Inspection on 18/03/09 for Reddown Road (37)

This inspection was carried out on 18th March 2009.

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

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

Other inspections for this house

Reddown Road (37) 15/04/08

Reddown Road (37) 02/07/07

Reddown Road (37) 23/06/06

Reddown Road (37) 25/10/05

Reddown Road (37) 28/06/05

Reddown Road (37) 02/11/04

Reddown Road (37) 15/04/04

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Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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: Reddown Road (37) 37 Reddown Road Coulsdon Surrey CR5 1AN     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: Lee Willis     Date: 1 8 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 35 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 35 Information about the care home Name of care home: Address: Reddown Road (37) 37 Reddown Road Coulsdon Surrey CR5 1AN 01737559309 F/P01737559309 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) : Milbury Care Services Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 37 Reddown Road is a residential care home that offers accommodation and personal support for up to eight generally middle aged men with complex learning disabilities, communication needs, and behaviours that may challenge. The service is owned and managed by Milbury Care Services, a subsidery of Voyage. Carmel Rees was appointed the services new acting manager in May 2008 and has now submitted her application to be registered, subject to a fit person interview with the CQC. The home is situated on a quiet residential street in Coulsdon, a suburb located a few miles to the south of Croydon. The home has its own transportation, is close to several bus stops on main line routes, and is also within ten minutes walk of a local train station with good links to central London, Croydon and the surrounding areas. A wide variety of local amenities and factilities, including shops, cafes, pubs, and banks are all Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home located in the nearby village of Coulsdon. This detached property is built over two floors and comprises of eight single occupancy bedrooms, an open plan L shaped main lounge dinning area, a very well equipped sensory room, kitchen, laundry room, ground floor office, and staff sleeping in room. There is a passenger lift to enable people with mobility needs access their first floor bedrooms. Sufficient numbers of toilets and bathing facilities are located throughout the home, including a Parker bath and several raised toilet seats. The rear garden is relatively well maintained and accessible. All the people who use the service and or their representatives have been supplied with information about what services and facilities are provided at 37 Reddown Road and how much they can expect to be charged for them. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The outcomes the people who live at 37, Reddown Road experience has significantly improved since the services last Key inspection. Consequently, we have increased its rating from a 1 to a 2 star good performing residential care home. From all the available evidence we gathered during this key inspection it was clear the service now has more strengths than areas for improvement. There are no longer any significant areas for improvement relating to poor medication handling practises and low staff morale identified in the services last inspection report. Nonetheless, although National Minimum Standards under key outcome groups are generally met, there remains scope for further improvement in a number of important areas of practise (See the summary section entitled - what the service could do better). We are nevertheless Care Homes for Adults (18-65 years) Page 6 of 35 confident the new manager will continue to recognise and rectify all the shortfalls that emerge. We spent 5 hours at the service. During the site visit we met all 5 of the people who currently live at 37, Reddown Road, the relatively new acting manager, and 4 support workers, 2 of whom we informally interviewed. We also looked at various records and documents including, the care and health action plans for two people who use the service. The remainder of the visit was spent during the premises. Finally, the new manager completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what has improved since the homes last inspection, and what the manager thinks they could do better. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 35 All the positive comments made above notwithstanding the new manager is the first to recognise there remains considerable room for further improvement: Firstly, the way in which the providers let the people who use the service and/or their representatives know about increases in the fees they can expect to be charged for facilities and services provided should be reviewed to make the process more transparent and responsive to change. This will enable all major stakeholders to determine whether or not the provider is giving them value for money. As recommended in the services last report arrangements for keeping the people who use the service informed about what activities and meals are available each day has still not been improved. The notice board in the lounge should be up dated a regular intervals to ensure the people who use the service have all the information they need to make decisions about what they do and eat each day. Although progress continues to be made regarding the number of activities the people who use the service can choose to participate whilst at home (e.g. access to a well equipped sensory room and furniture in the garden), the manager acknowledges individuals should have far greater opportunities to engage in more meaningful and stimulating community based activities, including day trips and annual holidays. Easy read pictorial versions of the new healthier menus should be developed to enable the people who use the service to make more informed decisions about what they eat at mealtimes. As recommended in the previous report the providers should repaint all the homes exterior window frames and sills, and supply the people who use the service with more seating in the garden. Staff should be provided with lockers to keep their belongings in whilst they are on duty. This