Inspection on 05/08/09 for 58 Church Lane East

This inspection was carried out on 5th August 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

58 Church Lane East 07/08/07

58 Church Lane East 02/10/06

58 Church Lane East 28/02/06

58 Church Lane East 20/12/04

58 Church Lane East 02/08/04

58 Church Lane East 26/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 58 Church Lane East 58 Church Lane East Aldershot Hampshire GU11 3HB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Damian Griffiths     Date: 0 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 58 Church Lane East 58 Church Lane East Aldershot Hampshire GU11 3HB 01252311846 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.new-support.org.uk Dimensions (NSO) Ltd care home 5 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 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 58 Church Lane East is a registered care home providing care, support and accommodation for up to five persons with a learning disability. Dimensions is a specialist provider who are also responsible for a number of similar homes across the South of England manages the home. Accommodation is provided in large semi-detached three-storied house situated close to Aldershot town centre and other local amenities, which can be easily accessed on foot or by public transport. All residents are accommodated in their own single bedrooms. Shared /communal space includes a lounge, kitchen/diner, study and garden. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place at 10:20 am on the 5th of August 2009. This is the first key inspection since the 7th August 2007. We agreed and explained the inspection process with the manager. The registered manager was managing another Dimensions home. We were assisted by the senior staff member in charge who was present throughout the inspection. Information included in this report was gathered from talking to the service users and staff on duty. Care Quality Commission (CQC) survey forms were completed by four service users who required the help of care staff, three surveys were completed by health and social care practitioners and four surveys were completed by care staff at the home. We looked around all the communal areas of the home and documentation and records were read. Time was spent reading, reviewing care plans and records kept within the home. This included documentation including; pre-admission assessments, risk assessments, duty rota, training and recruitment records. We observed the way service users and care workers communicated and this also formed part of the information gathering process of this report. Care Homes for Adults (18-65 years) Page 5 of 31 The home had completed an Annual Quality Assurance Assessment (AQAA) a self assessment report. It provided us with information relating to; what the home considers it does well, what it could do better, what has improved within the last 12 months and planned improvements. The AQAA had been completed on time by the registered manager and contained basic information about the home. The judgements have been made using the Key Lines of Regulatory Assessment (KLORA) which are guidelines that enable the commission to be able to make an informed decision about outcome areas. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users received a comprehensive assessment of their care needs and an opportunity to visit the home before decisions to move in had been made. Evidence: General information relating to the home such as a statement of purpose and service users guide had been completed in a picture format considered to be helpful to the service users it concerned. There had been no new service users joining the home for some years. We therefore inspected three care plans to confirm how the home had assessed their care needs prior to admission. All care plans inspected contained a pre-admission assessment or, as the home preferred to call them, transition plans. Evidence was in place to show that a thorough assessment of care need had taken place before the new service user had moved into the home. Service users had complex care needs that required the input of a number of social and health care practitioners. Information had been sought and reports were in place to support the homes own pre-admission assessments. Areas of assessment covered a wide spectrum of support needs, including; personal Care Homes for Adults (18-65 years) Page 9 of 31 Evidence: and healthcare needs, abilities and communication. Social and health care practitioners confirmed that the homes assessment arrangements had ensured that the correct information had been gathered and that the right type of support had been planned for the new service users. Care staff completing CQC the survey commented in the section titled; what does the home do well; good communication regarding the clients needs and changes to routine. Care Homes for Adults (18-65 years) Page 10 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users individual care plans were clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences. Service users were supported to take risks as part of an independent lifestyle. Evidence: The three care plans sampled contained well documented information relating to service users care needs and the type of support required. Information had been determined from the pre-admission assessment that each service user had received prior to moving into the home. All records involving the service user had been compiled in a picture format to promote better communication. Service users had been involved with the planning of their care support and had signed their care plan along with the key worker supporting them. Care plans were seen to be up to date and regularly reviewed confirming the statement made by four care staff completing the CQC survey who said, in the section entitled; what does the home do well; all care plans are updated monthly and knowledge of what is happening with service Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: users is up-to-date. All care plans contained important details regarding; contact information for parents