Inspection on 01/12/08 for The Garden House

This inspection was carried out on 1st December 2008.

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

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

Other inspections for this house

The Garden House 23/01/07

The Garden House 21/11/05

The Garden House 02/06/05

The Garden House 17/11/04

The Garden House 28/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Garden House Bowden Derra Park Polyphant Launceston Cornwall PL15 7PU 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: Helen Tworkowski Date: 0 1 1 2 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 32 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.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: The Garden House Bowden Derra Park Polyphant Launceston Cornwall PL15 7PU 0156686230 0156686230 caryn@bowdenderra.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bowden Derra Park Limited Name of registered manager (if applicable) Mrs Caryn Anne Jory Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 care home 12 learning disability Additional conditions: Date of last inspection 2 3 0 1 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home The Garden House is part of the Bowden Derra Park complex, which is owned by Bowden Derra Park Limited. It provides care and accommodation in single rooms for adults with learning difficulties, some of who may have associated nursing needs. The people who live in the house are essentially of a younger age group. The home is situated within large grounds on the edge of a small village approximately seven miles from Launceston. Although it was built before the national minimum standards came into force the home has been designed to provide space for wheelchairs users to be able to move around with relative ease. The Garden House fees range from pounds 800 to 3,000 per week. This fee includes chiropody, basic toiletries, 1 session of hydrotherapy per week. The fee does not include clothes, reflexology, music therapy, and transport. 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home. This was an unannounced Inspection and took place between 7.30am and 5.30pm. We spent time with some of the people who live at the Garden House, including time at breakfast and at lunchtime. We looked at the care of three people who live at the home. We spoke with three of the staff who work at the home and with the Manager. We sent surveys to people who live at the home, though we did not get any back. We received comments back from two Social Workers and from one health care professional. We also sent surveys to care staff. As part of this inspection an “expert by experience” also visited the home. The expert is someone who knows about care services from their own experience or from contacts they have had. The report from the expert is included in this report. We also received information from the home as part of an annual questionnaire. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: The people who live at the Garden House have plenty to do. The staff are well trained. The Manager knows what is happening in the home. Care Homes for Adults (18-65 years) Page 8 of 32 What has got better from the last inspection What the care home could do better The dining room and lounge could be more homely. People need to have help so that they can enjoy their meals. Care Homes for Adults (18-65 years) Page 9 of 32 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Helen Tworkowski Colston 33 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 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 11 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 . People who are considering moving to the Garden House can be assured that their needs will be known prior to a move, and that both their wishes and needs will be taken into account. Evidence: No one new has moved to The Garden House since the last inspection. At the last inspection it was found that the outcomes in this area were excellent. We discussed with the Manager how she would assess people. Ms Jory said in practise they usually received information from the Social Worker about what an individuals needs are, she then went out and assessed the person using the organisations standard assessment form. Ms Jory said that offer the opportunity for the individual to visit the Garden House, to have tea, and to have a trial overnight stay. We discussed with Ms Jory issues relating to people moving to or from the home, and she was aware of the need to consult and to involve individuals in this process, rather than assuming that the service knew what was best for an individual. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live at the Garden House benefit from care which meets their needs and gives them choices in their life Evidence: We looked at the information that was held about three of the people who live at the Garden House. Information about how needs are to be met is kept in a Care Plan, this is a comprehensive document that gives clear information about the things staff are to do to ensure that peoples needs are met. There is space for the individual or their representative to sign to say that they agree to the document. We were told that the individual and their representative are included in the reviewing process. There are risk assessments in place to ensure that any perceived risks are managed and where possible eliminated. We asked staff about what they knew about people. The two staff we spoke to were the key workers for people whose care we were looking at in detail. We found that these staff were well aware of the individuals needs and what we were told was consistent with the information that was written down in the care plan. We were told Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: by staff that all staff read and become familiar with the Care Plans as part of their induction. We asked staff about the times that people got up or went to bed and was told that this was dependent on their preference, some people like to get up early others to have a lie in. We asked about who made decisions about buying clothes and was told the people at the Garden House had the opportunity to go shopping. One member of staff explained how when they went clothes shopping that they did not always try clothes on in the shop, but took them home. This meant that they could be tried on in more