Inspection on 01/12/08 for Green Gables

This inspection was carried out on 1st December 2008.

CSCI found this care home to be providing an Excellent 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

Green Gables 07/12/06

Green Gables 16/02/06

Green Gables 22/06/05

Green Gables 02/03/05

Green Gables 01/06/04

Green Gables 27/01/04

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: Green Gables Wingfield Road Alfreton Derbyshire DE55 7AN     The quality rating for this care home is:   three star excellent 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: Rose Moffatt     Date: 0 1 1 2 2 0 0 8 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Green Gables Wingfield Road Alfreton Derbyshire DE55 7AN (01773)832422 01773522502 linda.barker@lc-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Linda Barker Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 29. The provider may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission are within the following category: Physical Disability - Code PD Date of last inspection Brief description of the care home Green Gables is a purpose built home that provides nursing care, personal care and support for up to 29 people with physical disabilities. It is located on the boundary of the village of Oakerthorpe, near to Alfreton town centre. People live in three units within the home - Treetops and Fairways are single storey level access accommodation and The Snug, being the original building, is split level with assess by a passenger lift. Each unit has its own dedicated facilities, although there is also a central kitchen and a central communal area. All bedrooms are single, most with en suite facilities. The fees charged at the home range from £624 to £1939 per week, depending on the persons assessed needs. This information was provided by the manager on 1st December Care Homes for Adults (18-65 years) Page 4 of 32 care home 29 Over 65 0 29 Brief description of the care home 2008. Information about the home, including CSCI inspection reports, is available in the main entrance area of the home or from the manager. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use the service experience excellent quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of this home was on 7th December 2006. We looked at all the information we have received, or asked for, since the last key Care Homes for Adults (18-65 years) Page 6 of 32 inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an annual service review (ASR) of the home in March 2008. The ASR looked at all the above information. The ASR showed us the home continued to provide good outcomes for people living there. We carried out an unannounced inspection visit that took place over eight hours on one day. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 7 completed responses. We sent out 10 surveys to the relatives or representatives of people living in the home and received 4 completed responses. We sent out 10 surveys to staff employed at the home and received 6 completed responses. There were 29 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. Four people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: Approximately 50 of the people in the home had learning disabilities. All staff should have training about learning disabilities to ensure they have the right skills and knowledge to meet peoples needs. The care records were not well organised and information was sometimes difficult to find. There was old information included in the records that could be taken out and saved elsewhere. The manager was aware of the problems and new, person centred care records were planned. Care Homes for Adults (18-65 years) Page 8 of 32 People told us there were not enough opportunities for people to go out of the home. People said that the current staffing levels and the high needs of people in the home doesnt leave the staff a lot of time for activities. Staff said there should be more activities in and out of the home. The AQAA said that the home planned to improve by increasing the number of outings for people. The Snug was in need of general refurbishing and redecorating. The manager said that a decision had not been made about the use of The Snug and this had delayed the refurbishment. It was noted at the previous inspection in December 2006 that The Snug was in need of redecoration. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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. There was a satisfactory assessment process so that most people were confident their needs, or those of their relative, could be met at the home. Evidence: We received seven completed surveys from people living in the home. Six of these were completed with help from staff and one with help from a relative. All seven people said they were asked if they wanted to move to the home. Five said they had received enough information about the home, one said they hadnt, and one said they could not remember. We spoke to people living in the home. People told us, Im very happy and settled at Green Gables, and I love it here. Two people said they would like to go out more often. We received completed surveys from four relatives of people living in the home. One said the home always met the needs of the person, one said the home usually did, and two said the home sometimes did. We also spoke with relatives of people in the home during the inspection visit. One relative said Green Gables was the next best thing to Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: home. Another relative said the persons needs were met and the relatives were pleased they could be involved in the persons care. Another relative said that the persons needs were not always met as there were not enough suitable activities provided, there were not always enough staff available, and staff did not always have the right training