Care Home: 1 & 2 The Hedgerows

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What the care home does well The last inspection (May 2007) found the home`s admissions process was a sound one, which gave prospective service users and carers plenty of scope to get used to the home, so that they could make a positive decision to use its respite services. It found that the home`s care plans examplary and established what service users` strengths and needs were, and reviewed them on every stay or as new information became available. It found that service users` right to make decisions was being promoted, and that they benefited from a range of activities. And it found that there was a good level of investment in staff training and support for staff. Our own findings agreed with this. We found that this home blends in with the local community and is clean, tidy and odour free. It was being redecorated to reflect the service users` tastes, and there are some homely touches throughout. And all sources we asked told us the way staff interact with service users is kind, friendly and caring. What has improved since the last inspection? We found that progress had been made with matters raised for attention at the last inspection. This is judged a good use of the regulatory framework. The AQAA (March 2009) told us about a number of improvements as a result of listening to the views of service users. Support plans have become more inclusive and person centred. Pen portraits have been introduced, and risk assessments have been reviewed to be more specific to each individual. Staff have attended training to better meet the special communication needs of some service users. Staff have attended training in diversity and equalities to ensure their knowledge is up to date and can be promoted. Service users have been given the opportunity to experience events in the local community, in order to broaden their social network. The home does not provide a day service but has worked with existing day services to support individuals with public transport training so that they can access their usual employment or day services independently. Medication storage arrangements have been improved. Complaints have been discussed in team meetings to reflect on current practices, to ensure a consistent approach.A new kitchen has been fitted, and there are more improvements to the building in prospect. 77% of the staff have NVQ accreditation to level 2 or above, and two are undertaking NVQ level 3 training. The home`s senior home support worker has completed an NVQ level 4 in care and staff have been updating their training. Team building has been incorporated into the staffing rotas. The home has been producing its own business development plan to review its operation. What the care home could do better: The AQAA identified a number of further improvements to be made: There should be a more robust system to document the pre-admission process i.e. referral dates, readmission information, trial visits etc The home does not currently provide day care during the week but has identified this as a need and has been discussing this with Maidstone commissioners. The AQAA sees a need to better document how choices and decision-making are being promoted, through its daily notes. It also sees a need to better promote healthy lifestyles and eating. Currently no service users self medicate, but the AQAA envisages promoting this, so as to prepare individuals for moving on to supported living. The AQAA sees a need to improve the home documentation, to show how it addresses issues causing dissatisfaction, so that it properly informs future service delivery. There is a need to make better use of the garden area, and to develop a refurbishment / maintenance schedule, so as to maintain standards. The AQAA envisages service users being identified and trained to become involved in the recruitment of staff and in the planning of improvements to the service. It plans to evaluate training at team meetings and supervision or individual staff, to ensure it meets identified needs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 & 2 The Hedgerows Station Road Staplehurst Kent TN12 0QQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jenny McGookin     Date: 1 1 0 5 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: 1 & 2 The Hedgerows Station Road Staplehurst Kent TN12 0QQ 01580893269 01580893661 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kent County Council Name of registered manager (if applicable) Mrs Vanessa Elizabeth Donovan Mrs Susan Ann Pattenden Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Hedgerows offers respite care for short periods only. Service Users are required to attend day services, work experience and / or colleges from Monday to Friday. 24 hour care is provided over the weekend / bank holiday periods, except in exceptional circumstances. There are 5 single bedrooms, one of which is on the ground floor and is used by people with mobility difficulties. The Home does not offer services for wheelchair users requiring full care as there is not the equipment or facilities available to provide this. Many of the homes service users have been attending the home for Care Homes for Adults (18-65 years) Page 4 of 32 care home 5 Over 65 0 5 Brief description of the care home several years for periods of phased respite, the usual length of stay is 1 to 2 weeks. Staff work a rota that includes one member of staff sleeping in at night. Support workers assist Service Users with meal preparation and domestic cleaning. The Hedgerows is owned and run by Kent County Council. The Hedgerows is situated on the outskirts of the village of Staplehurst, which has a range of facilities including shops, library, medical centre, pubs and the village Community Centre. The nearest bus stop is on the main road, and there is a mainline railway station a short distance away. Limited parking is available to the front of the building and there is a large garden to the rear. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report is based on an unannounced site visit, which was used to inform this years inspection process; to check progress with matters raised for attention at the last inspection visit (May 2007) and to review findings on the day-to-day running of the home. The inspection took just over seven and a half hours. It involved meetings with two service users, a visiting relative, the manager, a senior home support worker, two home support workers, and an administrative officer. We sent a selection of feedback questionnaires for distribution to service users, their advocates or relatives, staff and visiting professionals (health and social care). Care Homes for Adults (18-65 years) Page 6 of 32 Feedback was not submitted in time for the issue of our report. Any responses will, therefore, be used to inform the Commissions intelligence in due course. The latest Annual Quality Assurance Assessment (AQAA) was submitted in March 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for the people using this service. It also gives some numerical information about this service. The inspection also involved an examination of records, and the selection of two service users case files, to track their care. We were able to assess some aspects of this homes recruitment processes, but recruitment is managed centrally by Kent County Councils Human Resources department, which keeps most of the original documentation at head office. And we looked at some staff training records. With one exception, service users were not due to arrive back at the home till the end of the day, but some interactions between staff and service users were observed as part of the visit. Four bedrooms were visited, one had been locked by the occupant so we respected their privacy), along with communal areas and the garden. What the care home does well: What has improved since the last inspection? We found that progress had been made with matters raised for attention at the last inspection. This is judged a good use of the regulatory framework. The AQAA (March 2009) told us about a number of improvements as a result of listening to the views of service users. Support plans have become more inclusive and person centred. Pen portraits have been introduced, and risk assessments have been reviewed to be more specific to each individual. Staff have attended training to better meet the special communication needs of some service users. Staff have attended training in diversity and equalities to ensure their knowledge is up to date and can be promoted. Service users have been given the opportunity to experience events in the local community, in order to broaden their social network. The home does not provide a day service but has worked with existing day services to support individuals with public transport training so that they can access their usual employment or day services independently. Medication storage arrangements have been improved. Complaints have been discussed in team meetings to reflect on current practices, to ensure a consistent approach. Care Homes for Adults (18-65 years) Page 8 of 32 A new kitchen has been fitted, and there are more improvements to the building in prospect. 77 of the staff have NVQ accreditation to level 2 or above, and two are undertaking NVQ level 3 training. The homes senior home support worker has completed an NVQ level 4 in care and staff have been updating their training. Team building has been incorporated into the staffing rotas. The home has been producing its own business development plan to review its operation. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can feel confidant that their needs will be properly assessed, before and upon admission, and that they will be offered the opportunity to visit and try out the home before their placement is confirmed. Service users may benefit be knowing what their rights and responsibilities are. Evidence: We were told that this homes Statement of Purpose and Service User Guide were under review, and revised versions were not submitted for assessment in time for the issue of this report, so we were unable to reach a finding on this. New service users are identified by care managers, who supply their own care plans. Prospective admissions are invited to make several tea visits to the centre, and a range of assessments are carried out throughout this period. This process enables all parties to try out the placement, to help them decide whether it will suit their needs. The manager told us she plans to arrange for each step in this process to be better Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: documented, so as to provide a tracking tool. We understand there is a process for emergency respite placements, but this would apply only rarely. We evidenced that the two latest admissions selected for case tracking had been appropriately introduced and supported to settle. We saw how daily notes were used, in one case, to record introductions to the people who were working and staying at the centre, observations of the way individuals interacted and the extent to which individuals needed prompts or support to do everyday things such as making tea. A draft support plan is set up during this period, along with a pen portrait in which the service user and their relatives or advocates have identified key likes, dislikes and goals. Upon admission, the assessment process is completed, and a support plan is set up. Thereon, the centres own feedback exercises are used to establish whether the existing service users were still content with their placement. We found that many have been using the service for several stays over many years. The centre tries to ensure