Inspection on 30/09/08 for Ventana

This inspection was carried out on 30th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ventana 10/09/07

Ventana 13/09/06

Ventana 05/10/05

Ventana 03/05/05

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ventana 33 Florence Road Boscombe Bournemouth Dorset BH5 1HJ     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: Heidi Banks     Date: 0 1 1 0 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 35 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 35 Information about the care home Name of care home: Address: Ventana 33 Florence Road Boscombe Bournemouth Dorset BH5 1HJ 01202390209 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Paul Anthony Greenwood Type of registration: Number of places registered: Ventana Homes Ltd care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Ventana is registered to provide accommodation and care for up to eight adults with learning disabilities. The home provides 24 hour care. The home is owned by Ventana Homes Ltd. The Registered Manager for the service is Mr Paul Greenwood. From information provided to us by the service in November 2008, individual weekly fees at the home range from 1000 - 1700 pounds. Further information on fee levels and fair terms of contracts can be obtained from the Office of Fair Trading at www.oft.gov.uk. 8 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was a unannounced key inspection of Ventana. The inspection took place over two days on 30th September and 1st October 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the requirements made at the last inspection of the service in September 2007. At the time of the inspection people living in the home were aged between 28 and 44. This inspection was carried out by one inspector but throughout the report the term we is used to show that the report is the view of the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 5 of 35 During the inspection we were able to meet most of the people who use the service and observe interaction between them and staff. Discussion took place with the Registered Manager of the home, Mr Paul Greenwood, the deputy manager and some members of staff in the home. A sample of records was examined including some policies and procedures, medication administration records, staff recruitment and training records and information about people who live in the home. Surveys were sent to the service before the inspection for distribution among people who live in the home and those who have contact with them. We received two completed surveys from people who use the service, one from a health care professional and five from care workers employed to work in the home. We received the homes Annual Quality Assurance Assessment before the inspection which gives us some written information and numerical data about the service. A total of twenty-two standards were assessed at this inspection. What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection we have made one requirement. This requirement is repeated from the last two inspections of the service and relates to the homes recruitment procedures. Out of three staff records we looked at for evidence of safe recruitment procedures, two did not fully meet the minimum standard. This must be addressed for the home to demonstrate that procedures for employing staff are robust and protect vulnerable people. The Registered Manager has stated his commitment to meeting the regulations in this area but must be aware that the Commission may take enforcement action if there is further breach of this regulation. We have also made thirteen recommendations as a result of this inspection. Recommendations are good practice and therefore should be taken seriously by the provider in order to promote positive outcomes for people who use the service. We noted gaps in assessment documentation for a person who had come to live in the home in the last twelve months. This should be addressed so that the home can be confident that they have full information about peoples needs on which to base their care. The care plans we looked at were not in a format accessible to people who use the service. Although they contain some appropriate information, there were some areas of the care plans and risk assessments that would benefit from more detail to promote consistency in care delivery and ensure a person-centred approach. The home aims to have an individualised approach to meeting peoples lifestyle and social needs. However, we identified some examples where there was limited evidence of peoples choices and goals being followed through in practice. The home needs to demonstrate through their care planning and record-keeping process that individuals have ample opportunities to engage in activities they enjoy and are meaningful to them. Although people benefit from the involvement of health care professionals in meeting their needs we noted that for one person a specific health care need identified at assessment had not been followed up appropriately and record-keeping in some areas Care Homes for Adults (18-65 years) Page 7 of 35 was incomplete. This should be reviewed by the home to ensure that health care needs are clearly identified and follow-up actions are consistently recorded. We identified that while core training for care workers is in place there is some room for development in relation to specialist training and to increase the number of staff with National Vocational Qualifications. This will help ensure that people who use the service benefit from staff who have relevant knowledge and skills about learning disability and their specific needs. We have made recommendations about the homes quality assurance and monitoring processes which need further development. This will ensure that the home continues to meet peoples needs and best interests and that systems in the home benefit from regular audit. A recommendation has also been made in relation to health and safety practices in the home to minimise potential risks to people who use the service and ensure their safety and welfare is promoted. 