Inspection on 09/10/09 for Reeves Court

This inspection was carried out on 9th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Reeves Court 30/10/07

Reeves Court 16/01/07

Reeves Court 30/11/05

Reeves Court 11/07/05

Reeves Court 28/09/04

Reeves Court 29/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Reeves Court Reigate Road Leatherhead Surrey KT22 8NR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 0 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Reeves Court Reigate Road Leatherhead Surrey KT22 8NR 01372389446 01372389416 v.seewoolall@seeability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SeeAbility Name of registered manager (if applicable) Mr Vishul Seewoolall Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 25. The registered person may provide the following category 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 category: Learning disability - (LD). Date of last inspection Brief description of the care home Reeves Court is registered to provide residential care for up to twenty five people who have a learning disability and specialises in supporting people who have a visual impairment. The home is owned and managed by SeeAbility, a registered charity who work with adults who have a visual impairment and additional disabilities. The premises were purpose built in the early 1980s and is presented across two floors with access provided to the first floor via a shaft lift or stairs. The home is split into three units called Flats 1,2 and 4. Each flat has its own lounges and dining area. There Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 25 Brief description of the care home are small patio areas surrounding the home. All bedrooms are for single occupancy. The home is located near local amenities, with the home also having access to its own transport. The home is located in the Seeability complex in leatherhead, which also provides a large day care services and supported living units. The whole complex is currently under massive redevelopment with the building of three houses on the site, which residents over the next few months will be relocated to. The original premises will then be redeveloped to provide private housing. The homes literature states that it aims to offer a service that encourages individuals with a visual impairment and additional complex needs to participate in all aspects of daily living. The manager reports that the fees for residential care are currently from £89000 per year, depending on the services and facilities provided. Extra such as newspapers, hairdressing, chiropody, holidays, toiletries are additional costs. The providers website is: www.seeability.org Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager had comprehensively completed an Annual Quality Assurance Assessment form (AQAA) and the information contained in this document has been used to inform the inspection process. The inspection was facilitated in by Mr Vishul Seewodall (Registered Manager). The focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown around the communal areas on each unit and invited to look at several residents bedrooms. The homes documentation was also looked at and residents observed in their daily routines and in their interactions with staff. Part of the lunch time meal and the afternoon events and activities were observed. Four residents, seven staff and three relatives were consulted as part of the inspection process. Care Homes for Adults (18-65 years) Page 6 of 32 Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Seven were returned in total, four from residents, two from health care professionals and one from a relative. Their feedback is included in this report. There were twenty four residents living at the home at the time of the inspection. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? No statutory requirements were made at the previous inspection. Care Homes for Adults (18-65 years) Page 8 of 32 The manager has continued with the maintenance and upkeep of the building which has seen improvements made to fire safety standards and the redecoration of several bedrooms and communal areas. Management focus has been on enabling and developing the skills of deputy managers on each unit to be responsible and accountable for each unit in light of the pending move to separate housing. The recent introduction of innovative annual reviews held with placement authorities ensures that the residents needs are being highlighted and reviewed in a person centred way. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is range of information about the home available to prospective and existing residents, however this does need to be more reflective of the wide services and facilities provided and in a more accessible format to help inform residents what to expect and of their terms and conditions when living at the home. Although there is a good assessment procedure for establishing the needs of new residents, it was not always evident that this was being followed to ensure that the home identified that they could safely meet a prospective residents needs. Prospective residents and their representative can visit the service as often as they would like prior to making any decisions to move to the home. Most residents have complex needs which the home is able to largely meet in an individualised way. Evidence: The homes statement of purpose, which is a book that tells people who the home is Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home. These are made available at the home and reported to be given to prospective residents, representatives and other interested parties and are available in an audio format. A relative fedback that although they did not receive any written information about the service during the assessment process they could ask any questions they wanted. It was noted that further minor works are needed to these documents to more fully reflect the wide range of services and facilities actually being offered, the terms and conditions of residency and be in a format which is more accessible to the residents for whom the service is intended (for example through the use of symbols and pictures). The manager agreed to ensure that the information was reviewed promptly. The homes admission procedure is that prospective residents are assessed by a manager or deputy with information about their needs gathered from a variety of sources