Inspection on 13/01/09 for Heywood Sumner House

This inspection was carried out on 13th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heywood Sumner House 12/02/08

Heywood Sumner House 31/10/06

Heywood Sumner House 16/01/06

Heywood Sumner House 19/07/05

Heywood Sumner House 26/07/04

Heywood Sumner House 03/03/04

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Dalewood Respite Care

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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: Heywood Sumner House Cuckoo Hill South Gorley Fordingbridge Hampshire SP6 2PP     The quality rating for this care home is:   two star good 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: Sue Kinch     Date: 1 3 0 1 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 30 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 30 Information about the care home Name of care home: Address: Heywood Sumner House Cuckoo Hill South Gorley Fordingbridge Hampshire SP6 2PP 01425652350 01425655736 heywoodsumner@truecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Truecare Group Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Mental disorder, excluding learning disability or dementia (MD) The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Mental disorder, excluding learning disability or dementia (MD) TThe maximum number of service users to be accommodated is 12 Date of last inspection Brief description of the care home Heywood Sumner House is part of the Truecare Group managed by C.H.O.I.C.E. Ltd. The home is located in the rural village of South Gorley between the market towns of Fordingbridge and Ringwood. It provides accommodation for up to 12 residents who Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 12 12 Brief description of the care home have a learning disability. The property is detached with car parking for several vehicles to the front of the building and well-maintained and accessible gardens to the side. Accommodation comprises of single bedrooms located on both the ground and first floor. There is a lounge and a dining area on the ground floor, together with various other facilities including an activities/games room. Recent refurbishment has taken place and improved two bedrooms and a third is having an improved en suite facility. The manager agreed at the inspection that the current range of fees is from 1,021 pounds - 2,662 per week depending on individual needs. Items not covered by fee include hairdressing, chiropody, and toiletries. Care Homes for Adults (18-65 years) Page 5 of 30 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the first key unannounced inspection since 12th February 2008. We considered information received by the Commission since that visit and this included an Annual Quality Assurance Assessment completed by the manager. We sent out twelve surveys to staff and received three responses. Nine were sent to people living in the home and we received six. Two of the twelve sent to health and care professionals were returned. The latter two responses were also discussed with respondents. All surveys were received after the inspection visit. At the visit, which took 7.5 hours, we talked to six people living in the home, four staff, the manager and the operations manager. We viewed a number of records and observed aspects of the environment. Some matters were discussed with the manager in a telephone call after the inspection visit. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: We have made one requirement in the report about the management ensuring that the work started regarding supervision,induction and training is completed for all staff and kept under review. We have discussed with the management about ensuring that the impact of actions taken to limit or restrict some people in the home based on risks to themselves or others, do not necessarily restrict those who are able to be more independent. The management have agreed to address this and after the inspection visit they reported that this had begun before the production of this report. The manager and deputy have received training in the Mental Capacity Act and plan to train staff in the implications for their work practices.We advised that risk assessments for self medication should be considered in this context and the manager agreed to address this. The environment is in need of much attention and the management have recognised this and produced a plan of action already underway when we visited. Care Homes for Adults (18-65 years) Page 7 of 30 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 8 of 30 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 9 of 30 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. Systems are in place to ensure that people moving into the home have had their needs assessed and are assured that the home can meet them. Evidence: In the six surveys received from people living in the home, completed with staff help, four said that they had been asked if they wanted to move into the home and two said they were not. Three said they had been given enough information and three said they had not. All of these people have been living at the home for some time. The manager said that no one had moved in since the last inspection. We were therefore not able to make further assessment of the use of the admission processes for this inspection. In the AQAA the manager said that information is available for people considering moving into the home and there is an assessment process so that the home can confirm that they can meet peoples needs before they move in. In the AQAA the manager said that the management has not been actively filling service users vacancies as we wanted to make further improvements within the house before Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: increasing occupancy she continued that they are now looking to admit people and they had recently made a communication aid for someone considering moving in. The manager showed that there is a pictorial version of the service users guide and another using symbols. There are still plans to have an audio version. As noted at the last inspection the home has a good process for admission which the company uses and includes pre admission assessments,trials, transition plans and reviews. The home is supported by the organisations referrals team and the companys assistant psychologist. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are increasingly consulted about aspects of the service that they receive but they would benefit from more recorded reviews and further consideration to broadening their range of decisions and choices. When restrictions are in place for some people others would benefit from more consideration to the impact on them to ensure they retain their independence. Evidence: During our visit to the home we talked to some of the people living there and the staff about choices and decisions about activities. They confirmed that people are asked about the care and support given to them at the home. They gave examples of activities that people like doing and are doing. One person talked about going shopping and this was planned for the afternoon. Another was interested in the work of the maintenance person and had chosen to observe that. A third was at college. One staff member spoken with confirmed that they had planned goals with the person they are key worker for and that this was being planned by the day services coordinator. They said that that person does get to do the things they want to do. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Another staff member said that details of support needed is recorded in the care plans. A third said that choices of what people want to do changes, and people mostly get to do what they want to do. One relative contacted us after the inspection visit and said that with the current management team the standard of care has improved and that their relative was fine and happy in the home. We sampled the care plans held for two people living in the home and noted that similar formats were in use and covered general areas of health and well being, behaviour support, life skills and occupational issues with daily recording from staff. We noted that there were risk management plans in place covering varying issues with details of support needed. We noted that one person had signed elements of their care plan. One person had a review in November 2008 and the other had one planned for January 2009 but other recording of consultation was missing. The home has a policy of providing monthly reviews of care plans and regular key worker support sessions and these were missing for recent months in both files suggesting a lack of evidence of review and consultation with people living in the home.The manager said that this work is supposed to happen and was advised to ensure that this is monitored. The manager was asked about work taking place in relation to the Mental Capacity Act 2005 and if this is taken into account in day to day practises in the home.The manager said that work was needed to train staff following training received by herself and the deputy.We did not make a requirement about this as she is planning to follow this up with staff. Risk assessments were discussed with the manager and the operations manager. It had been noted that some areas of the home are locked such as the laundry, art and craft room and the kitchen. This was understood to be because some of the people living in the home are assessed to be at risk if they have free access. Records were not viewed on this occasion. The manager was asked how the other people living in the home were supported as this had not been viewed in care plans. The manager agreed to address this. Subsequent to the inspection visit the manager sent us information on how this would be addressed regarding the kitchen but further work is needed regarding other areas of the home. Care Homes for Adults (18-65 years) Page 13 of 30 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. Work is continuing to increase the range of activities that people living in the home like doing and to offer opportunities to do them. Further work is needed to ensure that peoples rights are promoted fully in daily routines in and out of the home. Evidence: In the AQAA the manager said that people all have timetabled activities dependent on their hobbies and interests. At the visit we had information from people and staff supporting this. One person living in the home, was spoken with, in their room full of personal equipment for music and film interests. This person had a large room with a separate bedroom area. The person said that they had a key worker who they talked with and that they had planned to go shopping that afternoon which they liked doing very much. They also said they liked doing art and craft sometimes and sometimes went out with friends.They said they were involved in cleaning their own room. Another person had been supported by two staff to go out. A third person discussed Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: had been supported to get to college. In another room a person was being assisted with personal care and we noted that a communication board was being adjusted to indicate what activities were happening that day. Some people had plans to go to the doctor. Some had chiropody appointments in the afternoon and a group were see to be preparing to leave in a minibus in the afternoon. Another person was interested in the building work taking place and was occupied watching the workmen and talking to them. We had comments from staff in the surveys and during our visit. One said that there is a choice of activities and these are now more structured and based more on the choices of people. She said those choices are always changing as people change their minds and some people are difficult to motivate. Another said the service ensures a wide variety of activities to service users according to their interests. Another said the service Provides service users with the chance to go out and enjoy themselves and continue to develop social skills but went on to say that the service could Try to offer more day services activities such as going to the cinema, bowling, quazer etc every so often. A third said that service users could have more group activities. A staff member said that day time activities are arranged by the day service co-coordinator. When talking to staff they were noted to use Makaton signs and gestures effectively with one person and they used and referred to the activity boards and symbols in peoples rooms. A member of staff said that communication needs are identified in the care plan and this was helpful. We noted communication sections in the care plans viewed . The manager referred to speech and language support for two people living in the home. The manager told us, in a telephone conversation after our visit, she feels that things are being sought for individuals and gave examples of massage for one person, horse riding for other and individually for one person and individual swimming sessions. She said others use the public pools and a hired pools depending on needs. Other examples were sensory and music sessions which people enjoy. Each person also is