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 8 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that peoples needs are assessed prior to their admission but some gaps in documentation mean that there may not always be sufficient information to ensure the persons needs are fully met. Evidence: The home has told us in their Annual Quality Assurance Assessment that they carry out a thorough assessment of peoples needs prior to admission to ensure that the home is suited to them. We looked at the records for one person who had moved to the home since the last inspection. There was evidence of a Moving In Assessment being carried out by a representative of the home in conjunction with the persons key worker at their last placement. Although this contained some useful information we noted some gaps where certain sections had not been completed, in particular the persons religion and information about their previous medical history. Although the person is funded by the local authority the home had not obtained a copy of their assessment document. There was evidence on the persons record that liaison had Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: taken place between the home and the persons Care Manager with a transition meeting being held prior to their admission and that the person had been given opportunities to visit the home before moving in. We spoke with a relative who was visiting the home at the time of the inspection who expressed their satisfaction with the arrangements in place to support their family member with the transition. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning in the home shows some consideration of peoples preferences, choices and needs. However, written documentation does not always reflect how these are being met by the home. Evidence: The care plans we looked at contained some useful information about peoples needs, the choices they are able to make and their likes and dislikes. There was also reference to what the person can do for themselves, for example, X is able to carry out simple instructions in order to undertake her personal care needs although it is recommended that the home expands on this information so that the simple instructions understood by the individual are defined in the plan. This will enable new staff to communicate with the person and promote consistency among the staff team. We also noted that some information obtained in a persons admission assessment had Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: not been transferred into the support plan, for example, the fact that the person is known to settle better at night when she has certain items with her. Three out of five care workers who responded to our survey indicated that they were always given upto-date information about the needs of the people they support, two indicating that this was usually the case. They also commented that peoples needs were discussed in support sessions and team meetings and that staff were made aware of any changes. We noted that plans were not always in a format accessible to the people they belong to. The deputy manager told us that she would be attending training in Person Centred Planning with a view to developing this within the home. Goals for each person to achieve had been noted in the plans but there was limited evidence of progress being made towards achieving them. For example, accessing aromatherapy was an opportunity that was identified during the assessment process and in the support plan as an activity one person would enjoy. Discussion with the manager indicated that although the person had been resident in the home since March 2008 this had not been implemented to date due to funding issues. Another goal identified in the plan was For X to help with her own shopping at least once a month. However, the goal monitoring chart in place had not been completed in relation to this so it was not clear whether this had been achieved. We looked at the daily records for the previous month which did not show evidence that the individual had helped with shopping. For another person the care plan stated that X would like to go out for a pub visit once a week. Again, there was no evidence from daily records over the previous month that this had happened. This had been picked up on by a senior member of staff who had noted in the record that the persons goals were not being recorded on a daily basis by staff. A care worker who responded to our survey also indicated Individual needs are thought about and each (person) has objectives, aims and choices which we try to achieve each month although I think this could be improved upon as they are not always met. The care plans we looked at showed some consideration of risks. For example, for one person it was indicated that although they are able to walk independently while out in the community they have difficulty judging distance and different surfaces. The plan went on to say that the person will require staff support whilst out for support and stability. From this information it was not clear what support is needed from staff and whether more support may be required in some environments than others. Specific hazards and the level of risk to the person had also not been identified. For another person the plan stated that they have no awareness or concept of safety Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: outside of the home and went on to say I must always be supervised when out in the community. The specific nature of this supervision had not been identified in the plan. Specific risk assessments were in place for some of the people who use the service, for example, in relation to using the kitchen to prepare meals and make hot drinks, running the bath and going swimming. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights are respected by the service and their contact with their families is actively promoted. However, further development is needed in the provision of activities for individuals to ensure that their preferences and goals as identified in their care plans form the basis of care delivery. Evidence: The home has told us in their Annual Quality Assurance Assessment that each of our service users has an individualised timetable which is tailored to peoples wishes and needs. Timetables are displayed on the office wall, indicating that people attend a range of activities including attendance at a local arts centre, pamper afternoons, communication, horticulture, access to a sensory room, walks and visits to local cafes. During the inspection we observed that the home tries to promote an individualised approach to activities and while some people attend local day services, others were Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: engaging in activities on a one-to-one basis with staff including a trip to the pub and a walk to the beach. The home has recently purchased a Nintendo Wii game station which two people told us they enjoy. Discussion with staff indicated an awareness that individuals have different needs with regards to activities. One member of staff indicated in a survey that they thought activities and holidays was something the service did well, sometimes we are purposely overstaffed to allow more time to do activities and have 1:1 which is very useful and good for service users. Another care worker, however, indicated that they thought activities were an area which could be improved upon. For the two people we case-tracked, daily records showed evidence of one person attending a day centre on four days each week. The other individual did not access a day service so we looked to see what activities had been offered to them during the period from 3rd - 30th September. We noted that during the four week period there were numerous entries indicating that the person had stayed at home but generally there was little information about what they had done at these times. Entries we saw included; Afternoon at home; Stayed around the house; Stayed in Ventana the whole morning; Spent morning at home; Stayed in her bedroom listening to music and on the landing looking out of the window; Stayed in the house the whole morning wandering around. Approximately one third of the entries for the period we looked at indicated that the person had stayed at home for the whole day. We had already noted from the care plan that one of the persons preferred activities was going into town and looking around the shops and going out and meeting people and a goal had been identified for them to go out to the pub once a week. However, the daily records did not demonstrate how these preferences and goals were being met. We noted that the person had recently returned to college and therefore their records showed more structured activity since college had re-started. However, we have recommended that the home looks to ensure that the care they deliver offers real choice to people about how they spend their free time including activities that they have been identified as enjoying in their care plan. Observation of life in the home showed that there is acknowledgement of peoples rights with regards to having access to all communal areas of the house and possession of keys to the front door and their own bedroom doors where they have been risk assessed as able to do so. We observed some examples of staff interacting positively with people who use the service and communicating with them in a way that promoted their dignity. People are able to have visitors as they wish. We noted that one persons relative visited the home spontaneously during the inspection. He reported that he was always made to feel welcome in the home and felt there was good communication between him and staff. We saw evidence that meetings have been arranged in the home for relatives of people who use the service as a means of Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: involving them in their family members life and to promote open communication between the staff team and relatives. One care worker commented in a survey that the home could provide a better quality of food for people. The Deputy Manager told us that they are reviewing menus to improve choice and variety. Staff we spoke with during the inspection confirmed this. We looked at menus and recording of peoples food intake. We saw that recording had improved since the last inspection. The menu indicated that a range of foods is offered to people. There was some evidence of value brands being purchased including meat and fish which we suggest the home keeps under review. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home demonstrates some elements of good practice in the delivery of personal and health care to people who use the service. However, there are some gaps which should be addressed to ensure that people always receive the intervention they need and that record-keeping reflects this. Evidence: We looked at a sample of two care plans for evidence of information they contain about peoples personal and health care needs. We noted that they contained some good information about supporting one individual with their oral hygiene and how to promote their dignity when delivering personal care. We noted some use of general statements such as needs support with personal hygiene which should be avoided to ensure that care workers know exactly what support is required by the person to deliver consistent, person-centred care. The care plan indicated who would take responsibility for peoples foot care and records showed when people had been supported to have a bath or shower. During the inspection, we observed staff treating individuals with respect and being responsive to their individual needs, picking up on non-verbal cues that individuals wanted support. A health care professional who Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: returned a survey to us told us that staff