Inspection on 29/07/09 for Heads Meadow

This inspection was carried out on 29th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heads Meadow 24/06/08

Heads Meadow 27/06/07

Heads Meadow 28/09/06

Heads Meadow 01/03/06

Heads Meadow 20/09/05

Heads Meadow 15/10/04

Heads Meadow 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Heads Meadow 41 Ball Road Pewsey Wiltshire SN9 5NB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 2 9 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Heads Meadow 41 Ball Road Pewsey Wiltshire SN9 5NB 01672563851 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Steven@StevenAbbott.wanadoo.co.uk Mrs Jane Abbott care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Heads Meadow is a detached property in the village of Pewsey. It is one of a number of care homes in the Pewsey area of Wiltshire that are run by Mrs Jane Abbott. Together, the homes are known under the name of Valued Lives. Mrs Abbott is also registered as the manager of Heads Meadow. The people who live at the home receive support from a permanent team of support workers. They have their own rooms. The communal areas include lounges for different activities and there is a kitchen with a dining area. The home has a large garden and parking spaces at the front. A vehicle is available for trips out. The fees range from 677 to 1100 pounds per week. Information about the home is included in a Statement of Purpose. Copies of inspection reports are available from the home and they can also be seen on the Commissions website at www.cqc.org.uk 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 35 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: Before visiting Heads Meadow, we had asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. We sent surveys to the home so that these could be given out to the people who use the service, to staff members and to healthcare professionals. This was so that we could get their views about the home. We had surveys back from a staff member and from two healthcare professionals. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home, which took place on 29th July 2009. During the visit we talked to the people who use the service and to staff members. The registered manager, Mrs Abbott, was not present at the time, although we met with another senior manager from Valued Lives. We went around the home and looked at a Care Homes for Adults (18-65 years) Page 5 of 35 number of records. The previous inspection of Heads Meadow took place on 24th June 2008. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 6 of 35 What the care home does well: What has improved since the last inspection? We had recommended at the last inspection that new care plans should be developed for each person, and the care planning system simplified. This was to ensure that peoples plans were up to date and easier for staff to use as working documents. Work has taken place in line with this recommendation. New documentation is being used and each person now has the same sort of care plan. The parts of the plans that focus on peoples care needs are up to date and this information is more clearly presented. Some of peoples risk assessments, for example in relation to moving and handling, have also been reviewed and updated. Information about the meals that people have at the home was not available to us at the last inspection. Menus are now kept and we looked at some recent examples. These showed a varied range of meals being served, which are known to be popular with the people who use the service. The carpet in the hall and on the stairs has been replaced. This was something that we had talked about at the last inspection, as parts of the carpet were worn and could have been a risk to people when using the stairs. We were given information in the AQAA about other improvements and developments Care Homes for Adults (18-65 years) Page 7 of 35 that have taken place. For example, a new vehicle has been purchased for the home. A checklist is being used to ensure that it is kept in good order for people. We were told that policies and procedures have been reviewed, to reflect changes in legislation and new guidance about good practice. What they could do better: Some sections of peoples individual plans still need to be completed so that there is good information about their goals and how they will be supported with achieving these. Communication diaries and Health Action plans were included in the individual plans, but had not yet been recorded. Completion of the plans will help to ensure that they reflect a person centred approach and provide better information about peoples diverse needs. We have also recommended that all staff receive equality and diversity training, so they know how to recognise and meet peoples diverse needs. This recommendation is outstanding from the previous inspection. We reported at the last inspection that a detailed behaviour management policy and guidelines had been developed. This had been a requirement from a previous requirement, however it had not been met in full as the policy and guidelines had not been agreed with the community nurse. The nurse still needs to agree these, to ensure that they are appropriate for the people who use the service. There is a detailed procedure for the administration of medication that has been prescribed for use as required. However the home needs to ensure that this is always fully adhered to, so that there is good information about why the medication was needed and given by staff. We have also recommended that a new medication cupboard is installed, which complies with the storage requirements for controlled drugs. Although no controlled drugs were being kept at the time of our visit, this would ensure that they can be safely stored if they are prescribed in the future. There were a number of health and safety related checks that staff were expected to complete on a daily basis. The records of these checks need to be consistently and accurately maintained, to show that the checks have been carried out as planned. We have reported at previous inspections about quality assurance and the importance of obtaining feedback from people about the home. There has been some progress with producing a system of quality assurance for the