and relatives, family background, health and social care contacts, personal and health care needs, allergies, and medical conditions. All care plans detailed the individuals daily routines, for instance; X attended a day centre 4 times a week and they liked a bath before going to bed. Likes and dislikes of each service user informed care staff, for instance, that W did not like, loud noises, that they liked watching, TV cooking programmes and shopping for ingredients. A diary of events ensured that a detailed record was in place to assist the reviewing process and ensure that consistency of care was more likely to continue, for instance we were informed that; W prepared their cereal for breakfast, brought their laundry downstairs for washing, enjoyed a foot spa and went out for a drive. Smart Plans had been devised to summarise care needs, service users preferences and gaols to be achieved, for example some of the goals set were to, visit the local community once a week and visit the library every Saturday. Everyday areas of activity have been rigorously risk assessed for instance; care staff were made aware of Xs risk of choking at mealtimes and interaction between X and his peers often led to challenging behaviour. Goals had been set in order to measure the progress of X and the effectiveness of staff support. Behaviour plans had been completed through consultation and agreement with the service user and the most appropriate health and social care practitioners. Effective reviewing of the plans was made possible by the recording practices of care staff. All care plans had a, care action plan review sheet, that had been completed every month. The homes good practice reduced areas of risk and instructed staff how to respond safely and effectively. We observed care staff responding to behavioural guidelines that were detailed in the care plan, for instance; W required leaving alone when showing signs of challenging behaviour. Care staff reading a story to Z, this reduced the service users anxiety and illustrated how the home supported residents choices. Z had chosen the book from the local library. Service users required support with their money. We checked two service users accounts as they were returning from an outing with care staff supporting. We counted cash returned and observed care staff practice and checked receipts. The transaction was double checked by a witness and signed off. Both accounts matched the receipts and balanced with previous cash records. This showed how the home was actively engaged in providing good outcomes for its service users and staff. Care Homes for Adults (18-65 years) Page 12 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users had the opportunity for personal development and to take part in appropriate activities. They were always supported and able to maintain contact with their families. Systems were in place to ensure that service users choices were respected and that there meals were well balanced and varied. Evidence: Care staff completing the CQC survey in the section entitled; what could the home do better; commented; work harder on the personalisation agenda, both internally and externally. This might include advocates and in contrast; in the section entitled, what does the home do well; support service users to access the community, fulfil dreams and aspirations , including residents holidays, extra planned outings etc. We inspected three care plans to see inspected how the home supported individual lifestyle and the activities chosen by the individual service user. An activity log was Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: available to assisted staff/service users, that charted a seven-day record of activities. This included, what time the service user needed to leave/attend the activity, where they were going, what lunch they were taking, what money they needed and what key worker was involved. This provided a convenient at a glance summary that help ensure that the service users were well supported and safeguarded when accessing the local community or taking part in an activity. Service users were supported to visit and use a wide selection of community facilities that also included; visiting the library, swimming, bowling and visiting pubs and cafes. Service users were supported to attend local events such as the recent; Army day. We observed service users receiving one-to-one support to attend a local day centre, lunch out, visiting parents, and going swimming, and visiting the cinema. In-house activities included; aromatherapy and massage, sessions in the homes, sensory room, where a comfortable, relaxing atmosphere had been created. Examples of person centred work could be found in all the records inspected, for example; detailing how the home supported the service users independent living skills and everyday activities , including; chores around the house, housework, laundry and personal time for such things as, painting nails. Service Users Completing CQC Survey, with the help of key workers, confirmed that they could; do what they wanted, everyday and at weekends and that staff treated them well. In the section entitled what could the home do better; greater opportunity to do things for myself. The systems and ways of working with service users demonstrated how the home was involved in activities that promoted an individual lifestyle and activities of choice. The AQAA described how it continued to support the individual service user, in the section entitled, how we have improved in the last 12 months, it stated; all support plans had been reviewed, and we have reviewed person centred plans. Families were supported to visit a regular basis and this was represented in the service users care plan and the activity log, as mentioned, that showed one service user had arranged to go out with their parents. The home arranged garden parties and barbecues giving the home the opportunity to provide further support although there was no evidence showing that a quality audit had been conducted recently. The home had developed a picture menu planning system, that detailed meals that can be made available as part of the weekly menu. This system meant that the service users were fully involved in the process that encouraged self-help, community involvement, food shopping and watching TV cooking programmes. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal-care, health care support and assistance was planned and seen to be provided where needed, in a respectful and sensitive manner. All records had been completed appropriately. Policies, procedures and practices were in place to ensure the safe administration of medication. Evidence: 3 out of 4 care staff completing the CQC survey confirmed they had received training relevant to their work including information about, health care and medication and updates to help them meet the needs of the service users. Each service user had received a personal and healthcare assessment of their care needs as part of their preadmission plan and social/healthcare practitioners completing the CQC surveys, indicated, that the home had gathered accurate information. These had been regularly updated and recorded in individual healthcare plans. They were clear and easy to read and showed that they had received a range of healthcare support including; GP, dentistry, psychology and opticians. The home had made sure that healthcare conditions specific to the individual had been highlighted in case of hospital admission, for example; I have an enlarged thyroid, and to ensure Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: that healthcare practitioners were made aware. Where necessary, the service users condition, for example diabetes, had been regularly monitored and was kept up to date. Regular contact with the appropriate healthcare practitioner had been maintained and details of service users next appointments were in evidence. The social and healthcare practitioners completing the CQC survey confirmed that the home sought their advice whenever necessary to ensure that the service users healthcare needs were met. We were advised that the home took sole responsibility for the administration of the service users medicines. Staff had received training to give medication. We observed care staff administering the service users medication and examined the, Medication Administration Records (MAR).Staff administering medication to service users had completed the MAR afterwards. There were no spaces in the MAR that would indicate that the records were incomplete. The home dispensed medication from medication prescribed in blister packs. This was deposited into an individual plastic pot with the name of the service user on it and was immediately given to the service user who took the plastic pot and swallowed the medication. We were advised that service users preferred to take their medication in this way and that it helped promote service users dignity and independence. The MAR for each service user contained their photograph that helped to reduce the possibility of administrative errors, specific guidance and protocols were available, including guidelines for care staff when medication was required to be given, from time to time such as painkillers and sedatives. Details of medication disposal when medication was not required or spoilt was also available including appropriate medication returned records. This helped care staff to respond consistently and safely to service users everyday needs. Care Homes for Adults (18-65 years) Page 17 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had good systems to deal with complaints and responded to safeguarding alerts. Evidence: Care staff completing the CQC survey confirmed that they knew what to do if someone had concerns about the home. Health care practitioners completing the CQC survey commented in the section entitled, what does the home do well; humane respectful support for the individual. Another commented that the; residents appear happy and well cared for. The complaints procedures were well documented and in a picture format, entitled; making a complaint or speaking out. This included details of how to contact CQC; however, the commission had recently changed address to its Newcastle office. We discussed this and the manager agreed to change the address as soon as possible. Service users completing the CQC survey, with the help of their key workers, confirmed that they knew how to make a complaint. Care staff on duty had received safeguarding training that enabled them to feel confident when dealing with these issues. Care staff consulted confirmed that they were aware of each service users preferred method of communication and would be able to identify any signs of distress and change of mood. This could be confirmed by the homes record of response to safeguarding alerts. The homes AQAA stated that the home had needed to activate Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: the safeguarding procedures on two occasions. The home had informed all parties according to local safeguarding procedures including CQC. Care Homes for Adults (18-65 years) Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users accommodation was homely and comfortable but presented some unnecessary hazards to the service users health and safety. Evidence: 58 Church Lane East was situated near Aldershot town centre and accessable to public transport. It was an old building that was in need of constant maintenance. The reception hall and the front room had recently decorated and furniture was in good condition and we observed a service user, sitting comfortably, watching the daytime television before going out. There were plenty of room to relax around the home; it was well decorated and many rooms contained wooden laminated flooring, photographs and items belonging to the service users presenting a comfortable and homely atmosphere. The kitchen dining area appeared to be the hub of the home as most of the activity of the day centred around this location. There were problems with the ceiling that had been caused by a leak from the bathroom above. This had caused staining and there was a possibility of further health and safety risks, as we were advised, that water was still leaking. The homes maintenance log showed that regular attention to repair had been made around the home but there was no evidence of any risk assessment process of being completed about the ceiling. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Plaster work in the dining area, below the notice board, was in need of attention. We were informed that Dimensions leased the building and that they were in the process of looking for new accommodation for its services users. The home must ensure that the health and safety of the service users by completing the necessary risk assessment to evaluate and take the most appropriate action. That garden provided a relatively peaceful area for the service users to relax. This area was secured by a gate that led to the front of the house. Bathrooms were clean, tidy and without malodour. There were no paper towels or liquid soap available to prevent cross infection and promote hygiene. We were advised that this was because there was a risk that paper towels would be put down the toilets creating a blockage. There was no evidence of a risk assessment being completed to establish the extent of the risk and show possible solutions. The home must ensure that there are no unnecessary health hazards to service users and care staff. Service users bedrooms reflected service users interests and decoration preferences. Fire extinguishers around the home had been recently checked ensuring that they were in working order in case of fire. Hazardous chemicals were kept in a secure area. A separate laundry room contained a washing machine with a range of washing cycles designed to meet the needs of the service users. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff training and recruitment programme had been designed to ensure that service users were supported by competent and qualified care staff. The home needed to ensure that personnel records were up-to-date to make sure that service users were properly safeguarded. Evidence: In order to establish whether the staff skill mix was adequate to meet the care needs of the service users we inspected six personnel files of staff on duty. We looked at, the duty rota, training records and recruitment documentation. The personnel files showed that staff had gained a good mix of skills to meet the needs of the service users. Skills/training acquired included; medication administration, safeguarding, food hygiene, health and safety, first aid and relevant management of challenging behaviour. 4 CQC surveys were completed by the care staff. 3 out of 4 staff believed that there were, sometimes, enough staff available to meet the individual needs of the service users throughout the day. Staff comments in the section entitled, what could the home do better, added weight to this statement ; more staff on shift, as most of the time, only two staff are on each shift which affects the clients as they are limited to going out as there are not enough staff to support this. Service users completing the CQC survey, with help of their key workers, commented, in the section of the survey entitled, what could the home do better; I would like to do more things in Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: the evening but sometimes there is not enough staff on. There were three staff on duty plus the manager throughout the inspection. The duty rota showed that there were three staff on duty during the two day shifts, not including the manager. The night shift included two waking care staff. The acting manager had stated in the AQAA,that they beleived that staff team building, in the section entitled; what we could do better, and how we are going to do this;. This indicated that the home would be working with permanent and temporary care staff to review their concerns relating to staffing levels and person centred work. Care staff were consulted about various aspects of life at the home and working with service users, comments included; I love working here, I came here as a student, liked it so much, I decided to work here. The survey indicated that staff believed that they had received training that was relevant their role and in the section titled; what does the home do well, commented; experienced staff team who have worked together for numerous years, are very good at problem solving, developing new ideas and implementing change when necessary. The homes AQAA confirmed that they actively supported residents by involving them in the recruitment process. As ther had been no new recruits for some years there was no way of confirming this. The home uses a care bank system using its own personnel from other homes to fill staff vacancies. Care bank staff consulted confirmed that they had known some of the service users, ever since they have been at the home and also they were aware of, dimensions policies and practices. There was a large portion of care bank staff covering staff vacancies at the home. Staff completing the CQC survey, agreed that the home carried out checks such as, CRB and references before they started work. Care staff completing the CQC surveys agreed that when they first started working at the home their induction covered everything they needed to know about how to do the job. We inspected 4 personnel files, two of the files revealed a lack of documented proof of recruitment procedures and training amongst care bank staff working at the home. We were advised that this was because care bank files were kept at the home designated as their main place of work. There was , however, evidence, such as training certificates at the home showing that one of the care bank staff had been working within the organisation, and the home, for many years. The other care bank persons file showed evidence that the appropriate criminal records bureau clearance notification (CRB) had been completed . We were advised by senior Dimensions Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: personnel, in writing, shortly after the key inspection,that care bank that staff had received clearance from the criminal records bureau and had provided documentation, as required under scheduled 2 of the Care Homes Regulations. The two remaining personnel files contained evidence of criminal record bureau clearances, references and ID. There were no other areas of concern relating to the homes recruitment practice. Care staff completing CQC survey confirmed they were receiving training that was relevant to their work and met their training needs. Personnel files showed evidence of completed training in mandatory areas of care is such as; food hygiene and health and safety, as mentioned above. Specific training relating to service users needs included; autism, behavioural training and epilepsy had also been received. The homes AQAA stated in the section entitled if you how we had improved in the last 12 months; we have had our first autism assessment. This referred to the homes involvement with a leading national charity for people with, autistic spectrum disorder, to gain their accreditation. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for monitoring the management structure and the quality of care support available to service users, parents and relatives was in need of review to ensure that the home was considering their views and opinions. Health and safety was compromised due to ongoing problems within the home. Evidence: We were advised that the registered manager was currently managing another Dimensions home and was expected to return to, 58 Church Lane East, by the end of the month. The current senior in charge at managing the home had gained level 3 national vocational qualification award (NVQ3) and showed evidence of training courses attended this year that included; food hygiene and safe food preparation. The home had not confirmed the managers return date at the time of writing this report. CQC must be kept informed about how the home intends to ensure the health, safety and welfare of the service users when change occurs. Action was required to confirm that all safeguarding investigations had been satisfactorily completed, health and safety risks throughout the home were in need of completion and documentation necessary to ensure that temporary staff had all the necessary security checks were Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: not in place. 2 out of 4 staff completing CQC survey felt they were, often, given enough support from the acting manager and two indicated they sometimes, were given enough support, however, staff commenting in the section titled, what the home does well said; Communication regarding the clients needs, changes to routine through the communication book and verbally. Indicating that service users care needs were being met and care staff were observed providing service users with their care needs. Service users were observed to be well-dressed, happy and at times challenging. Care staff were aware and confident when meeting the service users care needs. Care plans were up-to-date and the AQAA indicated that new opportunities for service users were being sought; two people have new day services to meet their needs. The CQC surveys returned from the health and social care practitioners were very positive about the home. In the section entitled what does the service do well, health and social care practitioners commented; residents appear happy and well cared for. Liaise well with regard to any concerns relating to service user and care manager. Humane respectful support for the individual. Consistent and well established care team. The AQAA completed confirmed that the home periodically checked how the quality of care support was being provided. In the section of the AQAA titled; what we do well, it stated; quality audit for activities, people are supported to make choices in the running of the home. Evidence of a recent quality audit was not available to gain information about the way the home provided the care support for the service users, care staff and other people involved with the home. Care staff completing the CQC survey commented; Team members support each other. As mentioned in the environment section of this report there were health and safety concerns relating to the condition of the home environment. We were informed that the home was endeavouring to address these issues in the long-term, however risk assessments were needed to gauge whether or not service users and care staff were at risk of injury. All other safeguards relating to; storage of hazardous materials, fire safety, water temperatures, gas and electric appliance checks and accident records were all in place and had been reviewed. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 In line with regulation 23 (2) 18/10/2009 (b) the home must ensure that the ceiling above the cooking area of the kitchen is in good condition and does not present a threat to the health and safety of service users and care staff. This must happen to reduce the possibility of infection and injury to service users and care staff. 2 30 13 In line with regulation 13 (3) 18/10/2009 (a) (b) the home must make sure that there are no unnecessary hazards to the health and safety of the service users by conducting a risk assessment of all communal bathroom areas that are without paper towels and liquid soap. Care Homes for Adults (18-65 years) Page 28 of 31 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 This must happen to reduce unnecessary hazards to health and prevent cross infection. 3 37 38 In line with regulation 38 (1) 18/10/2009 (2) registered provider must ensure that CQC is kept informed of any changes on management and how care support service users is to be maintained. This must happen to ensure the health, safety and welfare of the service users is maintained . In line with regulation 24 (1) 18/11/2009 the home must continue to conduct regular quality assurance assessment make sure that the quality of care support provided to service users , their relatives, advocates and representatives is reviewed and maintained. This must be done to ensure that people involved with the home have had the opportunity to comment on the quality of care at the home. 4 39 24 Care Homes for Adults (18-65 years) Page 29 of 31 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!