Inspection on 05/11/08 for Vale Road (15a)

This inspection was carried out on 5th November 2008.

CSCI found this care home to be providing an Adequate 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

Vale Road (15a) 08/05/08

Vale Road (15a) 10/05/07

Vale Road (15a) 19/10/05

Vale Road (15a) 27/07/04

Vale Road (15a) 10/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Vale Road (15a) 15a Vale Road Ash Vale Nr Aldershot Hampshire GU12 5HH     The quality rating for this care home is:   one star adequate 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: Patricia Collins     Date: 0 5 1 1 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. the things that people have said are important to them: They reflect 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 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI 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 37 Information about the care home Name of care home: Address: Vale Road (15a) 15a Vale Road Ash Vale Nr Aldershot Hampshire GU12 5HH 01252334880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: United Response care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - (LD) Date of last inspection Brief description of the care home 15a Vale road is a care home providing personal care and accommodation for up to five adults of both gender, whose primary needs on admission are within the category learning disability. The home environment is in a purpose built bungalow owned by English Churches Housing and managed by United Response. Situated in a quiet residential cul de sac in Ash Village, the home is near to local shops and other amenities and a railway station. The home is served by good road links to the nearby towns of Aldershot, Farnborough and Guildford. All bedrooms are for single occupancy and facilities include two assisted bathrooms and equipment and aids for meeting the needs of people with physical disabilities, as secondary conditions. The accommodation includes a domestic style communal dining room, lounge, kitchen and utility room. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 5 Brief description of the care home There is an accessible furnished patio and enclosed garden. Parking facilities are available for several cars and a minibus. Care Homes for Adults (18-65 years) Page 5 of 37 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was completed on 8th May 2008. Weekly fees charges range from 1,319 pounds to 1,366 pounds. Additional charges apply for personal items, hairdressing and holidays. The unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. The inspection visit was undertaken by one inspector over six hours. The report will say what we found as it is written on behalf of the Commission for Social Care Inspection (CSCI). The inspection process incorporated discussions with the service manager and staff. Care Homes for Adults (18-65 years) Page 6 of 37 Because we were not able to communicate with the people using the homes services, indirect observations were made of care practice, noting the behaviours and body language of people using services to assess their state of wellbeing. We noted the quality of interactions between staff and individuals using services, and their reaction to their environment. We have taken into account all available information when forming judgements about how well the home meets the national minimum standards for adults. These are based on the cumulative assessment, knowledge and experience of the home since its last key inspection. The inspection process involved sampling records and a tour of the building and garden. We also considered information received in surveys from two people using services completed on their behalf by relatives. Survey feedback was also received from a general practitioner, care manager and two staff. Each year providers registered with the Commission for Social Care Inspection (CSCI) must complete a self assessment called Annual Quality Assurance Assessment (AQAA) and send this to the CSCI. It provides quantitative information about their service, requiring assessment of the service against the National Minimum Standards (NMS) outcome areas, demonstrating both areas of strength and where improvements can be made. The content of the homes AQAA was used to inform the inspection outcomes. We wish to thank all who contributed information to the inspection process. Also people using the homes services and staff for their time, hospitality and assistance throughout the inspection visit. What the care home does well: What has improved since the last inspection? People using this service are mostly unable to verbally express their choices or opinions. Staff have implemented use of new person centred tools to engage them in the process of care planning, to meet their individual, holistic needs. The organisation is committed to the Way We Work person centred approach in planning the care and support received by people using services. Staff training is ongoing to support their learning in this approach and use of these tools. Care Homes for Adults (18-65 years) Page 8 of 37 The home is working towards fuller community presence and participation. Since the last inspection a concerted effort had been made to recruit to staff vacancies, and two new full time support workers and one part time senior support worker employed. The service manager confirmed effort being made to fill remaining staff vacancies and to build up the relief staff bank. There is ongoing review and management of staff rotas, to ensure staff cover where needed. A mid-shift has been introduced Monday to Fridays which can be flexible, used for transporting people using services to and from day services in the homes vehicle, also to access community resources and for health and other appointments. A new shift planner system was being implemented, designed by two support workers in collaboration with the whole team. Staff stated that so far it was working well, with tasks and care and support responsibilities designated to named workers. The shift planner provides an audit trail of the care and support received by each individual and of their social activities. Maintenance work had been carried out to address health and safety and maintenance shortfalls in the environment identified at the time of the last inspection. The homes management structure