offered personal shopping session each week. She said that they are quite proactive in getting people involved in things and said that they do think about staff skills, strengths and who works well with who and try to use this to motivate people. She agreed that it was likely to improve with more consistent staffing. She also said that staff sometimes shadow others that are working well with a particular person to improve practice and develop positive approaches. Some of the people living in the home have high support needs and staff commented on those who need one to one staffing and two to one in the community. They said that this is provided. Because of some of the high needs there are some restrictions in Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: the home and some of the work needed to limit this is referred to in the section on individual needs and choices.The manager needs to make sure that the conversations and reviews with people living in the home are regularly documented.This was discussed with the manager. The manager said that they continued to support people to maintain and develop friendships with family and friends. We had comments from one relative only, who confirmed involvement in decisions. We noted that the manager commented on having plans for a friends and relative meeting in February for creating links and feedback. We were also shown a first newsletter produced in December 2008 which the manager said was sent to relatives. We talked to some of the people living in the home and staff about food.They confirmed that there is choice and we saw three options offered for lunch. Although there is a pictorial menu, this is only accessible when people are in the kitchen. The manager agreed that these could be made available on the new notice boards in another area of the home. However, we noted that at mealtimes people were given choices about the food offered and this included decisions made by seeing the options available. People could choose where to sit with one person preferring a quieter area. Staff were noted to eat their meals with the people living in the home. We heard comments that some people enjoyed being involved in the shopping and others in the cooking. One person commented on being involved sometimes in washing up. A staff member said that healthy eating is promoted and that people did not often ask for food between meals. They commented that some people have drinks a sweets held for them in the office.The manager confirmed this was the case for people who made weekly purchases and that agreements were held in their care plans. We also had information from a health professional confirming involvement with an eating plan for one person who had been referred by the home. They had made some recommendations for the staff to follow. Care Homes for Adults (18-65 years) Page 16 of 30 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. Work is continuing to take place to ensure that people living in the home are supported when necessary by external health and care professionals in meeting their health and personal care needs. People are protected by staff assessed as competent administering their medication but maximising independence through self administration should be considered using risk assessments. Evidence: In the AQAA the manager said that people living in the home receive support from a range of professionals including speech and language, neurology psychology, psychiatry, art therapy and from the organisations psychologist. From observation of a sample of records and talking to the manager, staff and people living in the home we noted examples of this. During our inspection visit a member of staff gave an example of support given regarding health. They said that, three weeks ago someone had a cold and the doctor was visited and medication given. They said that when staff go to the doctor with people they can read up about health needs and these are followed up and supported. They confirmed that it is their role to monitor peoples health and well being and that Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: this is in the care plans. Following our visit to the home we received information in surveys.Two of the twelve health and care professionals we sent surveys two responded. One included comments on poor communication between health professionals and the service and slowness to respond to guidance when they supported a client living at the home. In a telephone conversation with the the manager after our visit she said that a range of professionals are being used and gave examples of the people, using the service named in the first paragraph above. She feels that they are active in involving people and making referrals. She said that the home was also using the companys assistant psychologist and sometimes had a quicker response from her. She also said that where possible staff do support people to appointments consistently but this was not always possible. In the sample of records viewed personal care needs were recorded, we noted that when visiting one person in their room personal care had been provided but shaving had yet to be completed. Staff said that they were allocated specific people to support each morning and encouraged people to get up. One of the people living in the home said that they decided when to get up or go to bed. At this inspection the promotion of privacy was discussed with member of staff regarding chiropody treatment and they confirmed that it is promoted. Dignity was discussed with the manager following the inspection visit who said that she thinks the staff do address these issues and referred to personal care where staff are encouraged to take an individual approach and give space and privacy where needed. She said staff are trained when doing the Learning Disability Award Framework (LDAF) training and that there had not been recent issues. In our observations of the home we noted that some rooms did not have curtains, as found at the last inspection and the operations manager said that they are often pulled off rails and this was being addressed. We also noted that a small pane of glass in a rear bathroom window was not frosted and could compromise dignity. This was agreed by the manager to be addressed. At the last inspection we noted that an en suite facility had been planned for one person to meet specific needs. We noted that the work had been delayed but was taking place during our visit. Medication is held securely and individually for people. We talked to a member of staff Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: responsible for providing medication in the afternoon of our visit. We saw evidence of that persons training had competence assessment. The staff member was very clear about how to support people with medication and clear about procedures discussed. We sampled the recording and this was being completed to show that people were receiving their medication.Guidance for as required medication where sampled was in place. In a phone call on 20/1/09 in the context of Mental Capacity, the manager was asked if anyone in the home had a self medication risk assessment. She said that they had not. She agreed that the extent that people can be involved in their medication could be varied and agreed to give this consideration. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are increasingly able to express their views and concerns and staff are aware of their need to assist with this. The management of the home are promoting the protection of people living in the home by ensuring that staff are trained in safeguarding and the safeguarding procedures being increasingly used. Evidence: The manager said in the AQAA that formats of the complaints procedure had been increased to make the information more accessible and these were noted at the inspection although an audio version still needed to be completed. She also said that people can make complaints orally using a cassette recorder.We recommended a copy of the procedure to be posted on a noticeboard. We noted that a complaints log is held and complaints recorded are followed up. All six people, helped by staff, answering the survey said that they knew how to make a complaint, that they were treated well and that staff listened to them. This was confirmed by someone living in the home when we visited. A staff member agreed that there is a complaints procedure and thought that one person would make a complaint but others were possibly not aware enough although it is discussed in the home. They said that the communication boards may help but at times it is difficult to understand some people. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: The manager has been referring safeguarding issues to social services over the last year. The outcome of some of these were discussed at the inspection and the manager gave information of action she had taken in respect of these. Subsequent to the inspection we received some comments from a care professional stating that issues regarding specific interventions of one person had been addressed by the home earlier in 2008. During our visit to the home, we followed up one specific issue raised from an adult protection referral. It was discussed with the manager regarding a person who sometimes make allegations about staff. Aspects of the file for that person were viewed and it was noted that a risk assessment was written to guide staff for future occurrences. In the staff surveys they said that they know what to do if concerns were raised about the care at the home. We discussed safeguarding with a staff member aware of types of abuse and when to report. The manager said that she is getting staff to recognise when issues need to be reported on regulation 37 notices to CSCI as well as internal forms. Records showed that some staff had had safeguarding training in December 2008. Records also indicated that staff are having training in interventions and further training was reported to be planned for those who had not. The operations manager and the manager confirmed that there are enough staff in the home to work with the interventions needed for dealing with challenging behaviour. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In order to fully meet individual needs and provide a good environment several areas of the home need the maintenance and improvements now taking place. Evidence: We noted that some alterations were taking place at the last inspection and this included improving the bedrooms space and facilities for some people. The manager, in the AQAA, submitted for this inspection, said that there had been some delays in the refurbishment due to changes in the architectural plans. We noted that some aspects of the environment had been attended to such as the fence around the pond, completion of refurbishment of two bedrooms and the flooring of the laundry area. But we also noted that some areas of the environment were in need of attention with much work still outstanding although some of this work had begun. Redecoration of stairwells and provision of an en suite facility was taking place. Plans include further decoration and carpet replacement. We noted that a room that was a bedroom at the last inspection and now used for art and craft, contained some ageing furniture which the manager said would be replaced. It still had no curtains and the ceiling remained stained over a large area. A sensory room had not yet been provided as planned. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: We were shown records of a planned schedule of maintenance and agreed to be done in a meeting on 2/1/09 and scheduled to be completed by the end of January. This identified many areas for improvement. In a letter received from a representative of the company following the inspection, some reasons for delays were given but also the below standard environment was acknowledged. Representatives of the company are reviewing it again at the end of January 2009. Following the inspection, in a telephone call the manager said that the kitchen was out of action and being refurbished. She was advised to check the regulations and decide if the level of change and disruption warranted notification to the Commission. At the last inspection we noted that a plan was needed to increase the level of training in infection control. This was discussed with the manager at this inspection because she had said in the AQAA that plans for the next twelve months included infection control training. At this inspection visit we also viewed the summary of staff training completed and planned and this indicted that infection control training had not taken place and was planned in February for all staff. Subsequent to the inspection the manager confirmed that all staff would have completed infection control training from senior staff by the end of the following week and will have additional training by an external tutor in February. Care Homes for Adults (18-65 years) Page 23 of 30 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. Systems are now in place to provide the newly established staff team with support, supervision and training to fully meet individual needs of people living in the home but the management must make ensure that it is consistently provided. Employment procedures are good and enhance the protection of people living in the home. Evidence: We had comments from staff about training. In surveys all three staff said that they are being given training that is relevant to their role, helps them understand meeting the needs of people and keeping them up to date with the ways of working. At the inspection visit a staff member spoke of having induction training and managing challenging behaviour training. In the last inspection report we made a requirement that by 12/5/08 Evidence of induction and supervision must be fully recorded to demonstrate that staff are fully supported to learn about and reflect on their roles in meeting residents needs. In the AQAA the manager said that there had been problems in providing regular supervision but that there are plans to provide a minimum of 6 supervisions each year and an annual appraisal. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Information from surveys, talking with staff, viewing records and talking with the manager showed that staff feel that they can ask for support when they want help and that supervision was planned and provided for the majority of staff in December 2008 or followed up in January 2009. Further sessions are planned for January 2009 but an adequate frequency of formal supervision prior to that was not evidenced. We also discussed induction with staff, the manager and viewed records. We noted that one person said in their survey that the induction took over a year. All three staff answering the survey said that their induction did cover what they needed to know about the job well. Records sampled varied. For one person there was no clear evidence that the induction had been completed although the person had been included in supervisions in December and was starting National Vocational Qualifications level 2. For another person more recently recruited a more in depth induction checklist had been recorded and signed showing recent improvements. The requirement regarding supervision and induction was not met within the timescale and the manager cannot yet demonstrate that implementation is sustained. This will continue to be monitored. The manager referred to difficulties in recruitment of staff but that some had taken place. She said that the home does now hold the recruitment records we required the home to hold. In the last inspection report we made a requirement that Evidence of recruitment checks must be held in the home to demonstrate that residents are supported by staff who have been appropriately checked by 12/3/08. We sampled the records of people recruited since February last year when we last visited the home and found that the organisation keeps information centrally but that information is held at the home to show that checks are taking place. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work has taken place by management to increase consultation and planning of the service based on the needs of people living there but further work is needed to ensure that all aspects of health and safety are consistently monitored . Evidence: The manager has now completed her registration with the Commission and demonstrated during our visit that she is also updating herself in key training topics. A deputy has been recruited to work with her. The management team will be completed when a team leader and assistant manager commence work in February 2009.This has been part of the homes action plan in an attempt to improve the management of the home. The manager said that she has started work on Investors in People and is exploring with staff what they expect from management with a view to improving performance. In the last inspection report we noted that a quality assurance system was developing but further work was needed to demonstrate that it was fully effective. We made a requirement. We said A full quality audit system must be in place to ensure that Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: health and safety checks such as in house fire system checks are regular to minimise risks to people living in the home by 12/5/08.We noted at this inspection that recently this had improved but that some of the monitoring over that period had been inconsistent although not all the records were available for checking. We noted that a recording system is now in place. We have not repeated the requirement but will monitor this on future visits. We noted that there had been recent full audit of the homes environment (referred to in the environment section) and noted that following the homes own review of views of staff, relatives and people living in the home in August 2008 devised an action plan and has made progress in relation to some aspects of it including more supervision and recruiting management staff. The manager was advised to consider other areas where closer monitoring was needed to meet standards. We noted,when sampling aspects of health and safety, that the manager could demonstrate action taken following the visit of the health and safety officer. This included a review of the risk assessment regarding risks of violence to staff. We noted that two of the bedrooms in use had balconys which people could access. The risk assessments were not viewed but the manager confirmed that they were in place. In the last inspection report we required that training for staff in topics relating to health and safety such as infection control and fire safety must be consistently provided and recorded to ensure that residents needs are met. We discussed this with the manager and viewed records and noted that not all staff have received this training. Some have had general health and safety training but not infection control. The latter has been addressed in the environment section of this report. We also had confirmation that fire training was planned for February 2009. We therefore noted that the requirement had not been met within the timescale but that plans were in place to address these matters and we have not repeated it. This will be monitored further. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 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 35 18 The registered person must ensure that the work that has been started regarding supervision, training and induction, is completed for all staff and is kept under review. This is to ensure that all staff are fully equipped to meet the needs of people living in the home. 13/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 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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