home. However, this has not yet been fully implemented and peoples views need to be reflected in the homes development plans. A requirement was made at the last inspection that Mrs Abbot, the registered manager, must obtain an appropriate management qualification. We were told that this had not happened by the agreed date, because of a problem with the training provider. Obtaining this qualification is now a priority, to ensure that the manager is suitably qualified to run the home. We will be asking Mrs Abbott to provide us with an Improvement Plan in relation to matters arising from this inspection. Care Homes for Adults (18-65 years) Page 8 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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. Nobody has moved into the home for a number of years. There is a procedure in place for new admissions, and for assessing whether the home can meet a persons needs before they move in. Evidence: We were told in the AQAA that nobody had moved into Heads Meadow, or had left the home, during the last year. The people at Heads Meadow have lived together for several years. In the absence of any changes in occupancy, it was not possible to look at recent outcomes in relation to assessing the needs of people before they move in. We have found at previous inspections that peoples needs had been assessed and that contracts were in place with the local authorities that pay their fees. We were given information in the AQAA about the homes admission arrangements. There was a policy and procedure for referrals and admissions. This had last been reviewed in February 2009. We were told that prior to an admission, consideration would be given to the staff teams capacity to meet somebodys assessed needs, and Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: to the availability of specialist support. The needs of the people currently receiving a service at the home would also be a factor. Care Homes for Adults (18-65 years) Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual plans and assessments are improving so that they reflect their current needs. However, information about peoples personal goals, and how they will achieve these, is not yet included in the plans. This information will help to ensure that the plans reflect a person centred approach. People receive support which helps them to make and decisions in their lives. Evidence: We reported at the last inspection that there was a mix of care plans being used. A new style of care plan had been introduced and these were being used by two people. The new style care plans were clearer and easier to follow. We had recommended at the last inspection that new care plans should be developed for each person, and the care planning system simplified. This was to ensure that peoples plans were up to date and easy for staff to use as working documents. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: We looked at peoples individual plans again during this inspection. We saw that they had the new style of care plan on their personal files. The plans provided information about the support that people required. There were sections which covered different areas of need, such as dietary, social, spiritual, health and occupation. The plans were dated May 2009 and had a section for six-monthly reviews. The system of individual planning also included Personal Planning (PP) booklets and Communication dictionaries. These were designed to provide more information about peoples diverse needs and individual preferences. There were also sections for recording peoples personal goals and the action that would be taken in connection with these. However, these booklets and other records had not yet been completed. This meant that there was a lack of person centred information, and information about peoples goals and how they would be supported to achieve these. We were told in the AQAA that the people who use the service did not have the level of responsibility that was needed in particular areas, such as looking after keys and managing their own money safely. We were also told about occasions when people were able to take responsibility and be practically involved, with the support of staff. This included, for example, people being given their own post to open, with staff then explaining the content and acting on this as appropriate. A staff member explained how recipe photo cards were being used to help people select meals that they would like to be included on the menu. During the visit we observed people using the different areas of the home and were able to choose where to spend their time. People had their own rooms which they could decorate and personalise as they wished. One person chose to smoke and arrangements had been made for this in the home. The safety aspects had been looked at through the carrying out of a risk assessment. Risk assessments had been undertaken in relation to other tasks and activities involving the people who use the service. We saw assessment records on peoples personal files. The assessments included the action to be taken to reduced risks, whilst also promoting peoples independence and involvement in activities that could involve a degree of risk. Care Homes for Adults (18-65 years) Page 14 of 35 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 are provided with a range of activities that include their involvement in the local community. They receive support which helps them to maintain relationships and to make choices in their daily lives. People have a varied range of meals, which they have helped to choose. Evidence: When we arrived at the home people were preparing to go out for their days activities. People told us about the centres that they attended with other people from the Valued Lives homes. The centres activities included arts and crafts, music, gardening, looking after animals and playing games. Other activities were being arranged, which involved people going out in the community, for example visiting the cinema or going to a sports centre. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: We saw timetables on peoples personal files which showed how they spent their time during the week. In addition to attending the centres, people also had time when they were home based and had appointments, or made arrangements on the day about what to do. On the day we visited one person was at home during the morning because they had an appointment with an occupational therapist. Peoples weekly timetables showed that a Family Contact Visit was taking place every four weeks. We discussed this with the senior manager. They said that this did not necessarily involve an actual visit, but it was a time when people would be supported with their family relationships, for example by staff helping somebody to write a letter. This could have been made clearer on peoples weekly timetables. We were told that some people saw their relatives on a regular basis. Staff assisted people with shopping trips and with managing their personal money. Other regular events included attending a church service, which we were told had become a well established event every 3 - 4 weeks. The senior manager told us that these services were arranged specifically for the people from Valued Lives, and were geared to meeting their individual needs. Some people had chosen to be confirmed. We heard that peoples involvement with the church had also provided them with a social network and the opportunity to attend some one-off events. People said that they also went to a Gateway Club each week. People from the Valued Lives homes had the use of a caravan for annual holidays. Within the home there was communal space for different activities. There was a small lounge with a television, and other communal areas where people had quieter activities such as knitting, reading and writing. We were told that people could keep a pet in the home. House pets in the past have included a dog, a cat and a parrot, although there were no pets being kept at the time of our visit. People had access to the kitchen and domestic areas of the home under the supervision of staff. We were told that people were encouraged to be involved in the domestic routines, within their capabilities. This included for example, helping to lay the table, preparing vegetables and sorting laundry. For safety reasons, there were arrangements in place to ensure that people could not access some parts of the home when staff were not present to support them. A menu was being written each week with details of the days meals. We looked at recent examples and saw that there was a varied range of meals being served. Staff Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: told us that they had got to know peoples likes and dislikes and that the menus were based on a range of meals that were known to be popular. We were told about photo recipe cards that had been obtained to help people to choose the meals that they would have in a particular week. The cards also included information which helped people to buy the right ingredients that were needed for the meals. We were told in the AQAA that individual dietary needs were catered for. People had the option of eating on their own or with other people. We were also told that the timing of meals was flexible, although regular eating habits were encouraged as part of a healthy eating plan. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the support that they need with their health and personal care. They are protected by most of the homes arrangements for dealing with medication, although some areas should receive further attention. Evidence: Peoples individual plans included information about the support that they need with their personal care. This helped to ensure that staff had a consistent approach and assisted people in the way that they preferred. We were told in the AQAA that the people who use the service were encouraged to be as independent as possible with their personal care. The plans showed the level of support that each person required. There were also some additional support plans, which provided guidance about particular areas, such as continence and mobility. The staff team included a mix of male and female support workers. We were told in the AQAA that female users of the service users only received personal care from female staff. It was reported that every effort was made for the male users of the service to receive care from male staff. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Information about peoples health care needs was included in their individual plans. As reported under the Individual Needs and Choices section, some parts of the individual planning records had not yet been completed. This included Health Action Plans for the people who use the service. Daily reports were being written which included observations about peoples health and welfare. Overall, there was a lot of information recorded about on-going health matters. This showed that staff were aware of the importance of supporting people in this area. Peoples weights were being recorded regularly to help identify any significant changes which might need to be followed up. In their surveys, we asked the healthcare professionals whether the home sought advice, and acted on this, to meet peoples social and health care needs and improve their well-being. The two healthcare professionals responded Always to this question. One commented on what they thought the home did well: Holistic care of clients, most staff are very knowledgeable about their clients. Staff supported people with making appointments with healthcare professionals. People were registered with local GPs and there were arrangements in place for seeing dentists and opticians. Reports were being kept of peoples contact with healthcare professionals. These records showed how particular health conditions had been followed up and helped to ensure that there was good information when peoples health needs were being reviewed. We read about the support that people had received from outside professionals, such as an occupational therapist and speech therapist. The people who use the service received support from staff with managing their medication. There was a locked cupboard for the storage of medication. We have commented at previous inspections about the location of the cupboard which meant that there was a risk of medication being affected by heat and steam. The location has not changed; it is in a public area, so it also has an impact on the homeliness of the