Inspection on 23/02/09 for William Street (2)

This inspection was carried out on 23rd February 2009.

CSCI found this care home to be providing an Good 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

William Street (2) 06/02/07

William Street (2) 04/01/06

William Street (2) 18/07/05

William Street (2) 14/03/05

William Street (2) 04/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: William Street (2) 2 William St Calne Wiltshire SN11 9BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Barber     Date: 2 7 0 2 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: William Street (2) 2 William St Calne Wiltshire SN11 9BD 01249817215 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : United Response care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 2 William Street is part of North Wiltshire Community Living, which is run by the national charity, United Response. 2 William Street is a detached house in a residential area and is peoples permanent home so long as this is appropriate to their needs. The home is located on the northern side of Calne. There is a parade of shops situated a short walk from the home. A wider range of shops and services are available in Calne town centre. A house vehicle is used when transport is needed. Each person who lives in the home receives personal care and support throughout the day from a permanent staff team. Each person has their own room on the first floor. The philosophy of care emphasises the importance of an ordinary, domestic home environment and the involvement of people with a learning disability within the wider community. The fees are about 1100 pounds per week and depend on peoples individual needs. Information about the home is available in a service user guide and inspection reports are available from the home and CSCI website www.csci.org.uk. Care Homes for Adults (18-65 years) Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home. We had surveys back from three people who lived in the home and one staff member. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home which took place on 23rd February 2009. We talked to four people who lived in the home and three members of staff. We looked at some of the homes records. We Care Homes for Adults (18-65 years) Page 5 of 32 visited the organisations offices on 27th February 2009 to look at the staff training and recruitment records. An expert by experience helped us with the inspection. This is a person who has experience of using services themselves. They talked to the four people who live in the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 6th February 2007. What the care home does well: What has improved since the last inspection? When medication record sheets stated that medication should be given as directed the Care Homes for Adults (18-65 years) Page 7 of 32 staff had gone back to the original directions and written them on the sheets as a temporary measure. They were also obtaining new prescriptions with directions from the GP. This would help to ensure that all medicines were given in the right way. The cleanliness of the laundry area had been improved by painting the walls and laying vinyl flooring so that it was easier to keep clean. Improvements had been made to the accommodation by decorating the bathroom and two of the bedrooms and laying new carpets in the communal areas. New dining furniture and patio furniture had been obtained. There had been a programme of training for staff in person centred thinking and person centred tools to help them make the service more person centred. Staff had started to use these tools when reviewing peoples care. 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 8 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 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had the information they needed to make a decision about whether the home was the right place for them. Each persons individual needs were assessed so that their needs could be met. People had the opportunity to visit and test drive the home before they moved in. Each person had a contract with the home so they knew what to expect from the service and what they had to pay for. Evidence: The manager told us in the AQAA that they had a Statement of Purpose and Individual Charter that would be made available to prospective new residents, their family or friends and Care Manager. When we visited the home we saw that there was a statement of purpose that contained all the required information including information about how to make a complaint. One person had moved into the home since our last inspection. They completed a survey and said that they were asked if they wanted to move into the home and they received enough information about this home before they moved in so that they could decide if it was the right place for them. Two other people who completed surveys said that they moved in a long time ago and could not Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: remember. Three people had lived in the home for several years. We found at previous inspections that their needs were assessed before they moved into the home. One person had moved in since the last inspection. The manager told us in the AQAA that they had a community care assessment by a social worker before they moved in. We looked at this persons file and saw that they had had a social work assessment before they moved in and there was also information about their needs from their previous placement. The manager told us in the AQAA that this person moved in, in August 2007, following a period of introduction that involved a series of day and weekend visits and stays. The other three people were consulted before the decision to move in was made. They said that the placement was reviewed after a month and then after three months before the contract was signed and the placement made permanent. The person told us that they had a visit to the home and then moved in quickly. A member of staff confirmed this. We looked at three personal files. We saw that all three people had individual charters, which set out their terms and conditions, the fees and what they had to pay for. One person also had an individual service contract with Wiltshire County Council. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples assessed needs were reflected in their individual plans but these could be made more person centred. People made some decisions about their lives with assistance as needed but their opportunities to make decisions depended on staff availablity. People were supported to take risks and given some opportunities for independence. Evidence: We looked at the records of three people. We found that each person had a series of support plans for different issues. These included the morning routine, intimate and personal support, behaviour management, managing money and communication. These plans were written for the staff and were not in formats people could easily understand. People did not have their own copies of their plans. Each person also had recently had a person centred review. These reviews had included the person and people who were important to them such as relatives and staff and also other professionals who were involved. The reviews focused on what was important to the Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: person. Actions or objectives were identified at the review and written into a plan which was monitored every two months to ensure that the actions happened. These plans were separate from the suppport plans. The expert by experience talked to all the people who lived in the home and the staff. From talking to people they concluded, Staff said everyone had a person centred plan but residents did not know what this was. The plans are in the office. This is NOT person centred plans. When we looked at the records we saw that limitations were recorded in the plans and were in peoples best interests, for example to reduce self-harm. There was information in the plans about how staff advise people about the consequences of their choices and decisions. One person was a member of a womens group. There were records in the personal notes of how people had made choices. Staff supported people to manage their money, go to the bank, do their shopping and decide what to buy. The manager was the appointee for one person. We received surveys from three people who lived in the home. Two of them were completed with the help of a support worker. One said that they had made the decision to move into the house and the others said that they could not remember. They all said that they sometimes make decisions about what they do each day. One commented that sometimes other appointments get in the way. Another person said Like to choose what pub to go to, like to choose holidays. Decide what jobs to do in the house. All three people said that they can do what they want during the day and evening and at weekends. However, one person commented, Not possible to do what I would like due to other people having things to do as well. During the inspection two people were at home all day and were encouraged by staff to make decisions about what they wanted to do. They were offered choices to go out or to stay at home. One person went to the bank independently. A member of staff told us that this person did not always get their one to one time with staff to do what they wanted with support because the other person was at home as well. There used to be house meetings but staff told us that these had stopped. The expert by experience suggested that they should have independent advocates to support people at residents meetings. The expert by experience found The residents choose how their rooms are decorated but the common areas in the house are decorated by staff. They could make drinks when they wanted. There is one resident who has higher support needs than the others, but they are not supported to make drinks or snacks. Staff should encourage them more to help them-self. The manager told us that staff support this person to participate in house hold tasks such as making drinks, setting and clearing the table and vacuuming. The manager also told us that staff decorated Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: the communal areas but people were involved in choosing the colours and furniture. The expert by experience concluded I think people should have more choice and control and residents should be encouraged with cooking and being more independent. Staff do a lot FOR residents but not enough WITH residents. When we looked at the records we saw that each person had a series of risk assessments. The person who had moved in most recently had risk assessments in a new person centred format for example about managing their own money and going on holiday. These focused on promoting independence and the benefits to the person of taking risks. The other two people had older style risks assessments for example about washing, sleeping alone, fire alarms, upstairs windows, being home alone and going out socially. These did not focus on the benefits to the person of taking risks. The risk assessments were all reviewed in December 2008. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with some activities and opportunities to go out into their local community. People were able to maintain and develop appropriate relationships with family and friends. People were involved in the daily routines of the home although some people could be supported to be more involved. People were offered nutritious and enjoyable meals, in line with individual needs and choices. Evidence: When we looked at the care plans we saw that each person had day time activities. One person went to a day service two days a week. They did not have another day time activity and stayed at home the other days. A staff member told us that they were hoping to get more days at a day service for this person. A second person went to another day service two days a week. A staff member told us that the staff supported this person on other days for example to go out for a coffee and they were Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: hoping to start dog walking soon for a dog sanctuary. The member of staff told us that it was not always possible to give this person their one to one staff time on a Monday as was part of their plan. This was because another person was at home on that day and there was only one staff member on duty who could drive and they needed to collect the other people from day service. A third person went to a day service three days a week and the fourth person went to another day service three and a half days a week. They worked in a charity shop half a day a week and went to a work placement on the other day. During our visit two people spent much of the day at home and went out with the staff to collect the other people from their day service. The expert by experience found that everybody liked their day service. On the day of our visit one person went to the bank and to the shop independently. We looked at the daily records of the other person who was at home. These showed that they sometimes went into town independently for a cup of coffee or to go shopping. We looked at the daily diary entries for three people over the last month. We did not find much evidence of community participation. They