comfort and if not suitable returned. We spoke with a visiting health care professional and was told that he/she thought that the quality of care is good, however at times staff made choices on behalf of people rather than allowing them to make their own. There is information in each persons file about their income. We saw that each person has a bank account and that monies belonging to the individual is now being paid into the account. There is a clear audit trail of monies going in and out of the account and receipts are kept. We discussed with the Manager Disability Living Allowance - Mobility Component. Many of the people at the Garden House are in receipt of this benefit. Following previous discussions with the Commission it has been agreed that this money can be paid into the homes bank account for the running of vehicles. Money belonging to an individual must not be paid into the homes bank account unless it is for a charge made. We discussed with the Manager that this benefit should be paid to the individual, and if a service is provided, then a charge by the home may be made. This places the control of the money back with the individual, and also ensures that there is a clear audit trail should one be needed. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people at The Garden House have the opportunity to lead an active lifestyle, and take part in activities at home and in the community. The way that people are supported to eat is not always appropriate. Evidence: As part of this inspection an expert by experience looked at the lifestyle of people at the Garden House this is the report of the visit. When I arrived there I was told most of the residents are out, so I only spoke to two residents. A member of staff was also there to help me if I did not understand anything they said. The residents go on set days to a Day Centre, The Westgate Centre, in Launceston. The residents do various activities while there including painting and drawing. The staff from the Day Centre also takes them around Launceston. They go into shops, visit a cafe for Tea and Coffee etc. All the residents will be going to the Day Centre in Launceston for a carol service in the next few days. Because the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: residents have trips into Launceston a lot they meet people who they have become friendly with. The residents go to a local pub evening trips. They only have soft drinks. They also go into Plymouth to see films at the Odeon Cinema Because the house is connected to the internet the residents with staff look at the Odeon Cinemas website to see what films are on then book tickets on line. Some of the residents go as a group for a holiday at Butlins Minehead in Somerset. One of the residents goes on day trips only because of behaviour problems. It was arranged for one resident to go to Portsmouth. This was to board a square rigger ship. The ship is adapted for disabled people and people with learning difficulties to help crew the ship. Another resident on a Friday works at Launceston Library and helps to put the books away. One of the residents goes in the evening to a Monday club in Launceston. The other residents are given the option to go as well. All the residents are going to see a pantomime soon. Doing all this helps the residents build up their social skills. The house is two storeys on the ground floor there is a large room it can be used for conferences, at present Truro College is using it during the week to run a Life Skills Course. The two residents I spoke to and one other resident are attending that course. The course runs for 12 weeks The activities the residents can do at the house include painting drawing and playing games on the computers the home have. Because it is near Christmas the residents help to make Christmas decorations and cards. The residents are going to have a Christmas party. The residents and staff held a meeting to organise the party and decide what food and drink to have there. On Tuesday mornings there is a coffee morning at the house with tea coffee cakes and biscuits. The residents help make the cakes and biscuits Anyone can come to the coffee morning. The money raised from selling teas coffees cakes and biscuits go towards things for the residents. The visitors to the coffee have good interaction with the residents. The residents who have family they go home for overnight or weekend visits. At Christmas they go to visit from Christmas Eve and come back on 27th December. The house is signed up to the internet site Facebook. Money from the coffee morning helps to pay for it. Some of the houses computers have webcams which enable the residents with family who also have computers with webcams to contact each other. I feel this is a very good way for the residents to keep in contact with their family. More residential homes should do this. Some of the residents have pay as you go mobile phones. So they can contact their family when they like The residents use their own money to top up their phones. This is a very good way for the residents to be independent. All the residents can choose what they want to eat and drink. There is a good variety of food plenty of vegetables and meat and a variety of sweets ice cream puddings and cakes available. When asked what food you like one resident said I like vegetable soup. Another resident said I like roast dinners and chocolate cakes. All the residents help to choose the menus at the residents meeting. The menus run on a four week cycle. In the kitchen there is a menu on the wall. When I asked is there an accessible menu with pictures I was told there is but the staff member I asked did not know where it was so I did not see it. The residents can ask for a hot or cold drink when Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: they want. Some of the residents can make drinks themselves some need help. When the new houses are open there will be two kitchens one of them will be adapted with low worktops tables a low sink and low cooker hobs. This will enable the residents to help with preparing the meals and cooking them. Some of the residents can go to Lewannick church if they wanted to or a vicar can visit the house. All the residents have regular health checks that are their eyes, teeth, and general health. The residents use the house transport or taxis because the bus service is very in frequent. The