has been reconfigured. The roles of the registered service manager and deputy manager for the organisations care home in Aldershot have been extended to the management of both homes. Though some management shortfalls were identified, generally these arrangements appear satisfactory and staff reported feeling well supported. A care manager commented in positive terms regarding the new management arrangements, stating the manager and deputy manager are both skilled and enthusiastic about further developing the service. What they could do better: At the time of the last inspection the homes overall quality rating was no stars, poor quality service. An improvement plan was required and the homes management is working through this plan to improve outcomes for people using the homes services. There is a need to demonstrate these improvements can be sustained and for full compliance with the improvement plan. The home has not had a registered manager since April 2008 and a requirement has been made for this statutory requirement to be met. The homes statement of purpose could not be located at the time of the inspection visit. The service manager agreed to ensure the homes statement of purpose is found and reviewed, to ensure it reflects current services and is up to date. The service users guide was noted to need updating. Whilst improvement in arrangements enabling people using services to engage in community activities was evident, survey feedback from staff and other parties highlights that staffing levels can at time be stretched, especially in relation to transport and community outings. The service manager acknowledged that until a full compliment of staff is recruited that staffing levels at weekends restricts staffs ability to support people using services being part of their community. A copy of the local multi agency safeguarding procedures could not be found. Care Homes for Adults (18-65 years) Page 9 of 37 The service manager confirmed ongoing discussions and negotiations between the organisation and the housing association landlord for agreement on individual responsibility for repairs and redecoration at the home. A programme of redecoration and upgrading needs to be instituted to improve and maintain standards. It was stated this was planned to commence in the next financial year. A partial upgrade of the kitchen was anticipated and redecoration of communal areas, including bathrooms, by the landlord.The service manager did not know the projected timescales for completion of this work. The service manager referred to the need for agreement with the landlord on responsibility for conducting and paying for health and safety audits; also removal of trees in the garden, stated to be a potential hazard to the buildings fabric and to significantly reduce natural lighting in some bedrooms. There are plans for a senior support worker to redecorate the bedrooms in the next twelve months. Whilst staff recruitment procedures are safe some shortfalls in this area need to be addressed. Hazards found during this visit identified the need for staff to be extra vigilant and to recognise individual responsibility for ensuring a safe environment, at all times. The need to ensure an inclusive quality assurance system was discussed with the service manager. There had been slippage in the timescale specified in the homes improvement plan for undertaking a quality survey of service stakeholders. 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 37 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 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home must have an up to date statement of purpose and service users guide. The individual needs and aspirations of prospective people using services are assessed before admission, to ensure these can be met by the home. Evidence: The available information identified that the people using the homes services require a significant amount of support from someone who knows them well, to help communicate their views and choices. The views and choices made vary, dependent on the individual, and not all people would have had capacity to make a decision about where they wished to live. The homes statement of purpose could not be located at the time of the inspection visit. We last inspected this document in 2005 at which time it had just been updated. It included the required information in accordance with Schedule 1 of the Care Homes Regulations 2001, as amended. The service manager agreed to ensure the homes statement of purpose is found and reviewed to ensure this reflects current services Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: and is up to date. This document must be accessible and made available, on request, to representatives of people using services. The service users guide contains information about the home, staff, care plans, food, health, leisure and choices. The service aims, set out in this document, are to provide a safe, homely and comfortable environment, building a good relationship with people using services in order to promote rights, develop skills and independence. The service users guide states that all people using the homes services have learning disabilities and varying degrees of challenging behaviours. It is produced in a format using pictures and key words to aid understanding. Staff consulted stated that none of the people currently living at the home had capacity to read or follow easy ready pictorial symbols. For this reason they had not been issued with a personal copy of the guide. The need to update this document was identified. There are plans to further develop the documents format to make it more accessible to people who might use the homes services in the future. There were no vacancies at the time of the inspection visit. Four of the five people living at 15a Vale Road had done so since the home was first registered in 1996. Preadmission assessments had not been undertaken at that time. There have been no admissions or discharges since 1997. As at the time of the last inspection assessment records were not available for inspection. The organisations admission procedure requires management to obtain copies of the summary and care plans from the assessments carried out through care management arrangements. The service manager would consult the assessment information to see if the home