used local amenities but there was no evidence of being involved in community activities. We saw that people watched TV, played board games, went to McDonalds, went shopping in Melksham, went to a local garden centre, went shopping for toiletries or a newspaper, went to the pub, went out for a coffee, went for a dog walk and went for a trip to Bath. The expert by experience talked to everyone who lived in the home. They found There was not a lot of community inclusion. They found that one person had a bus pass but it had run out. However, this person had a good network of family and friends and went out with them including going up to Chelsea to watch football. They found that this person walked to town to get their benefits but the other people who relied more on staff for social activities did not get as much choice as there were not enough staff to support them to do things outside day service. The expert thought that there should be more evening and weekend social activities. Three people who completed surveys said that they could sometimes make decisions about what they do each day. One said Sometimes other appointments get in the way. Another said Like to choose what pub to go to, like to choose holidays, decide what jobs to do in the house. All three said that they could do what they wanted during the day, in the evening and at weekends. One person said Not always possible to do what I would like due to other people having things to do as well. Another person said, If I have money left I can go out and spend it. The expert by experience found that everyone had a holiday, one person was supported by a friend to go abroad, and another person had been on a short break in London to watch Phantom of the Opera. The expert thought that this was good, Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: because it means they dont all go together and people get to choose where they go. One person told us that they had been on holiday with a friend. Another person told us that they hoped to go on holiday to Turkey with their brother. When we read the files we saw that they contained information about peoples contact with their family and friends. They showed that one person saw their mother every other weekend. One person told us that they were planning to see their mother soon to go out for a meal. A staff member told us that another person kept in contact with their two friends. They went on holiday with one and went to football matches with another and also visited their mother. Information about peoples daily routines was recorded in their files. During our visit one person was doing their washing. The daily records showed that people were involved in cleaning, washing, stripping and making their beds and vacuuming. Staff told us that people were involved in these routines with varying levels of support. The expert by experience found that people could make drinks when they wanted. They noted that there was one person who had higher support needs than the others, but they were not supported to make drinks or snacks. They thought that staff should encourage them more to help them-self. During our visit we saw two people decide what to have for lunch and they prepared it with staff support. A member of staff told us that three people prepare their own drinks and snacks and cereal and toast for breakfast. They also said that some of the people could help to prepare meals for example by preparing vegetables. The records showed that people shopped for food with staff support. Staff said that people were asked in the morning what they would like for lunch and tea. People told the expert by experience that staff do all the cooking and they do not choose the menus. Staff told the expert that people could choose what they wanted for their evening meal from the freezer. We looked at the record of food served. These showed that there was a variety of meals. Sometimes people had the same meal and sometimes they chose to eat different meals. 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. People received personal support in the way that they preferred and required. Peoples physical and emotional health needs were met. People were protected by the homes policies and procedures for dealing with medicines. Evidence: Peoples preferences for how they were supported were reflected in their individual routines and specific support plans. Assistance with personal care was identified in the support plans and personal support took place in the privacy of peoples own rooms or the bathroom. Peoples preferred times for getting up and going to bed were identified in the daily routines while meal times were fitted in with activities. People chose their own clothes and hairstyles. One person had a wheelchair provided following an occupational therapist (OT) assessment. They also had an adjustable arm chair in the living room. People had access to specialist support and advice including OT, psychology, psychiatry and community nursing. People also had access to advocacy and had support from their family and professionals. When we looked at the care records we saw that each person was registered with a Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: GP. Appointments with health care professionals were recorded. We saw that people had appointments with their GP, the dentist, optician, nurse, psychiatrist and other consultants as required. We looked at the arrangements for managing medication. We saw that there was a clear procedure for administering medication to people and helping them to take it. A monitored dosage system was used and medication was stored in a locked cabinet. There was a controlled drugs cupboard. We suggested to a member of staff that they made sure it complies with the new requirements for the storage of controlled drugs. There were no controlled drugs at the time of our visit. A record was kept of each persons medication. Each persons consent to medication was obtained and recorded in their individual plan. Records were kept of medicines received, administered, leaving the home and disposed of. There was a weekly stock take of medication and we saw the records of these. At the last inspection we noted that the medication administration records did not contain instructions of how medication should be given but said as directed. We made a requirement that clear instructions must be obtained to ensure that medication is given correctly. This was being addressed. A member of staff told us that the GP was going to issue new prescriptions with directions on them. As a temporary measure staff had written directions on to the medication administration records. We saw that patient information sheets