Inspection on 24/02/09 for Walton House

This inspection was carried out on 24th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Walton House 02/03/07

Walton House 31/01/06

Walton House 22/09/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Walton House Hall Road Wallington Surrey SM6 0RT     The quality rating for this care home is:   three star excellent 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: Claire Taylor     Date: 0 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Walton House Hall Road Wallington Surrey SM6 0RT 02086478836 F/P02086478836 waltonhouse6@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Loving Care Ltd Name of registered manager (if applicable) Dionne Rose Hawkes Type of registration: Number of places registered: 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: 7 The registered person may provide the following category of service only: Care Home Only (CRH - 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 - Code LD Date of last inspection Brief description of the care home Walton House is registered to provide residential care for up to seven young adults with learning disabilities. The service is owned, managed and staffed by Loving Care Ltd who are a family-run business and also own a second residential home in Wallington. The home supports people who have specialist needs such as autism and behaviours that may challenge the care services that they require. The home is a large detached property situated in a residential street close to the centre of Wallington and well placed for accessing local shops and public transport links. It is a large house on a three-floor storey with seven en suite bedrooms. There are also two bathrooms, & one Care Homes for Adults (18-65 years) Page 4 of 32 care home 7 Over 65 0 7 Brief description of the care home shower room. Shared living areas include a lounge, conservatory, dining room, kitchen with dining table, laundry, office and a room known as The retreat. People can use this room as another sitting room during the evenings and day to undertake activities if they wish. More detailed information about the services provided can be found in the homes Statement of Purpose and Service User Guide- copies of these can be obtained directly from the home. Fees ranged from £1900 to £2200 per week at the time of this inspection. There have been no changes to the ownership or management since our last inspection in February 2007. We approved the registration for an additional bedroom in May 2008. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: We visited the home on 24th February 2009 and gave short notice of the inspection prior to our arrival. This was due to the specialist needs of some people who use the service. We spent a full day in the home and met with all six people living at Walton house during the course of our visit. We also met with the manager, a behaviour specialist and the staff on duty. We looked at records relating to the running of the home and how people like to be supported to live their lives. To help us further understand the experiences of people living at this home, we tracked records of care for three individuals and spoke with two people to hear about their experiences and views of the home. We also sent out surveys as part of this inspection to get feedback from people living in the home, their relatives and representatives and other professionals involved with the home. We looked around the building and viewed some Care Homes for Adults (18-65 years) Page 6 of 32 of the bedrooms with peoples permission. Prior to our visit, the manager returned a fully completed AQAA (Annual Quality Assurance Assessment) when we asked for it. The AQAA gave us very detailed information about Walton house and included service improvements over the past twelve months as well as plans for development during the coming year. Some of the information is included in the report and we saw lots of evidence that the homes practices reflected what they said in their self assessment. Five people living in the home completed have your say comment cards with support from the manager or a staff. We also received surveys from nine staff, one advocate and four relatives. We discussed what we found with the manager at the end of our visit. We would like to thank all those who took part for their time and contribution to this inspection. What the care home does well: What has improved since the last inspection? Extra work has gone into involving people in their care planning and the up keep of their records through person centered approaches. For example, each person has their own Service user Guide which is adapted and illustrated according to their specific needs and lifestyle. Health Action Plans have been personalised in a similar way so that people can understand them more fully. The home has looked at different ways for Care Homes for Adults (18-65 years) Page 8 of 32 supporting people who may show behaviour that challenges the services they require. This has included the use and evaluation of mood charts to record how people are feeling and monitor if there have been any changes in their care and support needs. This helps the staff team to recognise each persons unique behaviour patterns and take action to support them. There has been further work to make information more accessible to people. The fire and complaints procedures have been supplemented with photographs and easy read language. People living in Walton House helped with this. Following this key inspection, we have assessed the home has exceeding many of the standards and judged the home to provide excellent outcomes for the people who use this service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are arranged in a planned way and the needs of people who use the service are fully assessed prior to moving in. This ensures that the needs of the person are understood and can be met. Good information about the home and the costs is available to people who may be considering using this service. Evidence: The statement of purpose includes good information about the home and the facilities on offer and includes visual pictures and photos to