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Inspection on 07/08/09 for Waymead Short Term Care

Also see our care home review for Waymead Short Term Care for more information

This is the latest available inspection report for this service, carried out on 7th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Service users are supported and encouraged to make personal choices and decisions about their stay at the service, with activities planned around peoples` individual interests and hobbies. The staff work hard to ensure that service users` needs are appropriately assessed and kept up to date and that their care is planned to ensure that these needs are met, whilst encouraging and enabling service users to maintain their independence where possible. Service users spoken with told us they enjoyed their stays at the home and that they looked forward to their stay and spending time with their friends. Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere. One staff member commented on their survey form: `Waymead provides a very progressive and person centred service, due to the management of both managers I have worked for` and a social and health care professional commented on their survey form: `The management of the service is excellent and committed to providing a person centred service. There is a focus on supporting individual choices. The service aims not just to provide respite for families, but to enhance the quality of life for service users during their stay.`

What has improved since the last inspection?

All requirements and recommendations made at the last inspection have been met. Service users are now involved, as much as possible, in developing and reviewing their individual plan of care. Staff training in different methods of communication has been provided and the manager and team are currently looking at alternative ways to record people`s individual methods of communication. Over 50% of the current staff team are now qualified to National Vocational Qualification level 2 or above in care and changes to the system of staffing the home means that service users now benefit from receiving care and support from staff that know, and are known to them. Staff recruitment files are now complete and kept at the home. A system is now in place to enable the management to record and monitor any concerns raised about the home and an up to date policy is in place regarding the use of physical interventions and restraints. Monthly quality assurance visits now take place by a representative of the provider and service users` views about the future of the service are being sought. In the AQAA to demonstrate improvements made in the past twelve months the previous manager stated: `More activities now take place. We no longer use a contracted food supplier; this enables a more flexible approach to meal times and also enables people using the service to be more involved in the process including shopping, meal preparation and cleaning up. We now have access to two `Belingos` that are wheelchair accessible to enable people with more profound support needs to be able to access the community, without requiring a wheelchair accessible bus to take them. This creates more opportunities as the vehicles can be driven on a standard licence. A computer has been set up in the activity area as several people who use the service requested it, it has internet access. New dining table and chairs purchased as well as new Wii for individuals to play on. The new washing machine and drier that service users have used alongside staff. People using the service can be supported to do their own laundry and gain independence skills. All support staff are now employed on a generic contract, this provides the service with the flexibility to utilise staff where they are needed most.` These statements were all supported by the findings on the day of this inspection.

What the care home could do better:

Requirements have been made relating to staff training and competency. The provider needs to review the system in place at the home to ensure that service users are supported, at all times, by staff that have received training appropriate to the work they are to perform and that at all times there are staff on duty who are suitably qualified and competent. The manager needs to be provided with clear guidance on what training and competency assessments are required by the staff working at the home, how often such training should be up dated and how the manager can ensure that training is provided when needed.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Waymead Short Term Care St Anthonys Close Off Binfield Road Bracknell Berkshire RG42 2EB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 0 7 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Waymead Short Term Care St Anthonys Close Off Binfield Road Bracknell Berkshire RG42 2EB 01344451285 Telephone number: Fax number: Email address: Provider web address: derek.mccarthy@bracknell-forest.gov.uk www.bracknell-forest.gov.uk Name of registered provider(s): Name of registered manager (if applicable): Bracknell Forest Borough Council The registered provider is responsible for running the service care home 10 Type of registration: Number of places registered: 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 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 needs on admission to the home are within the following categories: Learning Disabilities (LD) Date of last inspection Brief description of the care home Waymead Short Term Care provides respite care for adults with a learning disability. The home is owned and operated by Bracknell Forest Borough Council and all referrals are made via their Community Team for People with a Learning Disability. The home Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 10 Brief description of the care home can accommodate up to ten service users per night, and was providing a service to thirty one service users overall at the time of this inspection. Fees are calculated on a basis of £158 per 24 hour period. This information was provided on 7th August 2009. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 7th August 2009 starting at 10:15am. The new manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 8th August 2007. The people who use this service prefer to be referred to as service users. For clarity and consistency this term will be used throughout this report. On the day of this visit four service users were involved in the inspection and information was gained from three on duty staff. Prior to the inspection, survey forms Care Homes for Adults (18-65 years) Page 6 of 34 were sent to ten service users, ten social and health care professionals and to ten members of staff employed at the home. Survey forms were returned by four service users, three social and health care professionals and five members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The previous registered manager left the home at the end of May this year, prior to leaving he had completed and returned the homes annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was clear and gave us all the information we asked for. Service users care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the service users and staff for their time, assistance and hospitality during this visit and the service users, social and health care professionals and staff who provided additional information and participated in the surveys. What the care home does well: What has improved since the last inspection? All requirements and recommendations made at the last inspection have been met. Service users are now involved, as much as possible, in developing and reviewing their individual plan of care. Staff training in different methods of communication has been provided and the manager and team are currently looking at alternative ways to record peoples individual methods of communication. Over 50 of the current staff team are now qualified to National Vocational Qualification level 2 or above in care and changes to the system of staffing the home means that service users now benefit from receiving care and support from staff that know, and are known to them. Staff recruitment files are now complete and kept at the home. A system is now in place to enable the management to record and monitor any concerns raised about the home and an up to date policy is in place regarding the use of physical interventions and restraints. Monthly quality assurance visits now take place by a representative of the provider and service users views about the future of the service are being sought. In the AQAA to demonstrate improvements made in the past twelve months the previous manager stated: More activities now take place. We no longer use a contracted food supplier; this enables a more flexible approach to meal times and also enables people using the service to be more involved in the process including shopping, meal preparation and cleaning up. We now have access to two Belingos that are wheelchair accessible to enable people with more profound support needs to be able to access the community, without requiring a wheelchair accessible bus to take them. This creates more opportunities as the vehicles can be driven on a standard licence. A computer has been set up in the Care Homes for Adults (18-65 years) Page 8 of 34 activity area as several people who use the service requested it, it has internet access. New dining table and chairs purchased as well as new Wii for individuals to play on. The new washing machine and drier that service users have used alongside staff. People using the service can be supported to do their own laundry and gain independence skills. All support staff are now employed on a generic contract, this provides the service with the flexibility to utilise staff where they are needed most. These statements were all supported by the findings on the day of this inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that the 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. Evidence: In the AQAA, the previous manager stated that: All referrals come through care management, all people new to the service receive an assessment, a transition/introduction timetable is then formulated with the individual and their main carer and any other significant individuals to the person. The manager explained that the initial assessment by the care management team, from the local community team for people with a learning disability, includes an assessment of the service users carers need for respite. Based on the information gathered during the assessment process, the service user is then allocated a number of respite nights per year by the care management team. Allocations for the people who currently use the service range from between 24 and 120 nights per year. Once the care management team have completed their assessment and the decision has been made that respite care would be of benefit, the manager will then visit the service user and carry out a Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: further assessment to be sure that the home would be able to meet the prospective service users needs. Two files were sampled during this visit for two of the four service users who were coming for respite care for the weekend. In each case pre admission assessments had been carried out. The home are developing a new assessment form which is more person centred and also incorporates assessments designed to more easily identify equality and diversity needs. Although the definite design has not been decided on at this stage, the manager is in the process of reassessing all service users so that they can be sure that they are still able to meet the needs of the service users that use the service for respite care at present. The service users spoken with during this visit all said that the staff knew what care they needed and how they liked to be supported. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their assessed and changing needs and personal preferences and goals are reflected in their care plans. Service users are able to make decisions about the way they spend their time during their stay at the home, with support from staff if needed. Service users are supported to take risks to enable them to stay independent. Evidence: Prior to this visit, social and health care professionals were sent survey forms, three forms were returned. In answer to the question Are peoples social and health care needs properly monitored, reviewed and met by the care service all people answered usually. Care plans for three service users were sampled and all were seen to be comprehensive, well set out and easy to follow. Care plans are drawn up with service users and their primary carers and are reviewed six monthly, or more often if needs change or a new concern arises. The staff document daily notes during a persons Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: respite stay providing evidence that individual goals and needs are being met. The care plans were all seen to be individualised and included the service users personal preferences in how they would like their support provided. Detailed risk