always respect individuals privacy and dignity. Peoples support plans indicated when they had last attended appointments with, for example, the optician or dentist. We looked at the records for one individual which showed that professional advice from a GP and district nurse had been sought in relation to the persons health care. Records indicated that the person requires regular enemas which are administered by the district nursing team on a regular basis. The manager told us that following the persons admission to the home they had liaised with the GP to explore possible alternatives to enema use. This is an example of good practice. A care plan was in place regarding action staff needed to take to support the person during administration of an enema. The admissions assessment for one person indicated some issues around eating and drinking. The notes from the transition meeting stated that the persons care manager would refer them for a speech and language therapy assessment in relation to their swallowing and communication needs. There was no evidence on file that this had been followed up. We discussed this with the manager and the deputy manager who confirmed that, to their knowledge, a referral had not been made. This means that a need for health care intervention identified during the assessment process had not been met. Since the inspection the home has contacted us to say that they are liaising with the individuals care manager to ensure that a referral is made. A Health Action Plan document was in place for the person indicating that they need help in all areas of their care, for example, oral health, keeping fit, continence, healthy eating, their moods and relationships. However, the area on the plan titled What are we going to do about it had not been completed. The individuals records showed two entries where care workers had observed a rash during April 2008; Rash in between legs noted. Looks very sore and causing pain; Lower back rash, seems like shingles. There was no further information on the record to indicate the action taken by staff to follow this up. The deputy manager told us that as district nurses visit the person twice a week they would have been aware of the rash. The deputy manager contacted us following the inspection to inform us that there was an entry in the district nurses notes stating Rash clearer. A health care professional who has contact with the home told us that the home is dedicated to supporting individuals health care needs and to ensure positive outcomes when accessing health services. The also told us that the home communicates well with them and are open to suggestions. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: We looked at medication practices in the home. Medication was being appropriately stored in two metal cabinets in the office area of the home. The manager told us that since the last inspection they have reviewed storage so that incoming medication is stored separately from medication currently in use. Medication is supplied to the home by a local pharmacy who also provide printed medication administration record (MAR) charts for use in the home. We noted some handwritten entries on the MAR chart which had not been double-signed to confirm their accuracy. Also not all of the MAR charts we looked at indicated whether people had any known allergies. The deputy manager contacted us following the inspection to tell us that she has liaised with the pharmacy to ensure this information is included. The deputy manager told us that both she and the registered manager carry out random audits on medication but these are not currently documented. We checked the medication for two people against the MAR chart. In both cases, the correct amount of medication was left suggesting that medication had been given as prescribed. We saw from documentation that administration of medication is an area covered in the homes induction programme. Two out of three staff whose records we looked at were documented as having received specific training in medication. The manager has told us in the homes Annual Quality Assurance Assessment that one area for improvement in the next twelve months is for new staff members to attend training in medication administration provided by the local authority. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to respond to complaints and concerns raised by people who have contact with the service and to protect people from abuse. Evidence: The home has told us in their Annual Quality Assurance Assessment that they have a revised complaints policy and new complaints book incorporating concerns in place. At the time of the inspection a notice telling people how they can complain was on display on the office door. This included the contact details for the Commission. We looked at the homes records for complaints and concerns. This provided a very clear record of issues that had been raised by people who have contact with the service and an account of action taken by the home. The Commission has not received any complaints about the home in the last twelve months. All staff who responded to the survey told us that they knew what to do if a person using the service or their relatives had concerns. A relative we spoke to during the inspection told us that there was good communication between himself and the deputy manager; Nothing is too much trouble. There have been no safeguarding referrals in relation to the home in the last twelve months. The manager has told us in the homes Annual Quality Assurance Assessment that they have adult protection and whistleblowing policies which staff sign as read Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: and understood. A care worker who responded to the survey indicated their awareness of protection and whistleblowing policies by telling us; There is a protocol to inform the manager and an external phone number (for the Commission) on the front of the office door if needed which you could use without informing anyone from the home. Out of three staff files we looked at, there was evidence of two staff receiving specific training in adult protection. The third member of staff had received induction training in March 2008 which covered adult protection. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a suitable environment for people to live in with procedures in place to maintain cleanliness and hygiene. Evidence: Ventana is a detached property situated along a road of similar properties within walking distance of the centre of Boscombe. The home has a spacious entrance hall with a ramp to enable access by wheelchair users. There is a lounge, sun lounge, kitchen / dining room and utility area also on the ground floor. There are two en-suite bedrooms on the ground floor of the home with two communal toilets, one of which has a shower facility. A further six bedrooms are situated on the first floor of the home, five with en-suite toilet facilities and one with an en-suite toilet and shower. A commual toilet and communal bathroom are also situated on the first floor. The homes Annual Quality Assurance Assessment indicates the providers plans to improve the premises to ensure they remain in good repair. The home presented as clean at the time of the inspection. The manager has told us in the homes Annual Quality Assurance Assessment that they have implemented a new cleaning rota. He has also told us that there is a policy in place for preventing infection Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: and managing infection control and that they have used guidance from the Department of Health to assess their procedures. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been unable to demonstrate that their recruitment procedures consistently meet the regulations and therefore fully protect people who use the service. Training is offered to care workers but some development is needed to ensure that the National Minimum Standards are fully met in this area so that all care workers have the necessary knowledge to meet individuals specialist needs. Evidence: At the last two inspections of the service a requirement has been made that the home must comply with the regulations relating to recruitment checks on new staff. The manager told us in the homes Annual Quality Assurance Assessment; We comply with the standards in the recruitment process. We looked at a sample of three recruitment records for care workers for evidence that robust procedures are in place. For the first person, there was proof of their identity and evidence of police clearance from their native country on file. We noted that one reference provided was a testimonial written to whom it may concern and not specifically in response to a request for a reference from Ventana. We saw correspondence on file that indicated the care worker had been interviewed by telephone for a post at an older persons care home and not the Support Worker position at Ventana. There was no evidence on file Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: that an interview had taken place in relation to the role that the person was now undertaking. We advised the manager that this was not appropriate as the interview process should determine the individuals suitability for the post they are to undertake. We asked the deputy manager when the individual had started in post and were advised their start date was 19/07/08 which was confirmed by the homes rota. However, the PoVAFirst check on file was dated 01/08/08 and the full disclosure from the Criminal Records Bureau was dated 06/08/08. This means that a PoVAFirst check was not in place at the time the care worker had started working in the home. In addition there was no evidence of a work permit or visa on file. The manager informed us that the person had a student visa. Evidence of this was obtained from the care worker at the time of the inspection. We have advised the manager to ensure that copies of such documentation are on file. For the second care worker whose records we looked at there was evidence of an application form, full employment history, proof of identity, two written references and suitable checks with the Criminal Records Bureau on file. Checks had been obtained before the person had started in post. For the third person, posts of previous employment as stated on their application form did not always show the dates of employment. This means that the provider cannot be confident that a full employment history has been obtained. There were two references on file but one was dated 30/07/08 when their start date was confirmed as 15/07/08. The manager told us that the person concerned had applied for a post with them earlier in the year when two written references had been obtained. These references had been destroyed when the person had not taken up the post and two new references sought when the person re-applied for the post. Only one had been received prior to the start date. We have supplied the registered manager with the current guidance in relation to checks with the Criminal Records Bureau as published on our website. The manager emailed us following the inspection to state his commitment to ensuring that procedures in the home are robust. The provider must be aware that enforcement action may be taken by the Commission where there are persistant breaches of regulation and must address this as a priority to ensure that people are protected. The homes Annual Quality Assurance Assessment tells us that each member of staff takes part in an in-house induction programme in addition to attending the Skills for Care induction and we have placed our new staff members of the induction training prior to starting or within a month at Ventana. Four out of five care workers who responded to our survey indicated that their induction mostly covered what they needed to know to do the job when they started. The fifth person indicated that the Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: induction covered what they