Inspection on 18/08/09 for Integrated Support Limited

This inspection was carried out on 18th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Integrated Support Limited Tanglewood Mews Wylam Road County Durham DH9 0EJ     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: Michaela Griffin     Date: 1 8 0 8 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: Integrated Support Limited Tanglewood Mews Wylam Road County Durham DH9 0EJ 07791690766 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): julie.heron@intergratedsupportcare.com Intergrated Support Limited Name of registered manager (if applicable) Mrs Andrea Beaumont Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 6 Date of last inspection Brief description of the care home Tanglewood Mews is a new purpose built home for younger adults, run by Integrated Support Limited. It has been built to the latest guidelines and requirements and offers a very high standard of accommodation and facilities. The home aims to provide person-centred support and care to individuals, based on their needs and wishes, and to promote their rights and independence. The organisation that runs this service respects the differences between people and hopes to provide an inclusive environment, where people feel welcome, whatever their backgrounds, circumstances or personal characteristics. Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 6 Brief description of the care home The home has six large bedrooms, all with their own en suite bathroom. It is close to Stanley town centre, but on the edge of a wooded area and park with views over open countryside. It is is set in its own grounds with other accommodation and services run by Integrated Support on the same site. There is ample free parking. People who use wheelchairs can move around the home easily, as it has level entry, a through floor lift and wide doorways and communal areas with circulation space. All the bathrooms and toilets are fully accessible. Care Homes for Adults (18-65 years) Page 5 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The provider supplied some information prior to the inspection on a form called an AQAA. This is an annual quality assurance assessment for the home to provide information about their service. The inspection took place on one day. It focused on key standard outcomes for people using the service. This was the first inspection of the home. It had been registered for less than six months and was just starting to admit people. There was only one person living in the home at the time of the inspection and one person staying there temporarily. The inspector visited the home and looked around it. She talked to the manager and four other staff and checked the paperwork. She met one of the people staying in the home and saw staff working with her. After the visit, the inspector spoke to three health and social care professionals about the home. Care Homes for Adults (18-65 years) Page 6 of 35 Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 9 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. People get the chance to visit and find out about the home before they decide to move in. The home intends to always make sure that it will be able to meet peoples needs before they are offered a service. Evidence: The home provides information about the services and lifestyle it offers. This is to help people to decide if they want to live there. Each person is given a service user guide with information about what to expect. But some of the words and terms used are quite complex and might be difficult for non-professionals to understand. The information should be written in simpler language and in shorter sentences. And it should be kept up to date, so that photographs of staff who have left are replaced to avoid confusion. The information is provided in a form that is intended to be easy to understand, with pictures and photographs . People can also look at this information on screen on the office computer, with the help of staff. The home plans to provide a computer for people who live there to use in its games room. This will mean that they can get more Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: up to date information in different forms, more easily. The home can also provide information in other languages, including Braille, for people who can not or prefer not to read written English. This is good because it means that people are being treated fairly and their rights to have equal access to information are recognised. It also lets people know that the home welcomes people with different communication needs and preferences and from different communities and backgrounds. The homes policies state that people who are considering moving into this home should have opportunities to find out about the service, by talking to the manager and staff and by meeting the other people who live there, before they are offered a place in the home. One person, who already lives in the home, visited and had overnight stays before she moved in for a trial period to help her decide if she wants to stay as a permanent resident. On the day of the inspection, another person came to look around the home with his care manager. He had the chance to look at the vacant rooms, to choose the one he wanted, and to talk to staff. There were only two people staying in the home at the time of the inspection and they been there for less than six weeks. But the manager and staff were getting to know them and understand how they prefer to receive their care and support. The file of one person, who was admitted through a planned process, contained records of an assessment carried out by the home and a lengthy period of introduction. A service manager had obtained as much information as he could about the individuals needs from health and social care professionals and then carried out his own assessment to make sure the service would be able to meet the persons needs. A professional said that the staff had managed the process of transition well: They were good on gradually introducing this person to the home. The homes referral and admission policy should state that professionals who refer people to the service must provide the home with a copy of the community care assessment or single assessment carried out by the funding authority. They should also be required to provide information about the legal status of the person and any treatment orders (under the laws that protect people with mental health problems) that have implications for the way that the home can care for them. This is to make sure that all information is shared about the persons needs and that any risks that may be involved in providing care for them are clearly identified, before they move in. This will be even more important when there are more people living in the home. The referring professionals should be required to provide copies of all assessment information and when they ask the home to take people in an emergency, before it Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: has had time to carry out its own assessment of needs and to confirm that it will be able to meet them. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans that explain what they need and want. The homes policies and guidelines for staff encourage to make choices and to lead full lives, with support to protect them from harm. The differences between people are respected. Evidence: One person was already living in the home at the time of the inspection. She has a person-centered support plan that is based on her assessed needs and the way she has said that she wants to live her life. The written guidance to staff tells them that the individuals preferences must be respected. A support worker said: Everything is focused on the people who live here. One area on the persons support plan was decision making. This gave staff guidance on how to help the person to understand and have a say in any decisions that may affect her. The home also provides people with information about local advocacy services. It has obtained an easy to read version of recent government policies for people who live in the home to read, so that they can find out about their rights and Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: how the government wants services to help people to exercise them. The care plans and other records the inspector also looked at included assessments of the risk for individuals, in leading full and independent lifestyles, and instructions for staff on how to minimise risks. These must be signed and dated. This is so that staff know that the actions required have been agreed by a suitable person, who accepts responsibility for the instructions given, and that anyone reading them knows that they are still current. 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 involved in the activities they enjoy and do the things they want to. The home is developing links with the local area, so that people can be part of their community. Evidence: The home opened earlier this year and people have only been using this service in the last two months. The manager and staff have been collecting information about what is going on in the local community and making links with other organisations, which provide activities and facilities that people who live in the home can participate in. The home has recruited some staff who already know the area but they are all trying to get to know it. One support worker said I am hoping to enable people to get out and about. I want to find community activities they will enjoy. The organisation that runs this home (Integrated Support Limited) is planning to set up a centre in the nearby area of Gibside, where people who want to can get involved in learning local crafts. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Each of the people who stays in the home will make a list of activities that they want to do and it is hoped that they will add to them as they become settled and start to try new things. The people currently staying there have made these lists with the help of staff. One persons list has a variety of things she likes to do inside and outside the home, from watching horror films and having her nails painted to going horse riding. Another person prefers to stay in most of the time and staff have respected her decision. Still, they have been able to persuade her to go out to get her hair done and to go on a trip in the car to Newcastle. This shows that she is developing her confidence in staff and that they are starting to find things that she likes to do that will encourage her to go out in the community. The guide provided for people who live in the home states that they are encouraged and supported to attend religious services or their choice and all beliefs are respected. But this statement is illustrated by the Christian symbol of the cross, which people from other religious traditions may not understand or may feel excludes them. The home should develop the information it provides so that it is as welcoming and inclusive as possible. It should make sure that the pictures and images for people who do not read written English match its statements and the values that it promotes. The homes policy is to encourage people to maintain their relationships with family and friends, but the two people who were in the home at the time of the inspection had not had any visitors. One had been keeping in touch with her partner by telephone. There are flats for people with disabilities on the same site as the home. The people who live in them get support from the homes staff and use the homes facilities. This has provided social contact for the very small numbers of people who have stayed in the residential home so far. But the managers should keep this arrangement under review to ensure that the people who live in the home are not detrimentally affected by it. The staff demonstrated in interview that they understand the importance of recognising the rights of individuals. It was clear they enjoy helping people to be independent and to live the lifestyles they choose. On the day of the inspection staff were observed engaging in conversations and activities with people who live in the home and treating them with respect and kindness. A support worker explained: We sit down with them every morning and say what would you like to do today? People who live in the home choose what they want to eat and when they want to eat. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: They can eat in the homes formal dining room, kitchen or their own rooms. There is also an outside area where they have already had one barbecue and invited their neighbours. People can make drinks and snacks and get involved in preparing food if they want to, with staff support. On the day of the inspection, one person who lives in the home was cooking the evening meal with a senior member of staff. People are given information about healthy food choices. Records are kept of what they eat and enjoy and their weight is monitored. 