Inspection on 24/02/09 for Sarum House

This inspection was carried out on 24th February 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

Sarum House 31/01/08

Sarum House 18/09/07

Sarum House 06/03/07

Sarum House 07/02/06

Sarum House 22/06/05

Sarum House 13/12/04

Sarum House 19/05/04

Sarum House 16/01/03

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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: Sarum House Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL     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: Pauline Lintern     Date: 2 4 0 2 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 34 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 34 Information about the care home Name of care home: Address: Sarum House Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL 01722335283 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) : Wiltshire County Council care home 15 Number of places (if applicable): Under 65 Over 65 2 0 learning disability physical disability Additional conditions: 11 2 The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Physical disability- Code PD Learning disability over 65 years of age- Code LD(E) Date of last inspection Brief description of the care home Sarum House provides personal care and accommodation for 15 people with a learning disability. The home is operated by Wiltshire County Council, and is on the outskirts of Salisbury. A nearby park and ride scheme offers regular bus journeys into the city, and Sarum House also has its own transport. The home is an older property, although good efforts have been made to maintain and enhance it. There are two floors for resident accommodation, and all residents have single bedrooms. Some of the residents on the top floor who have relatively small bedrooms also have their own sitting rooms. The home has no lift, making the upper Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home floor unsuitable for anyone with a physical disability. Baths, showers and toilets for general use are on both floors. Communal areas include a ground floor games room. All residents pay a top up fee in addition to the fee paid by the funding authority. In January 2008 this was: over 60 yrs - 98 pounds 60 pence, 25-60 yrs - 63 pounds 95 pence and under 25 yrs - 51 pounds 65 pence. Care Homes for Adults (18-65 years) Page 5 of 34 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: This service was last inspected on 31/01/2008 and 7/02/2008. The unannounced inspection took place over seven hours on 24/02/2009. The registered manager Ms Sue Gray was not on duty at the time of our visit, although we did meet with her at the end of our visit. The team leader, Mrs Tutty assisted us throughout the day. Mrs Tutty has worked at Sarum House for over twenty years and was able to provide us with the information we required. Our pharmacist inspector spent part of the day looking at policies and procedures relating to medication. Care Homes for Adults (18-65 years) Page 6 of 34 We were able to meet with the majority of the people living at the home. We were able to obtain their views on the service being provided to them. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys to be distributed by the home to staff, care managers, GPs and other health care professionals. We received responses from six staff members and four people currently using the service. The feedback received, is reported upon within this report We had the opportunity to meet with three staff members in private. This enabled us to obtain their views on service provision. We sent Ms Gray an Annual Quality Assurance Assessment (AQAA) to complete. This was their own assessment of how well they are performing and it gave us information about their future plans. Information from the AQAA is detailed within this report We reviewed the information that we had received about the home since the last inspection. We looked around the home and saw a number of records, including care plans, risk assessments, health and safety procedures, staff files and medication records. At the last inspection a number of requirements were made, which related to the use of relief staff. We noted that these requirements had now been addressed. What the care home does well: What has improved since the last inspection? What they could do better: Care needs to be taken to ensure that all documents and records are dated and signed. The storage of controlled medication must meet with current legislation. It was noted that hot water outlets in some bedrooms, were producing cool water. Although most people only use these supplies for hand washing, the water needs to be checked regularly to ensure the water is supplied at a safe and satisfactory temperature. Records should be kept of the findings. Care Homes for Adults (18-65 years) Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 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. Prospective new people to the service are provided with sufficient information. This enables them to decide if they would like to stay at the home or not. To ensure that a persons care and health needs can be met by the home, a full assessment is carried out prior to them being offered a place. Evidence: The home has a Statement of Purpose and a Service User Guide. Both documents are available in alternative formats and languages if requested. The Service User Guide is supported with pictures and describes the service provision, staffing levels and facilities on offer. Fee levels are also included. There has been one new admission since our last visit to the home. We sampled this persons initial assessment, along with two others. We noted that consideration had been given to all aspects of the persons life. This included health needs, social needs, Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: cultural needs, mobility, personal care, accommodation, communication and daily living skills. Within the AQAA it states, each service user has an assessment from CTPLD (Care Manager) before they are admitted. They come to look around the property first to see if they like it. They are then invited for tea with the service users. If they agree they come and stay for a weekend to see if they would like to live at Sarum. We also have the same for the Training/Assessment Unit (upstairs). The longest they can stay with us in the Training Unit is 2 years, in that time they have training in cooking, washing their clothes, shopping, handling money, travelling by bus/or different forms of transport, train and taxi. One person