and agreed at the weekly house meetings. One said they encourage you to be social and join in. Previously relatives have confirmed that the social life is an added bonus to the education. Students talked happily about their families, visits home and how they had made friends whilst at the college. Students spend term time only at the college and some also enjoy weekends at home with their families. Students can use the telephone, some have mobiles or use email to stay in contact with family and friends. Relatives spoken with confirmed that the college does help them to keep in touch with their relative and keeps them up to date with important issues. Comments included the house coordinator is very prompt and calls us, they are very co-operative especially for family celebrations and they are very honest and very supportive. Another felt they would like a bit more contact with their relative. One felt a regular newsletter would be good. Another commented that parents could be more involved with the running of the college. Recently a parents day has been held. The college has made arrangements to access the local Community Learning Disability team for advice, guidance and support on sexuality and relationships. Students have free time where they are able to spend time as they choose. When students were asked if they could make decision about what to do each day such as times for getting up and going to bed most said yes. Although one said in one way yes and in another no they said this was dependant on workshop sessions and if you were on breakfast duty. Students confirm they are involved in household chores such as cleaning, laundry and laying and clearing tables at mealtimes. It is apparent that staff encourage independence. One student said I am more independent now, I am learning to travel on the bus, cook and do my laundry. Students can also be involved Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: in exchanges with other Camphill sites in different parts of the country and preparing for this was a topic of conversation on the day of the visit. Students confirm they like the meals. The gardens are organic. The college tries to use seasonal produce and produces as much of this themselves as possible. The college uses only local quality food usually organic and all meals are cooked from scratch. The college puts a high importance on healthy diets and things such as convenience foods and fizzy drinks are not encouraged/available. Meat and fish are sourced from a local organic farm. Vegetables that cannot be produced are purchased regularly locally as is organic milk, eggs and cream. Breakfast is cereals, fruit, yogurt and toast. Lunch is the main meal. Supper is bread and spreads or a light meal or snack. On the day of the visit one main meal was pasta bake with bacon and salad followed by fruit enjoyed by all, evident by the requests for seconds. Each house has a cook for main meals who plans the menus with the house coordinator. Students can voice views at the weekly house meeting. Previously a relative commented the healthy lifestyle and excellent quality of provisions of food means that maximum health is achieved. Some students are involved in regularly cooking their own meals or preparing snacks. Care Homes for Adults (18-65 years) Page 17 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Professionals have been involved to improve care and support received by some students and further involvement is planned. Advice and guidance must be followed through into support plans to ensure a consistent approach is adopted to protect students. Medication systems have improved but minor adjustments would strengthen further to fully protect students. Evidence: Students preferences regarding all their personal support must be better detailed in their support plans. See previous comments in relation to shortfalls. Students were individually and appropriately dressed reflecting personalities. Individual houses have their own team of staff which ensure continuity for students. Students are registered with the local surgery for term time. The doctor will make an initial visit to students at the start of the first term. Records confirmed students have access to the local doctors. Other health appointments and check ups usually take place in college holidays at home. Previously students surveyed indicated the college always makes sure they get the medical care they need. The college has a speech and language therapist. Following advice from the safeguarding team referrals have Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: now been made to local health professionals for assessments, advice and guidance. Some students have been assessed and others are awaiting appointments. Two recent psychology assessments had resulted in recommendations being made by the professionals. However these have not or not clearly been followed through into support plans or behavioural guidelines which they must to ensure students are protected by a consistent approach adopted by staff when situations arise. Medication systems have improved but further tightening would fully protect students. A new medication policy is now in place. Medication Administration Records (MAR) charts and other documentation has been improved and is now consistent across the college. A system in one house was examined. Keys to the medication cupboard are now held securely. Medication is now supplied where possible in a monitored dosage system. Medication supplied from the chemist is logged in appropriately using the MAR chart. A signature list of staff trained to administer medication is in place. MAR charts evidenced appropriate use of signatures and codes. One student is currently self administering their own medication. A risk assessment is in place. However there is no audit of quantities of medicines given to the student and when. Ways of achieving this were discussed, once adopted the risk assessment must be up dated. Medication returned to the chemist is recorded appropriately. The manager told us over the counter medication and homoeopathic remedies are used although not currently in conjunction with prescribed medication. The manager told us they are in the process of obtaining written consent from the local GP for the use these which has already been given verbally. A system has also been set up for auditing medications taken out of the college on home leave etc and returned. These records were examined and showed an error which should have been picked up when the medication was returned to the college but was not. An audit of this system must ensure it is robust. A new controlled drugs cupboard and register is now in place although currently no controlled drugs are in use. There have been two recent medication incidents which were reported under safeguarding. In discussions with staff it is evident that procedures have been tightened and that administration does now follow correct procedures. All staff that administer medication have received training. In addition three staff have received medication assessor training. The manager told us they are also arranging for the pharmacist to deliver some medication training. Care Homes for Adults (18-65 years) Page 19 of 32 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 adequate 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 although written complaints procedures are not