assessments for all activities were seen in the files, giving clear guidelines for staff to follow to minimise any associated risks. A previous requirement that all current care plans must be fully completed, signed and dated has been met. Three completed service user survey forms were received prior to this inspection. The service users stated that they could do what they wanted to do during the day, in the evening and at weekends. On the day of this visit, there were no service users at the home until 4 pm when the new service users arrived for their weekend stay. All service users described their plans for the weekend and explained to us how they had been involved in the planning of activities in advance. In the AQAA, to demonstrate what the home does well, the previous manager stated that: All people using the service have a service user plan, this is drawn up with the person using the service and/or their representative and is reviewed every six months or more frequently if required. Risk assessments are also carried out where necessary and reviewed six monthly or when there has been a significant change in circumstances. All people using the service are supported to make choices, these include what time they would like to get up / go to bed, what they would like to wear, what they like to eat, what activities they like to engage in, and who they like to stay with (where this is agreed with all parties). Data provided in the homes AQAA does not identify any service users with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user is treated as an individual and the home is responsive to their individual needs. They help to plan activities that are appropriate to their age and culture and that relate to their personal interests. Systems are in place to ensure that service users rights are respected. Service users have meals that are well balanced and varied, at a time and place to suit them. Evidence: The daily routines at the home reflect the requirement to promote independence, individual choice and freedom of movement. Service users confirmed on the returned survey forms that they could choose what to do, when they wanted. This was also confirmed by observations made on the day of this visit. In the AQAA, to demonstrate changes made as a result of listening to people who use Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: the service, the previous manager stated that: More activities now take place as this had been highlighted not only by people using the service as an area in need of improvement and individuals are contacted the week before they are due to stay to be made aware of any activities and any cost that may be incurred. We now have access to two Belingos that are wheelchair accessible to enable people with more profound support needs to be able to access the community, without requiring a wheelchair accessible bus to take them. This creates more opportunities as the vehicles can be driven on a standard licence. It also means that individuals can do their own thing as opposed to being in a larger group. A computer has been set up in the activity area as several people who use the service requested it, it has internet access. This statement was supported by the findings on the day of this inspection. In the afternoon of the inspection four service users arrived for a planned weekend. All confirmed they had been involved in the planning for the weekend in advance and were looking forward to the activities that had been arranged. When asked Does the care service provided support individuals to live the life they choose wherever possible? the social and health care professionals answered usually with one adding the comment: There is a focus on supporting individual choices. The service aims not just to provide respite for families, but to enhance the quality of life for service users during their stay. Menus are planned with the service users who are staying at the home at the time. Where the service users have involvement from dieticians or special dietary needs, details and guidance for staff was seen to be documented in their care plans. The manager stated that, if they have any new concerns, they consult with the community dietician for advice. Some previous menus were sampled and were seen to be varied and well balanced. In the AQAA, to demonstrate changes made as a result of listening to people who use the service, the previous manager stated that: We no longer use a contracted food supplier; this enables a more flexible approach to meal times and also enables people using the service to be more involved in the process including shopping, meal preparation and cleaning up. Care Homes for Adults (18-65 years) Page 16 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support from staff in the way they prefer and want. Their health needs are met because the home has procedures in place that staff follow. If service users 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. Evidence: During this visit three care plans were sampled and it was seen that all health care needs were incorporated into the care plans. Diary notes evidenced that staff take prompt action to deal with any new health problem that may occur and care plans were specific with information for staff to follow when supporting service users to manage any long term conditions. We were advised that, due to the close working connection with the CTPLD team, any changes in needs or care required by service users are communicated before the service user arrives at the home for a respite stay and the care plan is amended in advance. At the last inspection a recommendation was made that all staff should receive training in specialist communication skills. This recommendation has been met, basic Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: communication skills are included in staff induction and the team have recently had training in intensive interaction. Care plans were seen to include details of service users individual communication methods as a guide for staff that may not know them. The manager and team are currently looking at alternative ways to record peoples individual methods of communication that would be useful for new members of staff to refer to, e.g. photographs, videos. This is still in the planning stage and the manager advised that this would only be done with peoples consent. Service users bring their own medication with them when they come to the home for a respite stay. The manager explained that this is always in the original packaging from their pharmacist and that, where the person usually