Inspection on 21/05/09 for 5 St Margaret`s Gardens

This inspection was carried out on 21st May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

5 St Margaret`s Gardens 24/05/07

5 St Margaret`s Gardens 25/05/06

5 St Margaret`s Gardens 18/10/05

5 St Margaret`s Gardens 09/05/05

5 St Margaret`s Gardens 20/12/04

5 St Margaret`s Gardens 20/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 5 St Margaret`s Gardens 5 St Margaret`s Gardens Melksham Wiltshire SN12 7BT The quality rating for this care home is: one star adequate 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: Malcolm Kippax Date: 2 1 0 5 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 36 Information about the care home Name of care home: Address: 5 St Margaret`s Gardens 5 St Margaret`s Gardens Melksham Wiltshire SN12 7BT 01225709691 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ordinary Life Project Association care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Date of last inspection A bit about the care home 5 St Margarets Gardens is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). 5 St Margarets Gardens is a detached property in a residential area on the outskirts of Melksham. Each person who uses the service has their own bedroom. One of the bedrooms is on the ground floor and has an en-suite bathroom. The other bedrooms and a bathroom are on the first floor. There is a lounge and a dining Care Homes for Adults (18-65 years) Page 4 of 36 room. The dining room has patio doors to a large garden at the side of the property. The homes garage is used as a laundry and storage area. The people who use the service receive support from a manager and a permanent staff team. There is at least one staff member working in the home throughout the day. Extra staff are deployed at certain times. The fees are in the range of 875 - 1100 pounds per week. Information about the home is available in a Statement of Purpose. Copies of inspection reports are available from the OLPA office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. Inspection reports can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 36 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 Care Homes for Adults (18-65 years) Page 6 of 36 How we did our inspection: This is what the inspector did when they were at the care home Before visiting the home, we asked the manager to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how the home was performing. It told us about what has happened during the last year and about their plans for the future. We sent surveys to the home so that these could be given out to the people who use the service, to staff members, and to health professionals. We had surveys back from the four people who use the service, five staff members, and three health professionals. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 21st May 2009. During the visit, we met with three people who use the service and with two staff members. We went around the accommodation and looked at some of the homes records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. The previous inspection of 5 St. Care Homes for Adults (18-65 years) Page 7 of 36 Margarets Gardens took place on 24th May 2008. What the care home does well People who use the service are asked about their needs and personal goals. Information about the goals is recorded in individual plans, which helps staff to support people in a consistent way. Peoples goals include such things as getting a job, attending a new college course, and being able to manage their own money. People also have goals that reflect their interests, such as having a pet and going to the theatre. One person enjoys looking after their own rabbit. People have other plans that include information about their health and care needs. These plans help to ensure that staff know about the support that people require, and what people are able to do for themselves. The staff team have got to know the needs of the people who use the service very well. The home is well placed for people to be able to get to their local activities. We were told about things that people like to do, such as going out cycling and being part of a singing group. People are supported to take risks so that they can develop their independence. One person was gaining experience of going out without staff. Another person was learning to manage their own medication. Care Homes for Adults (18-65 years) Page 8 of 36 People live in an ordinary type house and are involved in the domestic routines. Two people told us that they help out with the chores to keep the home looking nice. We saw people helping with the laundry and using the kitchen to make their own sandwiches for lunch. Tenants meeting are being held, when the people who use the service can talk together about the things that concern or interest them. The home has a well qualified manager who is able to develop the service that people receive. What has got better from the last inspection The manager has produced a development plan for the home. This includes improvements that have been suggested by the people who use the service. People had said that they wanted a new gas fire and television in the lounge, and these have been bought. The upkeep of the garden has improved since the last inspection. There was now a gardener and money was being spent on new plants and outside furniture. Two people have a shared goal concerning their personal relationship and plans for the future. Staff have been providing support with the arrangements and have involved an advocacy service. The Service Users guides now include a section called Financial Matters. This Care Homes for Adults (18-65 years) Page 9 of 36 gives information about what the fees cover, and what the people who use the service need to pay for themselves. It helps to ensure that are no misunderstandings about who pays for certain items and services. We reported at the last inspection that the lounge and hall