help people understand the information given. The manager has also included pictures of all the staff so that people can get to know who works at the home. Since our last inspection, each person has been given their own Service user guide. We looked at three and each one had been written in a personalised way to make it more meaningful. The owning organisation has clear procedures in place for people choosing to use the service. These ensure that any prospective person is central to the process and the service considers the needs assessment and the capacity of the home to meet their needs. The homes arrangements also ensure that any new person has the time they need to Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: settle in and that staff get to know their support needs. We looked at the care records for three people and each file contained a needs assessment that was undertaken through care management arrangements in the local authority. We saw that the home also carries out its own needs assessment.The assessment focuses on achieving positive outcomes for people and covers all aspects of a persons life, including individual strengths, hobbies, social needs, ways of communicating, dietary preferences, health and personal care needs. For the newest person, they were offered introductory visits including staying for meals and joining in with activities. Records showed that the home managed the transition in a well thought out and structured way. We looked at various records and assessments which showed how much work staff had done to help the person feel comfortable and safe in their new home. A review meeting was then held after six weeks to discuss whether the person was happy in the home and that it was suitable for them. The manager showed us a copy of a cultural needs assessment which she plans to complete with each person living in the home. This was detailed and made reference to all areas of any ethnic and diversity needs. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and goals are met as the home has a plan of care that the person, or someone close to them, has been involved in making. Individuals are consulted and given good opportunities to influence how the home is run. People are supported to take risks that promote their independence as well as their safety. Evidence: We saw that the manager and staff have worked hard to develop an effective care planning system. This was well organised with information divided into different files for easy access. For example there are separate Health action and Support plans and peoples individual goals and the action needed to achieve them are recorded in a separate futures file. One persons dream said,to do to Disneyland Paris and on a day trip to France. The consistent use of person centred care ensures that each individual has a unique plan which includes details of their background, family, interests and has very good detail on a persons likes, dislikes and their future Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: aspirations. The information recorded in them was current and clearly guides staff to effectively address each individuals personal, social and emotional care needs. We looked at three plans that were written in a way that gave ownership to each person. There was good information about a persons likes and dislikes and plans were also illustrated with pictures and photographs to help individuals understand them. The plans also emphasised the individuality of each person and reflected their qualities and personality. Examples said,I always greet people with a big smile and another said,I will inform you of things that need to happen and remind you when they need to be done. Plans had a section on what matters most to a person. An example said,my mum, drinking cups of tea, not rushing when I wake in the morning. Having my aromatherapy session. Staff were familiar with what was written in peoples care plans and could talk confidently about the support they give. A key worker system is in place that works effectively and gives consistency to each person. Records told us that the home makes sure peoples care plans are regularly checked and updated where necessary. Key workers do this on a monthly basis with people who live at the home, to make sure they are still meeting their needs properly. Things that were important to the person, raised at reviews, had been followed up by the home. For example, one person hopes to move into their own flat in the future and there were various support plans in place to help the person achieve their goal. Progress was being closely monitored with the person with additional support through a behaviour specialist. Staff were working closely with the person and the new staff team to ensure that a smooth transition process is achieved. The length of time that the person has had to wait is now causing them some frustration and an increase in episodes of challenging behaviour. Records showed that the manager and staff were supporting the person closely through this time of uncertainty to reduce their anxiety and keep them safe.Each individuals preferred communication ways were clearly recorded. Questions are used such as, how does the person ask for help; how do they relay past events and how do they start a conversation ? The profiles gave lots of detail about how a person expresses themselves. This helps staff to understand the persons unique behaviours, moods, signals and temperaments and what they might mean. Minutes of monthly meetings showed that people are consulted about what they want to do whatever their communication style. For example, picture cards and photographs are used to promote choice of activities, places to go and preferred meals. People are asked about the things that they like, what they want and how they want things to happen. We also saw detailed daily records that gave a sense of a persons experience of their day. As good practice however, staff should ensure that they sign care records more clearly for clarity and legal purposes.The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. We looked at recent minutes and they showed good discussions on everything