environment. The home did not have a medication cabinet which complied with the current requirements for the storage of controlled drugs. This meant that, although no controlled drugs were being kept at the time of our visit, the home would not be able to store these safely if they were prescribed in the future. Staff members had received training in medication handling and in some more Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: specialised techniques. There was a system in place for stock control. Records were being kept of medication received into the home and of its administration to people. Changes to peoples medication had been documented and signed. Each person had a list of homely remedies that they could take and this had been approved by their GP. Records and letters from a consultant psychiatrist showed that peoples medication was being reviewed regularly. There was a procedure for staff to follow in relation to the use of PRN medication medication that is prescribed for use as required. This included the involvement of a senior person and the completion of a Functional Analysis form. These forms were designed to show the circumstances that had resulted in the medication being administered. We saw that there had been occasions when the medication had been administered, but the appropriate forms had not been completed. Care Homes for Adults (18-65 years) Page 20 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally protected by the homes policies and practices about complaints and protection. However, some people may still be at risk of harm because the plans to manage their behaviour have not been agreed with the relevant professionals. Evidence: Information was available about how to make a complaint. A pictorial version of the complaints procedure was provided with the Service Users Guide, which has been given to the people who live at Heads Meadow. We were told in the AQAA that relatives had also been given a copy of the homes complaints procedure. It was reported that there had been no complaints since the last inspection. There was a wide range of information about adult protection issues. This included details of the multi-agency procedures within Wiltshire about recognising abuse and how any concerns should be followed up. Body maps were being used in the home to identify and record any physical changes which could be a cause for concern. Staff members had received training about the prevention of abuse from an external training provider. We were told in the AQAA that there had been no safeguarding referrals made by the home, and no safeguarding investigations, during the last year. It was also reported in the AQAA that there had been no incidents during the last year involving the use of restraint. Staff members had undertaken training in physical intervention, which we were told had been accredited by BILD (British Institute of Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Learning Disabilities). We have reported at previous inspections about the arrangements being made for the management of peoples behavioural needs. A requirement had been made about having strategies in place which contain appropriate guidance, show who has been involved in devising them, and are kept under regular review. We reported at the last inspection that progress had been made towards meeting this requirement and that a detailed behaviour management policy and guidelines had been developed. However, these had not been agreed with the community nurse and we confirmed at the time that the requirement had not been met in full. During this inspection we talked to the senior manager about the involvement of the community nurse. We were told that this had been followed up, but the nurse had not yet visited in connection with the behaviour management guidelines. The senior manager said that the nurse was shortly to visit another Valued Lives home, and it was anticipated that this would be followed by a visit to Heads Meadow. People received support from staff with the management and safekeeping of their personal money. Appropriate financial records were kept with receipts. Care Homes for Adults (18-65 years) Page 22 of 35 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. People live in a homely environment, which is meeting their needs. Evidence: Heads Meadow is a detached property in a residential area of Pewsey. The home has a large garden with parking spaces at the front. There were village shops and facilities within walking distance of the home. Vehicles were available so that people could get to their activities in the wider community. The property was domestic in style and did not stand out as being a care home. The home was furnished and decorated in a homely way. There were communal areas for different activities and each person had their own bedroom. The bedrooms did not have en-suite facilities and the home was registered at a time before these needed to be in place. We were told in the AQAA that any adaptations required following a change in an individuals needs had been provided in conjunction with the involvement of the relevant specialists from outside the home. An occupational therapist came to the home during the morning of our visit to assess one persons needs. There was a domestic type kitchen and a separate utility room for the laundry. The Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: standard of upkeep and the overall appearance of the accommodation were generally satisfactory. The carpet in the hall and on the stairs has been replaced. This was something that we had talked about at the last inspection, as parts of the carpet were worn and could have been a risk to people when using the stairs. A door in one of communal rooms was in need of repair and we were told that was receiving attention. We saw that the light bulbs in some areas were without shades. A staff member said that one person who uses the service had a tendency to damage the shades and they had not been replaced. We talked about using a different type of light fitting that is flush to the ceiling, as an alternative to one which uses a hanging shade. There were no unpleasant odours in the home and the accommodation looked clean. Care Homes for Adults (18-65 years) Page 24 of 35 