areas had been redecorated and refurbished, and given a more modern appearance. Work on improving the environment has continued since that inspection. This has included refurbishment of the dining room and the bathroom. As with the other areas, these rooms have been given a more stylish and co-ordinated look. One person who uses the service told us about a focus group that they were involved with. This was a new project that had been arranged through OLPA. It involved social work students, who were looking at improving communication with people who use services, so that they could be more involved in service development. What the care home could do better The home must ensure that there is a robust recruitment procedure being operated, which protects the people who use the service. We were concerned that the management of the service had allowed a new staff member to start their induction in the home before their name had been checked against the POVA Care Homes for Adults (18-65 years) Page 10 of 36 (Protection of Vulnerable Adults) list. If this list is not checked, then the people in the home are at risk of having contact with somebody who has been barred from working with vulnerable adults. We reported at the last inspection that the risk assessment records did not always have a review date, or include full details of the outcome. We saw that new risk assessments were being identified on the care plan review forms. This helped to ensure that they were brought to staffs attention. However, peoples files also included some older risk assessment records. It was not always clear whether these were current or had been superseded by more recent assessments. We were told that further improvements were being planned for the garden. We saw that sections of the wooden fence around the garden were broken and in need of attention. This gave a poor impression of the home environment when seen from the road. A more consistent approach to staff training is needed, to ensure that people benefit from an effective and well trained staff team. The training records need to be kept up to date. The homes plan for staff training should be developed to include more specialist and skills related areas of training for all staff. Care Homes for Adults (18-65 years) Page 11 of 36 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Malcolm Kippax 33 Greycoat Street London SW1P 2QF 02079792000 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 12 of 36 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 13 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are provided with sufficient information about the home to decide whether it will be suitable for them. The home has procedures in place so that it can obtain enough information about the needs of a prospective user of the service. Evidence: A Statement of Purpose for 5 St. Margarets Gardens was kept in the home. We also saw copies of the guides that had been produced for the people who use the service. It was reported in the AQAA that the Statement of Purpose and the Service Users guide were being reviewed regularly. We looked at the Statement of Purpose and saw that the details of fee levels and the staffing of the home had been updated. The Service Users guide included a new section called Financial Matters. This gave information about what the fees covered, and what the people who use the service would need to pay for themselves. This was something that we had talked about at the last inspection. It helped to ensure that there would be no misunderstandings about how certain items and services would be Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: paid for. Each person at the home had been given a personalised copy of the Service Users guide. We were told in the AQAA that one thing the home could do better was to ensure that the guides are in accessible formats. There had been no changes in occupancy since a person moved to the home in October 2005. We looked at the pre-admission process at a previous inspection which took place after this person had moved in. There were no requirements or recommendations made at that time. The home has not had recent experience of a new person moving in. However, we were given information in the AQAA about the homes procedures for admission. These included ensuring that the home received a full community care assessment from the placing authority. Other information would also be obtained from relevant parties, for example from families and outside professionals. This was to find out if the individuals needs could be met at the home. Visits, including meals and overnight stays, would then be arranged so that people had a chance to meet with each other at the home. Care Homes for Adults (18-65 years) Page 15 of 36 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 . Peoples needs and goals are reflected in their individual plans. People can make decisions about their lives. They are supported to take risks so that they can develop their independence. Evidence: Each person who uses the service had a Person Centred Plan (PCP). The plans included information about their needs and personal goals. They had been written within the last year, following review meetings. The plans helped to ensure that all the staff knew what had been agreed at the meetings, and the individual support that people required. We asked staff members in their surveys whether they were given information for example in the care plans about the needs of the people they supported. The staff members all responded Always to this question. One staff member commented Care plans always kept up to date. We looked at the PCPs and saw that people had a variety of goals which they were hoping to achieve. They included such things as getting a job, attending a new college course, and being able to manage their own money. People also had goals that reflected their individual Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: interests, such as having