can meet the prospective persons needs before making a decision to accept the application for admission. Pre-assessment procedures would include a visit to prospective people using services to find out, using appropriate communication strategies, what is important to and for that individual, consulting with relatives, carers and relevant professionals. Care Homes for Adults (18-65 years) Page 13 of 37 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 assessed and changing needs of people using services are reflected in individualised support plans. Staff assist them in making decisions, promoting independence and informed risk-taking within individual levels of capacity. Evidence: People using this service are mostly unable to verbally express choices or opinions. Staff have implemented the use of new person centred tools to engage them in the process of care planning and meet their individual, holistic needs. The organisation is committed to the Way We Work person centred approach to planning care and support. There is an ongoing programme of staff training to support their learning in this approach and use of these tools. The records sampled demonstrated that staff had been working with the Community Learning Disability Team to ensure the health and wellbeing of people using services. Discussion with staff confirmed their understanding of communication methods used by each person using services, addressing the Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: individuality of each person and enabling choices in their daily lives. This is achieved through observations of behaviours and by knowing individual likes and dislikes. Some staff have known the people living in this home long before their admission, whilst living in other care settings. Staff said the process of discovering what individuals really want and like can be lengthy, frequently involving a process of elimination. A flexible and individualised approach to the care and support of people using services was evident, ensuring continuity of structures and routines needed in their lives. The care plans sampled had been recently reviewed and incorporated the views of family members and other significant people. A key worker system ensured care plans are regularly reviewed and updated.Care records included personal information, likes, dislikes, procedures for care, prevention from harm, risk assessments, annual care reviews, health records and choices. The internal review system currently being implemented involves a whole team approach. All staff have opportunity to engage in the review process, contributing information and ideas during discussions at team meetings. Care management reviews were also evidenced. Survey feedback from relatives confirmed staff assist people using services in making choices and decisions in their daily lives. A relative commented, Though my relative is unable to make decisions about what he/she does each day, he/she likes the freedom to rush about in the garden. Another said, my relative usually makes decisions about what to do each day and can do what he/she wants at all times. Staff enable choice in the planning of holidays, menus and community activities by knowing each individual well. All people using services access day services, the frequency varying for each individual. Since the last inspection the staff recruitment process has taken account of the importance of matching staff with people using services and activities, in order to achieve maximum enjoyment for all. Discussions with the service manager confirmed effort made to recruit new care staff with skills and personalities to enhance diversity within the staff team. The homes management and staff recognise that the time taken to ensure a comprehensive induction for new staff and shortage of staff drivers had been a barrier to community inclusion for people using the homes services. There was evidence of effort having been made, however, to reduce the impact of these barriers through an increase in opportunities for social engagement using Mencap support workers, recruitment of a part time senior support worker who drives the homes vehicle Monday to Friday and changes to the staff rota. The home has linked up with another local care home within the group, increasing opportunities for community activities for a person who has autistic spectrum disorder in addition to learning disabilities. Care Homes for Adults (18-65 years) Page 15 of 37 Care Homes for Adults (18-65 years) Page 16 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been an increase in opportunities for people using services to take part in culturally and age appropriate activities outside the home during the week. This is an area for further development to enable integration into community life at weekends. People using services receive support to maintain personal and family relationships and are offered a varied, balanced diet. Evidence: The homes daily routines promotes independence, individual choice and freedom of movement, so far as possible within individual levels of capacity. Survey feedback from a care manager confirmed assessment arrangements ensured accurate information is gathered and that the right service is planned. The person she is responsible for has his needs met within the home environment, by accessing external support from day services and Mencap. He was stated to receive the support needed, Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: as far as possible, to live the life he chooses. His key worker has known him for many years and has a good understanding of his needs and communication methods. It was stated that the home accommodates people with diverse needs and these are well managed by staff, in a non-discriminatory way. The care manager described the home as welcoming and open, commenting on the enthusiasm of staff for the people they work with. She was positive about the review process, stating this was very person centred, involving all staff. A communication board using photographs and symbols to show what would be happening each day, including which members of staff were going to be on duty and the days menu, was not up to date at the time of the visit. A staff member said the communication needs and levels of capacity of the people using services impaired their understanding of this information.Observations