Inspection on 04/03/09 for King Street (57)

This inspection was carried out on 4th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

King Street (57) 08/03/07

King Street (57) 09/02/06

King Street (57) 18/08/05

King Street (57) 13/01/05

King Street (57) 15/07/04

King Street (57) 18/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: King Street (57) 57 King Street Melksham Wiltshire BA14 9AE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: King Street (57) 57 King Street Melksham Wiltshire BA14 9AE 01225707669 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : bevtravers@msn.com ABLE (Action for a Better Life) care home 6 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 6 57 King Street is one of two care homes in Wiltshire that are run by the voluntary organisation Action for a Better Life (ABLE). Knightstone Housing Association owns the property. 57 King Street provides care and accommodation for up to six people affected by mental illness. The home is situated within walking distance of Melksham town centre. The accommodation is on three floors. Each person at the home has their own room and there are three communal rooms. One of these is a dining room, which is also used as the homes office. There is an enclosed garden and a parking area at the rear of the property. People who use the service receive support from the homes manager and a permanent staff team of support workers. The fee level is 672 pounds per week. Information about the service is available in a Statement of Purpose. Care Homes for Adults (18-65 years) Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Before visiting 57 King Street, we had asked ABLE to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how the home was performing. It also gave us information about what has happened during the last year, and about their plans for the future. We looked at all the information that we have received about the home since the last key inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 4th March 2009. During the visit we met with the people who live at 57 King Street and we had a look around the house. We met with Mrs B. Travers, the homes registered manager, and with members of the staff team. A number of the homes records were seen. Care Homes for Adults (18-65 years) Page 5 of 32 Prior to the visit we had sent surveys to the home so that these could be given to the people who live there, to staff members, and to healthcare professionals who have contact with the home. We received surveys back from four people who live at the home, from two staff members, and from four healthcare professionals. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. The previous inspection of 57 King Street was in March 2007. What the care home does well: During our visit we observed how people were going about their daily routines and spending their time. People could come and go as they wished, and appeared to be doing things they enjoyed at their own pace, and without external pressures. This was helping to create a settled atmosphere in the home. People are encouraged to take responsibilities in the home, and to help out within their capabilities. They are supported with finding appropriate occupation. People attend a range of activities, such as work placements, drop in centres, and local clubs. Because most people have lived at the home for many years, they are very familiar with the local facilities and have well established routines and contacts in the community. People have meals that they enjoy and the meal arrangements are flexible in order to meet their individual needs. Information is being well recorded about peoples care needs and interests. This helps to ensure that staff provide consistent support in the way that people prefer. The care plans showed that there is an individual approach to meeting peoples needs and responding to their different interests. Areas of risk are highlighted in the care plans, and assessments are undertaken, which helps to ensure that people are safe in the things that they do. There is a risk assessment process which looks at the benefits for the person of taking part in an activity of their choice, as well as at the possible hazards. This helps to ensure that peoples rights are protected. People discuss things together at regular house meetings. One person described these meetings as a time to talk about worries, get it off your chest. Minutes were being kept of the meetings, and individuals had raised a range of topics that they wanted to share with other people. It was reported in the AQAA that one of the homes strengths was its key worker system. This enabled people to establish a one to one professional relationship, which made them feel safe and secure in discussing their needs and preferences. We heard that people have the opportunity to spend some quality time with their key workers, for example by having a meal together once a month, usually outside the home. People receive support in ways which they prefer and which promote their independence. Staff are aware of peoples health care needs and provide assistance so that people can access the health services that they require. People have accommodation that meets their individual needs and provides a level of independence that they are happy with. There are systems in place which help to ensure that the home environment is safe for the people who live there and for the staff. Staff members undertake training and qualifications, so that people at the home benefit from competent staff. The home has a recruitment procedure which helps to ensure that people are not being supported by unsuitable staff. The home has a well qualified manager who is a good leader for the staff team. People who use the service benefit from a well run home and are given the opportunity to Care Homes for Adults (18-65 years) Page 7 of 32 express their views. What has improved since the last inspection? What they could do better: We thought that the system of care planning could be developed further by incorporating issues in relation to equality and diversity. This would help to ensure that peoples diverse needs are being fully identified and addressed. We have recommended that a cupboard that meets the current storage regulations for controlled drugs is installed. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. Information about peoples on-going health matters was being recorded in their daily diaries, alongside other non-health related matters. We thought that separate forms would make it easier to track the progress of particular care and health needs and to review the action that had been taken. Part of the dining room continues to be used as the office area and there are several notices and posters displayed. This area would benefit from some reorganisation, so that the dining room looks as homely as possible. People who used the service, and other stakeholders were being given an annual questionnaire, so that they could give their views about the home and aspects of the service that was provided. We talked to Mrs Travers about how the quality assurance system could be developed further, for example by taking into account the feedback that people gave at other times, and in less formal ways, which they may feel more comfortable with. This would help to ensure that peoples views are fully reflected in the homes annual development and improvement plans. Overall, we were given a lot of information in the AQAA about how the home is performing. However, some sections would have benefited from being more fully completed, to show the details of what the service has identified that it could do better, and the plans for improvement. Care Homes for Adults (18-65 years) Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. Evidence: We were told in the AQAA that the same people had been living together at 57 King Street for over 20 years, until one person moved out in February 2007. This meant that there was a vacancy at the home for the first time since people had initially moved in. Mrs Travers reported in the AQAA that the assessment process was therefore a new experience at King Street, but she had been involved with the assessment process at ABLEs other home. This had enabled her to develop her skills to undertake assessments. The homes procedure for new referrals and admissions had been reviewed and added to since we last inspected the home. We met the person who had moved into 57 King Street at the end of 2007. They told Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: us about the arrangements that had been made at the time and they felt that the move had gone well. They had been able to meet with other people during visits to the home, and had had meetings about whether this would be the right move for them. Mrs Travers told us that she also thought that the person had settled in very well. We discussed the pre-admission assessment process with Mrs Travers. Various meetings had been held to confirm the persons current needs and whether the home could meet these. Documentation had been produced, including a confidential Risk Screen, a Community Care Plan Review record, and minutes of the meetings held. The person who had moved in had a personal file in the home that contained a range of individual support and assessment records. Mrs Travers said that some of the records that had been completed at the time of the move were kept at ABLEs office, and that these would be copied to the homes file, so that all the relevant information would be in one place. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and interests are well reflected in their individual plans. This helps to ensure that they receive consistent support in the way that they prefer. People are assisted with making informed choices and their right to make decisions is respected. They can take risks as part of an independent lifestyle. Evidence: We met people who told us about their daily routines and life at the home. Some people said that they went out by themselves and other people were accompanied by staff. People said that they chose to attend some regular activities during the week, such as art therapy sessions and skittles matches. Other interests included astrology and astronomy, and collecting things. On the day of our visit, some people were having home based days. They made their own drinks and snacks one person had chosen to have a kettle in their own room, Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: which had been arranged in the style of a bed sitting room. People told us that they helped with household tasks by cleaning their own rooms. We heard that people discussed things together at regular house meetings. One person described this as a time to talk about worries, get it off your chest. Minutes were being kept of the meetings, and individuals had raised a range of topics that they wanted to share with other people. Each person had a care plan file that was regularly reviewed and updated. We selected three peoples files to look at in detail. Their plans covered a range of subjects, which were recorded separately on numbered forms. The files included a care plan index and review sheets, which meant that the contents were easily located and amendments to the plans were clearly shown. Some people had recorded their own comments on the review sheets. The care plans focussed on peoples strengths and interests, as well as their individual needs or problems. Some subjects were covered in each care plan others were more individual in nature. For example, one person had a plan for making meal times less stressful, and another person had a plan for making regular visits to one of their relatives, which was something they wanted to do. We talked to Mrs Travers about how the care plan could be developed further by focussing more on issues relating to equality and diversity, and showing how peoples diverse needs were being addressed. One section of the care plans included information about the intervention of staff and who was overall responsible. We asked staff in their surveys whether they were given up to date information for example in the care plan about the needs of the people they supported. The staff members responded Always to this question. Staff members, in the role of key worker, had individual meetings with the people they supported. Peoples individual plans were amended to reflect any changes in their needs or circumstances. Diaries were kept for recording each persons progress and daily events. Some topics in the care plans concerned peoples safety when following a particular interest or choice of activity. Risk assessments had been highlighted in red on the care plans, which helped to identify them as being important. The assessments covered a range of activities and tasks. For example, one person liked to bring electrical items into the home, and the risk associated with this had been assessed. The assessments also showed the benefits for the person, and how they could be disadvantaged if not Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: taking part in an activity of their choice. Other risk assessments had been undertaken in connection with people smoking and with hazards within the home. The care plans showed that staff encouraged people to be independent in their day to day routines. Some people received support with the safekeeping of their personal money and other people looked after their own. Records were kept of any transactions that involved money that was kept on peoples behalf. People had individual savings accounts and during our visit we were aware of one person who had been out and was dealing with their personal allowances independently. We asked people in their surveys if they made decisions about what they do each day. Four people confirmed that they always did. In response to another question, each person confirmed that they could do what they want to do during the day, in the evening and at the weekend. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights and individuality are respected, which helps to ensure that they can lead a lifestyle that suits them. People receive support which enables them to be part of the local community and helps them to maintain relationships. People enjoy their meals and the mealtimes are flexible to meet their individual needs. Evidence: Information about peoples activities and lifestyle choices was recorded in their care plan files. The plans included sections such as Independence, Getting up, and Social skills. Individual needs had also been identified in areas such as improving literacy and money management. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: During our visit we observed how people were going about their daily routines and occupying themselves. People could come and go as they wished, and appeared to be doing things at their own pace, without external pressures. This was helping to create a settled atmosphere in the home. We heard that people were being encouraged take part in activities, and about the efforts were being made to find appropriate occupation for individuals. During the week, people attended activities in the community such as drop in centres, swimming, and some local clubs. At the time of our arrival, two people were out at work placements, which they had been going to for a number of years. Some people had attended courses in subjects such as adult literacy, and gained certificates which they had then displayed. People were being consulted at the house meetings, and through the key worker system. We were told about changes that had been made within the home in response to peoples ideas. These related to such things as how the meals are presented, including the use of a menu board, and having new outdoor furniture, so that better use could be made of the homes garden. We were told that people continued to go out each month with their key workers, which included having a meal together. It was reported in the AQAA that the key worker system enabled people to have a good one to one professional relationship which made them feel safe and secure in discussing their needs and preferences. One person who chose not to go out very often had a take away in the home with their key worker, instead of the monthly meal out, which appeared to be a good alternative for this person. This persons care plan also included the need for them to have one to one time with staff with other activities. People told us that they liked being close to the town shops and facilities. Because people had lived at the home for so many years, they were very familiar with the local facilities and had well established routines in the community. Some people had made a lot of contacts in the locality. The care plans included a section on Family contacts. During our visit, some people spoke about their relationships and the visits that they made to friends and family members. People told us that they liked the meals, which they helped to choose. A list of possible meals had been produced, to help with the process of menu planning. This included a range of vegetarian and meat based dishes. Food was bought from local supermarkets. The home has also used an organic vegetable box scheme at particular times of the year. Care Homes for Adults (18-65 years) Page 17 of 32 Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in the way that they prefer. Their healthcare needs are being met. People are protected by the way in which their medication is being managed. Evidence: It was reported in the AQAA that people had needs relating to their mental health, but only one person required help with some of their physical care. This was reflected in peoples individual plans, which showed that a lot of support was provided by way of encouragement and advice, so that people could maintain their independence in as many areas as possible. Peoples care plans included sections on physical care and medication, as well as some more specific issues such as fluid intake and skin care. People were registered as patients at one of the local GP surgeries. There were well established arrangements by which people received support from outside health Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: professionals, including a consultant psychiatrist and a community psychiatric nurse. Mrs Travers said that there were no concerns about peoples health at the current time, although one person had a condition which was being followed up with their GP. We saw reports and letters on peoples files in connection with various health appointments. Other relevant information was recorded in peoples daily diaries, alongside non-health related matters. We talked to Mrs Travers about using specific forms for recording this information. We though that forms would make it easier to track the progress of particular care and health needs and to review the action that had been taken. We saw the minutes of staff meetings, which showed that peoples health and care were being discussed regularly, to ensure that people were receiving the support that they needed. We had surveys back from four health professionals. We asked in the surveys whether the service met individuals health care needs. Three people reported that it always did, and one person that it usually did. Each health professional who completed a survey confirmed that in their view peoples privacy and dignity were always respected. One person commented I feel that all the residents are encouraged to be as independent as they are able and also encouraged to be an individual. Each person had a file that included a photo and a medication profile. There was also guidance about the safe use of homely remedies. Peoples prescribed medication was received as part of a monitored dosage system, which meant that stock bottles did not need to be kept. The medication was kept securely in a lockable cabinet in one of the communal rooms, which was also being used as the homes office. We reported at the last inspection that this location meant that staff could possibly be distracted when dealing with medication. We made a recommendation that the use of this room as an office area is reviewed (see Environment section of this report). The storage arrangements did not meet the requirements for the storage of controlled drugs, although we were told in the AQAA that nobody was being prescribed any controlled drugs. Mrs Travers also said that nobody was being prescribed medication for administration on an as required or PRN basis. People received support from staff with managing their medication, although there were ways in which individuals were encouraged to take responsibility. This included people looking after some of their medication, and the arrangements for this were being recorded. One person had a notice in their room, as a reminder of when they should be asking for their medication at different times of day. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Records were being kept of the receipt, administration, and the disposal of medication. Record sheets were looked at. We saw that there had been one day during the last month when some peoples medication had not been signed for. Mrs Travers followed this up at the time. This appeared to be an isolated occurrence and overall, staff were consistently recording when medication was given, or not given, for any reason. Care Homes for Adults (18-65 years) Page 21 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and receive support that helps them to express their concerns. Staff members receive guidance and training that helps to protect people from harm. Evidence: We were told in the AQAA that all of ABLEs policies and procedures were reviewed regularly, and that an updated copy of the complaints procedure was sent out an annual basis with the quality assurance questionnaires. People who used the service confirmed in their surveys that they knew who to speak to if not happy with something and also how to make a complaint. Copies of the complaints procedure were displayed in the homes front hall and in the dining room, so that the information was easily accessible to people at the home and their visitors. It was reported in the AQAA that the home had not received any complaints during the last year. None have been made to the Commission during that time. We asked the health professionals in their surveys whether the service responded appropriately if they, or the person using the service had raised concerns about their care. Three health professionals responded Always, and one commented Never raised concerns. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The organisations polices and procedures included one on whistle blowing. The staff members who completed surveys confirmed that they knew what to do if somebody had concerns about the home. When we met with staff members during the visit they confirmed that they had received guidance about abuse and how to report any allegations of suspected abuse. Copies of the No Secrets booklet about reporting abuse were available to staff in the home. It was reported in the AQAA that there had been no safeguarding referrals or investigations during the last year. Staff members had received in house training about the prevention of abuse and the procedures for safeguarding adults. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have accommodation that meets their needs. They have benefited from a number of improvements that have been made to the environment. Evidence: 57 King Street has been converted from a large town house to provide residential care accommodation. Its location meant that the people at the home could walk to many of the amenities and shops that they liked to use. Each person had their own room. One person had separate accommodation on the ground floor, which included their own bathroom and a small hall area. This meant that they could experience what it would be like to live in their own flat, and to be more independent from other people. Somebody else who had accommodation on the second floor, said that they liked their attic style room. The communal space included two lounges and a separate dining room. These rooms were generally homely, with a co-ordinated approach to their decor and furnishing. The home had a domestic type kitchen and a separate laundry. There was an enclosed garden at the rear of the property. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We had made a requirement at the last inspection to ensure that the kitchen, shower room, bathroom and first floor toilet were in a good state of decoration. We saw that refurbishment work had been carried out, which had improved these areas and created a better environment for the people who used the service. There was an enclosed and sheltered garden at the rear of the property. New garden furniture and a permanent gazebo had been purchased since the last inspection. This had helped to create a good outside space for socialising and for relaxation. We reported at the last inspection that one part of the dining room was used as an office area. There were a lot of files, notices and posters, which detracted from the homely appearance. We recommended that the use of this room was reviewed to ensure that a homely environment is maintained as much as possible. During our visit, we saw that the arrangements within this room had not changed. We thought that the office area could be better organised, and we questioned the need for some of the notices that were displayed. For example, two copies of the homes complaints procedure had been put up in the room. In their surveys, each person who used the service told us that the home was always fresh and clean. There were no unpleasant odours at the time of the visits. One of the lounges was designated as a smoking area. An extractor fan and air purifier had been installed to improve the atmosphere in this room. There was a kitchen and a separate laundry area, which reduced the risk of crossinfection. Infection control was included in the staff training programme and guidelines about good practice were displayed in the home. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent staff and they are protected by the homes recruitment practices. Evidence: People at the home received support from a permanent staff team, in addition to the homes manager. Relief and agency carers were not being used. We were given information in the AQAA about the arrangements being made for staff training and supervision. Each team member, except somebody who had started during the last month, had completed a National Vocational Qualification (NVQ) level 2 in care. Team members were given the opportunity to undertake NVQ at level 3 after they had been with the organisation for three years. Mrs Travers said that two staff members wanted to do NVQ at level 3, but progress with this was dependant upon when she could provide them with support as their internal assessor. We saw a training plan that had been produced for 2009. This showed that training events were being arranged in a systematic way. A training event had been planned for each month, in conjunction with the other home that is run by ABLE. We had recommended at the last inspection that staff are given opportunities to increase their Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: knowledge through the availability of a wider range of training methods. Mrs Travers said that the aim was to use a mix of training types, including workbooks, distance learning and external courses. This was reflected in the new training plan. The plan covered a range of subjects, including health and safety, care planning, risk assessment, team building, communication, mental health, and conflict management. Training in Equality and Diversity was due to take place in July 2009. Mrs Travers had produced other records in relation to training, such as one to show when staff needed to attend refresher training Each staff member had a training file, which contained a chronological record of the training undertaken. We saw records of training that staff had received in first aid, and other subjects such as the mental capacity act, which related to the needs of the people who used the service. Mrs Travers said that all the staff members had attended a course in first aid. On the day we visited, the staff team was present in the home as they were being introduced to a new Certificate in Nutrition and Health course. This had been arranged in conjunction with a local training provider. We met members of the staff team afterwards and they spoke positively about the training and support that they received to do the job. The staff members who completed surveys also responded positively about the training and the support that they were being given. They also told us that their employer had carried out checks, such as references and a CRB (Criminal Records Bureau) disclosure before they had started work. One new member of staff had been appointed during the last year and we looked at their employment and recruitment records. An application form had been completed and there was evidence of a thorough recruitment process. References and proof of the applicants identity had been obtained. CRB and Protection of Vulnerable Adults (POVA) checks had been undertaken before the applicant had started work. The new staff member was undergoing a programme of induction. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run home, and their views are being taken into account. Peoples health and safety are promoted and protected. Evidence: Mrs Travers was well qualified to manage the home, having completed the Registered Managers Award and achieved NVQ Level 4 in Care. Mrs Travers had also gained the NVQ Assessor A1 award. Mrs Travers attended some training events with the staff team and had also undertaken training specific to her role. This had included courses in supervision, effective appraisal and leadership. Mrs Travers said that she was due to attend a course about the new deprivation of liberties legislation. ABLE had achieved the Investors in People award, which recognised the importance that the organisation attached to staff training and development. Training also Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: featured strongly in the AQAA, as being something that the home did well. We were told in the AQAA that there would be further developments in relation to training in the coming year. Overall, we were given a lot of information in the AQAA about how the home is performing. However, some sections would have benefited from being more fully completed, to show the details of what the service had identified that it could do better, and the plans for improvement. A representative of ABLE was visiting 57 King Street regularly and they produced a report on what they had found at each visit. People who used the service, and other stakeholders were being given an annual questionnaire, so that they could give their views about the home and aspects of the service that was provided. A report of the findings was produced and people were informed of the outcome. We talked to Mrs Travers about how the system of quality assurance could be developed further, for example by taking into account the feedback that people gave at other times, and in less formal ways. This would help to ensure that peoples views were fully reflected in the homes annual development and improvement plans. We were given information in the AQAA about the arrangements being made for health and safety and the servicing of equipment. The electrical circuits were recorded as having been checked in 1998, but when we visited Mrs Travers said that a further check had been carried out in February 2009, after the AQAA was completed. COSHH assessments were being undertaken. A health and safety file was being maintained in the home. Risk assessments were being recorded. These covered a range of hazards, including one for slips, trips and falls, which had been completed in the last year. There was a fire risk assessment. A system was in place for checking on potential hazards in the home and items in need of repair. These were recorded on a checklist to show what was in need of attention and when this was completed. There was also a monthly check of the property being undertaken and recorded. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 That the system of care planning is developed further by incorporating issues in relation to equality and diversity. This would help to ensure that peoples needs are being fully identified and addressed in relation to the six strands of diversity, which are gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. That information about peoples on going health matters is recorded on appropriate forms. This is so that it is easier to track the progress of particular care needs and health conditions and to review the action that has been taken. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. That the use of the dining room as an office area is reviewed to ensure that a homely environment is maintained as much as possible (recommendation first made at the previous inspection). 2 19 3 20 4 24 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - 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!