needed to know very well. We looked at the training records for three care workers for further evidence of this. One record showed evidence in the form of a certificate that the care worker had attended an induction programme covering the Common Induction Standards. We were verbally informed that the two other care workers had completed their induction training earlier that month although certificates to confirm this had not yet been received. The homes Annual Quality Assurance assessment states; we could have more staff members undertake their NVQ (National Vocational Qualification) training. The AQAA states that out of a total of twelve care workers, three staff have a NVQ at Level 2 or above while two care workers are currently working towards a qualification. A member of staff responding to the survey told us that they were always encouraged to undertake NVQs. Although the sample of training records we looked at generally showed evidence of core training being received by care workers we noted that there was less consistent uptake of specialist training. Out of three files we looked at, only one showed evidence of epilepsy training being received. Two out of three files showed evidence of training in footcare. One out of three files showed evidence of training in the Mental Capacity Act. None of the three files we looked at showed evidence of specialist training in areas relevant to learning disability. One care worker who responded to the survey told us; I have been given training for moving and handling and attended an epilepsy course, both very useful. Another member of staff told us they felt provision of specific training was an area the home could do better in; More training, new training and seminars specific to service users. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further development of quality assurance processes within the home and review of some areas relating to health and safety are needed to ensure that people are fully protected and the home bases its development on consultation with people who use the service. Evidence: Paul Greenwood has been the Registered Manager of the home since November 2007. He is a Registered Nurse in Learning Disabilities and has extensive experience of working in the field. Discussion with Mr Greenwood during the inspection indicated that the deputy manager is taking increasing responsibility for the day-to-day management of the home. It is anticipated that she will apply for registration as the manager of the service in the near future. The deputy manager told us that she is currently studying towards her NVQ Level 4 in Care and gaining suitable management experience in her present post. Discussion with a relative and review of surveys received indicated that people who have contact with the service view the deputy manager as having a high degree of responsibility for managing the home. We agree, therefore, that this should Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: be formalised through the registration process. As indicated in the section on staffing the home continues to be in breach of Regulation 19. The home told us in their Annual Quality Assurance Assessment that they were meeting the standards in relation to recruitment but our inspection evidenced that there are gaps in obtaining all relevant information about care workers before they commenced in post. The regulations are in place to protect vulnerable people and continued breach of a regulation reflects adversely on the running of the service. We discussed with Mr Greenwood whether visits by the registered provider are made to the home on a monthly basis to assess and report on how the home is running in accordance with Regulation 26 of the Care Homes Regulations (2001). Mr Greenwood told us that visits had not been taking place in recent months. Since November 2007, Mr Greenwood has been both the Responsible Individual for the service as well as the Registered Manager and therefore this had confused responsibilities in terms of meeting Regulation 26. We discussed that it would be good practice for a nominated person, external to the home, to visit the service in accordance with the regulation to assess, audit and report on systems in place. We saw a service development plan for 2008 which set objectives for review of care plans, the production of a newsletter, carers evenings, training in the protection of vulnerable adults, improvements to the home environment and promotion of the use of external advocacy. It was not clear from the plan how these objectives had been identified although from the inspection process we were able to see some evidence that the home is working towards meeting them. The homes Annual Quality Assurance Assessment tells us; We have annual service user surveys. We saw evidence that two people who use the service had completed a survey in May 2008 which covered choice, complaints, staff support, the home environment, food and community access. However, it was not clear how other people who use the service, who have severe learning disabilities and communication needs, have been supported to express their views about the home to ensure that developments within the service are based on their needs as well. Discussion with the deputy manager indicated an awareness that a quality assurance strategy needs to be based on the views of everyone who uses the service and she reported that the home is consulting with a local advocacy organisation to see how this can be taken forward in a meaningful way. We looked for evidence that appropriate checks are in place to promote the welfare of people who use the service. We saw that refrigerator and freezer temperatures are recorded on a daily basis. The homes Annual Quality Assurance Assessment tells us that a system for testing portable electrical appliances is in place and this was last Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: carried out in February 2008. During the inspection we looked in two bedrooms on the first