indicated that staff know the people using services well and their needs. There was regular interaction between staff and people using services, in a positive manner, calling them by their first names and providing support with tasks, as required. Staff explained how they communicate with individuals through body language, pointing, facial expressions and behaviour. One person using services took hold of the inspectors arm and led her towards the front door. The manager stated this was his way of communicating he would like to go out for a walk or in the minibus. People using services do not access employment or further education, due their capacity levels and communication needs. The home is working towards fuller community presence and participation. Since the last inspection a concerted effort had been made to recruit to staff vacancies, and two new full time support workers and one part time senior support worker had been employed. Effort is ongoing to recruit to remaining staff vacancies and to build up the relief staff bank. There is ongoing review and management of staff rotas, to ensure staff cover where needed. A mid-shift has been introduced Monday to Fridays which can be flexible, used for transporting people using services to and from day services in the homes vehicle, also to access community resources and for health and other appointments. A new shift planner system was being implemented, designed by two support workers in collaboration with the whole team. Staff stated that so far it was working well, with tasks and care and support responsibilities designated to named workers. The shift planner provides an audit trail of the care and support received by each individual and of their social activities. Though improvement was evidenced in enabling people using services to engage in community activities, survey feedback from staff and other parties continue to highlight that staffing levels can at time be stretched, especially in relation to transport and community outings. The service manager acknowledged that until a full compliment of staff is recruited that staffing levels at weekends restricts staffs ability to support people using services engaging in community activities. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: Some people using services attend a Mencap Day Centre during the week where they meet with their peers and participate in a range of activities, for example, dance, drama, arts and crafts. Support workers from Mencap take individuals out for meals, shopping, swimming and walks. This was evidenced in care plans and by direct observation. At the time of the inspection, two support workers from Mencap went out with two people, using community resources. Support workers said they can only take people out into the community and shopping for food when there are more than two staff on duty. They also advised that they need to carefully select community activities according to the needs, understanding and behaviours of each individual, to avoid distress. People using the homes services do not go to cinemas or churches due their low level of understanding. Positive feedback was received from a relative about new arrangements for a person using services to attend a specialist day service one day a week, after a five year wait for a place. Observations confirmed good practice approach to meeting this persons complex needs. Records and discussions with staff confirmed good understanding of the underlying impairment to functioning and behaviours of this individual. They were well attuned to how he sees the world. Structures were in place to look holistically at this person, trying to establish needs, likes and dislikes. A senior support worker had attained a certificate of studies with the National Autistic Society and is currently undertaking further training in this area of practice. As key worker for this person, he is the designated link between the Autistic Society and the staff team. Observations confirmed clear behavioural management guidelines and risk assessments in place. There is a team approach to managing his complex and challenging behaviours, which can be destructive and adversely impact on the rights and privacy of others living in the home. The strategy for safeguarding the personal possessions of others and the privacy of their personal space is to lock all doors throughout the home, leaving keys in locks. Records include the reason why people using services have not been issued with a personal key to their rooms; also the rationale for locking doors including bedroom doors when occupants are out or not using their bedroom. Developments in meeting the needs of this person included review of his bedroom to provide a low arousal, safe environment, aimed to reduce anxiety and minimise destruction of furnishings and possessions. Work is ongoing to enhance this bedroom, with plans for redecoration using appropriate colours and provision of a blind, though this might need to be an external blind. Staff ensured this persons choices were respected at the time of the visit. He had access to his bedroom at all times, his preference to eat alone in the dining room before others was accommodated also his wish to accompany the driver on journeys to and from day centres each day. The need to ensure a risk assessment is carried out for this person when in the mini bus with only the driver was discussed with his key worker. Since the last inspection this person Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: and one other had enjoyed a weeks holiday with staff support, staying in self catering accommodation at a seaside resort. Relatives and friends of people using services are welcome to visit at any time. Members of staff shop for food twice a week, prepare and cook meals and have received food hygiene training. Staff know the favourite foods of people using services and accommodate their preferences and special diets when planning menus.Practice observations included lunch and the evening meal. The meals were appetising and substantial and nicely presented. There was a relaxed, social atmosphere in the dining room. Care Homes for Adults (18-65 years) Page 20 of 37 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 health and personal care that people using services receive is based on their individual needs. The management of