to meet the persons needs. We received six completed surveys from staff at the home. Two said they were always given up to date information about the needs of people at the home, three said they usually were, and one said they sometimes were. All six said they were given training to help them understand and meet the needs of people in the home. We looked at the records of four people living in the home. Each included assessments of the persons needs by social services and / or hospital staff, or from previous placements as appropriate. The home carried out an assessment of the persons needs, including input from the physiotherapist and occupational therapist. The AQAA said that people were consulted with and involved throughout the admission process. The AQAA said the home could improve by further developing person centred care planning and assisting people to write their own plans in a format and design of their own choice. The information in the AQAA showed that about half of the people in the home had learning disabilities. The home had changed their registration in April 2008 to increase the number of people accommodated to 29, and to provide nursing care where people were assessed as needing this. The manager said there were no people currently in the home who were assessed as having 24 hour nursing needs. Where people needing nursing input, this was provided by the local district nurses. Prior to the inspection visit, we received comments from two relatives and two other people involved in the care of people in the home. They all expressed concern about the lack of staff training to meet the needs of people with learning disabilities. We found that some staff had recently received training about the needs of people with learning disabilities. The manager said that further training was planned to ensure that all staff had the right skills to support people with learning disabilities. 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. Generally, people were supported to make decisions about their lives and their choices were respected. Evidence: Three people who returned surveys to us said they always made decisions about what they did each day, two said they usually did and two said they sometimes did. One relative who returned our survey said the home always gave the support to the person that was expected or agreed, two relatives said this usually happened, and one relative said it sometimes did. Two relatives told us that consultation with and involvement of relatives could be improved. People we spoke to were aware of their individual support plans (ISP). They knew who their keyworker was and confirmed that they had regular one to one time with their keyworker. People told us they were usually able to follow the routines they preferred. People were involved in making decisions about the home in regular meetings and as Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: part of the recruitment process for new staff. One person said I like interviewing new staff, though Im a bit nervous!. The manager said one person was being encouraged and supported to develop a quarterly newsletter about the home. We looked at the care records for four people living in the home. Each person had an ISP produced from the assessment of their needs. Three of the ISPs covered all the assessed needs of the person, one did not have a plan to ensure staff knew what action to take to prevent the person developing pressure sores. The ISPs were signed by the person, or their representative, to indicate their involvement and agreement. The ISPs were reviewed every six months. There were appropriate risk assessments in place, such as risks associated with smoking, and going out of the home. The care records were not well organised and information was sometimes difficult to find. There was old information included in the records that could have been taken out and saved elsewhere. The manager said a new system was planned and showed an example of a care record developed with a person living in the home. This had a person centred approach and the emphasis was on the record being more meaningful and accessible to the person. The six staff who returned our surveys said they had training to help them understand and meet the needs of people in the home. Staff spoken with confirmed they had relevant training, though not all had received training about the needs of people with learning disabilities. Staff spoken with were aware of individual needs and preferences, and were clear that personal choices should be respected. 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. People were generally satisfied with the range of activities provided in the home. The staffing levels did not allow for people to go out of the home as much as they wanted to. Evidence: The six people who returned our surveys all said they could do what they wanted to during week days, evenings and weekends. People told us they enjoyed the activities offered, such as bingo, making Christmas cards, music and movement, and playing games. Some people said they had been away on holiday this year, and also out on day trips in the summer. Some people were planning to go out Christmas shopping. Three people went out from the home to day centres and another three people regularly used an IT centre in Alfreton. One person used a local swimming pool each Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: week. There was a church service at the home every month, and one person went out regularly to a local church. There was a team of about thirty five volunteers led by a volunteer coordinator based in the home. Some of the volunteers worked one to one with people in the home. On the day of the inspection visit, we observed activities in each of the three units that made up the home. In Fairways, people were colouring pictures and playing games around