including the resident, their representative and health care professionals, this included an assessment by the placement authority. However the homes assessments could not always be located during the inspection. The organisations rehabilitation staff also undertake an initial assessment, but again this could not always be located. Therefore it was not always clear what assessment had been undertaken in order to form the decision that a prospective residents needs could be met. A relative confirmed that their relative was provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit depended upon the preferences of their relative and involved day and overnight stays, with staff from their previous home also involved. The first six weeks of residency is looked upon as trial occupancy. Permanent residency is usually subject to a review of care needs with the residents their representatives and the placement authority. Residents are assessed as having medium to high level of assessed needs including having a visual impairment. Some residents assessed as also having mental health needs and behaviour which can be challenging. Several residents are further assessed to need one to one support throughout periods of the day. The age range of residents is from twenty-three to seventy years old. A resident said how nice it was to feel safe by living at the home. A sample of relatives comments about their experiences included I am pleased my relative has good care she looks like she enjoys her life under their care and they do care, looked after really well I feel much happier that Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: she is there. A health care professional fedback always show deep concern for the needs of residents and look out for and monitor progress. Always professional and caring with some quite challenging residents. Observation and discussion with residents, staff and relatives indicate that residents receive individual care with most of their needs being met, however these good care practices and the level and type of support being provided must be identified in the care planning process to ensure that resident needs can be met in a consistent way. This is discussed under standard six of this report. It was reported that each resident or their representative has a singed copy of the terms and conditions of residency with the home, however these could not be accessed at the time of inspection. Blank copies of these are included in the information in residents bedrooms for reference. The manager spoke of the plan to tailor each terms and conditions to the individual to help aid their understanding of their roles and responsibilities while residing at the home. Care Homes for Adults (18-65 years) Page 13 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangement for planning care and support was variable, with some good person centred practices evident while other support plans did not include the range of residents needs or the guidance for staff on how to support residents in a consistent way. The home tries to balance the rights of residents against any unacceptable risk to themselves or others, however not all risks faced and posed by residents had been assessed in order to guide staff in managing or reducing the risks. Services are designed to provide appropriate care and support in ways, which encourages participation and choice for the residents. Evidence: Each resident has a plan of support in places, which are designed to enable personal, health, communication, social, cultural and religious needs of each person to be identified and addressed. Support plans from each unit were looked at which showed Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: varying standards. Some plans provided clear and up to date assessments on the needs of residents and staff with the guidance they needed to ensure that they could meet residents needs in a consistent way. However, other support plans were large, bulky documents which made it hard for staff to navigate and retrieve essential information and which did not always reflect the needs of residents observed by the inspector or the support being provided by staff. The manager reported that new care planning documentation is in the process of being implemented to promote a more person centred approach to care planning. Residents who are receiving rehabilitation input have a rehabilitation programme, however these could not always be located and therefore were not easily accessible for staff. One rehabilitation plan seen as part of an annual review documentation was detailed and provided for a range of rehabilitation support to be undertaken by health care professionals. It was not always clear when support plans had been reviewed as this was not always noted to ensure that any changes in residents needs and preferences were being identified promptly. Annual placement reviews are held with the placement authorities, resident and their families. One was being held at the time of the inspection which was very innovative in its approach with much good practice evident in a person centred approach being undertaken to ensure that the residents needs remained at the centre of the review. This is to be commended. The home tries to balance the rights of residents to take reasonable risk as part of an independent lifestyle against the risks faced and posed by themselves or others. This is usually supported through the written assessment of risks. However, where residents rights are restricted for example to move around the home freely this must be based on an assessment of the risk in order to demonstrate why a kitchen is locked, the use of pressure alarm mats which indicate when a resident is moving around their bedroom and why pureed meals are provided to some residents. Furthermore some risk assessments were not accessible to staff as they had been removed for reviewing. There were no risk assessment in place to support residents with a visual impairments moving around the building safely. The manager agreed to undertake this as a matter of priority. Respecting residents rights to make decisions about their lives is integral to the day to day ethos of the home with various communication systems and methods used to engage residents in discussions and deciding what they wanted to eat, drink and what activities they wanted to do. The manager had identified the need for further