that the booking service takes the compatibility of its service users into account. The placement of all service users is funded by Kent County Council, which has its own contractual arrangements, which are outside the scope of this inspection. We did not see any in the files we looked at nor did we see any terms and conditions in accessible formats so we were unable to evaluate whether service users knew what their rights and responsibilities were. See section on Individual Needs and Choices for our findings on the quality and development of care plans; and sections on Environment, Personal and Health care Support and Staffing for other key findings. The centre can demonstrate its capacity to meet the needs of its current service users. Less clear, however, was its capacity to accommodate a diversity of service users. All the current service users are, for example, reported to be white British. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Services users can be confident that the care they receive, is based on person-centred assessments of their individual needs, and that their perspective will be central to this process. Services users can confidently expect to be treated with respect, dignity and privacy. Evidence: See section on Choice of Home for our findings in respect of pre-admission assessments. On their admission, the centre confirms its draft support plan, which is intended to work alongside the care managers own care plan. Each support plan is signed off by the service user, where s/he is able, or their representative (e.g. relative or advocate). A separate pen portrait, drawn up with the service user and their relatives or advocates provides the key elements and helps to keep the service users perspective Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: central. Four service users at this centre have a range of special communication needs. Staff use pictures and symbols in documents to make them more meaningful to them and can interpret their responses and behaviours accordingly. We found that this arrangement properly details the service users health and personal care needs as well as their preferences and these documents were underpinned by daily reports, detailed practical instructions for staff and risk assessments (specific to each individual, their activities and environment - on and off site) to keep people safe. Reviews are carried out on each stay thereon and followed through with How was your stay feedback questionnaires, to ensure provision is kept up to date. The manager told us that she plans to ensure daily reports detail the extent to which service users are supported to make day-to-day choices. When we asked one service user, we were reassured to hear that he clearly knew he had a care plan, where it was kept and confirmed that they had talked about it. All five bedrooms in this centre are used for single occupancy, which means support with health and personal care can be given in privacy. We observed interactions between the staff and the service users and judged them appropriately familiar and respectful. This centres arrangements for keeping information confidential and personal effects are safe. Storage facilities are lockable and computerised information is password protected. Confidentiality features in staff terms and conditions and in KCC policies. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to make decisions and choices about their daily routines. The social, cultural and recreational activities being offered by the home are tailored to the preferences of the service users. Service users can be confident the home will support them to keep in contact with family and friends. Service users can be more confident that they will receive a healthy, varied diet according to their assessed requirements and choice. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: As a respite service, the expectation is that service users would continue attending any existing day services, education or work placements they are committed to, and, with rare exceptions, the centre is not staffed throughout the working day accordingly. We were told that activities over the evenings and weekends are planned with the service users. The home maintains daily reports for each service user. We looked at a selection of these, and spoke to three staff on duty, two service users and a relative. All these sources confirmed a range of opportunities, separately tailored for each service user. We were assured there are enough staff to enable each group to split off for separate activities. Access to community resources is promoted. Activities off site include bowling. swimming, trips to the seaside, activity parks, cinema, discos with SEC, pub, garden centre cafe, and a trip to an aerodrome. Activities on site include gardening, woodwork, listening to music, watching TV and staff offer direct support in some light practical daily living skills (e.g. tidying, collecting laundry or crockery, and the [preparation of snacks and meals). The centre organises a number of themed weekends throughout the year. When we visited we were shown an impressive dalek theyd made for a Doctor Who themed weekend. The centre has two communal TVs (one in each lounge) and some service users bring in their own portable TVs, so there is always a choice of viewing. We were told that one service user would be bringing in a play station and that a desk and chair would be provided in each bedroom to facilitate activities in bedrooms. Service users are able to have visitors at any reasonable time, but the nature of the service (respite) would not in practice anticipate this. Car parking facilities are good (6 spaces on site and more if grassed areas are used). The home is well placed for links with the community. There is a bus stop across the road and regular bus routes into Maidstone town