at the home keeping everyone informed and included in the developments of their home. Plans show what action should be taken to lessen risk, whilst encouraging independence for Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: people. A risk assessment also tells the staff how to make sure that each person is kept safe from anything that might harm them. Any risks to people through general health,needs or activities are assessed and clear action to reduce any risks is recorded. Examples seen included personal care, safety in the home, accessing the local community, moving and handling, swimming, owning a front door key and management of epilepsy for one individual. We suggest that the moving and handling risk plan for the newest person in the home is rewritten as it made reference to the persons previous home environment and was therefore not relevant to their surroundings in Walton House. Observation and records showed that where an individuals behaviour could potentially present risks this is well managed with staff continuing to promote the persons independence at home and in the community. We received nine staff surveys and a 100 response that they were always given up to date information about the needs of the people they support. For what the home does well one staff wrote, Provide a person centred approach, service users choices and rights are respected. Where need be service users are assisted to make informed decisions. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead fulfilling lives as they are supported in the lifestyle they choose and have good links with the local community. Relationships with family and friends are well supported and daily routines ensure that peoples 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. Evidence: This service provides people with lots of varied activities and social experiences both within the home and beyond. Preferred interests, hobbies and likes are identified as part of the personal care planning process. We looked at records for three people. Each person had a full activity programme as part of their care plan. Activities are flexible but act as a structure to each persons week as most people require routine and consistency in their lives. We saw lots of information about the newest persons Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: lifestyle and that they were still involved with activities that they did before they moved to the home. This included regular hydrotherapy sessions and visits to a local animal rescue centre. Records and discussion showed that the staff team are motivated to make sure that people are given the opportunity to go out when they wish and experience activities and social events that meet their needs and wishes. These ranged from trips out to evening social clubs, educational groups, art,craft and music sessions, shopping, lunches out, trips to the theatre and many more. During this inspection, most people were out at their usual activities which matched up with their written plans such as college courses and activity centres. People ticked on their surveys that they always made decisions about what to do each day and one said usually. All responded that they could do what they wanted during their day. We spoke with one staff who clearly described the needs of the person they supported including their preferred leisure interests. This included organising regular trips with the person to see greyhound racing. Records told us that the service is very responsive to individuals changing needs, choices and wishes. Each persons file showed that staff also carry out thorough risk assessments to help make activities as safe as possible. Throughout our visit we saw staff commitment to support people with their social needs and requests. The AQAA also said, One client wanted a sunshine holiday where she could swim. As she had never flown before she had a test flight to Manchester which she enjoyed and subsequently went to Menorca for a week. Care records include details about each persons social needs and who is important in their lives. People living in the home have the opportunity to develop and maintain important personal and family relationships. Staff support this with sensitivity and respect of each familys circumstances. Family and friends are encouraged to visit the home at any time and this is also achieved by holding special events throughout the year such as parties, barbecues and celebrations. Relatives who returned comment cards as part of this inspection all commented positively on the support their relative receives. One said the level of care is exceptional and has exceeded what we expected. We saw records to show that people are asked what they want to eat and that their food choices were included on the weekly menus. The menus reflected a healthy and varied diet. Again, photographs are used to help people to make choices. Dietician support is used where needed and one person had a specific plan for eating and drinking so that staff support them safely when eating. We spoke to several staff as they prepared the evening meal of spaghetti bolognaise. Staff knew each persons favourite dishes and what type of support they required during mealtimes. For example, one person uses adapted cutlery to aid their independence and another person needed their food chopped into small pieces due to a choking risk. Most people eat together in the main dining room although there is additional dining space in the kitchen if people prefer a quieter area. Planned improvements on the AQAA said,The purchase of a computer and real time cooking DVD to enable clients to be more independent in the kitchen. Clients to save personal photographs of activities, events etc on a computer based Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: photo book/ album which they can share with family and friends. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The practices for dealing with medication are well organised to ensure safety and consistent treatment and support for each person. Evidence: As stated within other parts of the report, records told us that each persons individuality is recognised and this extends to how they have their personal and healthcare needs met. Records seen showed that staff have the information they need about how each person prefers to be supported with an emphasis on recognising their independence. The plans take into account the persons choice for a bath or shower and their preferred time of getting up for example. Equipment has been provided in the ground floor bathroom to help support one person with their physical care needs. We saw detailed health action plans for three people that gave a comprehensive overview of their healthcare needs and how staff should support them. Health care plans are developed with each person and illustrated with pictures to help them understand the information. Any health or behaviour changes that are observed are Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: clearly recorded and necessary action is taken to gain specialist advice. The home retains close links with a behaviour specialist who visits on a frequent basis. Any guidance given is recorded and this was particularly evident in relation to supporting people who have behaviours that may challenge the services they require. For example, mood patterns are recorded so that staff can review how a person has been feeling, assess possible reasons for any changes and take appropriate action. The guidelines also aim to protect people and staff from potential harm. Each person is registered with a GP of their choice and have access to other Health Care services. We saw that healthcare records were well maintained,kept up-to-date and linked to each care plan with additional monitoring sheets for specific issues such as epilepsy, mobility and mental health needs for some individuals. Routine checks such as optician, dental, Community Psychiatric Nurse and consultant psychiatrist appointments were also recorded clearly. This shows that the staff team monitors healthcare needs closely and works positively with other health care professionals to offer a responsive and supportive approach in maintaining peoples health and well being. Feedback cards from relatives included,I will get a phone call if X is ill. Another wrote,If there are any issues affecting our X they contact us (if necessary in their own times in the evenings) and if we have any we discuss with them. We looked at the storage and procedures for handling medications at the home and they were found to be well maintained and safely managed. Staff who support people with their medication had received training from Opus Pharmacy in April 2008. The manager advised that each staff member also has an assessment on their competence before they are given the responsibility of administering medication. The medications records were very detailed, signed and accounted for when we checked the balance of medication. The manager also makes weekly checks on all medication stock and records. People have informative medication profiles that detail any side effects, known allergies and reasons for use. The clear systems for dealing with medications, along with a good commitment from the manager to ensure accuracy help to reduce the risk of mistakes occurring. They also provide a clear audit trail to check people receive their medication correctly. An appropriate healthcare professional reviews each persons condition regularly to ensure that they receive the correct medication regime or treatment where necessary. Guidelines for the use of as required medication were in place to ensure that staff are clear about when and how to administer this type of medication. We suggest that some additional information is provided so that there are clearer timescales for staff to follow. This will further ensure that when such medication is needed, there is an agreed length of time before it can be given. For how the home has improved the AQAA stated, Clients who needed to have lost weight through a review of menus, exercise and health education and support. We have pictorial and written medication information. On line GP appointments and repeat prescriptions. We have made adaptations to the home to facilitate wheelchair access for a person who moved in this year. Her bathroom has also been adapted with a rise Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: and fall bath and grab rails. Forthcoming improvements said,We are exploring the possibility of people having their medication in a locked facility in their bedroom. Care Homes for Adults (18-65 years) Page 21 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for dealing with complaints or concerns ensure that people feel listened to and their views are acted upon. The homes safeguarding procedures and practices are effective in protecting people. Evidence: The homes policies and procedures help ensure that people are safeguarded from harm and their views and concerns are listened to, and acted upon.Information about how to raise a concern or complaint is made available to the people living at Walton house. Staff have developed this by using pictures to help people understand how they can be supported in making their views and concerns known. Survey responses told us that people were clear about who to speak to if they felt unhappy or worried about something. They included, to Dionne the manager or my key worker.I can speak at our meeting. Likewise, feedback from relatives showed confidence that the home would deal with any complaints appropriately and that the manager and staff are approachable and receptive to any concerns raised. One relative wrote, have only ever had minor concerns that have always been dealt with promptly and efficiently. Since the homes last inspection in February 2007, no complaints or safeguarding concerns about the service have been raised with us or to the home. Records confirmed that staff are properly inducted on abuse awareness and there are policies and procedures for safeguarding adults that give clear specific guidance to those using them. This includes appropriate local authority procedures so that staff know who to Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: alert in the event of a safeguarding concern. Records showed that all staff had received training in safeguarding in April 2008. Other training around dealing with physical and verbal aggression has also been arranged for staff. Any specialist guidelines were clearly recorded and reviewed to enable staff to support the person appropriately. We saw records where a persons behaviour had challenged the service and the staff team had promptly reviewed the situation and amended the guidelines and corresponding risk assessments. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with a safe, clean and very comfortable living environment that meets their needs and lifestyles. Adaptations have been made where necessary for those with mobility difficulties. Evidence: We were shown around the home and looked at some of the bedrooms with peoples permission. Walton House is decorated and furnished to high standards and there are many homely touches to reflect the individuality of the people who live there. For example, there are childhood photographs of each person and artwork pictures created by one individual. People have a choice of living areas with a large lounge, dining room and a further sitting area for activities or quieter space to relax. There is a large rear garden that is well maintained and safe for people to use. There is lots of indoor entertainment for people to choose from including widescreen TV, DVD player, grand piano, board games, puzzles and art and craft activities. Bedrooms clearly reflected each persons individuality, interests, leisure needs and preferences. People have personalised their rooms how they like and been involved with choosing their room colour and furnishings. Individuals have their own TV, music systems and chosen possessions such as art creations and personal photographs that are meaningful to them. People we spoke to said that they were happy with their bedrooms. Specialist Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: equipment had been purchased to meet the physical needs of one person who recently moved in- an adapted bath has been fitted in their ground floor bathroom. We saw that an Occupational Therapist assessed the premises for suitability before the person came to live in the home. Doors have been widened to allow wheelchair access and a ramp has been purchased for entry at the front door. People responded on their comment cards that the home was always fresh and clean. The home has a redecoration and maintenance plan that sets out any planned home improvements with timescales. Since our last inspection, various rooms have been repainted, the front driveway and rear garden redesigned and some new furniture purchased for the lounge and conservatory. The home was very clean and tidy with good hygiene practices in place. Hand washing and drying facilities were available in all areas of the home. A part time cleaner works at Walton House and people are also involved with household tasks such as the upkeep of their rooms and personal laundry. For how the home has improved the AQAA stated,The home and the gardens have been refurbished. Specialist equipment and adaptations have been made. Implemented an environmental statement and policy. Planned improvements on the AQAA said, As one clients day service is finishing and he enjoys DIY we are looking to erect a small workshop in the garden for him to do plant care and woodwork. Remove two trees from the rear garden that are blocking sunlight. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a competent and knowledgeable staff team, who are provided with the necessary training and guidance to support their specific needs. Recruitment practices are securely managed so that people are protected. Evidence: We looked at staff rotas, which showed that the home is staffed efficiently, and the staffing structure is planned around peoples routines, lifestyles and assessed needs. There are always between three and four staff each day and staffing arrangements are flexible so that people are appropriately supported. For example, extra staff are allocated on shift for a weekend activity such as going to see the greyhound racing. At night, there is one waking staff with a second staff on a sleep-in duty. There is a low turn over of staff, and people benefit from the consistency of a well-established staff team who know each persons support needs. People who returned surveys ticked that staff always treat them well and that staff always listen and act on what they say. All staff responded on their surveys that they had appropriate recruitment checks carried out prior to them starting work. The homes recruitment procedures are thorough to ensure that staff are vetted correctly and people are safeguarded. The homes policy requires that all staff undergo a refresher Criminal Records Bureau check every 5 years. In addition, the manager completes a checklist to ensure that all the correct Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: checks and records have been put in place prior to a staff appointment. We looked at three staff files which included the most recent employee. Each one contained all the required recruitment records, training certificates and supervision meetings with the manager. The recruitment process is securely followed so that people using the service are protected from unsuitable workers. Some of the people living at Walton House are actively involved with staff recruitment and have joined in on interviews to ask their own questions. As some of the staff team are related to one another, Loving care Ltd (the owners) have implemented a policy on family members working in the same care service. This is to ensure there are clear lines of accountability for those staff members and that any conflicts of interest are considered. On the returned staff surveys, all ticked that their induction to the service covered everything they needed to know very well. We saw that the newest employee had completed an induction based upon the Skills for Care standards. This is designed to help ensure that all new staff entering into the care industry undergo a minimum level of initial training. We saw a training development plan for all staff that covered key health and safety issues as well as courses