a pet and going to the theatre. Two people had a shared goal concerning their personal relationship and the future arrangements. These people were also receiving support from an advocacy service. The PCP records included 3 Monthly Action Sheets. These were the way in which peoples progress with achieving their goals was monitored and recorded. We read that people had achieved various goals from the previous year. People who use the service met together at tenants meetings, when they could talk about matters that affect them and be given information by staff. The outcome of the meetings was being well recorded. We saw how people had made decisions about things they wanted to do. People talked about their relationships and their plans for the future. They were being kept up date, for example about changes in the staffing arrangements. One person who uses the service spoke to us about a problem when people were in the lounge and wanted to watch different television programmes. This resulted in people trying to keep the remote control to themselves. We suggested to the person that they talk to the manager or discuss it at a tenants meeting, so that an agreement could be reached. They thought that it was something that they could discuss at the meeting. People told us about their goals and plans for the future. These were consistent with the information that had been recorded in their individual plans. In their surveys, the people who use the service confirmed that they could make decisions about what to do each day. One person commented that they could decide What I like to wear, what time I go to bed, what I like to eat. Risk assessments had been undertaken in connection with various activities that were linked to peoples goals. Some people spent a lot of time outside the home and did some things independently. We saw records of risk assessments in relation to traveling in a taxi without staff support, and spending time at a club, or being at church without staff present. One of the health professionals commented in their survey Good evidence of service user being supported to access the community independently and progress in terms of developing independent living skills. People had locks on their doors so that they could be private in their own rooms. Care Homes for Adults (18-65 years) Page 17 of 36 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 . People take part in activities which reflect their abilities and interests. People receive support which helps them with their relationships and with being part of the local community. People are happy with the meals and the domestic arrangements are flexible to fit in with peoples individual circumstances. Evidence: One person who uses the service was out at a resource centre when we arrived at the home. Three other people were doing jobs around the house, such as cleaning their rooms and helping out in the kitchen. Later in the day somebody went out with items for recycling at a nearby centre. Another person hung their washing out to dry in the garden. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: The three people were having home-based days, but they told us about other things that they did during the week. This included going to college and day centres. One person had a part-time job and was looking at other employment opportunities. This person often went out on their own and a local delivery job was one option being considered. Another person used to work as a cleaner and general help, but this had stopped and they were actively looking for a new job. Staff were supporting the person with this and were in contact with a charity that helps people to find employment. We spoke to the people who use the service about their interests and social activities. One person used to have their own cat, but now enjoyed seeing the neighbours cat each day. Somebody else liked to go out cycling and they had their own rabbit to look after. There was a local singing group that some people were involved with. We saw that people who use the service had received poll cards, so that they could vote in a forthcoming election. People said that they could use the homes phone to keep in contact with friends and relatives. One person went out to post a letter during our visit. People told us about their friendships and the relatives who they saw or contacted regularly. One person had a good friend outside the home, who they were able to see on a regular basis. Two people in the home did a lot of things together and liked to spend time in each others rooms. They were making plans for the future and receiving support from staff with the practical arrangements in connection with their plans. Information about peoples family contacts was included in their personal files. There was guidance for staff about the visiting arrangements and how good communication could be maintained. People said that they helped out with the laundry and the cleaning of their own rooms. We saw people using the kitchen and preparing their own lunches. One person chose to boil some eggs and then made sandwiches for themselves and for somebody else. Another person chose a different filling for their sandwiches. People could help themselves to fresh fruit in bowls. People had their main meal together in the evening. One person who uses the service told us that staff write the menus after asking people what they would like. Menus were displayed in the kitchen. A staff member said that it was not kept to rigidly, as people sometimes wanted an alternative on the day. People told us that they like the meals. One person said that one of their favourite meals was cottage pie, which they were able to have sometimes. Care Homes for Adults (18-65 years) Page 19 of 36 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 . People receive the support that they need with their personal and health care needs. They are protected by the homes procedures for dealing with medicines, and receive support which helps them to manage their own medication. Evidence: The people who use the service had their own rooms where personal care could be carried out in private. One person had a ground floor room with an en-suite bathroom. People had individual care plans which described their personal and healthcare needs. Care plan review forms were being used, which showed where the care plans had been amended because of changes in peoples needs. The records reflected peoples different needs and type of support that they required. For example, one person needed support to ensure that their skin remained healthy. We saw that the procedure for skin care had been reviewed and amended in April 2009. Another person had a plan for mouth care and this had been updated in March 2009. One persons care plan included the need for their weight to be monitored regularly. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: We saw that a weight chart was in use and that this was up to date. Other support was provided by way of verbal prompting. This was to encourage people to manage their personal care by themselves as much as possible. Sometimes risk assessments were being undertaken when people needed support or observation to ensure that they were safe. This included for example, the risk of choking when somebody was eating. We reported at the last inspection that the risk assessment records did not always have a review date, or include full details of the outcome. We saw that new risk assessments were being identified on the care plan review forms. This helped to ensure that they were brought to staffs attention. However, peoples files also included some older risk assessment records. It was not always clear whether these were current or had been superseded by more recent assessments. We read that people also received support which helped them to develop their independence, both within the home and in the community. One person was receiving support with the aim of eventually being able to go out on their own. They had initially only gone out with a staff member present. The care plan review form showed that a risk assessment was completed in May 2009, when the person started making some journeys with another person who uses the service, rather than being accompanied by a staff member. The next step was for the person to make one of the journeys independently. One of the health professionals who completed a survey commented that the home is Good at explaining risk and managing this, rather than trying to prevent risk by placing restrictions. People received support with managing their behaviour. The home had involved outside health professionals, such as a consultant psychologist, so that appropriate plans could be agreed. The people who use the service were registered with local GPs. Details of appointments with GPs and other healthcare professionals were recorded on forms in peoples personal files. We read about the contact that people had had with opticians, dentists and chiropodists in recent months. A staff member told us that each person received a chiropody service, which included toe nail cutting, and there was no charge for this. We did not see health action plans on peoples files, and these were not mentioned in the Healthcare section of the AQAA. The completion of these should be priority, as the Governments Valuing People White Paper recommended that each person with a learning disability should have a health action plan in place by June 2005. We looked at the minutes of staff meetings and saw that peoples health and care needs were being discussed. This helped to ensure that any changes in peoples wellbeing were identified and responded to appropriately. People told us that they were happy with the support that they received from staff. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: We looked at the medication arrangements. There was a written policy on medication and a procedure for its administration. Information about peoples medication was included in their individual plans. There were medication profiles, signed consent forms and drug information cards. One person did not have medication prescribed. Staff were supporting two people with managing their medication. Appropriate records were being maintained to show what medication was being kept in the home and when it had been administered. No medication had been prescribed for use on a PRN (as required) basis. There was a suitable cabinet for the storage of peoples current medication. There are specific requirements in relation to the storage of controlled drugs. No controlled drugs were being stored at the time of the inspection, although it is recommended that an appropriate facility is obtained. One person had a plan for self-medication. Initially they had looked after their medication for a day, but were now looking after a weeks supply. A risk assessment had also been undertaken, to ensure that this was a safe practice. The person who uses the service was involved with staff at all stages, including the preparation of a dosette box / compliance aid. Staff members were recording their involvement in this. The person who uses the service was also keeping their own records in relation to this practice, and telling staff when they had taken their medication. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are listened to by staff and their views are acted on. There are procedures in place which help to ensure that people are protected from harm and abuse in most areas (people are not well protected by the homes recruitment process - see Staffing section). Evidence: We asked the people who use the service if they knew who to speak to if they were not happy with something. They mentioned a range of people who they would talk to, including family members, staff, and an OLPA service co-ordinator. People had the opportunity to raise concerns and discuss things together at the regular tenants meetings. People could contribute to the meeting agendas, and the minutes showed that their issues were being followed up. One person who uses the service spoke to us about a problem when people were in the lounge and wanted to watch different television programmes. This resulted in people trying to keep the remote control to themselves. We suggested to the person that they talk to the manager or discuss it at a tenants meeting, so that an agreement could be reached. They thought that it was something that they could discuss at the meeting. OPLA had produced a formal complaints procedure for use by all parties. This had been Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: adapted into a pictorial version for the people who use the service. A copy of the procedure was included in peoples Service Users guides. We were told in the AQAA that the home had not received any complaints during the last year. In their surveys, staff members confirmed that they knew what to do if somebody had concerns about the home. We saw guidance displayed in the home about what staff should do if they have a concern about possible abuse. Staff members had been given their own copy of the No Secrets booklet, which summaries the local authoritys procedure for safeguarding vulnerable adults. An easy read version of Keeping People Safe in Wiltshire was kept in the home. This booklet was designed for people who use services and gives them information about abuse and what they should do about it. One person who uses the service told us that they had looked at the booklet. Abuse awareness was included as a subject in OLPAs staff training programme. We have recommended at previous inspections that staff have the opportunity to receive abuse awareness training more than once during their employment. This was so they would be familiar with any changes that are made in the policies and procedures for safeguarding adults. We were told in the AQAA that further training about abuse and the protection of vulnerable adults was going to be arranged. OLPA have had experience of making referrals under the local authoritys procedures for safeguarding vulnerable adults. The OLPA service co-ordinator had usually taken the lead on this, on behalf of the organisations residential services. We were told in the AQAA that there had been no referrals to the POVA (Protection of Vulnerable Adults) List. This is a national register of people who should not be working with vulnerable adults. One new staff member for the home had been recruited since the last inspection. This person had been appointed and started their induction in the home before the outcome of their POVA list check was known (see Staffing section of this report). This means that the people who use the service were at risk of having contact with somebody in their home who should not be working with vulnerable adults. Care Homes for Adults (18-65 years) Page 24 of 36 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 . The accommodation is generally homely and well maintained. People like the improvements that have been made to the home environment. Most areas of the home are kept clean and tidy. People would benefit from further support with the cleaning of their own rooms. Evidence: 5 St. Margarets Gardens is in a residential area and within walking distance of Melksham town centre. The home is an ordinary domestic property and its style is in keeping with the local area. It has a good-sized garden with a patio and lawn. We reported at the last inspection that the lounge and hall areas had been redecorated and refurbished, and given a more modern appearance. Work on improving the environment has continued since that inspection. This has included refurbishment of the dining room and the bathroom. As with the other areas, these rooms have been given a more stylish and co-ordinated look. The environment has been enhanced further through the use of more modern furniture and the purchase of new items, such as a flat screen television and art pictures. We saw people using the lounge, which was well lit and comfortably furnished. There Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: was a separate dining room, which provided an additional communal space for quieter activities. There were patio doors in the dining room which people used to get to the garden. A railing and sloped walkway had been installed to help one person in particular. People who use the service told us that they liked the garden. People spent time in the garden during the afternoon of our visit. The upkeep of the garden had improved since the last inspection. There was now a gardener and money was being spent on new plants and outside furniture. We saw that sections of the wooden fence around the garden were broken and in need of attention. This gave a poor impression of the environment when seen from the road. Laundry was carried out in the garage that was attached to the house. People could avoid the food preparation and dining areas when taking their laundry to the garage. This reduced the risk of cross-infection. Each person who uses the service had their own room. After seeing the accommodation at the last inspection, we reported at the time that one person may need more support or encouragement with maintaining cleanliness in their room. Two people showed us their rooms, which they had personalised and decorated as they wished. The sink in one persons room was blocked and had a build up of scale around the taps. There was also a lot of dust above head height. We talked to this person about the cleaning of their room. They said that they did their own cleaning, but would be happy for staff to help them with some areas. During our visit, a staff member contacted the OLPA maintenance person about the blocked sink. The maintenance person visited the home later in the day to fix the sink. The other persons bedroom that we saw was relatively small for the amount of items being kept in it. This meant that there was little room