commented within their survey, I wanted to move to this house, I can watch Casualty and Dancing on Ice. I can go to the Blue Skies as well, to see my friends. Care Homes for Adults (18-65 years) Page 12 of 34 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 in place and reflect the assessed needs of the person, using the service. People told us that they are able to make decisions about their life. People are supported to take risks where appropriate. Evidence: We examined three care plans in detail. Evidence shows that care plans are kept under review and that the person using the service is involved in the care plans development. Every month staff members sign a record to confirm that they have read each care plan and noted any changes, which may have been made. One member of staff told us we discuss any changes to support plans at handovers and team meetings. Peoples care plan reflects their assessment. Where an activity or task indicates that there may be a potential risk, this is indexed and clearly linked to the accompanying Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: risk assessment. The person using the service and the manager or their key worker signs each support plan. It was noted that a couple of records and documents, were not dated and signed. Care needs to be taken to ensure all records and documents are signed and dated to provide a clear audit trail. Support plans have been developed using a Person Centred Approach. People using the service inform the reader of how they choose to live their lives and what is important to them. For example, one person says that the things important to them are, going to the gym, collecting fighter planes, their relative, going shopping for DVDs and going out for a meal. Records also detail how staff can best support the individual. Support plans outline peoples individual goals. This includes the steps needed to achieve them, timescales, support required and when the goal has been achieved. Goals sampled include, using public transport, thinking about where I want to live in the future, going on a cruise and to become more organised in the mornings. Support plans take into consideration peoples cultural and religious needs. One persons plan shows that attending church weekly is very important to them. Another person does not wish to attend church but enjoys watching religious films and programmes on the television. All of the staff members we spoke to had a good understanding of peoples needs and how best to support them. One member of staff told us that it had been nice to see how one person they support had achieved so much in the time they had been at Sarum House. The person themselves confirmed that since moving to Sarum House they have developed their skills and have now achieved permanent voluntary employment at the local hospital. People living at the home, confirmed that they make decisions about how they choose to live their lives. One person decided that they no longer wished to attend day services and this was respected. They told us I have now retired. People are able to go to bed when they choose and get up when they want, subject to attending day services. One person told us they often stay up until 2am watching football. Another person added that they like to go to bed by 10.00 pm every night. As mentioned earlier in this report, one person had identified their goal as becoming more organised, in the mornings so that they are ready for work on time. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Within our staff surveys we asked the question, what does the home do well? One person commented, promotes independence and self worth for the residents. Where potential risks have been identified, measures have been put in place to minimise these. Risk assessments are completed by a competent person and kept under review. It was noted that one person had experienced a fall. This was recorded on the appropriate accident form. A risk assessment was carried out and placed on the care plan to minimise the chance of it happening again. Care Homes for Adults (18-65 years) Page 15 of 34 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. People who use the service are encouraged and supported to participate in appropriate activities, within the local and wider community. If a person living at the home wishes to maintain links with family and friends, staff support and encourage them to so. Peoples rights are respected and responsibilities recognised in their daily lives. People living at the home have the opportunity to choose what they eat. The menu was varied and healthy. Evidence: Within the AQAA it states, the service users participate in the local community, visiting Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: pubs, cinema, leisure centres, and attending the place of worship of their choice. We ensure that Service Users have knowledge of what is going on in the area. Service Users are enabled to use a range of transport, choosing which they prefer. Some receive bus training and some prefer to go by car/taxi. Family members and friends are encouraged to come and visit and the Service User can see their visitors in communal areas or in their own room for privacy. Service users are supported with boyfriend/girlfriend relationships. Activity programmes demonstrate that people attend various social clubs and day services. One person told us that they work in a local charity shop, where they sort out and hang up clothes. Another person works at a local barbers for work experience. The key worker explained that they had arranged this for them. One person explained that they had previously worked as a temporary volunteer. They were very pleased to tell us that this has now turned into a permanent voluntary post. They added that they are also very involved in the Salisbury Independency Self Advocacy Group, and is often called upon to chair meetings and discussions. There are opportunities for people to go to the theatre and cinema if they choose. Some people were going to see ABBA the week of our visit. Last year one person joined in on a Mencap holiday to Spain. They said they had a great time. One support plan records that the person has a personal trainer and enjoys going to the gym. They told us that they really enjoyed going and keeping fit. A copy of their recommended exercises are kept within their support plan. This enables staff to support the person to carry the exercises correctly. Many people attend Blue Skies social club where then can join in with drama, keep fit, board games, play pool and attend art sessions. New Horizons and Evergreens are also social clubs, widely used by the people at the home. Route 36, is a dance and music workshop, which is enjoyed by many people living at Sarum House. The home has a large games room. This is equipped with a table tennis table, pool table, dartboard, table football, music system and various games and books. We spoke to one person who was using the room to listen to their music. They said they enjoyed being in their on their own. A feature of the home is the space that is available to the people living there. For example, there are various communal areas where people can choose to either mix with others or sit quietly on their own if they wish to do so. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Some people have their own separate sitting rooms. One staff member told us that one person really enjoys writing letters and listening to their music. Their sitting room is equipped for them to do so. They also have a large comfortable armchair in there. Another persons sitting room has a personal computer and other technical equipment, which they enjoy using. They told us that they are happy with their room. People told us they are able to have friends visit them at the home, if they wish. Relationships with family members and friends are supported and maintained, if the person wishes to do so. We met with three people who live at the home, while they were having their lunch in the upstairs dining area. They had chosen and prepared their lunch for themselves and were happy for us to chat to them. They all confirmed that they are happy living at the home and spoke well of their key workers. When staff members came into the room, the atmosphere remained light hearted and comfortable. Staff were observed interacting well, with the people they support. Within support plans peoples preferred routines were recorded. One person stated, I am not a morning person I am not particularly cheerful. I like to have a lie in on a Sunday and have a lazy day. Another person reports, I like to keep all my clothes in the bottom of my wardrobe for easy access. People living at Sarum House have a key to their bedroom. In a residents quality assurance survey, when asked what are the best things about the home, one person replied having my own front door key, choice of food and where I go at night, having control of my money, having my own bank account, having friends upstairs and getting advice from the staff. People have the opportunity to develop their daily living skills and independence. One person explained, that they now purchase their food for their meal after work and then come home and prepare and cook it. On the day of our visit they had chosen to cook cauliflower cheese. They told us that they were pleased that they had developed the skills to carry out these tasks independently. Most people living at the home take responsibility for keeping their bedrooms clean and tidy. One person added, I change my own bed. One staff member explained, that once a week a member of staff will ask each person using the service, what meal they would like for the following week. Everyone has the opportunity to choose a meal. Staff report that they will sometimes choose to have a Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: take away. Some people take a packed lunch to work or day services. One the ground floor, staff takes responsibility for food preparation and cooking, whilst the people residing upstairs, make their own arrangements. Menus sampled showed choices to be healthy and varied. Care Homes for Adults (18-65 years) Page 19 of 34 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. Guidelines within each persons care plan, inform the reader on how the person wishes to be supported. People have access to healthcare professionals to ensure that their physical and emotional health needs are met. People are protected by the homes procedures for the safe handling of medicines and are supported to manage their own medicines where appropriate. Evidence: Care plans detail the amount of support the person requires with their personal care. One file states, I will need support to make an appointment with the GP, I will ask for pain relief if I need it. Another persons plan states that they need support with personal hygiene. People have Health Action Plans in place. One person had a plan in their file although it had not been completed. Another person had a completed plan but it had not been Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: dated or signed by the person completing it. This made it difficult to determine when it was completed and needs to be updated. Within the AQAA it states, All service users receive personal, physical and emotional support in the way they prefer and require. All service users choose their own clothes, hairstyles, (have their hair done at the hairdressers) so their appearance reflects their personality. Service Users are supported regarding their personal hygiene, washing and shaving (whether its with electrical or manual shaving equipment). All service users have their own medical folder; this contains information on; Doctors, Dentists, Chiropodists, OTs, psychiatrists and any other professional they may need to see. Staff support service users to appointments if need be. Records demonstrate that the people using the service have access to healthcare professionals, as required. This includes, doctors, dentists, opticians etc. One person attends the Scholl Total Foot care centre every two months, to have their toenails maintained. At the time of our visit to have anyone living at the diabetes. They confirmed specific training would be meet their needs. the service, the team leader confirmed that they did not home with specific healthcare needs, such as epilepsy or that if a person with such needs was admitted to the home, provided to staff members to ensure they had the skills to All staff members receive mandatory training in manual handling. This now includes all relief staff. Our pharmacist inspector looked at the medicine handling in the home. All medicines are kept securely in individual rooms allowing staff to respect peoples privacy and individual needs. Self medication is supported for those who are able and want to do so, however the records were not dated with the most recent review. All staff have training in medication handling including relief staff. A comprehensive policy is available to suport them. The home makes use of help and advice from healthcare professionals. A controlled drug cupboard is available but needs to be secured to the wall with the correct bolts. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People told us that they knew how to make a complaint and raise any concerns. Arrangements for protecting people from abuse are suitably in place, with staff being aware of the procedures to be followed. Evidence: Within the AQAA it states, we have a complaints procedure in place. The service users have a picture format in the bedrooms to show how to make a complaint. We also listen to service users and act immediately to alleviate any problems that may arise. One Service User was having difficulty walking up an incline in the hallway. We have now fitted a rail to assist him/her in walking up the incline. Any complaint that is made will be recorded along with any action taken and the outcome of any issues. All staff are aware of the No Secrets guidance and have POVA training. I like staff to have POVA training yearly as this keeps everybody up to date and aware of any situation that may arise and what to look out for. All service users also have an emergency evacuation plan attached to their bedroom doors. People we met with told us whom they would speak to if they were unhappy. Some people said they would speak to the manager and others said their key worker. Within our surveys one person said I would speak to the staff if I was not happy. Another person commented, you dont fight in this house and we make friends, no Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: arguing and be kind. Since the last visit to the service, there have been no complaints received regarding this service. No safeguarding referrals have been made, within the last twelve months. Staff members confirm that they receive training in safeguarding people. Copies of the Wiltshire and Swindon guidance No Secrets are available for staff members. At the last inspection a requirement was made relating to relief staff, receiving training in the protection of vulnerable adults. This was discussed further with the relief co-ordinator, who confirmed that she is looking into accessing this. She added that all relief staff now receives a pack, when they commence employment, which includes a copy of No Secrets. All relief staff now complete the Learning Disabilities Qualification LDQ, which includes safeguarding procedures. Care Homes for Adults (18-65 years) Page 23 of 34 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 home is clean and hygienic throughout and residents live in a homely, comfortable and safe environment. Evidence: At the time of our visit to the service, seven rooms were occupied upstairs and four on the ground floor. As previously mentioned, some of the people living on the first floor have the benefit of an adjacent sitting room. The furnishings throughout the home are comfortable and good quality. Each bedroom is individually personalised to suit the persons needs and preferences. One person has a vast collection of model planes and pictures and photographs. Some people have televisions and music centres. People we spoke to told us that they are happy with their rooms and the facilities at Sarum House. It was noted that some areas of the home were in need of some attention. For example the hallway downstairs could benefit from being re-decorated. Staff reported that some bedrooms could also do with brightening up. Consideration should be given to when work on the new bungalows may commence. If this continues to be put on hold, a planned maintenance programme will need to be considered to ensure that the Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: home does not deteriorate further. Within our surveys people commented, our service is well run at the moment, but will only improve if ever the bungalows are built and can meet the service users needs and dreams in the Salisbury area. Independent living plus supported living is the future if it ever happens and this is an old building, but has lots of comforts and security that the service users like. For some service users they want to leave the establishment when the time comes. For others who are younger the chance of a new life with support is their future expectation. Within the AQAA we asked, what could be done better, regarding the environment. The response was, as stated before, this is a large building and moving to the new bungalows would be much more beneficial to the service users. The bungalows will be smaller and have more of a homely feel instead of a large building. They will also be living in the community. At the time of our visit the home was found to be clean and hygienic. One bathroom floor has recently been replaced. Hand washing facilities throughout the home had antibacterial hand wash available. The laundry is sited away from any food preparation area. There are washing machines and driers available on each floor. The team leader told us that each person using the service has their own laundry basket for transporting soiled washing to the machines. Infection control training is available to the staff team. Care Homes for Adults (18-65 years) Page 25 of 34 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. Records show that staff are recruited, inducted and trained properly. Improvements have been made with regard to the recruiting, inducting and training of relief staff. Permanent staff are provided with one to one supervision, although relief staff meet as a team unless they request one to one time. Evidence: Staff members told us that they work a fairly flexible rota to enable them to meet the needs of the people using the service. Generally staffing levels are 2/3 staff downstairs and 1/2 on the first floor. During the night there is two staff sleeping in. There is one staff member to each floor during the night. Many staff have completed NVQ level 2 and 3. All new staff work within the LDQ framework. This now includes all relief staff. A log is kept of all training applied for and attended by permanent staff members. Recently there has been a disability equality workshop as well as the mandatory training and refresher courses. All staff receives annual refresher training in most subjects. In March senior staff will be attending training in supervision skills. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: We sampled some relief staff files and it was noted that this is an area where there has been much improvement. For example, recruitment files now contain evidence of satisfactory safeguarding checks, prior to a person commencing employment. Files contain a photograph of the person and evidence that they have completed an induction into the work place. The relief co-ordinator told us that all relief staff now receive mandatory training in manual handling, first aid, basic food hygiene, medication and fire safety. She explained that new relief staff are booked in for an induction, prior to working within the home, to ensure that they are competent. There is a training matrix now available to monitor all relief staffs training progress. Within staff surveys, people commented that staff are well trained and highly motivated. One person felt that to improve the service they could, use the skills of highly skilled and motivated staff to better effect and it would be more productive and improve service provision if, relief staff hours were averaged out and the equivalent permanent staff employed. People living at the home spoke positively about the staff team. Many confirmed that they like all of the staff. One staff member told us in their survey Staff are happy working in this environment. As the future is also uncertain for staff, we all hope there is employment for us all now and with the future changes ahead. Another person commented, they could be more open and honest about the future of the service. The home holds evidence to show that permanent staff members have had a CRB check carried out and a check against the POVA list. Files also states whether two satisfactory references have been sought. Files contain proof of identity, a photograph and application form and a job description. Staff members spoken to confirmed that they receive regular one to one supervision, by their line manager. Annual performance appraisals also take place. Staff members sign a supervision agreement when they commence employment at the home. The supervision of relief staff, takes place as a group approximately every 3-6 months. The relief co-ordinator explained that this is due to the logistics of there being so many relief staff. She added that if any one wishes to meet on a one to one basis, this would be arranged. Likewise, if there were performance issues, which need to be discussed, this would take place in a one to one forum. We discussed the communication links between the home and the learning disability relief service and how they can ensure that information is passed between the two. The team leader suggested inviting the relief co-ordinator to the senior meetings, or part of them. This would ensure that feedback could be given to both parties and everyone would be aware of any issues or Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: situations arising. Staff told us that they regularly attend team meetings at Sarum House. Care Homes for Adults (18-65 years) Page 28 of 34 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 home is well run by a competent and qualified manager. The views of the people living at the home and their representatives are canvassed. The health, safety and welfare of people using the service is promoted and protected. Evidence: Ms Sue Gray is the registered manager of Sarum House. She has the appropriate qualifications for her job role: Registered Managers Award, NVQ 2/3 D32/33 and has now started taking her NVQ4 in Management. Staff members speak well of Ms Grayss management approach. Within their survey one staff member commented, our manager always makes sure we have a well-run service, meeting the needs of the service users and staff. Staff we spoke to, on our site visit reported that Ms Gray is supportive and approachable. Regular residents meetings are held, to enable people to share their ideas and raise Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: any concerns. The team leader confirmed that attendance to the meetings is fairly good overall. It was noted that one persons file included two completed surveys, which they had been asked to complete. The questionnaires stated, we would like to know what you think about living at Sarum House and the service we offer you. The remaining two files we sampled did not indicate that they had been asked to complete the satisfaction questionnaire. Canvassing the views of the people living at the home is good practice and should be continued. Wiltshire County Council conducts a quality assurance audit annually. Monthly senior management audits are also completed and recorded. We ask the service to complete the AQAA annually and make an assessment of the service being provided. Individual staff members at Sarum House take responsibility for various tasks, such as infection control, fire safety, health and safety and water checks. The home has a maintenance person, who carries out tasks around the premises. All toxic materials are securely locked away and the corresponding data is available. We noted that some bedrooms on the first floor had wash hand basins, which were supplying water that was not very warm, from the hot water tap. We discussed this with the maintenance man. Records show that although hot water temperatures are checked and recorded in bathrooms and shower rooms, they are not often checked in bedrooms. Although most people only use the facility in their room for hand washing, it is recommended that these hot water outlets are also regularly checked and recorded. All radiators are guarded to protect people. The designated person completes regular health and safety checks and records are kept. Environmental risk assessments are in place, highlighting any potential risks and the measures in place to minimise them. Accidents and incidents are recorded properly. These are then kept on individual files for confidentiality. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 20 13 The controlled drug cupboard must be secured to a solid wall using rag or rawl bolts. This will ensure that it complies with current legislation for the storage of controlled drugs. 22/05/2009 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 19 All people using the service should have a completed Health Action Plan, which is dated and signed by the person completing it. Regular reviews for people managing their own medicines should be recorded in their care plan. Consideration should be given to maintaining the decorative state of the home. To maintain good communication links between the relief staff co-ordinator and the senior staff at Sarum House. All hot water outlets should be periodically checked to ensure they are supplying water at the correct Page 32 of 34 2 3 4 5 20 24 36 42 Care Homes for Adults (18-65 years) temperature. 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