geared towards the specialist needs of the people who use the service. E.g. autism, epilepsy and the management of challenging behaviour.This means that staff keep their knowledge and skills updated in line with current good practice and that they can support individuals with such specific needs in a safe way. We saw that individual training needs for staff are addressed through supervision and appraisal with the manager. The home also has a challenging behaviour and autism resource pack for staff to use. Over 70 of care staff have obtained NVQ qualifications level 2 and above. This is a national recognised qualification where staff have reached the standards of care expected in care homes and the service is commended for exceeding this standard. We received nine staff surveys and when asked if there were enough staff to meet the needs of people using the service, seven responded always and two ticked usually. Records showed that staff receive regular supervision with the manager or deputy as well as an annual appraisal of their work. All staff who completed questionnaires said that they regularly meet with their manager and comments included,our manager is always available if we need to talk to her. Comments about working experiences at Walton House were very positive and included, training courses have been excellent; I am very proud to work at Walton House, staff and clients get on well most of the time. A third staff wrote I have had very good training! Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run by a competent and established manager. People are often consulted about how services are provided and have influence over the way the home is run. There are good arrangements for monitoring the quality of care provided. Record keeping is well managed to ensure that peoples rights and best interests are safeguarded. The environment is safe for people and staff because health and safety practices are carried out. Evidence: Walton House continues to benefit from an experienced and appropriately qualified manager who demonstrated that she effectively manages the home in the best interests of everyone living there. The manager has been at Walton House since it opened and has an open and positive management approach, also regularly working as part of the team. Staff meetings are held regularly. We looked at some minutes of these meetings which showed clear discussions for keeping everyone up to date and sharing information about developments and practices in the home. The home frequently measures the Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: quality of its services and people living in the home are very involved. Records showed that their views are valued and always considered. Examples include care plan reviews, regular meetings and time for people to meet with their key staff. An appointed representative visits the home once a month and completes an audit of the service. Reports were detailed and showed that the owners make sure the conduct of the home is closely monitored and that any areas that need attention are acted upon. An annual quality assurance questionnaire is distributed to those living at the home, family, friends, advocates, professionals and specialists and staff for feedback on the service provided with any ideas for improvement. From the findings, the manager produces and distributes a yearly evaluation and audit report that also identifies the aims and outcomes for the next year.We were sent a copy of the 2008 report which was full of information about the homes achievements, feedback from people who live in the home, their relatives, the staff and future plans. The report also referred to a summary of each persons achievements over the year and their activities, holidays and things they each wanted to do in the future. This report clearly showed the homes strong commitment to monitoring the quality of its services and to improve upon outcomes for all people using the service. Feedback from questionnaires was also included in the annual report and was highly complimentary.Record keeping was of a consistently high standard. We saw records stored securely and that administration systems within the home were clear,up-to-date and in good order. The returned AQAA was well written and fully supported by appropriate evidence from this inspection. Records are maintained of all accidents and incidents at the home. As required by law, the service keeps us informed of any reportable events. We saw a detailed risk assessment that aims to safeguard the welfare of all people living and working in the home. It included information about maintaining a safe environment and working practices such as moving and handling, house security, use of hot water and storage of knives and sharps. There is a health and safety coordinator within the staff team. A regular check of the environment is carried out monthly to ensure that it remains safe. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances, the gas supply and regular fire checks. These systems help to make sure that the home is well managed and is a safe place to live and work in. There was a rolling programme of mandatory training to ensure that staff update their skills and knowledge in key health and safety topics. Most staff had completed training on fire safety, moving and handling, infection control, food hygiene and first aid. There were arrangements for remaining staff to update such training. Some improvements on the AQAA said, A new If a fire happens poster has been designed and features the clients in photographs showing us what to do. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 6 9 Staff should ensure that they sign care records more clearly for clarity and legal purposes. The moving and handling risk plan for one person is rewritten so that it reflects their new surroundings in Walton House. Some additional information is provided concerning the use of as required medication. This will further ensure that when such medication is needed, there is an agreed length of time before it can be given. 3 20 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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