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 support in the way they prefer. The home is developing its procedures and practice to ensure that health care needs are met. Evidence: The home has policies, procedures and facilities that are intended to enable peoples health care needs to be met safely and with as much independence and dignity as possible. Peoples care plans have details of their health and social care needs, how much help they need from staff and how they prefer that help to be given. The home also has a key worker system. The intention is that each person will have one or two members of staff that they get to know well, who makes sure that their plans are reviewed regularly and that staff continue to give them support to achieve their own personal goals. At the time of the inspection there were only two people staying in the home and both had been carefully matched with a key worker, who had similar interests to them. A support worker said I am one persons key worker. We have things in common, we both like like knitting and singing the old songs together. Each person has their own room with an en suite bathroom. This means that any help Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: they need with personal hygiene and health care tasks can be provided in privacy and with respect for their dignity. The home employs both women and men, so people who need help with intimate care tasks can choose to have it provided by someone of the same gender as them. Staff have had some training on the ways that people are different and how peoples beliefs, cultural heritage and lifestyle choices must be respected in the delivery of care and support. The home has begun to establish links with health care services and the managers intend to work closely with health professionals to ensure that peoples needs are met in a coordinated way and that information is shared appropriately. Health care professionals said that the home seems very keen to work with people with people with complex needs and has a positive approach and attitude. The home has involved practitioners in training staff about health care issues. But some professionals are concerned that the staff lack experience in following their advice in practice and implementing the details of behaviour management plans. The home intends to work closely with health and social services, but at the time of the inspection there had been no joint meetings or reviews held at the home to discuss the needs of individuals staying there or longer term plans for them. There were not full contact details for the health and social care practitioners on individual files and care plans and one professionals comments suggested that the homes systems for recording and sharing information were not yet established. The homes policies and procedures include guidelines on how to enable people to manage their own medication safely. But at the time of the inspection, the people staying in the home were not looking after their own medication. Care Homes for Adults (18-65 years) Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to protect people from abuse and neglect and to enable them to make a complaint about the service. Evidence: The home has a clear complaints policy and procedure. It explains how complaints can be made and how they will be dealt with. It tells people who will investigate their complaints, how long the process will take and how they can appeal if they are not satisfied with the outcome. But these guidelines must be updated with current contact details for the Care Quality Commission. The home is very new and has not received any complaints yet, so these procedures have not yet been followed and they have not been tested. The organisation that runs this home has policies and procedures that give staff clear directions on how to respond to an allegation or suspicion that an adult has been or could be harmed through abuse or neglect. Staff have had training to enable them to recognise the signs and symptoms of abuse and neglect and to follow the organisations procedures. But they have not yet had the opportunity to put this training into practice. The organisations own safeguarding (adult protection) procedures are displayed on a noticeboard in the homes office, with the contact number for Social Care Direct. That is the local authority service that deals with allegations or alerts about safeguarding (adult protection)issues. This means that staff can quickly check what they must do if they are concerned that abuse or neglect have Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: taken place. And they know how to contact the appropriate agency quickly to report their concerns. Care Homes for Adults (18-65 years) Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe and comfortable and promotes the privacy, dignity and independence of the people who live there. Evidence: The home has been designed and built to provide high quality residential care and accommodation. It is very modern and equipped with the latest equipment and facilities to keep people safe and support their independence. The home is on two floors with a through-floor lift. People who use wheelchairs, or who have mobility problems, can move about freely and easily. It is airy and attractive, with a homely feel. A professional commented: It has a warm and friendly atmosphere. The home is within walking distance of the centre of the small town of Stanley, in an apparently tranquil location next to wooded areas. It is in a high position and approached by a fairly steep road and so benefits from views over open countryside. But people who have mobility or health problems may have to use motorised transport to visit. There is ample free parking on site and the home is fairly close to major roads and bus routes. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: The bedrooms are large enough to have single or double beds, depending on what the individual wants. They are intended to be occupied by one person only but could accommodate a couple who chose to live together, as long as a second room was available for their exclusive use. This is good because mixed or same sex couples may want to move in to residential care together and some people may form relationships when they are living in the home. Each bedroom has its own spacious en suite bathroom. The rooms are attractively furnished and decorated, but people are encouraged to personalise them to suit themselves. People are moving in gradually, so they have choice between vacant rooms, but all the bedrooms offer a very high standard of accommodation and are all large and comfortable. People can enjoy the peace and privacy of their own rooms whenever they want to and can see visitors in them if they prefer. The home also has plenty of communal space, where people can spend time with others if they choose. There is a shared lounge and dining room on the ground floor and an upstairs games and recreation room. There is an accessible toilet suitable for people who use wheelchairs, including visitors, on the ground floor. The home is set in pleasant landscaped gardens and has an enclosed outside seating and dining area. This is the only place that people are allowed to smoke and is not sheltered. This arrangement should also be monitored to ensure that people who choose to smoke are not subject to risk or unreasonable discomfort in bad weather and that in good weather non-smokers can enjoy sitting outside, without being bothered by other