a table. A visiting relative said theres always something like this going on. In Treetops, some people had manicures, whilst others made Christmas cards and played bingo. People in The Snug had made Christmas decorations. The manager said it was planned to have an area in the grounds for people in the home to grow fruit and vegetables. Two people in the home and two relatives told us there were not enough opportunities for people to go out of the home. Two people said they would like to go out more but not always enough staff to take me. Two relatives said people in the home did not go out as often as they would like to. One relative said trips from the home dont seem to happen. A relative commented that the current staffing levels and the high needs of people in the home doesnt leave the staff a lot of time for activities. Staff said there should be more activities in and out of the home. The AQAA said that the home planned to improve by increasing the number of outings for people. Two relatives who returned our surveys said the home always helped the person to keep in touch with them, two said this usually happened. Three relatives said they were always kept up to date with important issues affecting the person in the home, one relative said they sometimes were. Relatives spoken with said they were pleased they could remain involved in the care of the person if they wanted to. People in the home could have a key to their bedroom door if they wanted to. The care records seen included confirmation signed by the person, or their representative, of whether or not they wanted a door key. There were notices on bedroom doors to remind staff and visitors to knock before entering and we observed staff doing this. We observed that people who were able to could move freely around the home. Each of the three units had its own kitchen area and there was also a main kitchen. The menus were in the process of being revamped with photographs of the meals offered. There were regular menu planning meetings for people in the home. People Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: said they enjoyed the meals at the home. The lunch time meal served on the day of the inspection visit offered choices of main course and dessert. The meal included fresh vegetables and looked appetising. Lunchtime on Treetops appeared unhurried with staff helping people as required. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a focus on individual needs so that people generally received care and support in the way they preferred and required. There was good access provided to healthcare services so that peoples physical health needs were well met. Evidence: The seven people who returned our surveys, and the people we spoke with, all said that staff always treated them well. Six of the people who returned surveys said staff always listened to them and acted on what they said, one said staff sometimes did. One person said their keyworker always listens to me. A relative said they were always satisfied regarding the care of the person in the home. Another relative said the person was always well cared for and its the next best thing to home. One relative said that new staff or agency staff were not always aware of the persons needs and preferences. The care records we looked at included details of how the person preferred their care and support to be carried out, including the preferred gender of staff for personal care. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: People confirmed that they could get up and go to bed when they chose and could follow their preferred routines during the day. The home had introduced more flexible staff shift times to take account of people wanting to have a lie in (see Individual Needs and Choices section for further comments on care records). Before the inspection visit, we had received several comments that staffing levels were not always sufficient to ensure that peoples needs could be fully met. People spoken with during the inspection visit said that staff were usually available when needed. Two people said they would like to go out more often but there were not usually enough staff to do this. Two relatives said the staffing should be increased to ensure people could go out more often and to allow staff more time for activities. Staff said that staffing levels had improved on The Snug. The manager said that seven people in the home had one-to-one care hours funded, and nine others had one-to-one hours with volunteers. People had one hour per week of one-to-one time with their keyworker and this could be saved up to provide a longer period for activities or going out. The care records showed that people had access to a range of healthcare services, such as their GP, District Nurse, chiropodist, dentist, and optician. People were referred to specialist services, such as speech and language therapy and the tissue viability nurse. The home had introduced a health passport for people to take with them if they needed to be transferred to hospital. This document included information about the persons needs and preferences. People had access to a physiotherapist at the home. The care records included physiotherapy assessments and records of physiotherapy provided. People had suitable equipment to ensure they could remain as independent as possible and to ensure their needs could be met. All the people in the home were wheelchair users and each of the care records seen included records of the maintenance of wheelchairs. There were ceiling track hoists and portable hoists for safe moving and handling. Medication in the home was stored securely on each of the three units. Medication was administered by staff who had received appropriate training. The medication administration records (MARs) seen were correctly completed. There was a system in place where staff on each shift checked