Inspection on 07/08/08 for New Horizons

This inspection was carried out on 7th August 2008.

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

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

Other inspections for this house

New Horizons 24/09/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 New Horizons 83 Upper St Helens Road Hedge End Hampshire SO30 0LS Lead Inspector Christine Walsh Unannounced Inspection 7 August 2008 10:00 th New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Horizons Address 83 Upper St Helens Road Hedge End Hampshire SO30 0LS 01489 795385 01489 797144 newhorizons@ilg.co.uk winchesterroad@ilg.co.uk Iliace Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Paul Smithson Care Home 3 Category(ies) of Learning disability (0) registration, with number of places New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 3. Date of last inspection 24th September 2007 Brief Description of the Service: New Horizons is registered to provide care, support and accommodation for up to three younger adults with a learning disability. The service is one of a number belonging to the Independent Living Group. The accommodation is in a residential area within walking distance of local shops and public transport. It is a detached house with three single bedrooms, and has communal areas of lounge/dining room kitchen and enclosed rear garden. Current fees range from £2,050 to £2,950 per week. These fees do not include: Leisure activities such as going to the cinema. Hairdressers Chiropody Personal requisites such as toiletries and magazines. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector, the registered manager assisted with the inspection visit. The Annual Quality Assurance Assessment (AQAA) document was completed and returned to the Commission for Social Care Inspection on time. It informed us that the service supports the service users using a person centred approach respecting their race, culture, faith and sexual orientation. The AQAA also tells us that the appointment of a mixed race staff team and the diversity training they receive supports them to have a better understanding of service users diverse needs. The information obtained to inform this report was based on viewing the records of the people who use the service, of which two service user’ records were looked at and of staff who work for the service. The day-to-day management of the home was observed, and discussions with service users and staff took place. In addition “Have Your Say” comment cards were received. The people who use this service are known as service users and referred to as such throughout the body of the report. What the service does well: New Horizons does well to ensure it provides prospective service users and their representatives with information about the home, it assesses if it can meet their needs and supports them to become familiar with their new surroundings and others living in the home by supporting regular visits prior to moving in. The home does well to support service users using a person centred approach, respecting their wishes and everyday decisions. It encourages them to develop and maintain their independence, integrate into their local community and maintain contact with family and friends. The staff do well to ensure the physical and psychological needs of service users are being met, providing them with support to access health care professionals such as GP’s, dentists, psychologists, community nurses and take their medication. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 6 The home listens to service users’ needs, wishes and concerns and acts promptly to deal with any concerns or complaints they or their representatives may have. Staff are trained to protect service users and to inform someone immediately if they are concerned that they are at risk of harm. New Horizons offers a homely, safe and welcoming environment. It is spacious, tastefully decorated and furnished. Individual bedrooms are personalised and decorated to service users choice and liking. The manager and his staff are skilled and competent to meet service users needs, they go through a thorough interview and induction process and receive mandatory training such as moving and handling and fire safety. They also receive training specific to service users needs such as communication, Autism, abuse awareness, and managing challenging behaviour. What has improved since the last inspection? What they could do better: The AQAA tells us that the home recognises where they could do better and how they plan in the next twelve months to make the improvements, such as supporting service users to increase their self help skills and independence, and how they plan to continue to develop staffs understanding of service users rights. The home supports service users with their medication and they recognise that this is an area of improvement. The AQAA states that it would like to support service users to work towards self-medicating in the future. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 7 Whilst viewing medication procedures such as storage and records, it was found that there was gaps on the record where the staff member administering the medication must sign to indicate that the medication has been given. This could potentially place service users at risk of receiving medications they have already had and cause potential side effects. It was also noted that topical lotions such as creams and medicated toothpaste were stored in the same place as tablets. The Royal Pharmaceutical Guidelines provides guidance on what can be stored safely together and the manager has been advised to seek this guidance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the people who use the service with a Service User Guide that has been developed in an accessible format. The Service User Guide tells them about the home and the services it provides. The home ensures the people who express a wish to move into the home have their needs assessed to ensure the home can meet their needs. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) told us that the home does well to carries out a detailed assessment with the service user. All service users needs are taken into account during the transition period and remains ongoing, such as needs and compatibility issues. This is done to ensure correct placement and a smooth admission. This was tested by viewing the homes Service User Guide, assessment documents for two service users and discussion with the registered manager. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 10 The service users’ guide has been adapted to suit the communication and cognitive needs of the service users currently living in the home, and is displayed on the service users notice board for them to read when they wish. A service user told us that they were aware of the service user guide and where it was if they wanted to use it. The service user guide includes how the service users can complain or raise a concern, this includes how to contact the Commission for Social Care Inspection. The manager was informed that the contact details need to change to reflect the Commissions change of address. The assessments seen are in three parts and include general description of the service users care needs and resources required to meet those needs. It identifies behavioural support needs and how these may impact on individual service users lives. Within the general description it informs the reader what support is required with areas, such as personal care, communication, relationships and social activities. The Independent Living Group (ILG) has a designated placement team who supports the manager with the assessment process. The placement team are responsible for identifying vacancies throughout ILG services, identifying suitable placements, carrying out the initial assessments and identifying the actual support required. The manager stated that once the initial assessment has taken place he will meet with the prospective service user to establish if the home can meet their needs. The process of admission then takes place and includes the prospective service user visiting the home, meeting with other service users and staff and familiarising themselves with the environment over a period of time that is suitable for them. Arrangements are made to support the service user to move in once the home has agreed they can support the perspective service user and the service user has agreed to move into the home. The manager said: “It is very important to ensure the existing service users are also involved in the transition process and are enabled to have a say about who moves into the home”. This tells us that the home considers how service users will get on with one another. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures personal plans are in place that reflects people’s individual needs and tell the staff how the people who use the service wish to be supported. By using a person centred approach the home ensures the people who use the service are supported to make informed decisions about how they wish to live their lives. The home ensures the identified individual risks to the people who use the service are minimised and staff are aware of what they need to do to protect their health, welfare and safety. EVIDENCE: The AQAA told us that the home does well to have a system of care planning that caters for the service users needs and which are evaluated on a biNew Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 12 monthly basis. They include the ways in which the service user wishes to be supported. The home has a keyworker system in place and the keyworker will meet with the service users once a month to evaluate their personal plan and support them to make decisions about their lives. The AQAA also told us that the service has improved behaviour management guidelines, risk assessments and are more and more involving the services users to make decisions about what is going on in their home. This was tested by observing day to day practices, viewing the personal plans of two service users, which included care plans and risk assessments and speaking with two service users, staff and the manager. The personal plans told us that the service provides a person centred approach to the care and support needs of individual service users. It tells us who the important people are in their lives, gives an insight to their personality, their likes and dislikes and how they need to be supported in areas of their daily lives. Care plans are written in way that promote service users dignity, privacy, choice and independence. A note on all care plans advises the staff of the importance of reading and following the care plans. Staff have to sign to indicate they have read the care plans. There is evidence that service users are involved in the planning and reviewing of their support plans and the manager said service users have access to their plans if they wish. A service user confirmed that they had been involved in the development of their personal plan and agreeing areas where formal arrangements are required to support them with their personal challenges. Staff said they found the personal plans to be informative and tell them what they need to know when supporting service users with their daily lives. It was noted that the personal plans are held within a large file, which also holds old and out of date information. It was discussed how the volume of information could prove difficult for service users and staff to access. The manager agreed that he would review the files and archive old information. Throughout the course of the inspection visit it was observed that staff support service users to make decisions about what they wish to do. This was done using various communication aids dependent on how service users communicate and understand. It was witnessed that service users are provided with choices and asked what they would like to do. Personal plans tell the reader what areas service users are confident in making choices and decisions and areas where they may need support or prompting. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 13 The home has various communication tools to assist with the decision making process such as a picture menu and Makaton (an adapted form of the British Sign Language). A member of staff wrote in a comment card that the home does well to provide a caring environment and promotes and respects the service users independence and choices. Each service user is assessed on aspects of their care and support that could prove to be a risk to their health, welfare and safety. These include areas of personal care and environmental risks such as bathing, accessing the kitchen and the community. The risk assessments tell the reader what the risk is and what action is needed to minimise it. The home has detailed behavioural support plans that tell the reader what they must do to recognise and minimise thins that might prevent escalation of behaviours that challenge and the risk of harm to the service user and others. Staff spoken with at the time of the visit confirmed that as part of their induction they are made aware of service users personal plans, risk assessments and behavioural support plans. They are asked to read these and shadow staff who know the service users. They also confirmed that when changes are made they are informed of these. An agency member of staff who was new to the home was observed reading the required information to help them support the service users. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The home ensures the people who use the service have their rights respected, are provided with opportunities to make decisions and develop individual living skills. The home ensures the people who use the service are provided with support and guidance to plan and prepare healthy meals. EVIDENCE: New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 15 The AQAA told us that the home does well to provide all their service users with varied activities with maximum input from the service user. Individual activities include accessing the community, socialising with friends and the local community and regular contact with family and friends. The service recognises the importance of regularly reviewing activities and adapting the activities to meet the service users needs. The home realises this is an area for improvement. The AQAA told us that the service does well to maximise independence and support service users to contribute to planning the weekly menus. This was tested by viewing personal plans, daily activities, menu plans, observing practice, and speaking with service users, staff and the manager. Each service user’s personal plan has an activity record that identifies the activities they enjoy and a record of activities they have been involved in each day. The plans include attending college, bowling, swimming, going to the pub and trampolining. Service users are encouraged to attend these and access the community. This was observed on the day of the visit when several trips to the shops were made and a service user said they had enjoyed their trip out to a seaside resort on the outskirts of the New Forest. The service has a designated team of carers known as “ACE”, they are responsible for organising and supporting service users to access alternative activities throughout the summer period whilst college, and other activities are not available. The AQAA told us that the home has plans for the next twelve months to continue to encourage service users to access varied activities of their choice, using designated times and support from staff to do this. Service users are supported to maintain contact with family and friends, this was evidenced in records held in their personal plan. The information tells the reader about relationships that are important to service users and the contact they have with those people. Daily notes record if contact has been made with family and friends, which includes visiting the family home for the weekend or speaking with a family member on the phone. Through observation the staff and the manager showed us they treat service users with respect and uphold their dignity, privacy and individual choices. Information in personal files inform the reader, the name by which services users wish to be to known by, and what behaviours and non-verbal clues are telling staff about how they are feeling. A member of staff was aware of their roles and responsibilities in respect of providing an individual approach and valuing service users for who they are. This shows us that they have an awareness of the importance of treating and respecting service users individual rights and beliefs. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 16 Service users have access to their own bedrooms when they wish and have access to all communal areas of the home. For service users who require supervision for their safety, staff provide support to access areas such as the kitchen, garden and the community. Mealtimes are led by service users and their wishes. This includes service users taking responsibility to plan, shop for and prepare meals. A member of staff said that they support service users to make healthy options, offering advice when planning the menu to ensure they are considering foods such as fruit and veg. The menu appeared balanced and provided healthy options. A service user said they enjoyed their food. Weight charts in personal plans provide information that service users weights are monitored and advice is sought from a health care professional if needed. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to ensure the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they require and prefer. EVIDENCE: The AQAA told us that the home does well to ensure service users personal and health care needs are set out in their care plans, all service users are registered with a GP and they are supported with their medication. It goes onto to tell us that service users are given as much freedom and choice as possible, such as what time of the day they would like to do their personal care and if they would prefer a bath or a shower. This was tested by viewing personal plans and medication records, speaking with service users, staff and the manager. The personal plans provide detail on how service users wish to spend their day including what time they like to get up, go to bed and when to have a bath. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 18 The plans provide detail on how to support service users with their personal grooming. This was observed on the day when verbal support and encouragement was given to a service user, who was asked to consider their appearance and change before accessing the community. A member of staff said they were aware of service users individual support needs as the staff are encouraged to read the plans, be involved as a keyworker to support service users with their everyday needs and be involved in reviewing their personal plans. There was evidence of regular reviews taking place and service users being involved. Plans demonstrate that there are clear structures in place, which have been developed to support service users to undertake everyday activities with limited stress and anxiety. The AQAA tells us that the service is aware of the importance of promoting independence and provided evidence of areas of where this has taken place. This included supporting a service user to wash their own hair and scrub their own back, this has been done by obtaining specific tools, such as a back scrub. The manager stated that the home has good links with primary care and specialist health care teams. Service users personal plans provide evidence that their health care needs are regularly monitored and reviewed. The plans also provide information on specific health care needs, what action is required and how staff must support service users’ with these health care needs. On the day of the visit, arrangements had been made for a service user to visit their GP. The service user confirmed that they had seen the GP, this was followed up by a visit to the pharmacist to get a prescription. The home has systems in place for the administration of medication. The home uses a monitored dosage system (MDS) supplied by a recognised high street pharmacy. Medications are received, stored, recorded and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. It was noted that the medication cupboard was clean and tidy, however the manager is advised to seek advice on the arrangement for storing creams and tablets together. Service users have been risked assessed as not able to administer their own medication although the home can show that it promotes their independence in this area. Service users are supported to collect their prescriptions and medications from their GP and local pharmacy. The AQAA tells us how they have improved in this area in the last twelve months, such as supporting a service user to initiate discussion with their GP on what medications they are taking. Each service user has a list of medications prescribed, which includes regular and “as required” medication. “As required” medications are supported by care New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 19 plans that detail when the medication needs to be administered, such as when a service user is feeling overly anxious. All staff are responsible for the administration of medications. The manager confirmed that they have all received training which was delivered by an outside agency and which covered such areas as storage, procedures for administration and side effects. Some signature gaps were found in medication administration records, so it was not clear if the service user had received their medication a perscribed. The manager stated that action would be taken to address the concerns with the member of staff concerned and ensure they receive further medication training. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures it listens to and acts upon the concerns raised by the people who use the service. The home ensures the people who use the service are safeguarded from potential risk of harm. EVIDENCE: The AQAA told us the home has a complaints procedure that is available to service users and staff, any complaint received is dealt with in line with the services policies and procedures. All staff have received training in adult protection and copies of the local authority’s and services policies and procedures are available in the home. The AQAA went on to tell us that the manager holds regular meetings and supervisions with staff, this is to promote good practice and to discuss potential problems/concerns with service users. This was tested by viewing the homes current complaints policy, the complaints log book and service user behaviour support plans, speaking with service users, staff and the manager. The complaints procedure details how service users can make a complaint and what action must be taken to resolve it. There is an accessible format for service users who have limited communication. The AQAA tells us that the New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 21 home has received four complaints in the last year that have been resolved with in the guidance time of twenty-eight days. The complaints log provided evidence of the nature of the complaint and what action was taken by the home to resolve it. The manager stated that the home encourages open dialogue with service users and relatives. The home holds meetings with service users and will spend time with relatives sharing relevant information. A service user said that they know how to make a complaint. The service user said they would speak with their keyworker or the manager. A member of staff was clear about the procedure in responding to complaints. The staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. A member of staff spoken with at the time of visit confirmed that they had received training and was aware of their roles and responsibilities in maintaining service users health and wellbeing and reporting incidents of concern. Some service users present with behaviours that challenge. There are detailed intervention plans in place and the home monitors the wellbeing of service users on a regular basis. The home has support of specialist health care teams who are skilled in managing challenging behaviours. The manager is aware of the importance of ensuring there are adequate staff on duty when service users are presenting with challenges. Recent increased staffing levels have minimised the risk of service user conflict. The manager must ensure that the risks associated with staff working alone have been assessed and what actions can be taken to minimise these. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service live in a welcoming, comfortable and clean environment that meets their physical and social needs. The home ensures the people who use the service are protected from the risk of infection by ensuring its staff receive infection control training. EVIDENCE: The AQAA told us that the Independent Living Group have a maintenance department that is responsible for keeping the home in a good state of repair. Service users are involved in choosing how they wish their room to be decorated and furnished. The AQAA goes on to tell us the areas of improvement since the last visit to the service and that all staff have received training in infection control. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 23 This was tested by touring the home, seeking the permission of a service user to view their bedroom, speaking with service users to obtain feedback on the homes facilities and viewing staff training records. New Horizons is a domestic style dormer bungalow with bedrooms and bathing facilities on both levels. Communal areas are spacious and are decorated and furnished in keeping with service users wishes and needs. Warm subtle colours on the walls, and quality furniture and soft furnishings are in place. The manager stated that arrangements are in place to redecorate and purchase new furniture for these areas. The kitchen is domestic in size and fully equipped to allow service users to participate in the daily preparation and cooking of meals. The home has a reasonable size garden with a patio area and houses a large trampoline. The manager said they are currently waiting for new garden furniture so service users can relax in the garden if they wish. The home has access to regular support from the companies maintenance department, at the time of the visit two maintence workers visited the home to undertake minor repairs. They described their roles and responsibilities and response times to repairs. The service users who were spoken with said they liked their home. Service users bedrooms were comfortable, clean and furnished with quality furniture and furnishings. The bedrooms are personalised to reflect service users personality and individuality. The home was clean and follows recognised practices in maintaining a clean hygienic environment and staff have received training in infection control. Staff are provided with protective disposable gloves to use when required, such as assisting with personal hygiene. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service are supported by competent, skilled and appropriately recruited staff in such numbers that meet their individual needs. EVIDENCE: The AQAA told us that they have a strong staff team who interact well with the service users. Each service user has a keyworker and they are made aware of what staff will be on duty by the use of a staff picture board. The AQAA goes onto to tell us that all training is undertaken by the services’ training department and service users are involved in the interview process. Staff receive regular supervision. This was tested by viewing staffing levels and observing practice on the day, viewing staff recruitment and training records, speaking with staff, service users and the manager. The home was busy at the time of the inspection visit as service users were undertaking various activities with staff support. This included supporting New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 25 service users to visit a place of interest, supporting a service user to attend their GP and pharmacist. The staff appeared organised and confident. The manager stated that they have recently had to increase staffing levels to provide one – one support throughout the day. They have called