peoples smoke. People admitted to the home for respite or temporary care in an emergency should live in a separate area to the people who regard it as their permanent home. They do not currently and this is not ideal, but is because the home is not yet fully occupied. And the person who is currently the only long term occupant may have benefited from the companionship and stimulation temporary guests have offered. The provider plans to develop separate accommodation to offer short breaks and emergency care, on the same site. There are appropriate systems in place to keep the home clean and safe, including a separate laundry. Care Homes for Adults (18-65 years) Page 23 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 protected by the homes policies for recruiting and training staff. Staff are encourage to respect people and to treat them fairly. Evidence: Records showed that the home is careful to carry out checks on new staff to make sure that they have nothing in their backgrounds that mean they are unsuitable to work in a care setting. The recruitment process includes police checks and references from previous employers. The organisation has policies and procedures in place to ensure that it can recruit a workforce of people of different ages, from different communities, with different experiences, beliefs and lifestyles, including women and men and people who are gay or straight. This is good because it will encourage people who could make good carers to apply for jobs, whatever their culture, heritage or individual characteristics. It also lets people who may be considering using the service know that it provides an inclusive and supportive environment, where differences are recognised and respected. Staff have had training about how to promote Equality and Diversity in the workplace and this benefits people who use and work in the service. The home should continue to monitor the effectiveness of its policies and practices to ensure that they they are achieving its aims and attracting and retaining staff from all communities and who are Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: representative of our diverse population. Most of the homes current staff currently have been employed since last November. This meant that they had a long period of training to prepare them for working with people with complex needs. People commented on the high quality of the training provided and the organisations very positive attitude to encouraging staff to acquire skills and knowledge. One support worker said: They do provide very good training, its very professional. A professional said: Their training is excellent. This is good because it shows that the home wants to develop the potential of their staff, and not just to ensure that they have the basic training required to care for people and keep them safe. This will benefit people who use the service and help keep staff motivated to contribute to the work of the home and to keep improving the quality of the service. The staff who work in this home also support the small number of people who live as tenants in the adjoining flats. The intention is that the group will eventually be split into two teams, each dedicated to one of these services, but able to provide back up and cover for each other in emergencies. This will benefit people because it will maintain some consistency in the way that support is provided to individuals. It has not been possible to split the staff team up to now because of the small numbers staying in the care home. The people who have used these two services during this early stage have benefited from high staff ratios and more individual attention than they may have had if the home had been full. But new staff have not yet had the opportunity to work in a variety of situations and to support a variety of people. Some of the staff were already qualified and experienced when they joined this organisation. But some of the inexperienced staff had not yet had many opportunities to learn how to put their training into practice by shadowing more experienced staff. All the staff who have been in post for six months or more have, or are working towards, a National Vocational Qualification in Care at level two or above. This is the recommended and nationally recognised qualification for people who work in care services. All the staff interviewed were very enthusiastic about the work and keen to promote the rights and the independence of the people they support. Some had significant experience of working in care settings. Others had brought relevant skills and knowledge from their work in other fields. They were all looking forward to being involved in developing the service and improving the lives and opportunities of the people who use it. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: Staff must have training on mental health legislation and the implications for how they support and protect people must be communicated to them clearly. Care Homes for Adults (18-65 years) Page 26 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. The company that runs the home and its management team seem committed to developing a high quality service. There are policies and systems in place to ensure that the home is well-run for the benefit of the people who live there. Evidence: The company that runs this new home, Integrated Support Limited, appears to have a strong value base and to be keen to establish its reputation as a provider of a range of services for people with complex needs in the area. The registered manager has suitable qualifications and experience of managing services for people with learning disabilities and mental health problems. However, the organisational and management arrangements for the home were not fully established at the time of the inspection. Some of its policies and procedures had yet to be implemented and their effectiveness tested in practice. The home was first registered in March 2009, but people only began to use the service in July and August. There are ways in which the outcomes for people who live in the home will be better when it is operating as a separate service focused on their needs. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: Half the staff team and the manager have been employed since November 2008. After a period of introductory training, they supported people in both the care home and through a domiciliary care agency run by Integrated Support Limited. The domiciliary care agency provides home care to tenants living in flats on the same site. The providers intention is that these two services will eventually be managed separately, with separate staff teams. A second manager has recently been appointed who will be the registered manager for the domiciliary care agency. But on the day of the inspection the staff interviewed were still supporting people in both services and not clear where they would be working in future. The manager did not have internet access on site and was therefore using the domiciliary care agencys office in the centre of Stanley to send and receive email. There was only one telephone in the homes office for all purposes and no separate line for the use of people who use the service. Because the homes office is closer to the supported flats than the domiciliary care agencys office, staff were using the homes office facilities for the service to the tenants. People have also been admitted to the home for short breaks and for care in emergency situations and this should be provided in a separate unit, and not in what is supposed to be the long term residents home. The home has set up a quality assurance system based on periodic service reviews. It is currently focused on health and safety and environmental issues and involves weekly checks by the staff team. The results of these checks are recorded and presented in graph form. As the home develops, it should include the views of people who use the service and their representatives. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 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 9 14 Assessments of risk and instructions for staff on action they must take to minimise risks must be signed and dated. This is so that staff reading them know that the actions required have been agreed by a suitably qualified and authorised person and that they know that they are still current. The home should ensure that current contact details for the health care professionals who are responsible for individuals are kept on their files. This is so that staff know how to contact and consult the appropriate practitioners in a timely way. 03/12/2009 2 19 13 29/01/2010 3 19 13 The home must put systems 29/01/2010 in place to ensure that information is shared quickly Page 30 of 35 Care Homes for Adults (18-65 years) 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 and appropriately with responsible health and social care practitioners and to demonstrate that staff are implementing care plans as advised by professionals. This is so that peoples needs are addressed in a holisitic and consistent way and that any problems in the delivery of care or in following advice given by professionals are quickly identified and communicated appropriately. 4 22 22 The homes complaints 04/01/2010 procedures must be updated with current contact details for the Care Quality Commission. This is so that people know how to contact the Care Quality Commission if they have serious concerns about a regulatory issue or if they are not satisfied with the process or outcome of a complaint that has been taken through the homes own complaints and appeals procedures. 5 35 18 Staff must have training on 09/01/2010 mental health legislation and the implications for how they support and protect Care Homes for Adults (18-65 years) Page 31 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 people must be communicated to them clearly. They must have opportunities to understand the relevance of their training to the way that they work with people. This is to enable staff to understand the homes responsibilities for keeping people safe and to understand the implications of mental health law for their practice. 6 39 24 The home must develop its systems for assuring the quality of its services in a way that includes the views of people who use the service and their representatives. Any plans must record consultation with people who use the service and their representatives. This is so that people can be confident that their views underpin all self-monitoring and review by the home and influence changes and developments. 01/09/2010 Care Homes for Adults (18-65 years) Page 32 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 2 1 2 The home should ensure that the information it provides is in clear, simple language and kept up to date. The homes referral and admission policy should state that professionals who refer people to the service must provide the home with a copy of the community care assessment or single assessment carried out by the funding authority. This is to make sure that all information is shared about the persons needs and any risks that may be involved in providing care for them are clearly identified before they move in, including when they are admitted in an emergency. The home should ensure that the people who live in the home are not detrimentally affected by people living in the flats next door sharing the use of their facilities. If this continues there should be demonstrable benefits for the people who use the service. The home should provide documents and information that are as welcoming and inclusive as possible. It should make sure that the pictures and images for people who do not read written English match its aims and the values that it promotes. Short breaks and care in emergency situations should be provided in separate accommodation and not in what is supposed to be the long term occupants home. This arrangements for people to smoke outside should also be monitored to ensure that people who choose to smoke are not subject to risk or unreasonable discomfort in bad weather and that in good weather non-smokers can enjoy sitting outside, without being bothered by other peoples smoke. The home should ensure that new staff have the opportunity to demonstrate that they can put their induction training into practice, by working with and under the supervision of experienced and qualified staff, before they are left to work unsupervised in the home or to support people individually in the community. The home should continue to monitor the effectiveness of its employment policies and practices to ensure that they they are achieving its aims and attracting and retaining staff from all communities and who are representative of our diverse population. Page 33 of 35 3 13 4 13 5 24 6 28 7 32 8 35 Care Homes for Adults (18-65 years) 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 9 35 As the home becomes fully occupied, the organisation should develop a training programme based on the assessed needs of people who live there and provide them with opportunities to contribute to the planning and delivery of training. The management and staffing arrangements for the home should be established, so it is clear who is responsible for the development and running of the service and staff are clearly focused on the homes stated purpose and the people who live there. The effectiveness and continued appropriateness of the homes policies and procedures should be regularly reviewed as the service develops. 10 37 11 40 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). 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. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!