were kept for all prescribed medication. Staff monitored the condition of people and called in the GP for review when there were changes. We saw in the files that each person had a list of acceptable non-prescribed medication agreed with the GP. There were also guidelines for the administration for as required medication agreed with the psychiatrist. All staff administered medication and the training records showed that they had had training. A consultant reviewed the medication. We saw that a record was kept when medication was handed to a relative for safekeeping when one of the people visited them. A symbol A for absent was recorded on the medication administration record. A member of staff showed us the envelopes they used to put the tablets in. They used one envelope for the tablets at each time of day that they were due. They wrote on the envelope the list of medicines, the dose, the date and the time to be given and the directions so that it was clear when and how to give the medication. 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. People knew how to make a complaint and felt that their views would be listened to and acted upon. People were protected from abuse, neglect and self harm. Evidence: When we looked at the files we saw that each person had information about the complaints procedure and advocacy. Three people said in their surveys that they knew who to speak to if they were not happy and knew how to make a complaint. One said Talk to a member of staff. To the manager Boni. There had been no complaints since the last inspection. United Response guidance for staff was contained in a Prevention of Harm policy and procedure. Staff members had also received a copy of No Secrets in Swindon & Wiltshire booklet giving guidance on the local arrangements for the reporting of suspected abuse. No allegations or incidents of abuse had been reported. When we looked at the training records we saw that staff received training about prevention of harm. There was guidance about the management of peoples money, valuables and financial affairs. Two people were supported to manage their own money and the manager was appointee for one person. Records were kept of all financial transactions. Two people were able to sign the records when they received money. Staff signed the records Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: when dealing with money. We made a recommendation at the last inspection that when a person withdraws money from their cash box the person and a member of staff should sign the record. When a person is unable to sign two members of staff should check and sign the record. This had been addressed. People who could sign had signed each time they received money and two staff signed the record when people could not sign. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a homely, comfortable, clean and safe environment. Evidence: We looked round the accommodation. We observed that the property was in keeping with the other houses in the surrounding residential area. The upkeep of the home and on-going maintenance appeared to be of a good standard. There were systems for monitoring of health and safety. The accommodation was decorated in a homely manner and was comfortably furnished. The premises were accessible to all the people who lived there and people had access to local shops and amenities. Since the last inspection the dining furniture had been replaced, the carpets had been replaced and the computer station had been replaced with one which was easier for people to use. The downstairs bathroom and two bedrooms had been redecorated. The home was maintained to a good standard and the accommodation looked clean and tidy. There were no unpleasant odours. There were infection control guidelines. The washing machine and tumble drier were kept at one end of the garage. We made a recommendation at the last inspection that the cleanliness of the laundry area could be improved by painting the walls and resealing the floor to make them easier to Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: clean. This had been addressed. There was vinyl flooring and the walls had been painted. There were no hand washing facilities but the shower room with a wash hand basin was nearby. People did their own washing with different levels of support. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by an effective team of competent staff who were appropriately trained. People were protected by the homes recruitment policies and practices. Evidence: A member of staff told us that there were two staff on duty from 10 am each day to 3 pm and two in the evening. They said that one member of staff slept in at night and they were on their own from 10 pm to 8 am on weekdays and 10 pm to 10 am at weekends. The staff member told us that only one person needed help with personal support during the mornings. We looked at the staff rota and it confirmed what the staff member said. During our visit there were two staff members on duty throughout the day. The manager told us in the AQAA that there were seven care staff and two had a National Vocational Qualification (NVQ) at level 2 or above. The manager also said in the AQAA that there was a comprehensive induction programme for all new staff involving completion of the Common Induction Standards. They also had training about first aid, food hygiene, health and safety, manual handling of objects, medication, challenging behaviour, prevention of harm, The Way Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We Work (training about the ethos of the organisation), communication awareness and equality and diversity. The manager said that all training is repeated and refreshed on a rolling programme. They said that any additional training needs are identified through support and feedback and the changing needs of the people they support. They also stated that all new colleagues are expected to undertake NVQ after the six month probationary period. When we visited the office we looked at the training records of three members of staff. One member of staff had started work recently and had had all this training and had a certificate to show that they had completed the common induction standards. They had also had training about epilepsy and they already had an NVQ level 2 in care. The other two staff had worked in the home for several years. They had had all the induction and basic training and had had this updated. Further updates were planned. One of these staff had also had training about autism and about acquired brain injury. The other member of staff had had the induction training and all the basic training, which had been updated. They had