on agency staff to cover shifts, as they currently do not have enough staff to provide the required support. The manager said service users know the agency staff as the home requests the agencies to provide regular staff for the purpose of consistency and continuity of care. It was observed that service users were comfortable and relaxed in the presence of the agency staff. A service user said: “The staff are nice” Service users are involved in the recruitment of staff, this was observed on the day of the visit. The manager was holding interviews and a service user was invited to join in and assisted to show the applicant around the home after the interview. Staff are encouraged by the Independent Living group (ILG) to undertake a national vocational qualification (NVQ) and will support them to undertake NVQ levels 2 and 3. Currently the home has 86 of its staff trained or working towards a NVQ. Recruitment files were viewed and found to hold all appropriate documents required when employing staff to work with vulnerable people. Evidence of an application form, two references, criminal record bureau (CRB) disclosure and protection of vulnerable adult (POVA) check were in place for each member of staff. A member of staff confirmed that they had completed an application, attended an interview, provided identification and names of referee’s. Staff undergo an induction into the home where they are supported by a named member of staff to become familiar with the needs of service users, the ethos of the home and the way in which the home works day to day. Following the last visit to the service in September 2007 it was issued with two immediate requirements to ensure all staff receive up to date training in fire safety, strategies for crisis prevention and intervention (SCIP) and training in all other key areas of health, safety and adult protection. The Commission for Social Care Inspection received written acknowledgement of the home receiving the immediate requirements and it told us what action they would take to address the concerns. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 26 Records provided evidence that staff received the required training by the time specified in the immediate requirement and continue to receive training required by law (mandatory training), such as moving and handling, first aid, fire safety and food hygiene. In addition staff receive training specific to the needs of the residents such as communication, managing challenging behaviour, autism and medication. A member of staff said in response to the question what does the service do well: “It ensures all staff have the correct training to do their job well”. Records provided evidence that the manager is meeting with staff on a one to one basis to provide support and identify areas of training they may need. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent manager manages the home with a skilled staff team who ensure the home is safe and run in the best interest of the people who live there. EVIDENCE: The AQAA told us that the home does well to have a manager in place who is currently undertaking the Registered Managers Award (RMA). The home is visited monthly and the area manager assesses if there are any actions needed to improve the service. Service user and staff meetings take place and there are regular checks on fire systems and appliances such as gas and electric to ensure they are working correctly. The manager recognises there is areas for improvement such as auditing medications and food safety, he plans to start doing this in the next six months. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 28 This was tested by speaking with the manager, the area manager, viewing Regulation 26 reports, staff training records, touring and viewing fire service records and speaking with service users and staff. The manager demonstrated through the course of the day that he has a good understanding of the needs of service users and of his roles and responsibilities in ensuring their needs are appropriately met. The manager was observed interacting positively with service users and, giving clear guidance and direction in a relaxed manner. The manager is working towards his registered manager award and regularly updates his skills and knowledge by attending mandatory and related training courses. A member of staff said about the manager: “The manager here at New Horizons does a brilliant job, not only in the office but also has time for all service users as well as staff if problems arise” The manager stated that company (ILG) has recently employed a quality compliance director who will be responsible for annual reviews of the service and quality assurance, such as regulation 26 visits. (Regulation 26 visits are carried out monthly by a person not in day to day control of the home, they seek consent to speak with service users and persons working in the home to gauge their views of the home, tour the home, sample records and compile a report that must then be held in the home). Two reports were seen and provided evidence that the person carrying out the visit has looked at records, spoken with service users and staff and looked around the environment. Service users are supported with the management of their money, and their care plans detail the level of support required. The home has good systems for managing and monitoring service users spending, and supports them to develop their personal skills in managing their own money. There are safe systems in place for fire safety. Following the immediate requirement left after the last visit to the home where staff had not received fire training, it can now be evidenced that staff receive regular training. Regular checks are made on fire safety equipment. On the day of the visit the home was due its weekly check on the fire alarm systems and automatic door closures. A service user was observed to be helping staff with this process and informed the manager that a fault had been detected and that the manager would need to report it. In addition to fire training the manager undertakes random weekly fire evacuations. Substances that may be hazardous to health are securely locked away and there are notices discreetly displayed around the home. This is to remind staff to test and record hot water temperatures and follow good hygiene practices. Records seen provided evidence that all utilities such as gas and electrical New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 29 systems and small electrical appliances are regularly checked to ensure they are in good working order. New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The home must ensure all staff trained to administer medications to the people who use the service follows the correct procedures. This must be undertaken as stipulated in the Royal Pharmaceutical Guidelines, which includes ensuring an accurate record of what medications have been given. Timescale for action 07/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI New Horizons DS0000069600.V369487.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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