robust. Systems to protect students from abuse are now in place and delays in reporting have got better. Procedures for dealing with verbal and physical aggression must be strengthened to ensure students receive consistent support. Evidence: Students confirmed who they would talk to if they were not happy or had any concerns but confirmed they had no concerns at present. When asked if they knew how to make a complaint students said yes, they were not quite sure or roughly. Students spoken with did know who to speak to if they are not happy and said that staff listen and act on what they say. They also told us small problems can be raised in weekly house meetings. One said they take you aside if there is a problem and you learn from this. Most relatives spoken with said they knew how to make a complaint, one was unsure. Where relatives had raised concerns previously these had been addressed. The manager told us one complaint has been received by the college since the last inspection. Records were examined. Procedures had been followed and appropriate action taken. The complaint was substantiated. Two complaint procedures were examined previously. Both must be reviewed as timescales for action to be taken were not specified as required by legislation and the address of the Commission was out of date. The procedure for students could be more user friendly which would be good practise. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Procedures to protect students from abuse have been strengthened. A new safeguarding policy is now in place. All staff have received safeguarding training covering abuse and the local protocols. In addition the manager plus two staff have either attended or are booked on an East Sussex Social Services safeguarding train the trainer course. It is intended that these trainers will cascade further training to staff and dates are booked for June. There continues to be a number of open safeguarding alerts at the college on a low level. Some have been closed and another was due to be closed the day after the inspection visit. The safeguarding team confirmed that incidents are now reported and previous delays in reporting have got better. This shows an improved understanding of appropriate safeguarding procedures. One member of staff spoken said they felt more confident about safeguarding and procedures since the training. A student confirmed that students have receive training in Keep Safe which covers types and signs of abuse and support. Each student was given a pictorial and written handout and also completed an individual list of contacts. Physical and verbal aggression by students has been incorporated into behavioural guidelines but these must be strengthening. All staff have now received training in challenging behaviour which was a 2-3 day course accredited to the British Institute for Learning Disabilities. Some behavioural guidelines have now been developed. It is evident that over the last few months the detail in these has improved but they do require further work. As previously mentioned where professionals have made recommendations these are not or not clearly followed through into the behavioural guidelines and must be to ensure a consistent approach is adopted by staff. The manager told us that it is planned that a professional team are going to deliver training and support staff and will also have input to the behavioural guidelines. Training is planned to start in July. Care Homes for Adults (18-65 years) Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students benefit from accommodation that is safe, homely and well maintained and they have access to extensive well kept, safe outdoors space. Evidence: Students benefit from a college, which is set in extensive very well maintained grounds down a driveway, situated on a quiet country lane. The main building (with bedrooms on two floors) is a grand old monastery with a separate house attached. In the grounds there are two further houses and another a short distance along the lane. All student accommodation is shared with staff. There is also a sports hall and two further buildings used for workshops within the grounds. Some parts of the college were viewed on this occasion. The college provides students with individual accommodation, which is homely and very well maintained. There is a maximum of seven students per floor or house. Eight bedrooms are singles the rest are doubles. Six rooms have wash hand basins. Male and female bedrooms are separated. Bedrooms have been personalised with individual belongings. Students spoken with told us that they were happy or very happy with their rooms and everything is in working or good order. All floors/houses have two shower/bathrooms with two having an additional shower room. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: All houses have a kitchen, dining area/room and lounge. The main building also has a snooker area, conservatory and library with two computers. Staff have previously told us that any maintenance issues are dealt with and redecoration is completed during college holidays. An outdoor sports area is located in the grounds. The college was exceptionally clean throughout. Paper towels and liquid soap are supplied in all shared toilets. Students spoken with said the college was always or sometimes clean and tidy. One said we all chip in with the cleaning. Care Homes for Adults (18-65 years) Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the college are in sufficient numbers although work is ongoing to ensure they are sufficiently skilled, trained and supervised to meet the needs of students. Evidence: Students benefit from most staff having been involved with the college for a considerable period of time. In addition new staff are recruited each academic year and arrive at the college for the start of term in September and usually stay one year. Most of these but not all are usually recruited from overseas. Staff and their families live as well as work at the college. Each house/floor has a dedicated team, which includes two house coordinators, a cook and one to three trainee co-workers depending on the number of students. The manager told us these positions are made up from 16 trainee co-workers (volunteers) and 12 house coordinators (mostly volunteers). The term co-worker is used as it describes the college ethos that staff work alongside students and share their experiences. House coordinators are part of the management team. The volunteers may receive pocket money, English lessons, board and lodging and nationally accredited training. Staff can also have responsibility for teaching or running workshops. Staff spoken with were very clear about their roles. They are very aware of the aims of the college. These aims are embedded into day-to-day practise with enthusiasm. Since the last inspection it is apparent that staff have taken on board the need for change, to ensure current good practise is Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: embedded into their day-to-day work and the college meet legislative requirements. Students spoken with confirmed staff treat them well. One commented we couldnt wish for better staff. Students will benefit from improved recruitment procedures. Recruitment procedures/files were not looked at on this visit as they were fully examined during a random inspection in April which focused on recruitment