Inspection on 27/06/07 for 7-8 Hancox Close

This inspection was carried out on 27th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Hancox Close, 7-8 Weston Under Wetherley Leamington Spa Warwickshire CV33 9GD Lead Inspector Justine Poulton Key Unannounced Inspection 27th June 2007 13:30 Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hancox Close, 7-8 Address Weston Under Wetherley Leamington Spa Warwickshire CV33 9GD 01926 633548 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Coventry and Warwickshire Partnership Trust Mrs Lisa Quinlan Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to provide care and accommodation for 6 service users under 65 for reasons of learning disability. The home can continue to accommodate 2 service users with a learning and physical disability beyond the age of 65, for as long as their age related needs can be met. N/A Date of last inspection Brief Description of the Service: 7 and 8 Hancox Close is a purpose built, large semi detached pair of bungalows. The home was purpose built to accommodate 6 people with learning disabilities and additional physical disabilities. The home has recently reregistered under Coventry and Warwickshire Partnership Trust and is staffed 24 hours a day. The premises are leased from a local housing association. Both bungalows have been adapted to meet peoples and include a good range of equipment to assist with daily routines. There is a large communal living/dining area. Number 8 has two bedrooms with washbasins, one shower room and separate toilet and a communal living/dining area. A mini-bus driven by staff members is provided to transport people around the community. Information regarding funding was not available for this inspection. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first key inspection of this service following reregistration with Coventry and Warwickshire Partnership Trust. The inspection was carried out to establish the outcomes for people living in the home, and to confirm whether they are protected from harm. Identified key standards were looked at. The pre fieldwork inspection record was completed , as well as a site visit to the home, during which time service users, staff and the manager were spoken with. Six completed surveys were received from the people using the service, as well as three from relatives and carers. Two people were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. Records, policies and procedures were examined and the environment was looked at. All of the people who live in the home were in for all or part of the inspection. The inspector would like to thank the service users, manager and staff for their hospitality and co-operation during the inspection. What the service does well: The home consistently meets the key national minimum standards ensuring positive outcomes for the people who live there. The home presented with a very relaxed atmosphere. Staff appeared confident and competent in their roles, and were careful to ensure that peoples needs and wants were met. Peoples care plans reflect their assessed needs. They are detailed and informative, make excellent use of photographs and ensure that staff are able to support them appropriately. Similarly risk assessments enable people to take meaningful risks in a safe manner. People are actively supported to make decisions about their lives both on a daily and more long term basis by staff who consistently work to ensure that they are able to recognise and interpret peoples limited verbal and non verbal communication skills. Day services provided in house ensure that people are supported to participate in their interests, hobbies and leisure pursuits, as well as with planning holidays. These are varied and reflective of individual likes and dislikes. The involvement of families and friends is important to people, and is encouraged by the home. Clean, tidy, well stocked kitchens enable people to choose from a range of meal options. Support with any special diets and assistance with eating is provided as required. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 6 Individual personal care needs are met sensitively and discreetly by staff in line with peoples assessed needs. Their health and wellbeing is also promoted via attendance at routine and more specialized healthcare appointments as necessary. Medication is managed safely on their behalf. The home has both a complaints policy and an adult protection policy in place. Staff were aware of how people with limited verbal communication make their needs known. At the time of this inspection no complaints had been received by us. Staff were aware of their responsibilities regarding adult abuse, and were undertaking training provided by the Warwickshire vulnerable adult committee. The home presented as comfortable and clean with no offensive odours apparent. It was decorated nicely with good quality furniture and soft furnishings throughout. Staff numbers were satisfactory. Training undertaken by the staff team ensures that a competent and sufficiently knowledgeable team supports the people who live in the home. The home is managed by a competent manager with whom both the residents and staff team appeared to have a good rapport. Health and safety is managed effectively within the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is good. Suitable and appropriate information to help prospective residents (and their representatives) to decide if the home is the kind of place they would like to live in is available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This is the first inspection of this service following registration with us under Coventry and Warwickshire Partnership Trust. The home has actually been in existence for a considerable number of years however, with a stable resident group. The homes Statement of Purpose was looked at as part of the inspection. This document clearly identified the types and levels of service that could be offered to specific user groups. It was detailed, informative and reflective of the actual service being provided. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 9 As there have been no new service users admitted recently the pre assessment process was not examined as part of this inspection. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 (Adults 18 – 65) 7, 14, 33 (Older People) Quality in this outcome area is excellent. People’s needs are well documented and reviewed so that staff are able to provide them with the support they require, in the manner they prefer it. Risk assessments that support people to live full lives in a safe manner are also in place. This judgement has been made using available evidence including a visit to the service. EVIDENCE: As part of this inspection two people were chosen for case tracking purposes. All of their care planning, health, medication, daily diaries and day service documentation was looked at. Both care plans followed a similar format, and made excellent use of photographs, backed up in written format in the first person, ensuring that Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 11 they were person centred and provided a sense of ownership for the people using the service. Both plans contained a life story, daily routines, likes and dislikes, communication and abilities amongst others. The required levels of support were detailed, thus enabling staff to provide appropriate care and assistance for each person. Information available indicated that peoples care plans are reviewed routinely in house on a three monthly basis, with more formal reviews being held annually. Records seen also evidenced that risk assessment is good and ensures that staff have specific guidelines to follow to minimise risk, and guidance in the event of needs changing. Again these were reviewed in line with the care plans. The majority of the people that live in the home have limited or no verbal communication skills, however it was apparent throughout the inspection the staff were able to interpret their individual means of communication, and were seen to support them with making decisions about their day to day lives. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 (Adults 18 – 65) 10, 12, 13, 15 (Older People) Quality in this outcome area is excellent. People are offered a variety of age, peer and culturally appropriate activities that make best use of in house and community facilities. Relationships with families and friends are promoted. A Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 13 healthy, nutritious diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the people resident in the home have their day service provided in house. Each person has a separate individual day time activities file. Separate day staff are also employed over and above the care team to provide this service. Although the day service is generally provided over 5 days, the manager said that if something special was planned for the evenings or weekend it is extended to cover this period as necessary. It was possible to cross reference the activities listed as being enjoyed by the people being case tracked, in their care plans, with their programme of activities recorded in their day care files. These included activities such as flower arranging, music, ironing, aromatherapy, singing and cookery sessions amongst numerous others. Each activity was accompanied by guidelines for the staff on how to support the person undertaking it. A weekly record of activities participated in was also in place in both of the files looked at, along with regular reviews that were used to ensure that the person still wished the activity to be included within their programme. During the inspection one person being case tracked was supported by staff to attend a local flower arranging group whilst the other went out for a walk and lunch. As well as their weekly programme of activities, the people that use this service also enjoy regular holidays and short breaks. One person was looking forward to a 4 day break in the Isle of Wight, whilst others were in the process of planning their break with staff support. As previously recorded, the majority of the people resident in the home have limited or no verbal communication, therefore staff are relied on to assist and support with maintaining personal relationships with relatives and friends. These relationships are seen as being of prime importance by the home, and are facilitated as appropriate. Comments made in the surveys received from relatives indicate that they are “kept informed of their relatives welfare”, and welcome the support provided by the home to ensure that their relative visits them weekly. Although the home consists of two separate bungalows connected via an internal door, the manager said that she tends to see them as one home. As such meals are generally planned and prepared in one of the bungalows, although the people who live in the other are free to eat their meal in their own bungalow if they wish. Both of the kitchens were clean and tidy on the day of the inspection. They were domestic in both size and functionality, and had the necessary checks and records in place. The main food stocks were in the kitchen of number 7, and were plentiful and varied, consisting of a wide selection of fresh, frozen and tinned foods. Menus are planned on a weekly basis, and take into consideration peoples individual likes, dislikes and Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 14 preferences. It was noted during tea time that people were able to choose something different to what was on the menu if they wished. It was also noted that staff were following guidelines provided regarding special diets and food presentation where applicable. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 (Adults 18 – 65) 8, 9, 10 (Older People) Quality in this outcome area is good. People who live in the home receive personal support in line with their assessed needs. Their healthcare needs are monitored and addressed. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has their levels of personal care and support needed detailed clearly within their care plans. This ensures that staff are able to provide the necessary levels of assistance as directed by their assessed needs. For example, whether some is right or left handed was recorded, as were their set routines regarding personal care needs. Photographs showing how to position people in their wheelchairs were in place, along with written guidelines. The home also has a gender specific personal care policy in lace that states that Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 16 female staff work with female residents at all times with regards to their personal care, and that where possible male staff work with male residents, however it was acknowledged that this isn’t always possible due to the female/male ratio of employed staff. Information available within the two personal files looked at confirmed that people are supported with their healthcare appointments such as the dentist and chiropodist at the recommended intervals, along with GP appointments and medication reviews were recorded, as were attendance at more specialist appointments and clinics such as with a dietician, psychologist, speech and language therapist, epilepsy specialist and wheelchair services. Each person also has a completed health screen in place. The outcomes of all healthcare appointments were clearly recorded along with any actions necessary. None of the people living in the home currently administer their own medication. Instead they rely on the staff team to undertake this for them. Medication is provided by Boots, in a mixture of blister packs, bottles and packets, and is accompanied by medication administration record charts. A member of staff talked through the medication procedure, and said that they are not allowed to administer mediation to people until they have received training. A nurse from the Trust then checks their competency on an annual basis. Records to confirm this were seen in the homes training file. The medication records for the two people being followed for case tracking purposes were checked and provided no cause for concern at the time of the inspection. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 (Adults 18 – 65) 16 – 18, 35 (Older People) Quality in this area is good. The homes policies of complaints and protection from abuse ensure that people’s views are listened to and acted upon, and that they are safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a service user friendly version of the organisations complaints procedure which is available to the people who live in the home should they need it. All of the surveys received from relatives indicate that they are aware of how to make a complaint. Additional comments made within the surveys included “…is taken care of so well, we have never had to make a complaint”, “we are happy with the home” and “…this home is very satisfactory…”. Surveys received from the people who live in the home indicated that they all knew how to make a complaint. This was confirmed within their care plans, as there were grievance / complaints profiles written in the first person, that detailed how they expressed if they were unhappy or distressed about something. No complaints were recorded within the homes log. Similarly we have received no complaints since the home was registered with the new provider. The home also has a policy and procedure in place for the protection of vulnerable adults from abuse. Staff were currently undertaking training in this Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 18 area via vulnerable adult workbooks provided by Warwickshire Vulnerable Adults committee. Once completed these workbooks get returned to the committee for verification. Staff spoken with were knowledgeable about abuse and were able to say what they would do should abuse be suspected or disclosed. Clear audit trails and financial management guidelines were in place for individual personal spending monies. Each person’s money is checked on a daily basis, and two members of staff are required to sign for each transaction undertaken. Monies checked during the inspection tallied with balances recorded and receipts available. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 (Adults 18 – 65) 19, 26 (Older People) Quality in this outcome area is excellent. The appearance of this home creates a pleasant, comfortable and homely environment that is well maintained. The home presents as clean and hygienic. This judgement has been made using available evidence including a visit to this service. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registration for this home covers both numbers 7 and 8 Hancox Close. These are a pair of semi detached bungalows that are connected via an internal door in a hallway between the two. The décor throughout both properties was immaculate, with very good quality soft furnishings and modern furniture. Peoples bedrooms looked at were seen to be decorated to individual taste with plenty of personalisation in the form of pictures, photos and ornaments. The bungalows are leased from Trident Housing Association. The manager said that any maintenance issues are undertaken by both the Trusts maintenance department and the housing association as applicable. At the time of the inspection the manager said that they were experiencing ongoing problems with engaging the services of a gardener, due to the considerable cost that it would incur. The rear gardens are large, and require regular garden maintenance to keep them nice. Currently, it was reported that staff are undertaking gardening tasks as their time allows until this issue is resolved. Each bungalow has a separate utility room that is away from the kitchens. Personal protective clothing was available for staff to use. People are supported to manage their own washing, ironing and cleaning as appropriate. On the day of the inspection the bungalows were clean and tidy and free from offensive odours. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 (Adults 18 – 65) 27, 28, 29, 30 (Older People) Quality in this outcome area is excellent. People who live in this home benefit from sufficient numbers of competent, knowledgeable staff. Recruitment practices ensure that they are safeguarded from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs 17 staff including the manager. Staff spoken with said that there were generally four care staff on duty during the morning shift with three care staff in the afternoons. In addition one or two day care staff would also be on duty. The home is staffed over night by one waking and one sleeping staff member. This was verified by the homes rotas which were looked at during the Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 22 inspection. Staff spoken with felt that the staffing levels in the home were satisfactory. One member of staff has commenced work at the home since the previous inspection of the service. This person’s staff file was looked at and was found to contain all of the necessary documentation including a criminal record check and two written references. This confirmed that a thorough recruitment process that safeguards service users is undertaken. The manager of the home holds comprehensive training records for all staff, which confirmed that they are all up to date with their mandatory training. In addition, nine staff have successfully completed NVQ II or above, with 13 also having completed the Learning Disability Awards Framework induction and foundation. Training in relation to specific people who use the service is also provided for staff and covers areas such as epilepsy, buccal midazolan administration and person centred planning. The manager has copies of certificates for all training undertaken and has introduced a training “wall of fame” in the hallway between the two bungalows to celebrate staff achievements. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 (Adults 18 – 65) 31, 33, 35 (Older People) Quality in this outcome area is excellent. A suitably qualified manager is in place at the home who ensures that the people that live there benefit from a well run service. The quality audit system ensures that people’s views are at the forefront of service provision and development. Health and safety is Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 24 managed appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed by a competent, experienced and appropriately qualified manager, who was clearly knowledgeable about the people using the service. Staff spoken with talked very highly of the manager, commenting that she is always available and approachable. Positive relationships between the manager, people who use the home and staff were seen throughout the inspection. The home has a quality file in place, in which a quality report dated January 2007 was available. This was generated from the returned questionnaires sent out by the home specifically for determining the quality of the service provided. Responses were received from professionals linked to the service, relatives, staff and people who use the service. The report was highly detailed, and included an action plan that would ensure that a high quality service continued to be provided. The manager said that this review of service quality would be undertaken on an annual basis. In addition the quality of the service provided is monitored via the managers development plan that is updated annually, regulation 26 visits and reports and a monthly quality monitoring checklist that the manager completes. Regular staff meetings are also held. A sample of maintenance records that included the gas safety certificate, portable appliance testing, an electrical installation report and fire safety records confirmed that these are all undertaken at the required intervals, thus maintaining the health and safety of all who live in, work or visit the home. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT Standard No Score 37 3 38 x 39 4 40 x 41 x 42 3 43 x 4 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hancox Close, 7-8 Score 4 3 3 x DS0000068558.V334766.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Hancox Close, 7-8 DS0000068558.V334766.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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