nearest train stations are Plymouth or Bodmin Parkway. One resident has a vehicle paid for with mobility allowance which the house uses. The other vehicles at Borden Derra Park have to be booked in advance. The two residents I spoke to said We like doing things drawing. The beds are comfortable, good food, staff very nice, look after us well and one said Im happy here. All the residents have their own money Karen the boss would get it out of the bank for them. If the residents were not happy about something they would talk to Karen the boss. They can have advocacy if needed, this is based in Penzance. Because most of the residents at the Garden house have communication problems its difficult for them to form relationships but they have friends. I felt there was good interaction with the residents and staff. The house felt very homely and the residents rights choices and independence were being respected. As has already been noted we were told by staff that the people who live at the home had a choice about when they got up and went to bed and other daily routines. We noticed during our visit that not every one was up at the same time. We discussed with the Manager the lack of proper locks on bedroom doors. At the time of the visit doors had star locks, we were told that these were to be replaced in the very near future with other locks that would provide the individual with the ability to lock their door to provide both privacy and security. The visit to the Garden House started at 7. 30 a.m. and went on over lunch time we were therefore able to see people having breakfast and lunch. Food is brought over from the main kitchen on a trolley and served in the kitchen. We observed that people were able to make choices about what they ate. We noticed at both of these meals that there was some variation between how different staff interacted with the people they were assisting. Some of the staff were attentive and paid close attention to the individual and talked with them. This was not the case with some of the other staff, who moved people to the table without speaking to them and did not speak to them throughout the course of the meal. We noticed that there were no napkins or serviettes. At lunch time no drinks were provided with the meal. The tables used had Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: been raised to accommodate wheelchairs however this meant that the tables were not at an appropriate height. The tables were not well laid at lunch time old repaired tablecloths were used. We discussed our concerns with the Manager and she said that she thought that perhaps the presence of the Inspector might have affected the way staff behaved. Meals should be well presented and tables should be laid in a manner that indicates sharing food is a important and potentially pleasurable time of the day. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live at the Garden House are provided with a good level of support to ensure that their personal and health care needs are well met. The Medication system is generally very well managed. Evidence: The information in the Care Plans provides clear information about the manner in which people wanted assistance with their personal needs. This included information they was particular to them, for example one person like to sleep with their hair tied in a pony tail. This was recorded in the Plan and staff spoken to were aware of this. When we look around the home we saw that each person had their own equipment to help them move around or to get washed and dressed. The Manager discussed with us some of the issues and difficulties they faced in keeping equipment, particularly wheelchairs in good repair. Each person has a key worker, and at the beginning of the day staff were allocated to work with individuals, so that there was a consistency of care throughout the shift.We were told by one of the staff completing a survey that A daily handover/chat happens about all care issues for our service users. All new issues/concerns are discussed. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The Garden House is a care home that provides nursing, and has a nurse on duty at all times who can meet any nursing needs within their skill range. We looked at the records relating to health care, and found that there were good records of contacts that had been made with other health care professionals. A number of the people at the home have epilepsy and need to take medication when they have seizures. We found that there was clear guidance to staff on the actions they are to take if an individual has a seizure, and that there are good monitoring systems of seizures, so that it is possible to see any patterns that might emerge. We were told that there had been agreement with the relevant professionals, the individual and where appropriate their representative to use a CCTV system for monitoring the individual whilst they slept to see if they had a seizure. We were told that such agreements were not in place for everyone who had epilepsy, only for those where it was considered to be the only suitable method. We saw that the monitor was in the lounge, and was told that it was only switched on when all the other residents were in bed. We were told that during the intervening period that staff were close on hand to each individual who needed it to ensure that they were safe. As part of this inspection we were shown how the medication system works by one of the staff who has responsibility this area. We found that medication was well managed.There was a record of administration and drugs were kept in a secure manner.We found that there were systems to audit medication, however these were not as comprehensive as they could be and it was not possible to readily check at any point if the correct amount of medication was held. We discussed with the Manager and staff issues relating to one particular drug which is in liquid format. We were told that on occasions some of this drug leaks from the bottle when it is transported, and this leads to difficulties accounting for all of this medication. We advised that difficulties with leaking bottles should be reported to the Pharmacist, however an accurate as possible account of all medication must be kept. This medication is schedule 3 controlled drug and stocks of this medication must be stored in the controlled drug cabinet, and accounted for