floor of the home. Both had large, external windows which opened very wide but were not restricted. We identified that the height of the windows above the ground would present a serious risk to people if they were to fall. Mr Greenwood told us that window restrictors had been installed on bedroom windows of two individuals where there was a perceived risk. We checked the window restrictors in a bedroom belonging to a person who had been identified as at risk and found that the restrictors in place had been manually overriden to open the windows. We noted that bedroom doors in the home are unlocked and therefore there is the potential for people to wander into other peoples bedrooms. Once we highlighted our concerns, Mr Greenwood took immediate action to install window restrictors on all windows on the first floor of the home on the same day to minimise risks. The type of restrictors used were those that can be manually overidden and therefore we recommend that the home reviews this to ensure peoples safety in the home. We noted on our tour of the premises that the lock on the door to the utility room is a sliding lock. We also noted that a laundry detergent was not securely stored in the utility room. The deputy manager told us that some of the people who use the service like to be involved in doing their laundry and therefore have access to the utility room. While we agree this should be encouraged, we recommend that the home undertakes a risk assessment on the secure storage of chemicals hazardous to health. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes R 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 34 19 The registered person must obtain all information and documentation as specified in Schedule 2 of the Care Homes Regulations 2001 prior to care workers commencing employment in the home. This requirement is repeated from the last inspection as the previous timescale of 30/11/06 was not fully met. 30/11/2007 Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 You must obtain all information and documentation as specified in Schedule 2 of the Care Homes Regulations (2001) prior to care workers commencing employment in the home. This requirement is repeated from the last two inspections of the service as the previous timescales of 30/11/06 and 30/11/07 have not been fully met. You must do this to demonstrate that the people you employ to work in the home are safe to work with vulnerable people. 31/01/2009 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 1 2 You should ensure that, where a person is funded by the Page 32 of 35 Care Homes for Adults (18-65 years) local authority, a copy of the care management assessment of a persons needs is obtained prior to their admission. Information about a persons religious beliefs should be obtained as part of the homes assessment process. 2 6 Care plans should be accessible to the person that they belong to. Care plans should contain specific information about the individuals needs and how these are to be met by the service so that care workers always have enough information on which to base person-centred care. 3 7 You should ensure that where people are known to have goals that they would like to achieve, these are always followed through and reflected in their care plan. Risk assessments should always contain specific information about potential hazards, the level of risk and staff actions that need to be taken in order to minimise the risk. This will enable care workers to ensure that the care they deliver is consistent and meets the individuals needs. You should ensure that all individuals who use the service have enough opportunities to do activities that they are known to enjoy and which meet their personal preferences and goals as stated in their care plan. You should ensure that all individuals who use the service are given real choice to access and participate in their community on a regular basis as identified in their care plan. You should ensure that actions identified at assessment in relation to individuals health care needs are followed up promptly. Health action plan documentation should be completed fully to ensure that actions to be taken by the home or other relevant parties are clearly recorded. Where concerns are noted in records about peoples health there should be a clear account of the action taken by staff to follow these up. 8 20 Handwritten entries on medication administration record (MAR) charts should be double-signed to confirm their accuracy. Random audits on medication should be documented to provide clear evidence of medication that was checked, any issues identified and how these were resolved. 4 9 5 12 6 13 7 19 Care Homes for Adults (18-65 years) Page 33 of 35 Individuals allergies should be indicated on the MAR chart or none known stated where appropriate. 9 32 You should ensure that all care workers employed in the home are either qualified to, or working towards achieving, a National Vocational Qualification in Care. You should ensure that all care workers employed to work in the home receive specialist training that reflects the diverse needs of people who use the service. You should nominate a person to visit the service in accordance with Regulation 26 to monitor and report on the development of the home and audit systems in place. The homes quality assurance process should be expanded so that it is clearly based on the views, needs and wishes of people who live in the home and those who have contact with the service. You should find ways of consulting with all the people who live in the home as part of this process. 13 42 You should review window restrictors in place in the home to ensure they cannot be manually overidden and therefore ensure the safety of people who live there. You should risk assess the storage of chemical substances hazardous to health in the home to ensure risks are minimised. 10 35 11 37 12 39 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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