self-medicates, lockable storage is provided in all bedrooms for this purpose. Medication administration records (MAR) from previous stays, medication storage facilities, policies and procedures were all sampled and found to be in good order. Staff training in the safe handling of medications is provided by Bracknell Forest Borough Council and the manager is able to contact the boroughs pharmacy advisor for advice and guidance if needed. During this inspection, all interactions observed between staff and service users were polite and respectful of peoples privacy and dignity. Staff never entered service users private rooms without asking permission to enter. All personal care was carried out behind closed doors. Of the three social and health care professionals who returned survey forms, all stated that they felt their clients health care needs were usually properly monitored and attended to by the home. One felt that the staff always respected the service users privacy and dignity and two answered usually. When asked if the service supports people to administer their own medication or manage it correctly where this is not possible two answered always and one answered dont know. The five staff members who returned survey forms all stated that they are provided with training that gives them enough knowledge about health care and medication. Care Homes for Adults (18-65 years) Page 18 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 home safeguards people from abuse, neglect and self-harm and staff know the actions to take following any allegations. Evidence: At the last inspection a requirement was made that the manager must ensure that the complaints system enables the tracking of relevant documents regarding investigations and outcomes. This requirement has been met. The manager explained that, where possible, any concerns are dealt with by the staff at the home, at the time they are raised. The complaints procedure sets out that any formal complaints would be dealt with by the complaints department of Bracknell Forest Borough Council as the registered provider. The manager stated that, should a formal complaint be made, the manager is advised of the outcome and any actions to be taken when the complaint has been fully investigated. Records of the details of the investigation and all related documents are kept at the providers head office and the home keep a record of any concerns or compliments within the home. In the AQAA, to demonstrate what the home does well, the previous manager stated that: All people using the service have been sent a copy of the complaints procedure. Of the four service users who returned survey forms, two said they knew who to speak to if they were not happy and two left this answer blank. One of the service Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: users spoken with during the visit said they would speak to any member of staff if they had a concern and confirmed that the staff always take note of what they say and act on it. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. All staff surveyed stated that they knew what to do if someone has concerns about the home. The manager is aware of their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DOLS) and the homes initial needs assessments now include a mental capacity assessment form and a DOLS screening tool. They are also in the process of completing these two documents with all present service users who use the respite care service. CQC has received no information relating to any safeguarding concerns since the last inspection. Care Homes for Adults (18-65 years) Page 20 of 34 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. Service users stay in a safe, well-maintained home that is clean, comfortable and hygienic. Steps are being taken by the management to address the limitations of the current layout of the building. Evidence: Waymead Short Term Care provides respite care for adults with a learning disability. The home is owned and operated by Bracknell Forest Borough Council and is located in a residential area, next to the offices of their Community Team for People with a Learning Disability. The home can accommodate up to ten service users per night, and was providing a service to thirty one service users overall at the time of this inspection. There are three bedrooms on the ground floor and seven on the first floor. The first floor rooms are not accessible to service users that are not able to safely negotiate stairs. All communal rooms: lounge, dining room and conservatory, are on the ground floor and accessible to people who use a wheelchair for mobility. At the last inspection a requirement was made that The shortfalls of the current building must be taken into consideration in the current planning for the reconfiguration of the service. This requirement has been met. In their AQAA the previous manager described the shortfalls and the plans that are in place for improvement: Most of the upstairs rooms are too small and can only be accessed by Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: stairs. No rooms have en-suite facilities and this means that all service users have to share the four bathroom/toilets (two upstairs and two down). The head of learning disability services, the learning disability services development manager and the respite manager are currently looking at new ways to develop the respite service, this could include reducing the number of bedrooms at the current site, a purpose built unit, or a combination of both. We are currently carrying out a feasibility study to decide the future of the service, as the building has been identified as being unsuitable for purpose. The outcomes of this study should be known by the end of 09. On the day of this visit we were shown around all areas of the home and grounds, with the exception of one bedroom. The furniture and furnishings were seen to be of a good quality and specialist equipment is provided, if needed by the service users. In the AQAA, to demonstrate what the home does well, the previous manager stated that: Every service user is offered to choose their room for their stay where possible. All the rooms have a sink in them to enable people using the service to have more privacy and promote independence. People using the service are encouraged to bring in items to make their room feel more homely during their stay. The unit has several small hi-fi units that can be put in individuals rooms. Each room has ample storage for clothing and belongings. People using the service are able to have their own key for their bedroom door during their stay to encourage independence as well as ensuring maximum privacy for the individual. People using the service are also able to lock their bedside cabinet which can be used for storing important items. The unit has a large lounge and conservatory both housing large flat screen TVs so that individuals can chose what they want to watch. There are computers available and recently a Wii has been bought. There is also a large dining area although people using the service can chose to eat there, in either of the lounge areas, or their room should they choose. Generally all the furniture and appliances are mainstream and not from specialist companies as it is important to maintain a homely ambiance. There is a ceiling tracking hoist in the bathroom and a level access wet/shower room. This statement is supported by the findings on the day of this inspection. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the service users staying at the home. The laundry room now has a domestic washing machine and drier and service users can be supported to do their own laundry and gain independence skills, if they wish. Three of the service users who returned survey forms said that the home was always fresh and clean and one left this answer blank. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: On the day of this visit the home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. Care Homes for Adults (18-65 years) Page 23 of 34 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. Service users are supported and protected by the homes recruitment practices and now benefit by the change to the homes staffing system ensuring they receive care from staff that know, and are known to them. Action must be taken to protect the safety and welfare of service users by ensuring that they are supported by suitably competent and qualified staff at all times. Evidence: Waymead Short Term Care is part of the wider day services department of Bracknell Forest Borough Council and the home works closely with other services in the department, with the majority of support workers now being generic and working in the day service facilities as well as at the home. In their AQAA, the previous manager stated that: This provides the service with more staff at critical times, therefore promoting more meaningful activities for the people receiving the service. During this inspection the manager also explained that the majority of the service users also use the day service facilities provided by Bracknell Forest Borough Council. As the staff from the home also work in the other services, there is frequent contact between the service users and staff outside of the times when the service users stay at the home for respite care. This also provides service users with the opportunity to get to know new members of staff who will work with them during their respite stays at the home. The staff rota evidenced that staff are provided in sufficient numbers to meet the Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: needs of the service users at the home. We were advised that staffing levels are calculated based on the needs of the service users staying at the home at the time and the activities that have been planned. The morning shift usually runs from 8am to 4pm and the afternoon/evening shift is 3.30pm to 11 pm, the night staffing levels are also calculated on the needs of the service users and usually consists of one waking support worker, with additional staff available to work if needed. The change of the care staff role to generic support workers, working across the different services within the department, has led to a reduction in the use of agency staff and an increased consistency for service users with the majority of staff being well known to them. A previous requirement for the home to take steps to increase the number of permanent staff to maximise the consistency and continuity of support provided to service users has been met. At the last inspection it was recommended that the home take steps to increase the level of staff qualified to National Vocational Qualification (NVQ) level 2 or above in care. Since that time and out of the current twenty two support workers, twelve now hold NVQ level 3 in care, with a further three people waiting to start. In addition, seven staff members are expected to begin learning disability qualification (LDQ) training within the next three months. This action meets the previous recommendation. At the last inspection a requirement was made that staff recruitment files must be available for inspection at the home. This requirement has been met and all staff files are now kept in the home. During this visit the files of two recently recruited members of staff were sampled. Both files were seen to contain proof of identity, two references, a completed application form and enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks had been obtained. Both had full employment histories with a written explanation of any gaps in employment. At present the home have not been verifying peoples reasons for leaving previous employment working with vulnerable adults or children, however, the manager advised us following the inspection that she is reviewing all staff files and, where applicable, contacting previous employers to verify the staff members stated reasons for leaving. Staff induction is in line with the new, mandatory Skills for Care common induction standards and formal training, covering mandatory health and safety topics plus medication administration, is provided by Bracknell Forest Borough Council training department. One member of staff is currently on induction but the manager was not aware that a named staff member should be allocated to the new worker until their induction is completed. A requirement has been made. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: At the last inspection a recommendation was made that the manager establish a collective record of staff training to enable monitoring of staff training needs. There is now a staff training log in place, meeting this recommendation. A requirement was also made at the last inspection that the training needs of the staff should be reviewed and that steps be taken to address any gaps in core training. This requirement was met for the staff team as they were then, but staff training has again been identified as a concern at this inspection. In the two staff files sampled there were no records of training for the mandatory health and safety training topics, apart from recent first aid training for one person. There were also no records of the two members of staff receiving medication training, or having had a competency assessment, although administration of medication is part of their role when working with service users at the home. It is positive to note that, following this inspection, the manager took immediate steps to address the concerns relating to staff training and supervision. We were advised by the manager that she has contacted the training department to gain more information; identified training that staff have attended but are waiting for certificates; obtained evidence of training that the new worker had received from their previous employer (and has been allocated a staff member); identified mandatory training that is overdue for other members of staff and started booking people on training updates. We were also advised that the manager has reviewed the staff rota and made amendments so that there are always suitably qualified and competent staff on duty each shift. Of the three social and healthcare professionals who returned survey forms, two said that the staff usually have the right skills and experience to support service users social and health care needs and one answered sometimes. Of the five staff members who returned survey forms, all stated that they were given training that is relevant to their role, helps them understand and meet the individual Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: needs of service users and keeps them up to date with new ways of working. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere. The home has a quality assurance and monitoring system in place that is based on seeking the views of the service users. Policies and procedures are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users and staff. Evidence: The previous registered manager left the home at the end of May this year. The new manager was appointed to her position on the 3rd August 2009 and is in the process of applying to us to become the registered manager for Waymead Short Term Care. She has over eight years experience working in care, has been assistant manager at Waymead since January 2008 and has just started on her registered manager award training course. In relation to the management of the home, one member of staff commented on their survey form: Waymead provides a very progressive and person centred service, due Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: to the management of both managers I have worked for and a social and health care professional commented on their survey form: The management of the service is excellent and committed to providing a person centred service. Service users views are sought on a regular basis and monthly visits by a representative of the responsible individual take place as required, meeting a requirement made at the last inspection. We were advised that service users had chosen not to complete survey forms after each stay at the service and are now sent forms every three months. Any concerns raised as a result of the surveys are passed to the home manager and actions are taken to resolve any issues. Service users spoken with confirmed that their opinions are sought and that they are involved in planning activities for their respite stays at the home. In the AQAA, the previous manager stated: The long term plan is to create a more socially inclusive service for people, while still maintaining a smaller residential service. This would give people more opportunities to get involved with the things they enjoy and make the respite experience more meaningful for all concerned. We are currently liaising with individuals to identify what they require from the respite service. All necessary health and safety checks are carried out by the staff at the home with documentary evidence inspected of routine fire practices and evacuations. Fire equipment checks, daily checks of hot food temperatures and a number of up to date maintenance certificates were seen. All records were up to date and well maintained. All interactions observed between the staff and service users were inclusive, caring and respectful. Care Homes for Adults (18-65 years) Page 29 of 34 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 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 The registered person must 07/09/2009 develop and implement an ongoing tracking and monitoring system to ensure that staff working at the home receive, and are up to date with, training appropriate to the work they are to perform and to ensure that service users are at all time supported by suitably qualified and competent staff. So that service users can be confident that the home protects their safety and welfare by ensuring that they are supported by suitably competent and qualified staff at all times. 2 35 17 The registered person must maintain in the home an up to date record of all training and competency assessments undertaken by 07/09/2009 Care Homes for Adults (18-65 years) Page 31 of 34 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 people employed to work at the home. In order to evidence that service users are supported by a staff team that is suitably qualified and competent. 3 35 18 The registered person must 21/08/2009 ensure that, for the duration of a new workers induction training, a member of staff (the staff member) who is appropriately qualified and experienced, is appointed to supervise the new worker; as far as practicable, the staff member is on duty at the same time as the new worker and the new worker does not escort any service user away from the home unless accompanied by the staff member. So that service users can be confident that the home protects their safety and welfare by ensuring that they are supported by suitably competent and qualified staff at all times. 4 35 18 The registered person must 07/09/2009 ensure that, at all times, suitably qualified, competent and experienced persons are working at the home in such Care Homes for Adults (18-65 years) Page 32 of 34 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 numbers as are appropriate to the health and welfare of the service users and that the persons employed by the registered person to work at the home receive training and competency assessments appropriate to the work they are to perform. So that service users can be confident that the home protects their safety and welfare by ensuring that they are supported by suitably competent and qualified staff at all times. 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 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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