within this system. Care Homes for Adults (18-65 years) Page 20 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 . There are good systems in place to ensure that people can raise any concerns or complaints, and to ensure that they are protected from abuse. Evidence: We looked at the record of complaints, and this was comprehensive, indicating that where there were issues people where prepared to raise them with staff. We discussed with the Manager cross referencing any letters sent or actions taken with the complaints book. This would ensure that it was clear record of actions taken in response to any concerns. One issue had been raised through the Safeguarding process and this had been dealt with appropriately. We are aware that from this experience that the Manager is aware of her responsibilities and will use this experience to help ensure that any issues are responded to by other agencies responsible in a timely manner. We asked the two staff we interviewed about dealing with concerns and both were aware of the need to report any issues. Information supplied to the Commission in response to a questionnaire states that staff have been undergoing additional training in relation to protecting people from abuse. When we checked training files we found that this was the case and that staff had received training. we were told that there was an open culture in the home, and that staff do not have concerns about approaching the Providers or Management. One staff said in a survey We have support from team leader/ nursing staff and manager, another commented I have excellent relationship Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: with all staff at Garden House inclusive of management. We discussed with the manager that we had received nine surveys back from care staff, however four of these individuals said that they did not know what to do if someone told them about a concern about the home.This information appeared to contradict other evidence. We were told that there are regular Service User Forums, and we saw that there was a lot of information displayed on the walls which told people about places they might receive support, help or guidance with any issues or concerns they might have. We were shown a new computer that has a web cam which means that some people can have visual contact with their relatives or friends, even if they are unable to talk with them. Such contacts are important in ensuring that individuals are not isolated and have contact with people outside the service who can act on their behalf if necessary. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Garden House is well equipped to meet the needs of the people who live in the house. Bedrooms are well decorated and furnished reflecting individual preferences and tastes. The main lounge/dining area and entrance hall are dark and poorly laid out, information aimed at staff intrudes and gives these areas an institutional feel not reflected in other areas of the home. Evidence: As part of this inspection we looked around the whole of the home. We found that the house was warm and clean. All of the bedrooms were of a good size and each had been decorated and furnished to reflect the individual who occupied it. Some of the bedrooms were minimalist, others had lots of cushions, pictures and ornaments. Some of the bedrooms had electric beds that could be adjusted, and a number had over head tracking which meant that floor based hoists were not needed. The bathrooms were well equipped and again individual equipment had been provided so that peoples personal care needs could be met. There are two lounge/dining rooms at the Garden House. The smaller of the two is light and well decorated and furnished with domestic style furniture. The larger lounge/ dining room is dark and has limited natural light. The room is in effect a corridor to the rest of the house. The arrangement of the furniture is such that sofas are pushed back against the wall, with the TV on the opposite wall, any one walking Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: into the house walks in front of the TV. There are a number of notice boards in this room, some of which provide information for the people in the Garden House but others provide information for staff e.g. shift allocation. It appeared that in this area and in the entrance to the home that that there were a number of notices which were unnecessary or related to staffing issues, and therefore should not be in the residents living space. We discussed the lounge with the Manager, and she explained some of the difficulties in that the room needs to accommodate a number of people in wheelchairs. However, she was aware that improvements need to be made to this area so that it, like the bedrooms, reflects the people who live at The Garden House. We also discussed with the Manager the entrance hall. There were a number of notices in this area which told visitors and staff what to do. The area is an awkward space and given this could be a visitors first experience of the Garden House, it was not particularly welcoming, and did not reflect the much higher standards in other parts of the house. 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 . The people who live at the Garden House are well supported by staff who are trained and competent in their work. Evidence: As part of this inspection we sent surveys to 12 of the staff, nine were returned completed. All of the staff who completed the form said that their employer had carried out checks on them before they started work. One member of staff commented in their survey I was not allowed to start work until my CRB check had come back. We looked at the recruitment files for two staff who recently started in the home and found that checks had been made prior to them starting work, these checks included taking two written references, a check of people who are not allowed to work with vulnerable people and a check on the persons criminal record. We found that there were good recruitment procedures in place. All nine of the staff responding to the survey said that their induction covered everything they needed to know about the job before they started work, either very well or mostly. One person commented ....I was allowed to take my own time getting to be confident with each individual service user and their level of needs, this allowed me to build a trusting relationship with them all. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: We looked at the training records for four staff and these showed that was a comprehensive range of training that was not only focused on care work in general but also on the needs of the people in the home in particular. We discussed with the Manager the use of training based on completing work books and she explained that this was a useful way of ensuring that staff get training in a number of aspects of the work, and that such training is supplemented by group and practical training. Eight of the nine staff who responded to the survey said that they had the training that was relevant to the role and were kept up to date. One of the staff commented ... has a very good training package and we are encouraged to go on as much external training as we wish which is paid by the company including NVQs. Information provided by the Manager confirms that more than half of the staff (22 out of 42) have a relevant National Vocational Qualification at level 2 or above. On the day of inspection some of the staff were attending training that as part of their Learning Disability Qualification, which specifically aimed at providing staff with knowledge and competence in working with people with a learning disability. We asked the Manager about training in relation to epilepsy, she confirmed that an epilepsy nurse had agreed that she was competent to do this training. We discussed with the manager the need for this agreement to be confirmed in writing. We asked two of the staff on duty if there was enough staff and was told there were. Seven of the staff who responded to the surveys said that there were always or usually enough staff, two said that there were sometimes enough.Concerns were raised by one Social Worker who responded to a survey that she thought that there were times when the staffing was not consistent either because of short staffing or a high turnover of staff. During this visit to the Garden House there was nothing to indicate that there was any shortfall in staff. We looked at information about staff turnover provided by the Manager and saw that of the 42 people employed, 7 had left the service in the previous 12 months, we consider this to be a low staff turnover. We discussed staff turnover with the Manager, she explained in recent months they had lost some longstanding members of staff who were from overseas, and who were unable to continue working due to changes in employment law. We talked with two of the staff about the support they received and both said that they felt well supported. One member of staff commented in the survey that I find it a very stimulating place to work and feel that a very high standard of care is given to all the service users, another person said Mr and Mrs Cash (directors of the company that runs the service) are very good employers, they are very fair to staff. 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 . The people who live at the Garden House benefit from a well managed and safe home. Evidence: The Registered Manager, Caryn Jory, supplied the Commission with a completed questionnaire and self assessment about the service. This information was clear and reflected a good knowledge of the issues related to the management of a care home. Ms Jory was able to show ways that the service had developed and practise improved. Ms Jory has explained that she works as part of a team with two other managers and that they are able to share and develop new ideas. We were shown a quality assurance system, that involves seeking the views of people who have contact with the service. One of the Social Workers commented in a survey ‘I have always found Caryn Jory, the manager, to be professional and willing to accommodate any changes that have been required. She has been easy to work with and responded to requests for information’. We looked at the way that risks are managed and was shown risk assessments, these included risks relating to Legionella and in relation to the fire. We looked at the fire Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: checks that were made, including staff training in relation to fire. We were told that it had proved difficult to ensure that all staff had training as frequently as needed, particularly if they worked nights or were bank workers and worked only occasionally. The Manager discussed with us the possibility of such training being delegated to one of the permanent night staff. We found that the building was in good repair, and that staff were aware of risks such as that caused by ice on the steps or path ways around the house. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  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 1 7 20 The registered provider must 01/03/2007 make arrangements for each resident to have their own bank accounts. 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 Description 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 Description Timescale for action 1 17 16 01/03/2009 People must be offered the opportunity to eat their meals, with appropriate support from staff, in convivial surroundings. This means that tables should be at an appropriate height, drinks should be provided, napkins or serviettes should be available, and staff should interact with individuals. This is so that individuals can enjoy their meals. 2 28 16 The decor and facilities in the 01/04/2009 main lounge and dining room, and in the entrance hall must be improved so that they provide comfortable and homely accommodation. The Garden House is the home of 12 people, and the accommodation should Care Homes for Adults (18-65 years) Page 30 of 32 reflect this, giving them the opportunity for an ordinary and valued lifestyle. 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 7 Money belonging to any individual service user should not be paid into any bank account for the running of the business, unless it as part of a charge made and payment for a service provided. Review the systems for accounting for medication so that it is possible to readily check that the correct amount of medication in the home at any one time. 2 20 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk 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 © (2008) 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. 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