will ensure the risk of staff losing their valuables is minimised. Despite the new manager ensuring the performance of each member of her team over the past year has been appraised the training matrix currently being used to assess gaps in peoples knowledge and skills is not being kept up to date. We strongly recommend this assessment is kept up to date to enable the manager to plan a staff training programme. To meet the needs and wishes of all the people who use the service more staff should receive specialist training in working with people with autism, communication difficulties, and the elderly. Finally, The way in which senior staff carry out supervisions and record the outcome of these sessions should be reviewed because at present they are not being held at frequent enough intervals (i.e. At least once every two months). This will ensure the people who use the service have their needs met by suitably trained and well supported care staff. If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 9 of 35 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the and their representatives have access to all the information they need to make an informed decision about whether or not the service is right for them and/or loved one/client. The impact any new referral would have on the people already living at the home is always taken into account when assessing the suitability of a prospective new admission. The providers arrangements for keeping the people who use the service and/or their representatives informed about fee increases should be reviewed to make the process far more open and transparent. Without this information major stakeholders are unable to determine whether or not they are getting value for money. Evidence: As recommended in the services last report the acting manager has up dated the Guide to reflect current provision. The Guide was also available in an easy read format. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: The manager told us the service had not received any new referrals since being appointment in May 2008 and has been very reluctant to accept any new admissions in this time because of all the staffing problems she inherited. Carmel demonstrated a good understanding of what constituted best practise regarding new admissions and was very clear that she would not accept any new referrals without first considering the impact this would have on the people already residing at Reddown Road. The manager acknowledged that the range of fees people who use the service and their representatives are expected to pay for facilities and services provided has increased in the past year, but the new costs are not reflected either in the services Guide or individual terms and conditions of occupancy. We recommend the providers review their arrangements for keeping major stakeholders informed about fee increases and make the process more transparent and responsive to changes. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are very person centred and reflect what is important to the individual, what their capabilities are, and what support they need to achieve their personal goals and aspirations. The service has satisfactory arrangements in place regarding the assessing, managing and reviewing of identified risks. This minimises the likelihood of people who use the service being harmed, whilst ensuring they retain their right to take responsible risks and live their lives as independently as reasonably practicable. Evidence: We looked at the care plans for two people who use the service. Both plans were very person centred and set out in detail their strengths, short and long terms goals, personal preferences, daily routines, and what support they each required to ensure all their personal, social, and health care needs were met. Both the plans viewed had been reviewed in the past six months and up dated accordingly to reflect any changes Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: in provision. Minutes of the last two care plan reviews revealed the people who use the service, their relatives, and professional representatives, had all been invited to attend these meetings. Both the care staff who completed our surveys told us they are usually given all the information they need to know about the people they support. Both plans viewed also contained a lot of detailed information about these individuals communication needs and preferred methods of communication. Since the service was last inspected the manager has introduced communication books and photographs to enable staff to communicate more effectively with the people who use the service and to ascertain their views. The manager told us the people who use the service do not have their own meetings because these large group forums are not ideal for enabling people with complex communication needs to express themselves. We agree that regular one to one sessions with designated keyworkers and sitting-in on staff meetings are more suitable forums for the people who use the service to participate in the running of their home. However, it disappointing to note during a tour of the premises that despite the good practise recommendation being made in the services last report the information board in the dining area was not being kept up to date to reflect what meals and activities were available that day, and who was on duty. A health care professional who returned our survey ticked the usually box in response to the question - Do care staff support individuals to live the life they choose? All the risk assessments included in the two care plans examined in depth were very individualised and covered every aspects of these services users personal, social and health care needs. It was positively noted that one risk assessment had been immediately reviewed following the occurrence of a significant incident involving this individual. Furthermore, all the risk assessments looked at had been reviewed in the past three months and up dated accordingly by keyworkers to reflect any changes in need or circumstances. The manager demonstrated a good understanding of her risk assessing responsibilities and was very clear that the people who use the service should not be denied the opportunity to take responsible risks in order to enable individuals to develop their independent living skills. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The opportunities the people who use the service to maintain and development their independent living skills and participate in the day to day running of their home has significantly improved since the last inspection. Furthermore, the number and variety of social, leisure and recreational activities the people who use the service have the opportunity to participate in has also improved in the past 12 months, although the service should be doing more to ensure individuals get out more and enjoy more meaningful activities in the local community, go on day trips and annual holidays. The dietary needs and preferences of the people who use the service are well catered ensuring they are offered daily variation and choice at mealtimes. The menus have also been recently improved following some professional input from a qualified dietitian ensuring the people who use the service are now offered far more nutritionally wellbalanced and healthier meal options. Care Homes for Adults (18-65 years) Page 16 of 35 Judgement: Evidence: We looked at activities schedules for two people who use the service contained their My life plans, which the manager has recently introduced. These activity schedules were person centred and reflected the social interests of the individuals concerned. During the visit staff were observed offering people who use the service the opportunity to go in the sensory room. Entries made in daily diaries in the past three months revealed people who use the service had more opportunities to participate in a wide variety of in-house activities and household chores including; reflexology, music, and cooking sessions. The manager told us activity schedules were very flexible and were used by staff as a rough guide to help them plan with the people who used the service what they might wish to do each day. However, the manager conceded that the service could do more to ensure the people who used the service participated in more community based activities. Staff who were informally interviewed during this site visit made similar points and told us none of the people who use the service had been on holiday in 2008 or many day trips. Daily diary notes looked at in depth indicated the people who used the service had not engaged in very many meaningful and/or fulfilling social activities outside their home in recent months. The manager told us this problem had been exasperated because the service only employed one driver, although this what about to change as the homes most recent recruit was qualified to drive the homes vehicle. We recommend people who use the service are provided with more opportunities to engage in appropriate community based leisure activities. Progress made by the service to achieve this aim will be assessed at its next inspection. Both staff spoken with at length told us the service is now much better at encouraging the people who live at Reddown Road to do more for themselves with appropriate staff support. Chores people who use the service regularly engage in include, cleaning their bedrooms, vacuuming the lounge, mopping the kitchen, bringing down dirty laundry, and helping staff to prepare meals. The relatively new manager is commended for placing more emphasis on the strengths and rights of the people who use the service to do more for themselves, although we do recommend this ethos is formally recognised in individuals care plans in the form of a structured programme for promoting independent living skills. The services visitors book, which staff ensured we signed on arrival in line with the providers visitors policy and best practise, indicated that the home continues to receive lots of guests including, the relatives and professional representatives of the people who use the service. The manager told us a new one week menu which staff actively encouraged the people Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: who use the service to create has now been approved by a qualified dietitian. The new healthier menu advertised a choice between two main meals at lunch and dinner, and was typically English in style, which reflected the cultural heritage of the people who use the service. The manager told us she was conscious the new menu was not available in an easy to read pictorial format, but was planning to rectify this after three more weekly rotating menus had been approved. Staff continue to maintain a record of the actual meals consumed by the people who use the service, which showed us people are now enjoying a healthier diet. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Staffs medication handling practises have significantly improved ensuring the people who use the service are kept safe from unnecessary harm or abuse. Evidence: All the people who use the service were suitably dressed in well-maintained clothes that were appropriate for the time of year. Written feedback from the people who use the service indicated they can do what they want during the day, evenings and weekends. Staff told us this includes being able to decide when you get up, go to bed, have a bath, and what clothes you wear. Manual handling and nutritional assessments had been carried out on the two people Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: whose care was being case tracked to enable staff to meet their mobility and dietary needs. Weight charts were also made available on request, which staff are carry out on a monthly basis. As required in the last report the manager has introduced new health care action plans, which set out in detail the outcomes of all the appointments the people who use the service had attended with various health care professionals. These records indicated advice and input is continually sought from various outside health care professionals including, GPs, dentists, dietitians and a speech and language. Written feedback from a health care professional who returned one of our surveys told us staff usually seek advice and act upon any given by health care professionals - adding although its sometimes difficult to understand the people who use the service because of their learning difficulties carers do seem aware if individuals are distressed or showing behaviour which is out of character. Two people who use the service were admitted to casualty in the past year. Both these incidents had been appropriately recorded by staff and the Commission