that MARs had been fully completed before handing over to the next shift. People who wanted to take responsibility for their own medication had a risk assessment in place and secure storage provided in their rooms. Care Homes for Adults (18-65 years) Page 19 of 32 Care Homes for Adults (18-65 years) Page 20 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. There were satisfactory systems in place so that people were protected and their complaints were taken seriously. Evidence: All of the seven people who returned our surveys, and the people we spoke with, said they knew how to make a complaint and who to speak to if they were unhappy. People said they would tell staff about any concerns and were confident that appropriate action would be taken. All of the four relatives who returned our surveys, and those we spoke with, knew how to make a complaint. One relative said the home had always responded appropriately to concerns raised, one said the home usually had, and two said the home sometimes had. One relative spoken with said that concerns taken to the manager had been dealt with straightaway. Another relative was not satisfied with the way their concerns had been dealt with and felt that there were ongoing issues that had not been fully addressed. We looked at records of complaints received at the home. Complaints were responded to promptly and records were kept of the action taken and the outcome. The complaints procedure was displayed in the main entrance area of the home and was also included in each of the care records seen. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: We had not received any direct complaints about the home since the last inspection, though some people had raised concerns about staffing levels, staff training to meet the needs of people with learning disabilities, and lack of communication between the management of the home and relatives. Staff training records showed that most staff had received training about safeguarding vulnerable adults. Staff spoken with were aware of safeguarding issues and the correct procedures to follow if abuse was suspected or alleged. There were satisfactory policies and procedures in place about safeguarding vulnerable adults. There had been a safeguarding issue for one person at the home since the last inspection. The home had followed the correct procedures and taken action to ensure the person was protected. Care Homes for Adults (18-65 years) Page 22 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. The home was clean, suitably equipped, and mostly well maintained so that people lived in a safe, comfortable environment that met their needs and preferences. Evidence: There were three units in the home - The Snug, Treetops and Fairways. The home was accessible throughout to people who used wheelchairs. There were pleasant, well maintained grounds for people to use. The manager said there were plans for an allotment garden in the grounds for people to be involved in growing their own fruit and vegetables. The Snug was in need of general refurbishing and redecorating. The kitchen had been upgraded and the lounge area had been redecorated in the last year. The manager said that a decision had not been made about the use of The Snug and this had delayed the refurbishment. It was noted at the previous inspection in December 2006 that The Snug was in need of redecoration. Treetops and Fairways were generally well maintained with bright and cheerful decor and comfortable furniture. The lounge area in Treetops had been redecorated and was awaiting new curtains. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Two new bedrooms with en-suite bathrooms had been created since the last inspection. Both were occupied and had been furnished and decorated to the taste of the people living there. Other bedrooms seen were individually decorated and furnished and were personalised with the persons own possessions and photographs. Two people spoken said they with were pleased with their bedrooms and confirmed they had chosen the decor. None of the bedrooms were shared and all except three had en-suite shower and toilet. The home was clean throughput and free from offensive odours on the day of the inspection visit. People spoken with said the home was usually clean and fresh. Staff were aware of infection control procedures. Most staff had received training about infection control. There were satisfactory laundry and sluice facilities and equipment. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory recruitment procedures and a good staff training programme so that people were protected and were supported by competent staff. Staffing levels were sufficient to ensure peoples care needs were met. Evidence: Two people living in the home commented they would like to go out more often but there were not always enough staff to do this. Two of the staff who returned our surveys said there were always enough staff to meet peoples individual needs, two said there usually were, and two said there sometimes were. They said, day to day needs met but extras eg social outings and activities cannot always be staffed, and, employ more staff and we need more volunteers. In response to the survey question How do you think the care home can improve?, three relatives commented: I think staff levels are a little low...with quite a few high need residents it doesnt leave the staff a lot of time for activities so more staff would be better, By ensuring that they have sufficient numbers of own staff, from the residents point of view, on duty at all times, Increase in staffing levels required to provide overall care - entertainment, activities etc.. Another relative told us during Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: the inspection visit that staffing could be better so more people could go out and do more activities. The home had