medication is safe and the principles of respect, dignity and privacy are put into practice. The ageing, illness and death of people using services is handled with sensitivity and respect. Evidence: People using services are registered with a general practitioner (GP) and receive effective personal and healthcare support, using a person centred approach. Personal and healthcare support is underpinned by quality principles and the right of people using services to privacy and dignity, equality and respect. The GP told us in our survey that staff always seek advice and act upon it to manage and improve individuals health care needs. He commented that individual needs can never be fully met but insofar as this is possible, it is done. He said that staff always respected the privacy and dignity of people using services, endeavouring to ascertain their wishes and provide choice in their lives. The GP expressed opinion that staff at the home provide an excellent standard of care to a very dependent and challenging group of Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: people. This opinion was endorsed by a care manager, who told us that at the last review meeting of the person living at the home for whom she had responsibility, his health care needs appeared well met. His review had been very person centred and his individual needs had been carefully considered. Personal and intimate support needs are recorded in care plans, based on individual needs assessments and known preferences. The fragmentation of care records and weight of information was observed to create difficulties in navigating care plans, to be clear of current needs, risks and goals. This was discussed with the service manager who advised that the deputy manager with delegated lead responsibility for care planning had recognised this issue. She was intending to streamline the care records in due course. The gender mix of people using services is two females and three males. The only male worker on the team confirmed that he does not routinely engage in the delivery of intimate personal care to female users, though if necessary in an emergency he would, assisted by a female worker. Staff felt that the care plans contained the information necessary to inform them of the way people using services prefer their care and support. They were confident that they would be aware if the people they supported were not happy with any aspect of their care, through their preferred method of communication. Care plans and risk assessments were sampled, focusing on the management of specific health conditions of individuals. These included the safe management of epilepsy, incontinence and constipation. Observations included infection control procedures and practice. It was good to note the homes managements engagement with relevant health professionals to ensure the health and wellbeing of people using services. There was evidence of staff have received training to enable safe and appropriate personal and healthcare. Aids and equipment are provided in accordance with assessed needs.These include wheelchairs, profiling beds, pressure relieving mattresses and cushions, hoists and overhead tracking in bathrooms. Since the last inspection the second new assisted bath not yet connected at the time, was now fully functioning, meeting the equipment needs of all people using services. The home has an efficient medication policy and procedure, which staff understand and follow. Medication records sampled were fully completed, containing required entries and signed by appropriate staff. Medication training was evidenced for staff responsible for administration of medication. Medication was securely and appropriately stored. The requirement for review of covert medication practice identified at the time of the last inspection had been met. A letter had been sent to the GP requesting his permission to administer medication in food products, such as jelly or yogurt. His agreement was recorded in care plans and in medication records.The service manager emphasised that covert medication administration is not practised Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: and this method of administration due to difficulties encountered by individuals in swallowing tablets. The service manager confirmed that the GP does undertake medication reviews and it was suggested she consult him regarding the possibility of prescribing liquid medication, where practicable, for these individuals. Other discussions with the service manager included end of life care planning and how the home deals with ageing, illness, death and bereavement. It was confirmed that the home had in the past endeavoured to provide terminal care with support from healthcare professionals. The service manager stated that end of life care planning is on the agenda at the time of care management reviews and she recognised the need to put end of life plans in place. Care Homes for Adults (18-65 years) Page 23 of 37 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 is a complaint procedure and the home has robust policies and procedures to safeguard people using services from harm and abuse. Evidence: We have not received any complaints about this service since the last inspection. The home has a corporate complaint policy and procedure and a pictorial complaint leaflet is on the files of people using services. Staff expressed the view that none of the people currently using the homes services had capacity to use the complaint procedure and advocates would need to do so, on their behalf. A relative who completed our survey said her relative living in the home has no verbal communication and is unable to tell people if unhappy or wishing to complain. Another persons representative felt their relative would know who to tell if unhappy. The homes records showed that no complaints had been investigated since the last inspection and the service manager stated none had been received. A new staff member consulted during the visit had read the complaint policy and procedure, and was able to give an accurate account of the process. We have not received any complaints about this home since the last inspection. Other staff were also aware of the complaint procedure and would report any concerns or complaints expressed to them to their line manager. At the time of the inspection visit there