notified about their occurrence without delay. The manager told us both the incidents were appropriately handled by staff on duty at the time. No serious injuries or side effects were sustained and risk assessments were reviewed to minimise the likelihood of similar incidents reoccurring in the future. Documentary evidence was produced on request to show that the half a dozen outstanding requirements and good practise recommendations made about the services poor medication handling practises at the last inspection have all been met in full in accordance with the improvement plan the service sent us. No recording errors were noted on any of the medication administration records (MAR) sheets used in the past 3 months and there was a clear audit trail of all the medicines received into the service on behalf of the people who lived there. As required in the last report the service has significantly improved its medication monitoring arrangements and the manager told us an independent pharmacist had inspected the service three times in the past year. Furthermore, senior managers representing Voyage always check medication stocks during their regulation 26 visits and the manager regularly carries out spot checks on her staff teams medication handling practises. All staff that are authorised to administer medication in the home have also refreshed their medication training and been reminded about their safe medication handling responsibilities. As recommended in the last report staff now maintain appropriate records that clearly states their rational for using as required (PRN) behavioural modification drugs. PRN Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: records also showed the use of this type of medication had been significantly reduced in the past year and was clearly being used only as a last resort in exceptional circumstances in line with individualised protocols for it use and best practise guidelines. Furthermore, staff are now expected to keep a separate record when Controlled Drugs (CD) are handled, which a second member of staff always counter signs. Finally, as recommended in the last report the service is no longer stock piling unwanted medication, which has made auditing them easier and minimised the risk of mistakes happening. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. The people who use the service are protected and kept safe by the safeguarding arrangements that are in place, which includes those relating to financial protection. Evidence: The manager told us she has received one formal complaint about Reddown Road since she has been in charge. A record of the complaint and the outcome of the internal investigation undertaken by the providers was made available on request. The services complaints book showed us the concern was taken seriously at the time and dealt with in a very prompt, transparent and professional manner. Trellising has been erected in the rear garden to minimise th risk of similar incidents reoccurring in the future. The manager told us the complainant was notified about the action the providers planned to take in response to the complaint as soon as their enquiry was completed. A health care professional who completed one of our satisfaction surveys ticked the usually box in response to the question - Does the service manage concerns raised well? The manager demonstrated a good understanding of what constituted abuse and who Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: should be notified immediately if abuse was witnessed or suspected. Records indicate that there have been no disclosures of abuse made within the service since it was last inspected or any staff refereed for possible inclusion on the Protection Of Vulnerable Adults register. As required in the previous report documentary evidence was produced on request that showed us sufficient numbers of the current staff team had recently attended an annual refresher course in the British Institute of Learning Disability (BILD) approved Non Violent Crisis Intervention (NVCI) training. The manager told us that none of her staff team had physically intervened to deal with an incident of aggression in the past year. Staff informally interviewed were both adamant that they would only ever use approved physically intervention techniques as a last resort when all other deescalation strategies had failed and they felt the people who used the service were in immanent danger. The manager told us all her current staff team had received safeguarding training that enabled them to recognise, prevent, and report abuse. Records and receipts of all the financial transactions that staff had taken on behalf of the people who use the service were made available on request. Balances recorded on financial records and bank books held in respect of two people who use the service matched the actually amounts of money individually stored in the homes safe. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior decoration of the home, including its fixtures, and fittings, are well maintained ensuring the people who use the service live in a very homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: Since the services last inspection there have been no changes made to the interior layout of the home, although there have been several improvements made to the decoration of the lounge, a number of bedrooms, and toilets. We confirmed during a tour of the premises that as stated in the services AQAA a number of the communal areas and bedrooms had been redecorated, and supplied with new curtains, flooring, soft furnishings, ornaments, pictures, and photographs. Staff spoken with told us the providers had also improved there arrangements for responding to routine maintenance issues and things tended to get repaired more quickly these days. Bedrooms viewed during a tour of the premises were in the main very personalised and decorated to a good standard, although a badly damaged chest of drawers was Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: noted in a ground floor bedroom. This will need to be repaired or replaced as a matter of urgency. A recommended in the services last report some wooden seating for the people who use the service to sit on has been purchased for the garden. However, this bench has become rather unstable and will need to be repaired or replaced. Now the weather is getting better we also recommend the service makes better use of the rear garden, especially the patio area, by purchasing some more garden furniture. The manager told us an action plan to repaint the homes exterior windows and sills had now been agreed as recommended in the last report, but was unsure when the work would be carried out. During a tour of the premises it was noted that all the communal areas and bedrooms were kept spotlessly clean. The laundry room is also well organised with freshly laundered clothes now kept in separately labelled boxes ready to be returned to their owners bedrooms. The cupboard in the laundry room where hazardous chemicals and substances are kept was securely locked at the time of this visit. The manager told us staff do not have their own lockers to store their belongings in whilst on duty. We recommend as a good security measure to minimise the risk of theft the providers should supply staff with their own lockers. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have safe and appropriate support as there are enough competent, qualified staff on duty at all times. Peoples needs are also met because staff get all the training they need to carry out their duties effectively, although there remains scope to improve the services staff supervision arrangements. Evidence: All three members of staff who were working the early shift on the day of this site visit were observed interacting with a number of the people who use the service in a very caring, respectful, and professional manner throughout the morning. A health care professional who completed our survey told us the staff always respected the privacy and dignity of the people who used the service, and seemed to understand their needs . The manager told us there were always at least three staff employed to work across the day which remained sufficient to meet the needs and wishes of the people currently residing at Reddown Road. Both of our satisfaction surveys returned to us by staff working at the home ticked the always box in response to the question - Are Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: there enough staff on duty to meet the needs of the people who use the service? The two support workers informally interviewed during the visit told us staff moral had significantly improved since the appointment of the new manager and they had begun to work as a team again. The manager confirmed that as she had stated in the AQAA the service had experienced very low levels of staff turnover in the past year and consequently she had not needed to recruit any new staff or rely on temporary agency staff who would not be so familiar with the needs and wishes of the people who used the service. The manager told us she was in the process of employing one new member of staff to fill the services one remaining vacancy. The manager demonstrated a good understanding of what constitute good recruitment practises and as recommended in the services last report told us she was always fully involved in the process and would not allow anyone to start without first supplying her with satisfactory pre-employment checks. The manager also told us she was looking into ways of enabling the people who used the service to participate in the selection of new staff. This standard will be assesed in greater depth at the services next inspection. 100 of our surveys returned to us by staff working at the home told us the training they received was relevant to their role, helped them meet the needs of the people who used the service, and kept them up to date with new ways of working. The manager confirmed that as recommended in the services last two reports the majority of her current staff team (i.e. well over 50 ) had either now achieved a National Vocational Qualification Level 2 or above in care or were enrolled on a suitable course. The manager stated in the AQAA that this had mainly been achieved because Voyage had appointed a manager and a number of assessors to oversee NVQ training. The new manager has also introduced a training matrix which sets out her staff teams strengths as well as gaps in their current knowledge and skills. Unfortunately, this tool was not particularly useful during this inspection because it had not been kept up to date. The manager confirmed that as stated in the AQAA most of her staff team were suitably trained to meet the needs of the people who used the service. Areas covered included, fire safety, first aid, basic food hygiene, health and safety, safeguarding adults, medication, and infection control. As required in the services last report documentary evidence was produced on request to show that sufficient numbers of staff had attended a promoting continence course. We recommend a number of staff receive specialist training to improve their understanding in relation to working with people with autism, communication needs, and who are elderly. The manager was able to produce documentary evidence to show us the each members of staffs individual performance since her appointment had been appraised as recommended in the services last inspection report. However, records of one to one Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: supervision meetings staff had attended with senior staff since May 2008 revealed they were not being held on a bi-monthly basis contrary to best practise and the providers own supervision policy. Staff spoken with also told us that although they felt suitably supported by the new manager who was particularly good at sharing good practise ideas with them, they had only received two supervision each in the past 10 months. This point notwithstanding it was positively noted that the relatively new manager had arranged for 7 staff meetings to be held since being appointed in May 2008. Minutes of the last two meetings revealed they had both been well attended by staff and had covered a wide variety of relevant topics, including safe medication handling practises, E-learning, team building and time keeping. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit from living in a home that is now being well run by an experienced and competent manager. The quality assurance systems that are in place ensures the views of the people who use the service and their representatives underpin all self-monitoring and future developments of the home. Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: Carmel Rees has been operational day-to-day control of 37 Reddown Road since May 2008. It was evident from the typical comments made by staff on duty at the time of this visit that the team like the leadership style of the relatively new manager. Typical comments from staff included, Carmels very approachable - you can talk to her about anything, the new manager has brought some stability to the home and staff now Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: work much better as a team, and Reddown is a much more pleasant place to work now, and i think the people who live here are much happier as a result. Furthermore, a health care professional wrote in one of our surveys they returned to us that the new manager seems to be very good at her job and also caring. Carmel told us she has submitted her application for the CQC to consider registering her as the services new manager, as recommended in the last report. Carmel is suitably qualified to run a residential care service for adults with learning disabilities having achieved her registered managers award. In the past 10 months Carmel has received training in the Governments Mental Capacity Act. It was also evident from comments made by a number of staff that the new manager is committed to ensuring her staff team take greater responsibility for running the home. For example, one member of staff have been designated in charge of fire safety, while another is responsible for carry out health and safety checks. The manager was able to produce evidence to show Voyage had carried out a comprehensive internal audit of the home in February 2009. The manager told us all the minor shortfalls identified in these reports have been acknowledged and action taken to resolve them. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis. During this visit staff carried out a prearranged fire drill. The fire alarm was audible throughout the home and staff responded promptly to the alarm being activated. One support worker spoken with about the services fire evacuation procedures was very clear where all the homes fire exits and fire assembly points where. Certificates of worthiness were made available on request to show that the service gas installations, portable electoral appliances, passenger lift, fire alarm system, and extinguishers - had all been tested by suitably qualified professionals in the last 12 months in line with recommended best practise. As recommended in the services last inspection report records showed us staff are now testing the temperature of hot water used in baths on a daily basis to ensure they remain close to a safe 43 degrees Celsius at all times. During a tour of the kitchen all the food kept in the fridge which had been taken out of its original packaging was being correctly stored in covered containers that were all labelled and dated in line with basic food hygiene standards. Care Homes for Adults (18-65 years) Page 30 of 35 Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 16 The damaged chest of drawers in a ground floor bedroom must be repaired or replaced. This will ensure the people who use the service have sufficient space to store away all their belongings. 01/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 5 The way in which the providers let the people who use the service and/or their representatives know about increases in the fees they can expect to be charged for facilities and services provided should be reviewed to make the process more transparent and responsive to change. This will enable all major stakeholders to determine whether or not the provider is giving them value for money. The way in which the home keeps the people who use the service informed about what activities and meals are available each day should be reviewed. The notice board should be up dated a regular intervals to ensure the people who use the service have all the information they need to make decisions about what they do and eat each day. This Page 33 of 35 2 7 Care Homes for Adults (18-65 years) recommendation was made at the services last Key inspection, but was not implemented. It is repeated in this report for the second and final time. 3 12 When all the services new healthier menus get approved by a dietitian easy read pictorial versions of them should be developed to enable the people who use the service to make infirmed choices about what they can eat at mealtimes. People using the service should be offered far more opportunities to engage in more meaningful and stimulating activities in the wider community and go on a week long holiday each year or the equivalent in day trips. This will ensure that the social interests and lifestyle expectations of the people who use the service are met. Staff should be supplied with lockers to keep their belongings in whilst they are on duty. This will ensure the risk of staff losing their valuables is minimised. The providers should repaint all the homes exterior window frames and sills within a reasonable time frame. This will improve the overall appearance of the property. This recommendation was made at the services last key inspection and was not fully implemented. People who use the service should be provided with more patio furniture to enable them to sit out and enjoy their garden. This recommendation was made at the service last key inspection and was not fully implemented. Specialist autism, communication, and working with older people training should be offered to sufficient numbers of staff who work at the service. This will ensure staff have the necessary knowledge and skills to effectively meet the unique needs and wishes of all the people who use the service. The matrix used by the service to assess the training strengths and needs of the staff team should be kept up to date. This will enable the manager to make plans to rectify any gaps identified in respect of her staff teams knowledge and skills. The way in which senior staff carry out supervisions and record the outcome of these sessions should be reviewed because at present they are not being held at frequent enough intervals (i.e. At least once every two months). This will ensure the people who use the service have their needs met by suitably trained and well supported care staff. 4 12 5 28 6 28 7 28 8 35 9 35 10 36 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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