also had training about epilepsy awareness, brain injury and mental health, administration of medicines by special methods and person centred review training. Two staff told us during our visit to the home that this member of staff was cascading the person centred review training to them. When we visited the home a member of staff told us that one member of staff had been recruited since our last inspection. They had worked for an agency before that so they had already worked in the home. When we visited the office we looked at their recruitment checks. We saw that all the required checks had been received before they started work. They had completed an application form with a declaration that they had no convictions and a declaration that they were physically and mentally fit. A copy of their birth certificate, marriage certificate and photo driving license had been kept as proof of identity. Two written references, a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults (POVA) check had been obtained before they started to work with people. When the expert by experience was talking to people they found that they do not interview staff that work there and there was a lot of agency work. They said I think they should interview their own support workers. The manager told us that people were involved in drawing up the specification for the job using a matching staffing form. We saw a copy of this and it included the skills and qualities that people would want a new member of staff to have. She said that after interview prospective staff visited the home and spent time with people so that the people themselves could make the final decision who gets the job. Care Homes for Adults (18-65 years) Page 25 of 32 Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were benefiting from a well run home. Peoples views contributed to all selfmonitoring, review and development by the home. Peoples health, safety and welfare were promoted and protected. Evidence: The same manager was managing the home as during the last inspection. She has responsibility for a number of homes that are run by United Response in the North Wiltshire area. The manager has a Registered Nursing qualification, a diploma in management studies and a qualification in the care of people with a learning disability. She keeps her training up to date. We saw that there was a Getting it Right manual which was a quality assurance manual with policies and procedures to ensure that a range of standards were met. The area manager conducted the monthly visits as required under Regulation 26 of the Care Homes Regulations. The manager conducted checks of health and safety, finance, training, supervision and care every two months. There was a two year corporate plan Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: for United Response. We saw that there were annual care reviews and monitoring of objectives to demonstrate year on year development for each person. The manager completed an AQAA. They told us about what was working well in the service, what had improved since the last inspection and how they planned to improve during the next twelve months. They told us about changes they had made as a result of listening to people. These included re-decorating the bedrooms of two of the people they supported in accordance with their wishes and choices and continuing to enable the people they support to enjoy holidays of their choosing; supporting one person to share her holiday with her mother (and a support worker) and another to have a holiday with support from his friend. They told us that they had sent questionnaires to peoples families and friends and professionals involved with their care to gain their views about the service provided. They told us about how staff had received training about person centred thinking and using person centred tools. They did not tell us how this development had improved outcomes for people who lived in the home and during our inspection we did not find evidence of how the person centred tools improved outcomes. We looked at the arrangements for promoting health and safety. We saw that there was a health and safety handbook with action to be taken in order to comply with the relevant regulations. We looked at a number of risk assessments and safe working procedures which had been recorded. A risk management manual had been produced by United Response. There were arrangements for the training of staff in moving and handling, fire safety, first aid and food hygiene. A monthly hazard inspection of the home was carried out. Hot water temperature regulators had been fitted to all taps apart from in the kitchen. Hot water temperatures were taken and recorded weekly and before bathing. There were individual risk assessments for bathing. There were COSHH assessments, the boiler, thermostatic radiator valves and equipment were regularly serviced and portable appliances were tested annually. There was a fire risk assessment and records of fire safety checks. There were risk assessments about the safety of radiators and windows. These were not considered to pose a risk to people who lived in the home so radiators were not covered and windows were not restricted. There were general risk assessments about safe working practices. Accidents were recorded and reported if appropriate. Care Homes for Adults (18-65 years) Page 28 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 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 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 Each person should have a person centred plan which reflects their diverse needs, their wishes and hopes so that all their needs will be met. People should be offered more opportunities to make choices and decisions about their everyday lives. The risk assessments could be improved by making sure that all of them include the benefit to the person of taking risks to promote their independence. People should be supported to be more involved in community activities and leisure activities when they do not attend day services and during evenings and weekends. People who need more support should be supported and encouraged to be more involved with the routines of the home so that they can be more independent. The registered person should make sure that the controlled drugs cabinet complies with the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). The AQAA should contain information about how service developments improve outcomes for the people who live in the home. Page 30 of 32 2 3 7 9 4 13 5 16 6 20 7 39 Care Homes for Adults (18-65 years) 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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