had no been any safeguarding incidents since the last inspection. On the day of the inspection visit the service manager was Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: following the organisations own procedures to ensure the safety of people using services, in response a potential safeguarding allegation. She was adhering to the organisations policies and procedures in this matter with input from the organisations human resources department. The internal safeguarding procedures integrate with local multi-agency safeguarding procedures. Staff training records evidenced they had received or were booked to attend safeguarding adults training. Discussions with a new staff member evidenced she had read and understood the safeguarding adults policy. She was clear of who to report allegations or suspicions of abuse to. Staff have access to the organisations whistle blowing policy challenging bad practice. The service manager was unable to locate a copy of Surreys multi agency safeguarding procedures at the time of the visit and was requested to obtain the latest copy, available on the web. She confirmed having attended safeguarding training in the past and her intention to enrol on Surreys safeguarding workshop, in due course. Systems are in place for the protection of people using services from financial abuse. During the visit, financial records were sampled and found to included details and receipts of all transactions made on their behalf by staff. The service manager audits the financial system and bank statements on a regular basis and the area manager also carries out checks, on occasions, during statutory visits to the home. Care Homes for Adults (18-65 years) Page 25 of 37 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 location and layout of the home is suitable for its stated purpose. The home was found to be comfortable, clean and hygienic on the day of the visit, but in need of further maintenance and redecoration and attention to hazards. Evidence: A full tour of the premises and garden was undertaken at the time of the inspection visit. All areas were clean and tidy and odour satisfactorily managed. Maintenance work had been carried out to address most environmental shortfalls identified at the time of the last inspection. This included fitting a lock to the garden gate leading to a canal tow path. Discussion took place with the service manager on the need for all staff to take individual responsibility for maintaining the safety of the care environment at all times. This was in response to observation of an unlocked boiler cupboard door in a toilet which was identified during the last inspection, also the need to keep the doors locked on automated disinfection units containing chemicals, for cleaning baths. The service manager accepted this was a shortfall in practice and drew this to staffs attention at the time of the inspection. The need to securely store toiletries left on a low, open shelf in a bathroom was identified. This had been an oversight by staff and stated not to be standard practice. Discussion took place with the service manager regarding her review of privacy of people using services when Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: using bathrooms. The review decision was it was not necessary to change the existing arrangements that were found to adequately safeguard privacy and dignity. Bedrooms, with the exception of one, were comfortable, well furnished and personalised with possessions reflecting the individuality and interests of their occupants. The home supports one person with autism spectrum disorder who rejects any furniture and objects from his room, including beds. This has been costly in the past. A person centred planning approach has been used to discover what is important to and for this individual and as a result a staff member has built a bed for him, secured to the floor. A gradual, long term approach to personalising this bedroom is planned, taking account of his needs and respecting his wishes. The home is fully wheelchair accessible, promoting independence. Aids and equipment, including profiling beds and hoists are provided to meet the individual needs of people using services. There are two new baths, one with a jacuzzi feature. Since the last inspection both are now fully functioning. Observations confirmed the need to replace the water damaged floor coverings in both bathrooms and to redecorate and replace some broken wall tiles. The need to upgrade the kitchen and implement a redecoration programme to improve and maintain standards is recognised by the homes management. The service manager confirmed recent progress in negotiations between the organisation and the housing association landlord specific to agreements on responsibilities for maintenance and decoration. It was understood the tenancy agreement did not clearly define each organisations areas of responsibility. A programme of redecoration and upgrading was stated to have been agreed with the housing association and due to begin in the next financial year. A partial upgrade of the kitchen was anticipated and redecoration of communal areas including bathrooms, funded by the landlord. The service manager did not have timescales for completion of this work. A further meeting has taken place with the landlord since the visit. The service manager also spoken of the need for agreement on responsibility for funding and carrying out health and safety audits and essential health and safety work. Specifically, removal of trees in the garden stated to be a potential hazard to the buildings fabric which also reduce natural light in some bedrooms. Other plans for improvement to the environment include the development of a sensory garden to enhance stimulation for people using services. Since the last inspection a relief senior support worker had joined the team, part time, who is willing and capable of carrying out repairs and undertake redecoration work the landlord is unwilling to do. It is the intention for this worker to redecorate all bedrooms next year. On the day of Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: the inspection visit he was preparing to clean moss off the garden paths, which was a potential hazard. Care Homes for Adults (18-65 years) Page 28 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are clear of their roles