introduced some different shift patterns to fit around the needs of people in the home, and also to attract more applicants for vacancies. Staffing levels had been increased on Fairways following the addition of the two new bedrooms , and also on The Snug. On the day of the inspection visit there was a total of thirteen care staff on duty. This included four staff who were working one-to-one with people in the home. From the rotas seen, and from discussion with staff, the minimum staffing level of three care staff on each unit was usually maintained, except for sickness at short notice. In addition to the care staff, the manager, care supervisor and the physiotherapy assistant were all on duty. The care team were supported by domestic, kitchen, administrative and maintenance staff. People said the staff are lovely, and, everyone listens to me. Relatives said the staff were always very pleasant, friendly and caring. We observed that there was a good rapport between people in the home and staff. All six of the staff who returned surveys said they had received induction training that covered everything they needed to do the job when they first started. They all said that they had received training to help meet peoples needs. One of the relatives who returned our surveys said staff always had the right skills and experience to look after people properly, two said staff usually did, and one said they sometimes did. We looked at the records of three members of staff. All had the required documents and information, such as a Criminal Records Bureau disclosure (CRB) and two written references. Although there were no photographs in the records seen, the manager later confirmed that staff photographs had recently been taken and were now all in place. The induction programme for new staff met Skills For Care standards. One member of staff said that their induction was excellent and that experienced staff always willing to share knowledge and give support. Another member of staff said Induction was brilliant, very informative. Staff training records showed that most staff were up to date with all the required training. Staff told us training to staff is excellent, I am given the training and support to give the best possible service, and, good support of staff ie training. Some staff had received training about supporting people with learning disabilities and Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: the manager said that more training in this area was planned. The AQAA said that 56 of care staff had already achieved a National Vocational Qualification (NVQ) in care at level 2 or above and another 22 of care staff were working towards the qualification. Care Homes for Adults (18-65 years) Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed and there were good systems in place so that the health, safety and welfare of people was promoted and protected. Evidence: The manager had been in post for about three years and was suitably qualified and experienced to run the home. People in the home were confident the manager would listen to them and take action on any issues raised. One person said, Weve got the best manager!. Staff said the manager was approachable and they were confident she would act on their concerns. Staff said, Excellent management of Green Gables, and, If I have any issues I can go to my manager to talk about it. One member of staff said the home could do better and listen to staff who have new ideas. Relatives said they could see the manager when they visited, and that action had been taken straightaway to address concerns raised. One relative said the communication between management and relatives could be improved, and that there should be regular meetings for relatives or representatives of people living in the home. The Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: manager said that she had an open door policy for relatives / representatives. The AQAA was completed by the manager and returned by the date required. The AQAA contained clear, relevant information supported by a wide range of evidence. The AQAA showed where changes had been made in the home and where improvements were still needed. The data section of the AQAA was fully completed. The quality assurance system at the home included internal audits and checks, surveys of people in the home, regular visits by the provider to comply with regulation 26, and the regular meetings for people in the home. People, or their representatives, were able to comment on the quality of the service they received at care reviews. The AQAA said that the home had taken action as a result of listening to the views of people in the home, such as increasing the number of special events held - parties, discos, karaoke evenings, increased access to college activities in the home and in the local community, and ensuring that everyone who was able to had the opportunity to go away on holiday. The AQAA showed that systems and equipment in the home had been maintained and serviced as required. Policies and procedures had all been updated in the last twelve to eighteen months. There were records of accidents and these were regularly audited by the manager. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 All staff should have training about learning disabilities to ensure they have the right skills and knowledge to meet peoples needs. The providers should make a decision about The Snug as soon as possible so that the necessary refurbishment can be carried out. People at the home should be consulted and involved in the decision so that their views are used to develop the service. There should be a review of staffing levels in consultation with people living in the home to ensure that individual needs are always met. 2 24 3 33 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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