procedures. On that occasion robust procedures had been adopted and staff files contained all required checks. No new staff have been recruited since that time. Students receive a service from staff that have or are undertaking qualifications. The manager told us that eight staff have obtained a Open College Network (ONC) qualification level 2 or above and another eleven staff are currently undertaking it. The manager told us the college intends to introduce National Vocational Qualifications (NVQ) in the future. Improved training will benefit students although remaining shortfalls must be addressed. Previously staff surveyed were mixed about whether their induction covered everything they needed to know. Induction was discussed with the manager who told us a Skills for Care induction programme will be in place for the new staff. Relatives spoken with felt staff had the skills and experience to look after students properly. Although one felt that new trainees might need a little more support and insight into dealing with students. They suggested trainees could come for more time before term starts. A requirement was made previously in regard to staff training and further training has been undertaken since the last inspection. The manager advised of the training data from a training matrix. There are still shortfalls in that not all staff involved in care and supporting students have received fire, first aid, food hygiene, infection control or moving and handling training which the Commission consider mandatory. Further places are booked for first aid, infection control and food hygiene. Further enforcement action is not taken at this time as it is expected the college will address the remaining shortfalls. Staff supervision is beginning to be implemented which should benefit staffs practise. A requirement in relation to supervision was made previously. A new supervision policy is now in place. Discussions told us that staff receive various forms of supervision or mentoring and attend regularly care or house or management meetings. A daily meeting takes place each morning to aid communication and give staff a handover. The manager told us they are supervising the management group plus three other staff. These staff have already received one to three supervision sessions. A member of the management group is booked to attend supervision Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: training in July and will then cascade this training to the rest of the management group. They then, will supervise the rest of the staff. Trainee co-workers are currently receiving mentoring and the procedures and boundaries for this have been tightened. Staff members spoken with confirmed they do feel supported. Care Homes for Adults (18-65 years) Page 26 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is now clearer management and leadership within the college that has a better understanding of regulation and the legislation requirements in order to keep people within the college safe. Work must continue with improvements to ensure requirements are fully met. Quality assurance and quality monitoring is being developed and implemented and the effectiveness of these systems will be the test of whether the college can sustain and build on the improvements. Evidence: The management arrangements at the college have changed. A new manager has been appointed and started in February 2010. They are currently completing their application for registration with the Commission. The manager told us they have a NVQ in health and social care management at level 4 as well as an assessor award. They have recently undertaken train the trainer safeguarding training. It is evident the manager is working hard to make the necessary changes to ensure the college will in time meet all legislative requirements. Several requirements have not been fully met and further enforcement action is not taken at this time as the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: manager has given assurances this work will be completed and sustained. Once this has been achieved it will be reflected in the quality rating. The management of the college creates an open, positive and inclusive atmosphere. The manager is communicating a clear sense of direction and working together with the management group to ensure better communication throughout the college as well as ensuring the aims of the college are central in the day-to-day running of the college. Staff spoken with felt communication has improved and that the management group works better with all areas of college now represented. Members of the management group have formed small groups to take specific responsibility for areas such as admissions, health and safety, finance and safeguarding. It is hoped this will help them build on their skills and training in an area to ensure the college is operating effectively and also take some of the day-to-day burden from the manager who is currently signing off most decisions and paperwork. Quality assurance and quality monitoring has started to be better implemented. The college completes an annual self-assessment for Ofsted, which examines all areas of the service. Students and relatives give feedback and their views are included in the self assessment. A quality improvement plan is then produced. The improvement plan is monitored at management meetings regularly. Any requirements from Ofsted or the Commission are included in the plan. Students have other opportunities to feedback at regular meetings, reviews and evaluations as do staff. Regulation 26 visits (required by legislation) are now being undertaken. The Commission has received copies of two reports following visits. A third visit has been delayed due to college holidays but the Commission expect to receive this report shortly. Questionnaires have also recently been sent out to relatives and some have already been returned. Feedback so far is very positive with some suggestions for improvement as well. A parents day was also held recently where people could give feedback. See previous comments in relation to shortfalls in staff supervision. Students interests are better protected with some updated polices and procedures. Several policies and procedure have now been updated including medication, safeguarding, supervision and quality monitoring. These polices are now available to staff on line. Improved records better protect students rights and best interests although further work is required. Students now sign their support plan and risk assessments. Consistency of records has improved. See previous comments in relation to shortfalls in support plans, risk assessments and behavioural guidelines. New accident books have been implement in line with data protection guidance. Records are stored Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: securely and are individual. The college has commissioned an outside health and safety audit which is planned for June 2010. The organisation produce an action plan and will provide support for one year to aid compliance. See previous comments regarding shortfalls in mandatory health and safety related subjects otherwise there were no further concerns in relation to health and safety. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 31 of 32 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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