and responsibilities. Policies and procedures ensure staff recruitment procedures are safe however shortfalls in this area need attention. The staff induction and training programme ensures staff have the necessary skills and competencies. Whilst positive to observe some improvement to staffing levels, shortfalls at weekends inhibit use of community facilities. Evidence: Relatives surveys confirmed their experience of staff always treating their relatives who use the homes services very well. One relative commented that staff listen and act on what he or she said, as their relative has no speech.The other stated staff always listen and act on their relatives wishes. Observations during the inspection visit confirmed consistency of care and support to people using services and staff evidently clear of the individual needs, methods of communication and personal preferences of people using services. Staff on duty presented as being motivated and committed to the people living at the home, organising services around their needs and wishes, so far as possible, within available resources. Staffing levels had been reviewed and increased since the last inspection. A mid shift had been introduced, providing a third worker for peak periods of activity Monday to Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: Friday. Staffing levels of two during the weekends continue, with the intention of an increase in due course, following recruitment of additional staff. The mid shift is covered by a senior support worker who transfered to the team from the organisations relief staff bank. He works part time at this home and part time at another nearby home, within the group. In addition to providing care and support to people using services, his duties include transporting them to and from day services and to medical and other appointments and some maintenance work. A staff member commented in our survey that since taking up post more staff had been recruited and staffing levels had improved. This person felt the needs of people using services were being met. Another staff member said that usually there is enough staff to meet individual needs, however sometimes there are still only two staff, expressing opinion that three are necessary, especially a driver. This person added that more staff need to be on duty to enable access to community activities. Both described good team work among staff. They confirmed that they ensure people using services attend their respective day services. They reported having person centred meetings involving all staff and frequent discussions with people using services, to establish what they need and want. A survey from another party also highlighted staffing levels can at times be an issue, commenting that staff can be overstretched, especially in relation to transport and outings. Senior support workers and support workers have generic roles and responsibilities. Additional to their care and support role, they are responsible for housekeeping and laundry tasks, for purchasing food and catering and accompany people using services on some community activities, transporting them to and from day services. It was evident from all available information that staffing levels are not adequate at weekends and need to be increased, to enable community participation. The service manager confirmed the intention to do so once staff vacancies are filled. In the interim the homes management should consider increasing weekend staffing levels using relief staff. The home commenced the recruitment process for support workers in March this year. Since then two new full time support workers have been recruited and a part time senior support worker to the team. Staff turnover in the last twelve months included three full time support workers and currently another is on special leave. The organisation has a comprehensive recruitment policy and procedure that lists the appropriate checks to be carried out for all new staff. Three staff files were inspected as part of the inspection process. A good understanding of equality and diversity was demonstrated throughout the recruitment, induction and training process. Whilst safe recruitment practice was evident, the service manager must ensure evidence of medical declarations completed by prospective staff is maintained on their files and a current photograph. A record must be in place and available for future inspection, in accordance with the Criminal Records Bureau (CRB) policy guidance. The need to Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: ensure that the CRB policy guidance is followed regarding storage and disposal of staffs CRB disclosures was also discussed. The content of the induction and probationary periods for new staff was seen to be very robust, detailed and service specific. Induction training covers the mandatory common induction standards. Feedback in staff surveys was positive about the induction and training opportunities. One staff member told us the staff induction covered everything needed, commenting, the staff team and management have been brilliant in inducting and teaching me. Both confirmed that the training received was relevant and enabled them to fulfil their role. One of the two respondents had completed NVQ Level 3 and spoke highly of the support received from the current service manager during the NVQ programme. The home is working toward meeting the standard for 50 of support workers possessing NVQ care qualifications of at least at level 2 or equivalent. Discussions with staff confirmed clarity of roles and responsibilities. They had job descriptions and contracts of employment. Staff training records had been reviewed and updated since the last inspection. Staff requiring refresher mandatory training had been booked onto the next available courses. Staff training is overseen by staff at head office and a system in place to alert homes managers when named members of staff are due refresher training. Copies of training certificates were seen including moving and handling, equality and diversity, health and safety and first aid. Mostly the people who use the service do not have speech and communicate in other ways. The manager confirmed staff access to a one day course to raise awareness of various forms of communication. Other external training undertaken included health action planning. The