Inspection on 15/01/09 for Falcons Rest

This inspection was carried out on 15th January 2009.

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

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

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Falcons Rest Wormelow Herefordshire HR2 8EQ     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: Christina Lavelle     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Falcons Rest Wormelow Herefordshire HR2 8EQ 01981541002 01981541002 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Voyage Care Ltd Name of registered manager (if applicable) Kimberley Michelle Hewins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accomodated is 14. The registered person may provide the following category of service only: Care Home Only (Code 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) 14 Date of last inspection Brief description of the care home Falcons Rest was registered as a care home in August 2008. The provider Voyage Care Ltd is part of Voyage, a large organisation that operates care services throughout the United Kingdom and has provided residential, nursing and supported living services for over 20 years. People using their services have complex needs and may also use challenging behaviours. Voyages stated aims are to provide high quality good value services, which are responsive to the needs and aspirations of people using them. People are encouraged to achieve their maximum potential in social skills and everyday living skills so they may live as independant a life as possible. People living at Falcons Rest must require accommodation with personal care because of learning disabilities. Care Homes for Adults (18-65 years) Page 4 of 32 care home 14 Over 65 0 14 Brief description of the care home They may also have physical disabilities and/or sensory impairments. The home is in the village of Wormelow, seven miles from Hereford city. It is close to main roads leading to Hereford, Ross-on-Wye and Monmouth and on a bus route into Hereford. The home was purpose built and has two seperate buildings within a large central courtyard. One building (Falcons Rest) has two floors and can accommodate six residents and the other (Poachers Cottage) eight residents. Both have good sized single bedrooms with en-suite wet room facilities. They have large kitchen/dining areas, seperate sitting rooms, an activities room, toilets and assisted bathrooms for everyone to use. Poachers Cottage also has a room with sensory facilities. Information about the service is provided in a statement of purpose and service users guide documents. The guide is available in a user friendly format with pictures. The fee for the service is based on individuals needs assessment , as agreed between Voyage and their funding authority. Extra costs include for personal and electrical items (TVs etc), meals out, some activities and shared transport. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is the first key inspection of the service provided at Falcons Rest. This means all the standards that can be most important to people using care home services are assessed. As part of our inspection we, the Commission, visited the home for five hours without telling staff or people living there. Our second visit was arranged at the first visit with the acting manager a few days later and took over three hours. It was agreed that people living at the home would be referred to as residents in this report. We were unable to ask residents directly about their lives and the support they receive because of their communication difficulties. Some time was spent in their company and interactions with staff observed indirectly. Three support workers were spoken with privately about their role, training and support. The way the service is being run was Care Homes for Adults (18-65 years) Page 6 of 32 also discussed with the acting manager and a senior support worker. Surveys had been sent to the home for residents (or their family and advocate), staff and care professionals involved with residents support. Of 20 surveys nine were returned and feedback from them and discussions during our visit are referred to in this report. An annual quality assurance assessment (AQAA) was completed before our visit, as now required. This asks managers to say what their service does well, could do better and about their plans to improve the service. Relevant records about residents care, staff and safety in the home were checked and one house looked around. There had not been any other information received about or from the home since it opened. What the care home does well: What has improved since the last inspection? What they could do better: Develop the keyworker role so care staff are more involved in planning and reviewing the care needs and goals of their allocated residents. This could help to ensure that their changing needs, wishes and goals are identified and included in their plans. Make sure that all staff know how to report any incidence or suspicion of abuse or neglect outside the home. This would better ensure the protection of residents. The staff team would have skills and knowledge, and so be able to understand and meet residents needs better, if they all have training about their disabilities and special needs. One aspect of selecting new staff needs to be improved to help to confirm they are suitable to work caring for vulnerable people. All new staff should complete training to introduce them to the way the home is run and about caring for people with learning disabilities. This would help them understand their role, the aims of the service and the needs of residents better. If staff had more regular support through meetings and supervision they could be Care Homes for Adults (18-65 years) Page 8 of 32 better informed and involved in making sure the home is meeting its aims. It could also be ensured they are working well and are suitably trained. If all staff had training about infection control, food hygiene and moving & handling it they could better ensure the health, safety and welfare of residents. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident the home could support them. This is because a full assessment is made of their needs. Staff know their needs and preferences from involving them and their representatives in their needs assessment and admission. Evidence: Voyage provide comprehensive assessment and admission procedures for staff to follow before people use any of their care services. This involves details taken from people who refer potential residents and a copy of an assessment obtained that has been made by their care manager or social worker. Voyages senior care planner makes an assessment to identify a placement that could be suitable. The manager of this service then initiates their own assessment and admission processes. There are currently five people living at Falcons Rest and their admission was discussed with staff and a sample of their care records checked. It is evident that thorough needs assessments had been carried out. This included lengthy transitions to make sure that staff at the home would be able to meet their complex needs properly Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: and that the environment is suitable. Relevant other people, such as their family and previous carers, were fully involved and provided information about their likes and dislikes. They were also given information about the home, such as the service users guide. It is good that the homes AQAA says they plan to produce welcome packs and more user-friendly guides with photographs for new residents. Staff confirm and records show that they had visited potential residents several times at their previous residence. They then visited Falcons Rest, some also having overnight stays. Two senior staff spent two weekends with one person and staff had a training day at their former placement. In respect of another resident two of their former staff team spent their first week with them at Falcons Rest working alongside staff. When necessary staff received training on such as individuals ways of communicating and or guidance had been provided for them to follow. Staff feel that residents transitions had been carried out well. One care manager also comments in their survey that there had been good assessment arrangements and information gathered and that the needs of their client are being met. Reviews are held during peoples trial stays, again with all relevant people involved, before a decision is made about the suitability of their placement. Consideration is also given by the home to their compatability with existing residents. Care packages had been set up based on residents former care plans and risk assessments before they moved in for a trial stay. They include special arrangements for staffing, activities and access to health care professionals. This was then costed and agreed between Voyage and their funding authority and a written contract made. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met and each person has a plan of their care, which they and their representatives have been involved in making. Staff enable residents to make choices in their daily lives and any safety risks are assessed so they can be reduced. Evidence: Residents care plans cover relevant areas of need and the support each person requires from staff and other professionals. Plans looked at are based on the individuals initial assessment and care plan packages, which are very detailed due to their complex needs. Plans include residents preferred routines, likes and dislikes. This had involved using feedback from their previous carers and families to identify their wishes so that staff can aim to enable them to lead their chosen lifestyle. Staff make detailed records about each residents activities, moods, health and behaviours so providing helpful information about their lives. They enable residents to express their daily life choices and views through their own communication styles. This Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: includes techniques such as pictures, objects of reference, smells and sensory sprays. Specialist speech and language therapists are involved in setting up detailed plans for staff to follow and some staff had received training on sensory impairment and communication to enable them to do so. One support worker comments in their survey that the home familiarises staff with residents likes and dislikes and communication possibilities. The homes approach to care planning is appropriately person centred in that they aim to identify and address peoples diverse and individual needs. Whilst it is difficult for current residents to be directly involved in setting up their own plans they are agreed with people close to them. One care manager comments in their survey that staff respond to service users different needs and respect their privacy and dignity. A keyworker system is operated whereby particular support workers are allocated to each resident. Keyworkers support these individuals more with such as their activities, health care appointments, personal shopping, clothes and maintaining links with their families. This should be developed so that they have more responsibility in planning and reviewing residents care. For example keyworkers had started to write monthly reports on their allocated residents, but had not done so for months in records seen. The home plans to arrange monthly keyworker meetings with residents and their relatives and to seek advocacy support, which will allow them to contribute more. The acting manager also said that plans are being reviewed now that most residents have lived there a while. This process should therefore update their plans to focus more on their goals and how they can develop their social and life skills. Each plan includes risk assessments, which due to residents high dependency relate mostly to mobility, moving and handling and self-harming behaviours. They include strategies for staff to keep people safe and to identify behaviour triggers so that they can divert and or manage them. It is good that the home plans to assist residents to open their own bank accounts, as currently in respect of an assessment of their ability to manage their own finances plans seen just state that I need support. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated as individuals. They can take part in activities that meet their personal interests, go out in the community and are supported to live their chosen lifestyle. Staff enable them to maintain links with their family, friends and representatives and provide healthy meals they like and that meet their special needs. Evidence: The home clearly recognises that residents should be encouraged to develop their social, emotional and daily living skills. Although their disabilities make it difficult for people to be involved in work related activities staff say they are looking for educational, social and leisure opportunities and to help them participate more in the wider community. Some residents are waiting for places at local colleges, to go horseriding (RDA) and other activity sessions through a local project called Echo. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Plans include each persons interests and hobbies and they all have a weekly activities schedule. These include therapies such as physio and massage, going to a hydro pool, going shopping weekly for personal items and other outings. A daily activities checklist is completed to show what they have all been doing and where they have been. Plans could however better reflect residents specific goals in respect of their social and developmental needs and how efforts are being made to achieve them. The home has a sensory room and two activities rooms. Sessions using these for painting, crafts and modeling are included in peoples schedules. Involvement in domestic tasks and cooking are also part of their regular routines and can be observing and/or helping staff prepare meals, clean their bedrooms and do laundry. The home has two vehicles with assisted access and two residents have their own car to provide transport for outings. Some staff comment that staff shortages due to sick leave, and a lack of drivers, has at times reduced support available for community activities, which it is hoped will improve when more staff are appointed. Staff support residents to maintain links with their families. They are fully involved in their admission and care plans and will continue to have input in their care reviews. One relative confirms they are usually kept informed and comments that everyone is very friendly. Staff also say they try to make visitors welcome in the home. Whilst developing friendships can be difficult for people with complex needs, some residents have joined a club for people with disabilities and staff have invited people from other local care homes and from residents former schools to parties at the home. Regarding food provided at the home individual diaries are kept for residents, which detail all the meals they have. Staff know what people prefer because they have compiled a list of everything they like and dislike. Breakfasts and lunches are taken flexibly according to chosen routines and activities, but they usually have their main meal together. Some staff feel that if a weekly menu was agreed it would help them to plan and shop for meals better, which should be considered. Staff aim to promote healthy eating by including such as fresh fruit and vegetables, cereals, yoghurts and wholemeal products. One resident needs a very specific diet and has had a nutritional assessment with very detailed guidance in place. Staff keep this persons food separately and have recipe books to consult to produce suitable meals. They are supported with this diet by a community nurse but plan to arrange a local Dietitians input. Other residents need assistance with eating and drinking, which is in their plans. We discussed with the acting manager that staff should be instructed about how to deal with choking as part of their first aid training. Care Homes for Adults (18-65 years) Page 16 of 32 Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal care from staff in ways they need and prefer. Their health needs are met and where necessary the home has procedures in place for staff to follow. Residents medicines are managed safely in the home by staff on their behalf. Evidence: Residents personal and health care needs are described in their person centred plans. They include any special needs in respect of their mobility, diet and medical conditions. Guidance is provided for staff in relation to such as moving and handling, exercises (with pictures) and there are individual epilepsy protocols. It is good that the AQAA says the home plans to introduce separate health action plans and hospital passports. Aids, equipment and adaptations such as hoists, ramps and grab rails are provided for people with physical disabilities, who may also be wheelchair users. Staff are supported in their practice by working alongside physio and speech language therapists with residents and most staff have received relevant training. Training on moving and handling, communication and sensory impairment needs to be arranged as soon as possible for newer staff who have not yet completed this. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: The home can seek input from Voyages behaviour therapist and they are working on developing better links with the local Community Learning Disabilities Team. Residents now access health care services from the local GP surgery and staff support them to attend routine health care appointments, such as dentists, out in the community. The AQAA says they will also be arranging annual well persons checks. Records are kept of all medical advice and treatment received and daily reports identify health related issues. Where necessary records are made of physical checks, for example fluid intake. Plans detail the support each resident needs with their personal care. They take into account their preferences as to how, when and any aids to be used, as most people need a high level of support. They include how staff should respect privacy and dignity. Personal care checklists are completed to show support received. Self care is promoted wherever possible and residents are encouraged to choose their clothes and toiletries. They were observed to be well presented and suitably dressed. Voyage provide a clear policy and procedures for the management of residents medication in the home by staff. This include homely remedies and protocols where medicines can be administered as and when required. Care records include consent forms and self administration assessments, although residents are not able to give consent or manage their own medication. Their plans list all their prescribed medicines with details of its purpose and dosage. Necessary records relating to medication were checked and found to be maintained appropriately. Senior staff carry out weekly medication audits. There are suitably secure storage arrangments for medicines in the home. Staff designated to administer medication have undertaken a formal training process for its safe handling. They have a competency test overseen by the manager or senior staff before they can do so. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can express their views and concerns about the service. There are systems in place to safeguard residents from abuse, neglect and self harm and for complaints to be made, with action taken to follow up any allegations. It could better ensure residents protection if all staff are clear about how to report any suspicion or incidence of abuse or neglect outside the home. Evidence: The home has a complaints procedure, which is also available in a user-friendly format with large print and or with pictures and simple language. There are cards called I am concerned that can be sent directly to Voyages Quality Assurance Director. This complaints procedure is in the service users guide and residents are given a copy. It is also displayed in the homes entrance hall, with a visitors comments book so that relatives and representatives can express their views and concerns if they wish. The home has recently started to arrange residents meetings with staff support so that they can advocate for them and help them to comment on and make choices and decisions about day-to-day life in the home. They plan to arrange relatives meetings. The home has an appropriate record of complaints showing details of issues raised, their response and actions taken. Two complaints had been made by residents relatives about low staffing, food on one persons clothes and the state of their Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: bedroom. This was dealt with by Voyages area manager who apologised, as there had been a high level of staff sickness at the time. It was also reiterated in the homes communication book that staff should respect residents privacy and dignity. Policies and procedures about recognising abuse, protecting vulnerable adults, whistle blowing and managing residents finances are provided. Staff are expected by Voyage to receive instruction on adult protection as part of their induction and through an interactive computer training programme, but some newer staff had not completed this. Staff confirm in their surveys that they would know what to do if concerns are raised with them. They also say that they would report any incidence, suspicion or allegations of abuse to Voyage management but some are not clear about how and which other agencies to refer to outside the service. The AQAA states that training on complaints and adult protection is reinforced in staff meetings and supervision, but few meetings have been held or individual supervision arranged. Whilst the home does have a copy of local multi-agency safeguarding procedures it should be ensured that staff know about them and understand when incidents need external input and where to refer any suspicion or incidence of abuse or neglect. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a safe, well maintained, decorated and furnished home that is comfortable, clean, pleasant and hygienic and suitably meets their needs. Evidence: Falcons Rest was purpose built to a high standard. The building was constructed in an eco-friendly way using sustainable materials and has such as sensor operated lights and a water recycling system. The houses are situated in a courtyard in the same grounds as another Voyage care home and a supported living complex. The home is in the village of Wormelow about seven miles south of Hereford city centre on a bus route into Hereford. There are also main roads nearby to the towns of Monmouth and Ross-on-Wye. The village has a shop, post office and pub within walking distance. The home is set in large, lovely grounds with its own garden and parking areas. Ramps and patios are provided outside. Within the home corridors and doorways are wide, there are grab rails, tracking hoists and other aids. The accommodation is open and spacious so providing access and plenty of room for wheelchair users. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The home comprises of two buildings, one called Falcons Rest and the other Poachers Cottage. Only Poachers Cottage is occupied currently and this building is all ground floor and has eight bedrooms. The other building has two floors and a lift. Both houses have a large sitting room, open kitchen dining areas, a separate activities room and assisted bathrooms for everyone to use. Poachers Cottage also has a sensory room. Bedrooms are all of good size with en-suite toilet and wetroom shower facilities and are being personalised when it is confirmed that people will be living at the home. The overall impression of the environment is bright, pleasant and comfortable and the furnishings, decor and equipment are of good quality. All areas of Poachers Cottage were looked around and found to be warm, clean, tidy, fresh and airy. There are cleaning schedules for staff to follow and suitable laundry and sluicing facilities. The home has policies and procedures on infection control and protective gloves and aprons are available for staff. Arrangements are made for proper disposal of waste and there are appropriate handwashing facilities with liquid soap and paper towels. This should all help staff promote good hygiene and reduce risk of infection in the home. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there are always enough staff on duty to meet residents personal needs they could be better supported if all staff receive appropriate training, support and supervision. Required checks are taken up for new staff, although if other necessary information was also obtained it would further ensure that they are suitable. Evidence: Staffing levels for the five residents include five or six staff on duty daily between 7.30am and 10pm with two waking night staff. For two people agreements are in place for one to one staff support throughout the day and two staff when they are out in the community. Staff are appropriately allocated to these residents on each shift. There are three vacancies for support workers and one on long term leave at this time. Two relief staff and permanent staff are doing extra shifts to cover the home. Recruitment is ongoing and staff report that there is usually enough staff except when staff are on sick leave, which several had been in December. Some staff feel that this can affect staff availibility to take residents out and follow their activity schedules. Voyage operate thorough recruitment procedures overall and new staff are not allowed to start working with residents until an enhanced criminal records check (CRB) and two Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: written references are obtained. This is confirmed by staff in their surveys and a sample of staff records looked at. Staff application forms seen however did not include their full employment history with any gaps explored and explained, as now expected. The AQAA states that all new staff complete Voyages induction programme within three months and an accredited training for new staff LDQ (Learning Disabilities Qualification). This is not confirmed by staff, two of whom report they had even not started Voyages induction programme yet, although they have worked at the home for over three months. Other staff who started longer ago than this this have not completed their induction yet. Staff comments in surveys include very minimal induction but most training since is relevant to the job role and I was left to make a lot of my own enquiries. The AQAA shows that the manager is aware that there are gaps in staff induction and training updates and plans to address them. Regarding staff training it is evident that staff appointed when the home first opened, and before residents moved in, had a full introduction to Voyages policies and procedures and completed all the core health and safety training topics. They also received relevant training relating to their special needs, such as epilepsy, moving and handling, communication and sensory impairment. However staff appointed since then have not completed all this training yet, which needs addressing. The AQAA says staff have two monthly supervision but this is not confirmed by staff. Some say they have not had any individual supervision sessions to date, not even during their probationary period. Voyage has a suitable format for supervising staff, which includes their work performance and identifying their training and development needs and regular supervision should be arranged covering these areas and recorded. In relation to team work and communication the home currently has two care teams covering separate shifts during the day. Staff feedback implies there is conflict between teams and a lack of communication generally and it is good therefore that the acting manager says efforts are being made to integrate them. Several staff comment in surveys that communication and team building could be better and there can sometimes be a lack of communication between staff. Staff also say there have been few team meetings held and one was very recently. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been run and managed consistently in all areas and there has therefore been some risks to residents. There are ways of reviewing the service to ensure that the home runs well but these have not always been used effectively. Evidence: The manager, Kim Hewins, has relevant qualifications and experience for the role. She has yet to undertake the companys management development programme, as discussed when she was registered. At the time of our inspection Ms Hewins had been absent from the home for several weeks and an acting manager was in place temporarily. The home also has a deputy manager and two senior support workers and the AQAA says there is always a designated shift leader. Evidence in the Staffing outcomes section of this report show that some Standards relating to staff management such as induction, training, supervisionand support are not being fully met. Feedback from seven staff and one residents relative in discussions and or or their surveys highlight their concerns about management support Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: and the management style. Some staff also told us that a lack of communication, team working and delegation of duties has also affected their working relationships and morale. Voyage operates a formal system to review and assure service quality. This includes the required monthly visits from their representative when relevant aspects are checked and people at the home interviewed, with reports written on the homes conduct. These visits had not been carried out in October and November 2008, although a full service audit was carried out in December. This audit had shown there was a less than 50 percent compliance with their specified standards resulting in a plan to address quite a number of identified shortfalls and areas to be developed. Some areas had already been actioned and a further audit was planned in the near future. The AQAA states that relatives and advocates are to be invited to meetings to obtain their views and incorporate them in future plans for the service. This would be positive and help to ensure that improvements will benefit residents. The AQAA contains clear, relevant information about the service and what it does well. However some evidence given is not confirmed in our inspection in relation to such as regular staff meetings, individual supervision, training and all staff having completed their induction within three months. The AQAA also identifies areas the home plans to improve, which include seeking advocacy, opening bank accounts for residents, arranging keyworker and relatives meetings and setting up individual health action plans. Regarding health and safety Voyage provide a full range of comprehensive policies and procedures for staff to follow in their working practices to enable them to maintain and promote the welfare and safety of people in the home. When the home was registered it was confirmed that the premises had been approved by relevant authorities such as Building Control and Environmental Health. The AQAA states risk assessments have been carried out and regular maintenance and or servicing of the fire safety, electrical and heating systems and equipment are arranged. There are records kept of required fire and health and safety checks, including kitchen hygiene, water temperatures, aids and equipment. However some of these checks were not recorded as having been carried out at the frequency required up until the last couple of weeks. For example the weekly fire alarm test was recorded just twice in November and once in December. Some staff said that they had never taken part in a fire drill and the acting manager arranged a drill between our visits. She also gave an assurance that arrangements had been made to ensure required checks are carried out in future and more drills would be arranged so all staff could take part in one soon. In relation to mandatory training several staff had worked at the home for some time Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: without completing infection control, moving and handling and food hygiene training. The AQAA shows nine had completed infection control and ten food hygiene. In view of residents conditions and physical disabilities it is essential this training is arranged to mimimise any potential risks to their safety and welfare. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The keyworker role be developed so they are more involved in planning and reviewing the care of their allocated residents. This should help to ensure plans are updated to reflect residents changing needs, wishes and goals. Staff should receive specific instruction on local multiagency safeguarding procedures for vulnerable adults, to be regularly reinforced with them in training, staff meetings and individual supervision. This is to ensure that all staff are clear about their responsibility and know where to refer and report any suspicion or incidence of abuse and neglect of residents outside the service. All staff should receive training related to the disabilities and specific needs of residents to include communication, sensory impairment and epilepsy. This is so they have the knowledge and skills necessary for their role and should be able to understand and meet residents needs better. A system should be put in place so a full employment history is obtained from potential new staff with any gaps in their employment record explored. This is to help ensure that they are suitable to work caring for vulnerable adults. All staff should receive structured induction training within six weeks of their appointment and accredited training in Page 30 of 32 2 23 3 32 4 34 5 35 Care Homes for Adults (18-65 years) relation to learning disabilities. This would provide them with the underlying knowledge they need to do their job and about the particular needs of the service and residents. 6 36 Team meetings should be held and staff receive formal supervision more regularly. This would keep staff better informed, involved and supported to make sure that the home is meeting its aims and that individual staff training and devolpment needs are identified and addressed. A system should be put in place to ensure safe working practices in the home through all staff completing infection control, moving & handling and food hygiene training. 7 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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