centre in one direction and Cranbrook, and Tunbridge Wells in the other. The nearest shops are in in Staplehurst itself and there is a newsagent about 400 yards away. The centre has its own vehicle with a tail lift and most service users have travel permits. There is a communal telephone in the dining room and a pay phone in the Quiet Lounge. Catering needs, likes and dislikes are properly identified as part of the assessment Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: process and are updated or amended thereon. Each service user is supported to plan their own menu and is supported in the preparation of meals. The centre maintains records of what each service user eats, as required. When asked whether they liked the food, both service users we spoke to said they did. One said, I think its marvellous! Evidence gained that individuals were given a choice. We were told that a couple of service users needed help starting off (e.g. by staff loading their spoons) and that plate guards were available. We were told that no other support is currently warranted. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive the personal and healthcare they need, and can be confident that their preferences will be taken into account. Evidence: We could evidence that this homes support planning processes properly assess the extent to which each service user requires assistance with their own personal and health care and that the support plans are underpinned by practical guidelines for staff, staff training and risk assessments (e.g.manual handling, fire safety, personal care, self medication) to keep people safe. Service users choices and control are being actively promoted by staff as far as possible. Both genders are represented on the staff team, so that there is scope for choosing support e.g. with personal care. Service users can choose when to go to bed or get up, and two were observed being supported to make some decisions during our inspection visit. All five service users bedrooms are single occupancy. Each bedroom door can be Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: locked by snib on the inside and we were told each service user is routinely offered a key. There were enough lockable toilet and bathroom facilities available. The AQAA confirmed that KCC has a comprehensive range of policies governing the health and personal care of its service users, but the centre does not have a policy for soiled waste disposal. This should be rectified as continence is being managed at this home, however we evidenced that in practice it was being managed well. The medication arrangements were compliant with expected standards and designed to minimise the scope for error. There were no gaps or anomalies in the records we looked at, and we can confirm that there have been no medication errors reported to the Commission since the last inspection (May 2007). There is a dedicated medication room, which is kept locked when not in use. Access to it is restricted to the shift coordinator. Each bedroom has a lockable facility, so that service users could store their own medication safely there, but we were told that none of the existing service users self medicate. The manager told us she plans to promote this. Records confirmed that all staff are given training (updated every two years) to administer medication, and that this is competency tested, to keep people safe. The centre has a copy of the Royal Pharmaceutical Society Guidance for reference, to back up KCCs own policy. The AQAA also told us that the centre has established a good working relationship with a range of health care professionals, such as a local GP surgery, pharmacist, community and district nursing team. 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. Service users can be confident that their concerns and complaints will be properly addressed, whether or not they use the centres formal complaints procedure. Service users can feel confident that they will be protected from abuse, should it occur. Evidence: This centre is subject to KCCs complaints procedure, which was designed to be available in a range of formats, so as to be meaningful for its service users. We were told that service users and their representatives (e.g. relatives or advocates) are routinely reminded of its provisions. The homes complaints register is in the form of a loose leaf folder which should enable anyone authorised to inspect it to track any emerging trends. We were satisfied that the complaints we saw on file had each been resolved without the need to escalate them any further. When we asked two service users what they would do if they had any complaints, they told us confidently that they knew who to speak to. KCC also has a range of policies and procedures (including the local multi agency Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: protocols) to ensure that service users are protected from abuse in all its forms. We understand that induction training for new staff covers safeguarding protocols as well as complaints management. Records confirm that safeguarding procedures training is updated every two years, and is covered as part of staff NVQ training. See also section on Staffing for our findings in respect of recruitment checks. We can confirm that no adult protection alerts have been raised against this home since the last inspection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a homely and comfortable environment. The physical design and layout of the centre generally enable current service users to live in safety, and encourages their independence. Evidence: This centres location (in terms of access to community resources) and layout are generally suitable for its registered purpose and measures are in place to keep the premises secure against unauthorised access. None of the service users is given a front door key. We were told a number would require support off site, though some individuals do go out to the local shops on their own, subject always to risk assessment. One told us, Youve always got to ask a member of staff if you want to go out. The gates are kept closed for safety. This centre comprises a pair of two-storey properties joined by a single storey building. One ground floor bedroom has an en suite bath, shower and WC, but the centre is otherwise generally unsuitable for people with significant mobility impairment such as wheelchair users. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Access to this centre for families,friends and visiting professionals is, however, good. There are six parking spaces on site, and more if the grassed areas are used. There is, however, no parking available along Station Road, which is busy. There is a bus station and bus stops within easy walking distance, which link the centre to Maidstone town centre, with all the community resources and transport links that implies. The rear garden is enclosed on all sides, and has a number of attractive focal features, including a patio` and barbecue facilities. The manager told us she is planning to introduce a sun house, which should further enhance its use, and that a planned gardening themed weekend had proved very successful. She also told us that service users will be encouraged to use a greenhouse to grow vegetables. All areas of the centre were inspected and found to be homely, comfortable,clean and odour free. Comfortable lighting levels and temperatures were being maintained throughout. The centre and site have clearly benefited from having a dedicated part time maintenance man. The furniture tends to be uniform and domestic in style. This is appropriate given the low level of assistance required, as reported in the AQAA. Since the last inspection a new kitchen has been fitted and we saw that some flooring (in one lounge and the WC) had been replaced. We were told that service users were involved in the choice of colours. This centre is currently registered to provide care for up to five service users at a time, and all the bedrooms are single occupancy, which means privacy can be assured. As reported above, one of the bedrooms is en-suite. All the bedrooms were inspected on this occasion, and found generally well maintained. Service users can and do bring in selected personal effects. Each service user has a lockable cupboard for personal effects and medication should any be assessed able to self medicate. Service users have a choice of communal areas. Each property has a lounge, and a garage is being converted into an activities room, for a pool table and table top pursuits. Service users also have a choice of bath and WC facilities, though we noted that each bath (including the en-suite) will require attention or replacement. This is already planned. The only shower facility is in the en-suite, so access to it would need to be negotiated. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: All the service records seen (e.g. gas, electricity, fire safety etc) were up to date and systematically arranged, to facilitate access. The centre has a laundry facility, which was judged well maintained and orderly. The centres washing machine has a sluicing cycle, and we were told red alginate bags are used to transport any soiled laundry through the centre, to maintain hygiene standards. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the staff training investments. The numbers of staff on duty at any given time can be adjusted to reliably meet the any emerging needs of the service users. The centres arrangements for staff supervision, team meetings and support provide the necessary checks on staff practices. Evidence: We were told that one should expect to find at least one member of staff on duty at all times, and two or more during more active times e.g. evenings and weekends. At nights there is one member of staff on sleeping duty from 11pm, who then also works from 7am till 11am. As a respite service, the expectation is that service users would continue to attend any existing week day commitments such as day services, education or work and staffing levels reflect that. KCC has on-call arrangements for advice and in the event of emergencies. There are no ancillary staff other than a part time maintenance man and an Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: administrative assistant. Support workers are responsible for cooking, laundry and cleaning as well as supporting the service users with light domestic duties. They are to be commended on the level of cleanliness we found. We can confirm that since the last inspection, there have been no concerns raised with the Commission about the homes capacity to maintain the staffing levels described. We understand the centre uses a bank of casual staff who are already familiar with its policies and procedures. Recruitment is managed by KCCs Human Resources department, which keeps almost all the original documentation at head office. These records are subject to a separate inspection at KCCs head office by one of the Commissions own senior officers and no major shortfalls have been reported through this route. There were some records on site which combined with feedback we received from staff, to confirm a systematic recruitment process to comply with the key elements of the standard, including references, criminal records checks and to account for individual employment histories, to keep people safe. Feedback from staff also confirmed that they had documented supervision sessions, and that the frequency of these was 4-6 weekly, indicating that the National Minimum Standard is being exceeded. We were also aware that all staff are required to countersign key policies as evidence of having read and agreed to comply with their provisions,and saw records to confirm regular staff team meetings. This is exemplary practice, as it is intended to ensure practice standards do not become variable. The AQAA told us that 77 of the staff team had achieved NVQ accreditation to level 2 or above and we understand all staff are required to complete Learning Disability Award training (LDAF); that there was an ongoing system in place for identifying training needs (e.g. to anticipate any special needs of incoming service users) and updating any training. Each member of staff has a personal development plan. In discussions with us, staff described a comprehensive list of mandatory training opportunities, designed to keep people safe. They said they felt well invested in. One said, I think training here is very good. And when asked what was good about this centre, both service users we spoke to said they liked the staff. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run for the benefit of service users in that it is based on a culture of openness and respect. Evidence: Vanessa Dovovan took on the manager post for this centre in November 2008 but has yet to submit an application for registration by the Commission. It is an offence against the Care Standards Act 2000 to be in day to day management of a registered service and not be registered with CQC. A managers application must be made by the date stated in this report. Staff spoke well of the manager and told us she had created a good atmosphere to work in, and observed interactions were judged appropriately familiar and respectful. When we asked one service user what was good about this unit, she told us, I think its nice and comfortable. Weve got a big garden. I get on well with the staff and other people. They always have the same people. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: When we asked one visiting relative what this unit meant for her, she told us, It means I know **** is being well looked after and is accessing the life he wants that I cant give him. He is supervised and is safe. It gives us time to ourselves. **** When asked staff what was good about this centre, one told us, the structure and support here feels safe and spoke of the adjustments service users faced leaving school for an adult environment. Theres so much change. Here its home from home. Another said, Its very homely. I think they (the service users) feel like its their home as well. Its quite relaxed when they come her and they like to come back. We give them feedback forms and they sign them if we fill them in for them. Another told us, Its quite s small unit. It enable people who come here to do more, who would find large groups difficult to cope with. Another said, Its very friendly. The people I see in the mornings seem in happy mood. When asked what could be improved, one service user told us it wasnt easy getting wheelchairs into the centres transport, and it was also difficult for clients to get in and out. A relative told us, just a little more information. Theyve shown me photos today. If I hadnt come in they wouldnt have done that except on Open days. They always ring to check if anything is different. One member of staff told us, maybe we could provide things like front door keys, little things like that. Ive seen huge improvements here as regards person centred planning. Another told us, A lot has already been done. The (garage) was converted so that service users could have another lounge facility and music. But the ceiling came down and it took a long time to get it fixed. Overall, were doing a good job I think! And one told us they could do with a bigger office and/or a conservatory. There are clear lines of accountability within the home, and within KCC but records showed that KCC has not been able to evidence a sustained compliance with its duty to carry out formal documented inspection visits of its own once a month (Regulation 26) since the last inspection. We found three months not accounted for over 2008/09 for example, KCC are reminded of their obligation to undertake Regulation 26 reports monthly. We were already aware that KCC has a corporate business plan and an action plan for the current year. These properly set an agenda for reviewing and developing its operations within a budgetary framework but we did not see a business plan for this centre to identify its contribution to this, though we were assured this was in progress. There was good evidence of quality assurance feedback exercises carried out by the centre over the past year, including How was your stay? questionnaires for individual Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: service users. But we did not see any analysis of emerging trends or issues. So we were unable to assess how feedback could influence the way services are delivered except on an individual basis, and through service users group meetings. We wanted to know more about the diversity of this centres service user and staff group. The staff group reflects the ethnicity of the service user group - all are white British and both genders are represented on each. This means that same gender personal care should be achievable if that is a service users preference. The AQAA told us all staff had been given training on diversity and on mental capacity issues, to keep this aspect of the homes operation an active consideration. We were satisfied that this centre makes provision for the proper storage of confidential information, personal effects and medication. The centres property maintenance certificates seen were up to date and systematically arranged to facilitate access. There are regular health and safety inspections around the centre itself, and we did not find any potential hazards. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 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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