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. People are supported by staff who they know well and are familiar with. Staff members have obtained a relevant qualification and received training, which helps to ensure that they are competent in their roles. Further training, and a more planned approach, would assist staff in their professional development for the benefit of the people who use the service. Evidence: Heads Meadow had a permanent staff team, with five full-time staff members and one part-time staff member who covered most of the shifts at the home. There was a minimum of two staff on duty during day time hours and one person slept in at night. There was an out of hours on-call system in operation, so that a staff member could contact a senior person if needed. We were given information in the AQAA about the make up of the staff team. Over 80 of the staff team have been working with the people who use the service since they moved into the home. There were policies about recruitment and staff selection practices. One new member of staff had been employed before the last inspection and we had looked at their Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: recruitment records at that time. We had made a requirement in connection with this, because the recruitment process had not included all the required checks. For example, two references are required before a staff member is appointed, but only one had been received. The recruitment checks in relation to other staff have been checked at previous inspections and found to have been satisfactory. In their survey, the staff member told us that their employer had carried out checks, such as a CRB (Criminal Record Bureau) disclosure and references, before they had started work. We were told that there had been no changes in the homes staff team during the last year, with no new staff appointed. This meant that it was not possible to assess current practice in relation to staff recruitment. The requirement from the last inspection will not be brought forward as outstanding, however we will refer to it as being a previous requirement if there are shortcomings in the recruitment of staff in the future. Following induction and after becoming established in the home, new staff members were expected to undertake a National Vocational Qualification (NVQ). Five staff members had achieved their NVQ at level 2 one staff member was undertaking a NVQ at level 3 after having completed level 2. We were given information in the AQAA about the arrangements being made for staff training. Most training was provided through a programme of distance learning courses that were arranged by an outside training provider. This covered the mandatory subjects such as health and safety, food hygiene, first aid, medication, and safeguarding adults. We looked at the training records at the last inspection and noted that staff had received the mandatory training in the subjects of health and safety, food hygiene, first aid, medication; including special methods of administration, and abuse awareness. There were also courses being arranged about epilepsy, challenging behaviour, person centred planning, physical intervention, autism, and dementia in people with Downs Syndrome. At the last inspection we talked about developing the staff training and development programme. We made recommendations about staff receiving Learning Disability Award training and training in equality and diversity. We saw that staff had received training in manual handling and care planning during Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: the last year. There was no record of training in relation to equality and diversity. The senior manager said that she was not aware of this having been provided. We were also told that there was no staff training plan for the year. A plan, based on an assessment of the staff teams training needs, would help to ensure that staff members receive the range of training that is expected in a care setting. Care Homes for Adults (18-65 years) Page 27 of 35 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. Further action needs to be taken to ensure that people benefit from a well run service and their views are reflected in the homes development plans. Evidence: Mrs Abbott is the registered provider for the Valued Lives homes. As the registered manager of Heads Meadow, Mrs Abbott also has responsibility for the day to day running of the home. Managers from the other Valued Lives services provided support to the different homes, when needed. Team leaders were in charge of shifts in the home and had responsibilities for particular areas. Mrs Abbott has many years experience of working with people with learning disabilities. She had a learning disability nursing qualification and had practiced as a nurse before running her own services. Mrs Abbott did not have an appropriate management qualification and we reported at the last inspection that she was working towards a National Vocational Qualification (NVQ) at Level four in Management. A timescale for completing this qualification had Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: been confirmed (December 2008). The senior manager who was present during our visit had a City and Guilds qualification in health and social care and told us that they had also been working towards their NVQ at Level four in Management. However, they said that problems with the training provider had meant that they, and Mrs Abbott, were no longer undertaking the qualification. They had not yet enrolled with a new training provider. We have reported at previous inspections about the need for the service to develop a system for quality assurance. This has progressed over time and a consultant has provided advice and guidance. At the last inspection we saw that a quality assurance folder had been produced, with information about the system, which included the sending out of surveys. We made requirements because the system had not been fully implemented and a quality assurance report had not been produced. We looked at quality assurance again during this visit. Surveys had been sent out to the people who use the service and to other people who had an interest in the home. A small number had been returned. We talked to the senior manager about other