left for socialising, although the person liked to have some of their meals in the room with another person. A staff member said that they were working with the person, to help ensure that a hygienic environment was maintained. The people who use the service told us in their survey that they thought the home was kept clean and fresh. One person commented I help to keep the home clean and tidy, and another I do my chores to keep it clean. The communal and domestic areas of the home looked clean and well maintained. The home was using the Safer Food, Better Business guidance and log book, as a way of monitoring hygiene standards in the kitchen. There was a large photograph on the kitchen fridge door, which reminded people of how to store food items correctly in order to prevent cross-contamination. Foodstuffs in the fridge had been dated after opening, to help ensure that they were eaten within the recommended timescales. Care Homes for Adults (18-65 years) Page 26 of 36 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 . The people who use the service are supported by competent staff who they know well. A more consistent approach to staff training is needed, to ensure that people benefit from an effective and well trained staff team. People are not well protected by the homes recruitment procedure. Evidence: There was a staff team of six, of whom five had achieved a National Vocational Qualification (NVQ) at level 2 or above. We were given information in the AQAA about staff training. It was reported that all mandatory training for staff was up to date. This included training in Health and Safety, First Aid, Medication, Food Safety, Fire Safety, Abuse Awareness, Manual Handling, Person Centred Planning and Infection Control. Each staff member had an individual training and development record. We looked at some records in the home, but these did not show that all staff had received the mandatory training, as identified above. We spoke to a staff member who thought that the records were not up to date or included details of all the training that had been provided. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: We recommended at the last inspection that the homes plan for staff training was expanded to include more specialist areas of training. The staff training programme still focussed on mandatory and annual refresher training, although courses in some other, skill related subjects such as communication and mental health awareness were available. It was reported in the AQAA that all staff had attended a course on bereavement during the last year. The training records showed that other courses, covering subjects such as epilepsy, disability and equality, mental capacity and person centred care had been attended by some staff. These subjects would be relevant for all the staff team, but individual staff members had not received all this training. We were told in the AQAA that the home would continue to improve training, internal and external. However there was a lack of detail about the subjects that would be covered. Most members of the staff team had worked in the home for several years. The relationships we observed between staff and the people who use the service appeared to be friendly and respectful. Staff members showed that they were aware of peoples needs and the areas in which they required support. It was reported in the AQAA that the home operated a robust recruitment procedure. We were also told that people who had started work in the last 12 months had satisfactory pre-employment checks. We went to the OLPA office before visiting the home in order to look at staff employment files. We met with OLPAs personnel officer, who showed us the recruitment record for a staff member who had been employed since the last inspection. An application form had been completed. Two people had interviewed the applicant and they had kept notes of the outcome. We talked to the personnel officer about other information that should have been recorded in connection with the interview process. Two references, proof of identity, and a Criminal Record Bureau (CRB) disclosure had been obtained in connection with the application. The system of POVA First had been used so that the persons name could be checked against the POVA (Protection of Vulnerable Adults) list before the outcome of their CRB disclosure was known. We looked at records in the home and saw that the new staff member had been appointed and started their induction in the home before their POVA First check had been returned. If this list is not checked, then people in the home are at risk of having contact with somebody who has been barred from working with vulnerable adults. Care Homes for Adults (18-65 years) Page 28 of 36 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 . People who use the service can be confident that the home is being managed appropriately in most areas. Procedures are in place that assist in the efficient running of the home and help to safeguard peoples health and safety. However, the management of the service has not ensured that the procedure for staff recruitment is sufficiently robust. Peoples views contribute to improvements in the service and the home is developing its systems for quality assurance. Evidence: Ms Saunders is an experienced manager who is also the registered manager of another similar sized home run by OLPA. Ms Saunders has achieved the Registered Managers Award and NVQ at level 4 in care. She is also a NVQ Assessor. We were told in the AQAA that Ms Saunders kept up to date on theory and practice through training and reading on subjects relevant to the service. Mrs Saunders received support from an OLPA service co-ordinator who visited the home regularly and wrote a report on its conduct. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: Staff members confirmed in their surveys that they met regularly with their manager for support and to discuss how their work. One staff member mentioned monthly supervision and another commented House manager very supportive, any problems that arise they are there to help at all times. There was a Quality Assurance file in the home. This showed the different ways in which people were able to express their views, and how these were being followed up. The file included Tenants meetings outcome forms, which showed how particular issues raised at the meetings had been responded to. We saw that some issues were being dealt with as they arose. People had talked about having a caravan holiday and this had been booked. Plans were being made for a large party to be held later in the year, and arrangements were being made for additional staff to be deployed to help with this. One person who uses the service told us about a focus group that they were involved with. This was a new project that had been arranged through OLPA. It involved social work students, who were looking at improving communication with people who use services, so that they could be more involved in service development. The manager had produced a Development Plan for 2009, which reflected some longer term improvements. People had said that they wanted a new gas fire and television for the lounge, and these had been bought. Further improvements were being planned for the garden. We were told in the AQAA that one thing the home could do better would be to have more involvement from families and friends in quality assurance. This should be addressed as a matter of priority, as it is important that people from outside the home have an opportunity to give feedback about the service that the home provides. It was reported in the AQAA that the development of survey forms had begun. The organisation had produced a range of policies and procedures for use in the home. These were designed to promote safe working with people and good practice in the running of the home. This included a procedure for staff recruitment. However we were concerned that the management of the service had allowed a new staff member to start their induction in the home before their name had been checked against the POVA list (see Staffing section). Information about health and safety, including the maintenance and servicing of equipment and the checking of the fire precaution systems was included in the homes AQAA. We also looked at some records in the home. There was a fire file, which included a fire risk assessment and a record of checks of the homes fire precaution systems. Fire drills were being held the most recent had taken place in April 2009. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: We saw records of daily night checks that were being carried out by staff. These involved staffing making visual checks of safety in the home, removing plugs from their sockets and checking the security of doors. A staff member said that appliances were due to be P.A.T. tested before the end of the month. Assessments had been undertaken in relation to environmental and other hazards that may present a risk to people. Control of Substances Hazardous to Health (COSHH) information was kept on file and readily available to staff. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  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 32 of 36 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 Description 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 Description Timescale for action 1 17 Records must be kept to show that a thorough recruitment procedure is being operated. 13/06/2009 This is to ensure that there is good evidence to show that there is a recruitment procedure being followed which protects the people who use the service. 2 17 Staff training records must 31/07/2009 be completed in full and kept up to date. This is to ensure that there is an accurate record to show that staff members have received the training that is appropriate for their roles, and that is necessary to meet the needs of the people who use the service. 3 34 19 There must be a thorough 13/06/2009 Page 33 of 36 Care Homes for Adults (18-65 years) recruitment procedure which ensures the protection of the people who use the service. New staff must only have contact with people who use the service user after a check has been made of the POVA (Protection of Vulnerable Adults) list and this is satisfactory. This is to ensure that the people who use the service at not at risk of being supported by somebody who is unsuitable to be working with vulnerable people 4 40 13 The management of the 13/06/2009 service, both internal and external, must ensure that the recruitment procedure is implemented appropriately. This is to ensure that the people who use the service can have confidence in the way that the service is being managed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 18 That the risk assessment records are checked to ensure that they are up to date. Review dates should be identified and the outcome of the reviews consistently recorded. That the people who use the service are supported with the completion of health action plans. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is Page 34 of 36 2 3 19 20 Care Homes for Adults (18-65 years) so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. 4 35 That a staff training needs assessment is carried out. This is to identify the training that staff members need to receive in the future. That the homes plan for staff training is developed to include more specialist and skills related areas of training. This will help ensure that people who use the service benefit from staff members who have attended a wider range of training courses. That appropriate outside parties are more closely involved in the homes system for quality assurance, and are invited to contribute their views on a regular basis. 5 35 6 39 Care Homes for Adults (18-65 years) Page 35 of 36 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). 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