service manager and deputy service manager attended an organisational practice development workshops to enhance their knowledge and skills and had shared good practice with staff. Care Homes for Adults (18-65 years) Page 31 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not had a registered manager since April 2008 and a requirement has been made for compliance with the statutory requirement to do so. Whilst acknowledging improvement in the homes management and in health and safety, shortfalls in staffing levels and environmental standards are in need of further attention. Quality assurance systems must ensure consultation with relevant stake holders. Evidence: The homes management structure has been reconfigured. The roles of the registered service manager and deputy manager for the organisations care home in Aldershot have been extended to the management of both homes. They have clearly defined responsibilities, the service managers primary focus being the day to day general management of each service. The deputy manager has delegated responsibility for practice development, care planning and coaching staff teams on use of person centred thinking tools. The managers spend two days a week working in each of the homes, providing a manager in each of the homes four days a week. They work Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: together on the fifth day, in each home, alternating the homes. The service manager has no management responsibilities external to the homes and is supported by an area manager. She attends managers meeting at the area office every two months. The management time spent at the home is now recorded on the staff rota. The service manager reported that the new structure was operating effectively and that the area manager shares on call responsibilities. When either manager is on leave the other manager divides their time equally between both homes. The management structure includes senior support workers who assume shift leader responsibilities. Comments from individual staff confirmed they are well supported by managers. A care manager told us in a survey that the new management arrangements had improved the service. It was said the manager and deputy manager were both skilled and enthusiastic about further developing the service. It was positive to note the action taken since the last inspection to partially address the staffing shortfalls in this services. During the week staffing levels have been increased and other arrangements put in place to afford increased opportunities for people using services to engage in community activities. The findings of this inspection however identified the need for the homes management to review arrangements at weekends for promoting and enabling community inclusion for people using services. Observations and discussions with the manager confirmed the need for further attention to be given to office management and administration. The need to ensure staff have access to the organisations updated policies and procedures was noted. It was suggested to the service manager she contacts the fire officer to ensure fire evacuation procedures are compliant with the Regulatory Reform Fire Safety Order 2005. The Annual Quality Assurance Assessment (AQAA) submitted by the service manager recorded that the home did not have a current electrical certificate. This had not been followed up by management at the time of the inspection visit and the service manager requested to give this priority attention. It has since been confirmed that a 10 year electrical certificate was issued in 2002 and a copy has been obtained and filed at the home. Though health and safety systems had generally improved since the last inspection, shortfalls found during the inspection visit highlighted the need for extra staff vigilance and awareness of individual responsibility for maintaining a safe environment. Health and safety checks are undertaken monthly and quarterly audits carried out on risk assessments. Work had taken place and is ongoing for updating record keeping systems, in the areas of menu planning, staff training and the staff rota. Hazardous substances, including cleaning materials and disinfectants had been removed from the laundry room. The service manager met with staff after the last inspection to refresh their knowledge of the Control of Substances Hazardous to Health Care Homes for Adults (18-65 years) Page 33 of 37 Evidence: Regulations 1999 (COSHH) and remind them of their related duty of care. The practice of toiletries stored accessible to people using services in bedrooms, was said to have been risk assessed. The gate leading to the canal has been secured with a new padlock and added to monthly safety check list. Garden and environmental risk assessments had been updated. The organisations getting it right policy and procedure, sets out how the organisation expects to find out the quality of its service provision. It was unclear how the information would be collected and put together so that people using services and their relatives would know the outcome of quality assurance audits. There had been slippage in the proposed time scale for carrying out a quality survey owing to unanticipated pressure on the service managers time. The manager confirmed her intention to imminently undertake the survey. Observations confirmed monthly visits to the home by a representative of the responsible individual, in accordance with statutory requirements. People using services have bank accounts. There is a safe in the home for security of their money. Two staff signatories are required for the withdrawal of money from these accounts. Systems are in place for audits bank statements and the management and expenditure of personal finances. Care Homes for Adults (18-65 years) Page 34 of 37 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 35 of 37 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 37 8 The home manager must be supported in making application for registration. This will ensure the home is managed by a person who is fit to be in charge, in the best interest of people using services. 30/01/2009 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 Care Homes for Adults (18-65 years) Page 36 of 37 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). 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