staff training around new legislation (Mental Capacity Act) which relates to residents rights Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: to make decisions in their lives. They had also identified the need to include more details in support plans regarding residents capacity to make decisions. Much consultation has been undertaken with residents, their representatives and placement authorities regarding the relocation of residents to the various units to ensure that each residents needs and preferences are taken into account. Some residents have been appointed independent advocates to assist in residents decisions about their future. A range of ways was seen of how well residents are involved in the running of the home with regular meetings and consultations. The manager said that residents are involved in a Quality Action Group which is run and managed by residents and has influence over what the organisation does and the ethos of care they adopt. Staff demonstrated an awareness of good practice about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Care Homes for Adults (18-65 years) Page 16 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to develop their social, emotional, communication and independent living skills through involvement with the organisations rehabilitation staff. Residents have opportunities to take part in meaningful, age appropriate and enjoyable activities which help to enrich their lives. Residents benefit by being supported to maintain relationships with their families and friends. Mealtimes and arrangements for eating are determined by residents and provide choice and variety. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Many opportunities are available for residents to continue to use practical life skills and to also develop new ones. The organisation employs a rehabilitation team who work with some residents to enhance their independence and support. They also provide some training for staff in rehabilitation support . A relative fedback that the home tries hard to create new experiences and to try new things with their relative which has started to make a difference to their confidence and level of independence. A video showing the mobility improvements of a resident was used as part of their review, this showed clearly their personal development since living at the home. The majority of residents access the organisations activity and resource centre during the day, which is located in the same site as the home. Here there is an opportunity for residents to take part in a structured programme of activities and events. Residents spoke of undertaking craft courses, hydrotherapy sessions, cooking and exercise activities. Staff spoke of residents also using local colleges as well as courses run by colleges being offered through the resource centre. Staff were knowledgable about the local resources, and records showed that use is made of the many local amenities in the area, including shops, pubs, theatre, cinema and cafes. Residents spoke of undertaking holidays which they particularly enjoyed with some residents going abroad. The organisation operates a (Just 4 You Fund) which is designed to support any resident with added finance where there are any financial constraints. This is to ensure that all residents have access to the same life enhancing opportunities. A relative spoke of their enjoyment of attending a recent birthday celebration held at the home. It was evident that residents are supported and encouraged to maintain family and friend links, through visits to their family, having family visit them and through telephone contact. Relatives commented upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. Relatives spoke of attending events held for families at the home, the last one being a summer barbeque. On the day of the inspection, it was observed that the routines of daily living of each unit were reflective of the individual residents needs living on that unit. A resident confirmed that they are free to choose what time they wanted to go to bed and get up but on certain days when committed to attend certain activities they were encouraged to get up at certain times. Each unit has there own arrangements for shopping, menu planning and cooking meals. One units residents decided to have their main meal at lunch times while Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: another unit choose to have theres during the evening. Some units have a housekeeper to assist with shopping and cleaning while another unit does these tasks themselves. Menus seen were varied and included some takeaway meals, which were very popular with residents. One example was noted whereby there was no documentation to support why a residents meal was to be pureed. Part of the lunch time meal was observed. Staff consulted had a good understanding of residents needs and preferences. Staff were observed providing sensitive assistance. In addition to the main meals, residents confirmed that snacks and drinks are available at various times throughout the day. All residents consulted indicated that they liked the food available. Care Homes for Adults (18-65 years) Page 19 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the provision of flexible and respectful personal and healthcare support that is individual, respects their privacy and dignity and encourages residents to remain as independent as possible. The medication systems are well managed promoting good health and residents safety. Evidence: During the inspection staff were observed to support and care for residents in a sensitive manner whilst offering choice and encouraging independence. In general good attention was given to the personal appearance of residents, which was age appropriate. A relative said they take time to make sure people feel looked after, she had beads on which matches her nail varnish, it is little touches like that which make her so contented. Staff spoke of how they record which staff are on duty and what events are occurring that day onto a tape recorder for one resident to help orientate them. Staff consulted with showed a good understanding of good practices in preserving Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: residents rights to privacy and dignity. Staff were able to give many examples of how they promote these rights in their every day care practices. Personal care information was displayed