ways in which peoples views could be obtained in order to provide better feedback about the service. A report had been produced about the Valued Lives services and how they could be developed and improved. However, this was not specific to Heads Meadow and did include peoples views about the home. Another part of the quality assurance system was an internal audit of standards in different areas of the home. There was documentation on file in connection with this, although a full audit had not been completed and recorded. The AQAAs that we received from Mrs Abbott at both this, and at the previous inspection, have lacked detail about how the home has improved in different areas. This showed that sytems for quality assurance were not well established and did not focus on the specific outcomes for the people who live at Heads Meadow. The AQAA gave us some information about the arrangements being made for health and safety in the home. During our visit we saw that there was a system in place for monthly health and safety checks. There was a report for June 2009 which stated that the fire log was up to date and that C.O.S.H.H. related items were kept in a locked cupboard. There were other checks that staff were required to make on a daily basis, for Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: example in relation to the security and cleanliness of the environment. Checklists were being used to record when these checks had been undertaken. However, we saw that there were gaps in these records and they were not all up to date. It is important to complete these checks consistently; an accurate record will ensure that there can be no misunderstandings about what has been done. Risk assessments were in place for some environmental hazards. There was a fire risk assessment, which was dated September 2008. Visits were being made by relevant contractors, for example to service the fire precaution systems and for portable appliance (PAT) testing. Radiators were covered to reduce the risk of burning. Thermostatic valves had been fitted to taps to regulate the temperature of the hot water. We recommended at the last inspection that these valves are serviced regularly. The senior manager we met during the visit said that they were being checked regularly to ensure that they were working properly. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13-&7151a17-1a Sch3-3q Strategies for management 30/09/2008 of behavioural needs must contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them, and be kept under regular review. The registered manager must obtain an appropriate management qualification. 24/12/2008 2 37 9 (2) b (i) 3 39 24 The registered person must 30/10/2008 continue to implement an effective cycle of quality assurance and ensure that the views of all stakeholders are represented. (This requirement has been met in part). Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The homes procedure for 30/07/2009 the administration of medication that is prescribed for use as required must be followed in full on each occasion. This includes completion of the Functional Analysis forms. This is so that people are well protected by the homes medication procedures. 2 23 13 Strategies for management 31/10/2009 of behavioural needs must contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them, and be kept under regular review. This requirement from the last inspection has not been met in full. The strategies need to be shared with the relevant professional to ensure that they are Care Homes for Adults (18-65 years) Page 32 of 35 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 appropriate for the people who use the service. 3 37 9 The registered manager must obtain an appropriate management qualification. Requirement outstanding from the previous inspection. Mrs Abbott is to confirm with the Commission the arrangements being made for her to complete the qualification. 4 39 24 The homes system for quality assurance must be implemented in full. This is to ensure that the outcomes are clearly identified and peoples views are reflected in a development plan for the home. 5 41 17 Records must be maintained 30/07/2009 so that they are accurate and up to date. This is to ensure that the correct procedures are being followed and there can be no misunderstandings about what has been done. 30/11/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 33 of 35 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 That the process of completing peoples individual plans is finished as a matter of priority. This is to ensure that the plans reflect a person centred approach and provide good information about peoples goals and diverse needs. That the Health Action plan parts of peoples individual plans are completed in conjunction with the appropriate healthcare professionals. That the location of the medication cupboard is reviewed. This is with the aim of identifying another location which would be less public and affected by environmental factors. That a cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 is installed. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. This recommendation is outstanding from last inspection. New staff should receive Learning Disability Award training as underpinning knowledge for NVQs. This recommendation is outstanding from the last inspection. All staff should receive equality and diversity training so they know how to recognise and meet peoples diverse needs. This recommendation is outstanding from the last inspection. hat a training plan, based on an assessment of the staff teams training needs, is produced. This will help to ensure that staff members receive the range of training that is expected in a learning disabilities service and which reflects the diverse needs of the people who use services. The thermostatic valves on taps should be serviced regularly to ensure that they continue to regulate the water temperature and people are protected from being scalded. This recommendation is outstanding from the last inspection. A record should be kept to show that these valves are being maintained and being kept in good working order. 2 19 3 20 4 20 5 35 6 35 7 35 8 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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