Inspection on 27/08/08 for Wendover Road (87)

This inspection was carried out on 27th August 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wendover Road (87) 28/08/07

Wendover Road (87) 10/07/06

Wendover Road (87) 21/11/05

Wendover Road (87) 19/04/05

Wendover Road (87) 24/01/05

Wendover Road (87) 06/08/04

Wendover Road (87) 11/02/04

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wendover Road (87) Stoke Mandeville Aylesbury Bucks HP22 5TD     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: Mike Murphy     Date: 2 7 0 8 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. 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: Wendover Road (87) Stoke Mandeville Aylesbury Bucks HP22 5TD 01296615403 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 87wendrd@nildram.co.uk Hightown Praetorian & Churches Housing Association Name of registered manager (if applicable) Tracey Strudwick Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: That the home may care for two service users with a Learning Disability- who also have a Physical Disability. That this condition applies to two specific service users- and should the service users in question leave the home for whatever reason this condition will cease to apply. That no further users with a physical disability are admitted to the home unless the home applies for a further variation to their registration. Date of last inspection Brief description of the care home 87 Wendover Road cares for 4 female service users with a learning disability. The home is located in a residential area about one mile from the centre of Stoke Mandeville. The home is a bungalow situated in relatively secluded grounds, with a Care Homes for Adults (18-65 years) Page 4 of 32 care home 4 Over 65 0 0 4 2 Brief description of the care home large rear garden. All of the bedrooms are single and there is a kitchen / diner and a separate sitting room. The home has its own transport and is accessible to local amenities. 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: 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 unannounced inspection was carried out over the course of one day in August 2008. It was a key inspection which focused on the key standards in Care Homes for Adults (18-65). The inspection included a visit to the service, conversations with the registered manager and staff, observation of practice, a discussion with an advocate who knows the home well, a tour of the home and grounds, examination of records (including support plans and personnel files), consideration of information provided by the registered manager in the annual quality assurance assessment (AQAA) in advance of the inspection, and consideration of the content of CSCI survey forms returned up to the point of writing this report. Care Homes for Adults (18-65 years) Page 6 of 32 Fees at the time of this inspection we 1400 per week. What the care home does well: What has improved since the last inspection? What they could do better: Support plans should be changed and presented in a more person centred format appropriate to the needs of people living in the home. This may include scanned in photographs and other images as well as text. While the difficulties of the local labour market are acknowledged, the registered manager should be supported in achieving greater stability and continuity in staffing the home. The quality of the environment in communal areas of the home must be improved and there should be an ongoing programme of redecoration and refurbishment to prevent deterioration in future. The organisation should reconsider its plans to permit other homes to access the planned multi-sensory room since this could compromise the privacy of residents in this small home. The registered persons must ensure that all of the information on staff required under the Regulations is on file in the home. The organisation should establish a comprehensive system of quality assurance which Care Homes for Adults (18-65 years) Page 8 of 32 should include seeking the views of a range of stakeholders in the service. 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. The needs of people considering using this service are assessed by experienced staff to ensure the home is able to meet their needs. People offered a place may visit the home prior to deciding whether they wish to live there. Evidence: The last admission to this home was in 2001. Hightown Praetorian and Churches Housing Association have policies and procedures governing the assessment of the needs of people considering using its services. These involve consideration of information provided by the referring organisation most likely a local authority. Liaison between the referring agency, the prospective resident, his or her family, the home manager, and with health or social care professional staff who may be involved. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The process would involve an assessment of the persons needs, consideration of whether the home could meet those needs, visits to the home by the person and his or her family, gradually extended stays so that the person and current residents can get to know each other, a trial admission and review at the end of that period. The new manager said that if a resident vacancy arose then the process would be overseen by the service manager. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans are in place for each person living in the home. While the care plans provide a good basis for organising care they are not in a person centred format to facilitate the involvement of people using the service. Evidence: There is a support plan for each person living in the home. The overall structure of support plans is comprehensive but such plans are not presented in a Person Centred Plan (PCP) format accessible to users of the service. Care plans include: a good pen picture of the person, a lifestyle plan outlining the persons programme for the week (daytime activity, personal activity, at home activities), risk assessments, healthcare contacts and appointments, communication needs, a form for recording contact with the persons family, and correspondence. The pen picture includes: communication, personal care, moving and handling, support Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: required at meal times, and likes and dislikes. Risk assessments cover (among others): activity in the kitchen, travelling in the homes vehicle, activity outside of the home, use of bed rails (cot sides), impulsive behaviours (pulling objects from shelves or pulling a persons hair for example), and the risk of choking while eating. Notes are made in a separate diary for each person towards the end of each staff shift. Care plans are reviewed by key workers monthly. The manager would like to see a more comprehensive review take place every six months. The manager reports that a representative of Buckinghamshire County Council Social Services attends an annual review for the people funded by it. It was reported that one resident, funded by Milton Keynes Council, had not had a multi-agency review for three years. Staff encourage residents to be involved in menu planning, trips out, and in the selection of new staff. An advocate from Aylesbury Vale Advocacy has been visiting the home for a number of years and knows the residents well. The involvement of an advocate supports an open culture and one which encourages the involvement of residents in running the home. Residents are unable to manage their own finances. Hightown Praetorian and Churches Housing Association has systems for dealing with these. Buckinghamshire County Council and Milton Keynes Council act as appointees for the people funded by them. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lead a varied lifestyle according to their individual needs, abilities and interests. This ensures that people experience a range of therapeutic, social and leisure activities and are supported in maintaining involvement with the local community. Evidence: Support plans include a weekly activity diary for each person living in the home. Around the time of this inspection residents used a range of local services including; a resource centre (Bierton Hill), a multi-sensory room at a local NHS service (soon to be relocated and developed within the home), a multi-sensory activity run by a not for profit organisation (Turnstone), and a regular social club, the Gateway Club (although this was closed over the summer period). An aromatherapist visits weekly and using a combination of aromatherapy, massage and warm stones helps residents Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: to relax. It is reported to be Fantastic and residents are said to be calm and relaxed after the therapy and show an enhanced sense of well-being. The new manager is keen to develop a wider range of activities and intends to address this more actively once a senior care worker is appointed (due to start the week after this inspection). This is likely to include using creative therapies such as music and art. For the first time since moving to the home many years ago residents have had a holiday away in the New Forest together. They have also had day trips to seaside resorts. This too is something which the manager wants to develop. The home has a vehicle which is used for outings. This includes taking people to the places listed above as well as swimming, soft play, shopping, and outings. One resident is Muslim and attends an Asian ladies group, wears traditional dress and jewellery, likes to hear Asian music on CD, and follows a Halal diet. Another is a Jehovahs Witness and the manager reports that staff and residents respect her decision not to celebrate some traditions. Residents contact with their families vary but staff support residents in maintaining contact where required. Residents have contact with people outside the home through involvement in social activities as described above. Peoples privacy is respected. Bedroom doors are locked when they are out and each person has their own key. Meals are planned by staff and residents. A Residents Menu Planning sheet is used to record how residents were involved in the process and how they made their choices. Breakfast is served around 8:00 am although one person likes to get up around 4:00 am and have a light breakfast. Breakfast is usually cereals, toast, fruit juice, fruit and hot drinks. Scrambled eggs may be served on some days. The routine at weekends may differ slightly and people may have a lie-in if they wish. Most people go out in the morning. Lunch is eaten around 12:30 and may be taken in a café, as a picnic lunch, or in the home. The evening meal is the main meal of the day and is taken around 5:30. It is a two-course meal. Selections from menus around the time of this inspection included: Beef Stew and Vegetable Rice followed by Ice Cream; Mixed Cold Meats and Salad followed by Jelly; Fish Pie with Brocolli and Cauliflower followed by Banana and Custard; and, Salmon, New Potatoes and Spinach followed by Yoghurt. A roast meat based dish is served at Sunday lunch time and a fish based dish on Fridays. Halal meat is provided for one person. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Additional supplements are provided for one person who is particularly active. Evidence of staff seeking the advice of a dietitian and speech and language therapist was noted in care plans. People living in the home are weighed monthly and records were examined during the course of the inspection visit. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for liaising with health and social care services in the community are satisfactory. These ensure that residents healthcare needs are met. Evidence: There is a key worker and co-keyworker for each person living in the home. Some key elements of how a person wishes to be cared for are outlined in the pen picture in their support plan. Staff provide support as required. Residents privacy is respected. Rooms are locked when residents are out. All residents are registered with a local GP practice where they may also see the practice nurse. Healthcare needs are noted in support plans. Evidence was noted while examining individual support plans of contact with healthcare professionals including dieticians, speech and language therapists, occupational therapists and hospital inpatient and out-patient departments. It was noted that representations in the form of a complaint were made on behalf of one resident about the quality of her care in hospital Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: One person sees a chiropodist regularly. An optician was due to visit the home in September 2008. Dentistry is accessed through Manor House hospital in Aylesbury. Psychiatry and specialist community nurses are also accessed through Manor House Hospital. Medication is prescribed by the persons GP. The home is subject to the policy of Hightown Praetorian and Churches Housing Association with regard to the control and administration of medicines. The contract for dispensing medicines had recently been changed from Boots Chemists to Intercare. Intercare were scheduled to carry out staff training in the home and had begun to supply materials in advance of this. These included individual electronic thermometers to monitor the temperature of the individual medicine cabinets in each persons bedroom. Staff training is provided through a combination of a Care of Medicines course run by the training department at the head office and supervised practice in the home. Updates are required every three years. The homes arrangements were audited by a pharmacist in January 2008 and a further audit was planned for the autumn of 2008. Examination of the MAR (Medicines Administration Records) charts and of the arrangements for storage and use of MDS (monitored dosage system) showed satisfactory practice. The only point of note was the quantity of Paracetamol supplied by the pharmacy for individual use. This came in units of 100 tablets which seemed an excessive supply given that this is for occasional use by one person. Care Homes for Adults (18-65 years) Page 19 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 are in place to ensure that managers respond appropriately to complaints by people living in the home or made by others on their behalf. The interests of people living in the home are protected by the homes arrangements for safeguarding adults which include links with a local advocacy organisation. Evidence: The complaints procedure of the organisation was available in the office and in a folder in each persons bedroom. The procedure is discussed verbally with residents. There have been no complaints since the last inspection. Four compliments were reported to have been communicated verbally by a day centre manager. An advocate of Aylesbury Vale Advocacy visits monthly. The advocate has also represented one of the residents at a case conference. The advocate visited the home on the day of the inspection visit and has contributed to this inspection. There is a policy on safeguarding vulnerable adults (also referred to as the protection of vulnerable adults) and a copy of the Buckinghamshire joint agency policy was available in the office. There have been no safeguarding investigations since the last inspection. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: The staff training programme includes training on Preventing and Responding to Violence - including de-escalation and breakaway techniques. Policy and procedures are in place for dealing with residents monies. Secure facilities for the storage of small amounts of cash are available in each room. Each person has a bank account and funds can be withdrawn subject to safeguards in the organisations policy. All transactions are recorded and the accounts are reconciled by managers monthly. Balances are checked twice a day and a record made in the handover sheet. Checks are made by managers on Regulation 26 visits to the home. The system is open to checks by internal auditors. Overall, there appears to be a good balance between people in the home having access to cash when they need it and the organisation having controls to prevent misuse of those monies. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and safe environment for people living there. However, the condition of many communal areas of the home is now deteriorating and requires some investment to provide a satisfactory quality of environment for residents. Evidence: The home is a detached bungalow situated in a residential area, on the main road, between Aylesbury and Stoke Mandeville. There is parking for a few cars to the front of the house and on the nearby road. The nearest rail stations are Stoke Mandeville or Aylesbury. The area is served by buses between Aylesbury and Wendover. The home has its own vehicle for use by residents and staff. Entry is controlled by staff. The accommodation comprises: entrance hall, staff office, staff sleep-in room with en-suite shower and WC, four single bedrooms, bathroom (Wet Room with shower and sit-in bath), separate WC and hand basin, laundry room, lounge, open plan kitchen and dining room and store cupboards. There is a garden to the rear and side of the house. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The communal areas of the entrance hall, corridor, lounge, bathroom, kitchen and dining room were all showing signs of wear and tear and were due for redecoration. The colour scheme was dull and outdated, paintwork was scuffed, and plaster damaged. There was an unpleasant odour in the bathroom. In contrast, the residents bedrooms were bright, clean, well furnished and well decorated in line with individual residents wishes. The kitchen is domestic in size and fittings and is suitable for current use. It was noted that some foodstuffs in the fridge had not been labelled when opened. The dining area has two tables and chairs for residents and a dresser. The lounge has a large LCD or plasma TV, a video/CD player, music centre, two sofas, and two armchairs. Both the dining room and lounge would benefit from refurbishment. The bathrooms and WCs are adequate for current use but again those areas would benefit from refurbishment. The laundry includes a washing machine and tumble dryer. There is a door to the garden from the laundry which aids ventilation in the home when open. The garden to the side and rear of the house is a reasonable size for the present number of residents and staff. A small patio area, outside the dining room door, leads to a larger area of lawn and shrubs. There were two tables and chairs, a swing, an old car, an outhouse and shed (both of which are used for storage). Wooden gates and fencing ensure that residents are safe. The garden is pleasantly secluded by shrubs and small trees. The home fits in well with neighbouring properties. There are plans to build a Snoezelen cabin (a room for multi-sensory stimulation) in the garden following the withdrawal of this facility by a local NHS service which is redeveloping the NHS site. This would be welcomed by the home and would benefit the residents. However, it is understood that this is to be made available to other homes. This would be less welcome since it could potentially change the character of this small home for its group of residents who have lived there together for some years. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by sufficient numbers of staff. However, a significant number of vacancies of staff on permanent contracts may lead to discontinuity in relationships with residents and potentially affect the quality of care. Evidence: The present staffing provides for three staff in the morning, three in the afternoon and one waking plus one sleep-in at night. These figures include the manager. The home had five staff vacancies on the day of the inspection visit. Staff numbers were being maintained through a combination of permanent staff, bank staff and agency staff. A new senior care worker was due to start work in the home a week or so after the inspection visit. The home is supported in the recruitment of new staff by the recruitment officer based in the Human Resources department in the organisations head office in Hemel Hempstead. Vacancies are advertised in the local press, on the organisations website, and recently at a recruitment fair. Two personnel files of staff recruited since the last inspection were examined. Both had completed an application form. With the exception of a recent photograph and Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: evidence of health fitness, which was absent from both files, the files were otherwise in order. Both files included an Enhanced CRB Disclosure - the organisation does not appoint staff on a POVA First bais. New staff undertake an induction programme and attend a series of training events including Abuse Awareness, Diversity, Epilepsy, Person Centred Planning, Learning Disability Awareness, Mental Health Awareness, Positive Approach, Preventing and Responding to Violence, and Mini bus training. Basic and update training is provided in Fire Safety and Evacuation, Emergency Aid in the Workplace, Care of Medicines, Moving and Handling, and Food Hygiene. The oragnisation has its own NVQ centre and supports staff on NVQ training at levels 2, 3 and 4. Personal supervision for staff is in place. The manager is aiming to ensure that this takes place every four to eight weeks. She expects to achieve this once the senior care worker settles in to her job. A schedule of supervision is to be finalised. Notes of supervisions carried out to date were noted during the examination of records. Care Homes for Adults (18-65 years) Page 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is generally a well managed home which is providing good care for people living there. However, the organisation has not established a systematic approach to monitoring the quality of the service and this may in time not be in the interests of people living there. Arrangements for health and safety are thorough and aim to ensure the maintenance of a safe environment for residents, staff and visitors. Evidence: The registered manager has been in post since December 2007. The manager was registered with CSCI towards the end of July 2008. The manager has acquired the NVQ4 in care and at the time of this inspection was studying to be an NVQ assessor. She intends to do the Registered Managers Award (RMA) as soon as it is convenient for the organisation and her own circumstances. It is not expected that this will be too long. Since taking up post the manager has attended all the required induction and basic training. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The manager has a very clear idea of the priorities for the next year or so. These include: to develop care programmes appropriate to the needs of individual residents, to introduce more variety and flexibility to the home, and to improve the quality of life for residents. In more detail the manager wants to: improve the quality of the environment, ensure that the homes approach to meeting the healthcare needs of residents is of a good standard, to create more meaningful activities, ensure that residents have at least one annual holiday, aim to establish greater continuity in staffing in the home, and, develop the multi-sensory room (Snoezelen room referred to earlier in this report). The organisation has not carried out a stakeholder survey since the last inspection. The manager said that format for such surveys was in place and it was expected that one would be carried out over the next year or so. The homes current development plan covers the period to December 2008. Perhaps because of management changes since the last inspection it has not yet developed one for 2009/10. The manager expects to start work on this, with the operations manager, during the final two quarters of the financial year (October 2008 to March 2009). Regulation 26 visits are carried out by managers of other homes. Notes of such visits are maintained. All staff are trained in key health and safety subjects as part of the staff training and development programme. A health and safety walkabout is carried out after the afternoon and evening handover meetings. The security of the building has been increased through the installation of new locks since the last inspection. Contracts for the maintenance of equipment are maintained by staff at head office. According to information provided by the manager the home fixed wiring, portable electric appliances, and fire safety equipment were checked in April 2008. The gas boiler was next due for a check in October 2008. The hot water storage system had recently been checked for Legionella bacteria but the results were not yet available at the time of this inspection visit. The manager said that the home had carrid out a fire risk assessment for the year. Update fire training for staff was now carried out through computer based E-learning. Attention to some details of the environment may be required. As noted earlier practice in labelling opened foodstuffs in the kitchen is variable and needs to be more consistent. A system needs to be established for defrosting freezers in order to Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: maintain efficiency. One freezer had accumulated a moderate amount of frost although its temperature was not impaired. The manager said that a new wheel chair ramp and rails is likely to be required as residents mobility needs change. Routines for cleaning may need to be increased in order to manage unpleasant odours on occasions. Systems are in place for recording accidents. These are checked by operations managers during their visits to the home. Care Homes for Adults (18-65 years) Page 28 of 32 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 Schedule 2 All the information about people working at the home required by legislation must be available at the home, including proof of identity. The quality assurance system must include consultation with the people living at the home and their representatives. 14/09/2007 2 39 24 (3) 31/03/2008 Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 24 23 The registered persons must 30/11/2008 establish a programme of redecoration and refrubishment of communal areas of the home To provide a comfortable and pleasant environment for people living in t he home. 2 34 19 The registered persons must 30/09/2008 ensure that the information required under Schedule 2 is available in staff files maintained in the home. To provide evidence of good practice in staff recruitment to avoid the recruitment of staff unsuited to working with vulnerable people. 3 39 24 The registered persons must 30/11/2008 establish a system for reviewing and improving the quality of the service. Care Homes for Adults (18-65 years) Page 30 of 32 To carry out periodic checks that the service is meeting the needs of people living there. 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 6 The registered persons should review the current format of support plans with a view towards developing a system which is person centred and appropriate to the needs of people living in this home. The registered persons should ensure that the programme of quality assurance includes seeking the views of a range of stakeholders in the service. The registered persons should reconsider plans to make the planned multi-sensory room available to other homes in view of the potential risk that this may compromise the privacy of the people living in this small home. 2 39 3 39 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. 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