in a bedroom within view of the door way and entrance to another bedroom. This practice was not conducive to preserving their privacy and needs to be reviewed. It was reported that it was displayed at the insistence of the family. Residents are supported to access a range of health care services, to meet their individual needs and their health action plans. There was evidence of involvement with Gps, specialist nurses, dentists, psychologist, physiotherapists, opticians, speech and language therapist. It was clear that where there are concerns regarding the health or welfare of residents prompt medical advice or intervention is sought. A relative spoke of the persistence of staff to sort out a recurring medical complaint. A health care professional fedback the home is a pleasure to work with I always feel relaxed and part of the team. It was reported that none of the residents accommodated are assessed to administer their own medication. The medicine administration practices observed was seen to be safe and the records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Good practices were noted in the management of As prescribed Medication which provided staff with guidance on when they should be administered. Care Homes for Adults (18-65 years) Page 21 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An effective complaints procedure and appropriate adult protection policies and practices helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. Although it is recognised by staff that some residents would require support to make a complaint and were knowledgeable on how they would support a resident to do this. It was reported that no formal complaints have been received or recorded by the home. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with confirmed that they have received formal training in safeguarding adults and prevention of abuse and showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. Where referrals have been made through safeguarding procedures the manager and organisation have acted promptly to report and appropriately followed the safeguarding guidelines. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in small units with each unit having its own distinct feel and environment which enabled the majority of residents to live in a homely environment with adaptations to promote the independence of people who have a visual impairment. Residents bedrooms are individualised and equipped to provide comfort and to meet their individual assessed needs Evidence: The premises were purpose build and although the building is due to be demolished in 2010, a programme of redecoration repair and maintenance continues. This has involved improvements to fire safety doors and some en suite bathrooms and the redecoration of some bedrooms and communal areas by volunteers. A relative said environment could be better, but there is no point in investing much money in it at the moment in light of what is going to happen to it. Major building works are underway around the site, with much effort made to promote the safety of residents, staff and visitors walking around the site. Although each unit is roughly designed the same they have an individual and very distinct feel to them with two of the units furnished to create a very homely Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: environment. One unit also has a cat. Communal space is very spacious with each unit having its own lounge(s), dinning room(s)and kitchens. There are small patio and grassed areas surrounding the home which have some seats. Although residents and staff spoke about using these spaces regularly they were not particularly inviting or sensory enhancing. The use of continence bed sheets on some lounge furniture did not promote residents dignity. The manager agreed to review this practice immediately. Residents bedrooms are highly individualised reflecting their tastes, lifestyles and any specialist needs. The home provides a good range of individual aids and adaptations to assist in maintaining residents independence. This includes height adjustable beds, walking and sitting aids and aids specifically to support residents with a visually impairment (. talking microwave, liquid level indicators, talking scales and alumious orientation markings). The manager spoke of the support they recieved from the organsations rehabilitation team in identifing any areas for further adaptation or additional aids. Some of the units had textile orientiation prompts along corridoors and communal areas. Some residents have pressure mats in their bedrooms which alert staff to movement during the night. As noted earlier this must be determiend by an assessment of risk and guidance for staff on its use to ensure residents rights are protected. Consistent feedback was received that standards of hygiene and cleanliness are good which was also confirmed during the inspection. Systems are in place for the control of infection with staff undertaking hygiene and cross infection training. Staff were observed to be working in ways that minimised the risk of infection, by appropriate protective clothing when required. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by an effective staff team who clearly make a positive contribution in residents lives as staff are well trained, supervised, understand and do what is expected of them and who are robustly recruited and employed in sufficient numbers as is necessary to be able to meet their needs. Evidence: It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. Staff spoke about the good levels of communication between themselves and management. The tasks of the day appeared well organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who was supporting them. Staff consulted with had a clear understanding of the aims of the home and how their individual role contributed towards achieving this. Residents, relatives and staff consulted with felt that generally there was sufficient staff on duty for residents to get the support they needed when they wanted it. Residents displayed many signs of positive body language in their interactions with staff. This included touching, smiling and laughing. The manager reported that there has been a significant turnover of staff since the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: previous inspection largely due to the pending reorganisation of the home. However there remains a core stable group of staff that have worked at the home for some time and who were knowledgeable about residents needs. Some agency and bank staff have been used to cover vacancies with clear protocols in place to ensure that some residents are only supported by permanent staff. All those consulted with felt that the recent staffing changes had not had a detrimental effect on the level and quality of care provided, which is to be commented. A sample of comments made about staff included staff are all very good they work very well with her and understand her communication I like the staff I can talk to them and staff are very good as he can be quite challenging and he gets so frustrated, they do cater for all of his needs. The manager reported that the majority of the current staff team do not hold a National Vocational Qualification (NVQ). This is due to the large influx of new staff that are yet to undertake this qualification. The personal files of two newly appointed staff were inspected and these showed that a good recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing to help ensure that only staff who are suitable to work with vulnerable people are employed There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with people who have a learning disability. Staff consulted with confirmed that they have undertaken or are in the process of completing all of the areas of mandatory training needed for them to work safely with residents. A staff member spoke about the extensive specialist ongoing training in visual impairment that is provided by the organisation across the first year of employment. Staff also spoke of specialist training in communication, learning and physical disabilities is also provided. New staff undertake an induction into the home including the industry recommended minimum induction standards. This helps to ensure that all new staff entering into the care industry have a minimum level of initial training. Staff confirmed that there is a formal programme of supervision and direct supervision with the deputy managers working along side support staff each shift. All staff consulted with felt well supported by the management team to undertake their roles. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the home because it is run and managed appropriately by an experienced, enabling manager who provides strong leadership and runs the home in the best interest of residents. Residents opinions are central to how the home develops and reviews their practices, as the home has appropriate ways of self monitoring and obtaining feedback about the quality of its services and facilities. The environment is safe for residents and staff because health and safety practices are carried out. Evidence: The current manager has been registered with the Commission since November 2008. They have many years experience in working and managing care services and hold many managerial qualifications. The manager was extremely knowledgeable on changes in good practice guidelines and legislation and models good practices in the care of people who have a learning disability and was open and transparent in his Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: conduct. Without exception all persons consulted spoke positively about the management of the home with particular reference to the managers drive for improvement and approachability. A residents said I like the manager Vishul very much. A relative commented very nice guy you can talk to him anytime and is very helpful. Staff comments included management very professional quite serious about his work interested and personable with a focus of getting things delivered to a high standard and manager absolutely excellent very supportive not afraid to tell you how it is and has supported me to improve my own knowledge and skills. Each unit is managed independently by a deputy manager who in term is supervised by the manager with much credence given to enabling the deputies to be responsible and accountable for the unit. however, as previously noted there were variable standards of care planning, risk management and environment across the units which the manager agreed to address as a matter of priority. There are many mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include internal audits, residents meetings, satisfaction surveys and as previously note Quality Action Group. Changes to staffing arrangements and daily routines have resulted from recent feedback from residents. The required monthly visits for the organisation to monitor the services and facilities are undertaken by managers from across the organisations. These had not been undertaken consistently which is necessary in order to meet the organisations legal responsibilities and to ensure that standards at the home are being regularly monitored. Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. It was reported that recommendations made from the last visit by Environmental Health have all be addressed. The manager reported that hot water is regulated by mixer values and are checked regularly by the homes maintenance staff. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been completed for each unit which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 That the needs of services 10/12/2009 users have been assessed by suitably qualified persons prior any admission in accordance with the homes admission criteria and the National Minimum Standards. To ensure that the home can identify whether a prospective needs can be safely met at the home. 2 6 15 That care plans provide clear 08/12/2009 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs and which are reviewed regularly. To ensure that residents range of needs are assessed and the appropriate Care Homes for Adults (18-65 years) Page 30 of 32 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 guidance provided for staff on how to meet these needs in a consistent individual way. 3 9 13 That personal risk 08/12/2009 assessments are completed for all service users on the significant risks they face and pose and which are reviewed regularly and records significant findings and the actions taken to minimise risks or mange any risks. To ensure that staff have the guidance they need to minimise or manage the risks faced and posed by service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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