Care Home: 1 and 2 Westbury Way

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What the care home does well All the information supplied by the home for current and prospective people, who might wish to use the service, is presented in formats accessible to people with learning disabilities. Care had been taken to ensure that all documentation is relevant to the people for whom it is intended and personalised with colourful photographs, symbols and large print. Care plans, risk assessments and health action plans are written in a person-centred way to promote the involvement and understanding of the people using the service. `Circles of support` explore the aspirations of the people living at the home with the people, who are important to the individual, and know them well. Diversity is celebrated and promoted through `Everybody Counts` training provided by the organisation and regular `inter-cutural days` are organised, in which individual staff members, the people living at the home, and visitors from different cultures and enthnicity actively encourage others to share their beliefs, cuisine and dress. Friendships and family involvement are promoted, and opportunities for the people living at the home to socialise, to take holidays, go on trips in the specially adapted vehicle, and to develop special talents are provided. All the people living at the home have health action plans, showing how they are supported to live a healthy lifestyle. The home has a positive attitude towards complaints and regards them as an opportunity to grow and develop. The home provides a comfortable, homely, and well-maintained living space for the people living there, and an environmental health visit from the local borough council in June, had allocated the service an `excellent` rating, and noted that the home provided, `a high standard of cleanliness`. The stable staff team are well-qualified and offer consistency and continuity of support to the people living at the home. The experienced, registered manager ensures that the people, who live at the home, are involved in developing plans for the future and that the home is run in their best interests. What has improved since the last inspection? Since the previous site visit, and as a result of listening to the people who use the service, `60 minute` plans had been developed to document short-term goals and Essential Life, Health Action, and Activity plans had also been introduced, and were produced in communications styles, accessible to individuals. New flooring had been laid in the kitchen and dining areas since the last site visit, to enhance the environment for the people living at the home, and a summer house had been erected in the garden, so that they could relax and enjoy the garden in comfort. What the care home could do better: The AQQA identified areas for the future development of the service, but there were no areas for improvement as a result of this report. This is a service where true dedication from a skilled manager and a loyal staff team really deliver a service, which is tailored to meet the needs of the individuals for whom the service is intended. Key inspection report Care homes for adults (18-65 years) Name: Address: 1 and 2 Westbury Way 1 and 2 Westbury Way Aldershot Hampshire GU12 4HE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Bowman     Date: 2 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 29 Information about the care home Name of care home: Address: 1 and 2 Westbury Way 1 and 2 Westbury Way Aldershot Hampshire GU12 4HE 01252311852 01252311852 info@new-support.org.uk www.new-support.org.uk Dimension (NSO) Ltd care home 6 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 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 1 and 2 Westbury Way is a care home providing personal care and accommodation in single bedrooms for up to six persons with a learning disability. Dimensions (NSO) (New Support Options) Ltd, who are part of the Dimensions Group, also responsible for similar services nationwide, provide the service. The home is located in a residential area within a mile of Aldershot town centre. Local amenities are accessed with the homes minibus. The purpose built home is comprised of two three-bedroom bungalows, which are linked by an office, and multi sensory room. Each bungalow also has a lounge, laundry, assisted bath, toilets, combined kitchen and diner and its own garden. Parking is available. The current fees for the home are #1357.18 per week. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 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 inspection report includes information gathered about the service since the previous site visit on 15th August 2007 under the Inspecting for Better Lives (ILB) process. An Annual Quality Assurance Assessment (AQAA) was completed by the manager, and returned within the required timescale, giving up to date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service, and of their plans for further improvements. All of the six people living at the home were supported by staff or relatives to complete surveys, giving their views on the service. An unannounced site visit, conducted on 20th July 2009, was completed over five hours commencing at 11:00am, to assess the outcomes of the key inspection standards for younger adults with respect to the people living at the homes. A follow-up visit was carried out on 22nd July over two hours to sample the staff files and to interview two of the staff because staff surveys were under review and not available to be completed. The registered manager, Mrs Mary Whitford, assisted with the inspection process by making Care Homes for Adults (18-65 years) Page 5 of 29 service user and staff files, the staff training matrix, quality assurance documentation, the service user guide, the statement of purpose, samples of policies and procedures and other documents and records available to be sampled. We sampled two bedrooms and the communal living areas and observed the staff as they carried out their duties. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? Since the previous site visit, and as a result of listening to the people who use the service, 60 minute plans had been developed to document short-term goals and Essential Life, Health Action, and Activity plans had also been introduced, and were produced in communications styles, accessible to individuals. New flooring had been laid in the kitchen and dining areas since the last site visit, to enhance the environment for the people living at the home, and a summer house had been erected in the garden, so that they could relax and enjoy the garden in comfort. Care Homes for Adults (18-65 years) Page 7 of 29 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 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 29 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 29 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 wishing to use this service are provided with full, detailed and accessible information to help them to decide if this home would be able to meet their needs. The home has a procedure in place to ensure that an accurate assessment is made of new people wishing to use the service, in which they or people close to them have been involved, and which clarifies the support they need and highlights their aspirations and hopes for the future. Evidence: The information available to prospective persons applying for a placement at the home was of a high quality and well illustrated with photographs. Background information about the organisation and the relevant experience of those serving on the board of directors, the executive management and the permanent and bank staff working at the home was recorded, inspiring confidence in the ability of the organisation to retain staff and afford consistency of support for the staff and for the people using the service. Both the statement of purpose and the service user guide had been recently reviewed. The statement of purpose recorded detailed information about the people for whom the service was intended, clear aims and objectives, the philosophy of care, Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: and an explanation of the services and facilities provided. Prospective applicants and people currently living at the home were promised that they would be respected as individuals, that they would be supported to uphold their chosen culture, beliefs and traditions, that their dignity, self respect and independence would not be stifled, and that they would be assisted to integrate into the local community. The service user guide, which was individually adapted for each person living at the home, was written in a person-centred way and included illustrations and photographs to promote the understanding of individuals with learning disabilities. Colour photographs of all parts of the home the persons using the service would have access to, including their bedroom, bathroom, sensory suite, dining room, kitchen, lounge, the garden and also the homes vehicle were included. An explanation, in words and drawings, of what the money the people who live at the home pays for, and of their rights and responsibilities, was also included and signed by the recipient or a representative to confirm acceptance. There had been no new admissions to the home in the past six years, but an admissions procedure set out clearly the process to be followed, should a place become available, and a new referral made. The procedure confirmed that the manager must have received a community care assessment prior to making an initial visit, that the preliminary support plan was to be drawn up in consultation with the supported person and their representative, and that visits would be planned, to enable the applicant to sample the service, and for the people currently living at the home to be consulted with as part of the process. If the planned visits were successful, the applicant would be offered a trial period of one to three months, during which their present accommodation would be kept open to them. A review meeting at the end of the trial period would be held to make the final decision on whether they would stay. Subsequent reviews would be planned for six weeks, three months and six months to ensure the placement was suitable. The home facilitates a person-centred plan or updates the original plan for the new person within the first three months of their admissions date. All the people living at the home confirmed, in the surveys they completed with support from the staff, that they had been asked if they wanted to move into this home, and that they had enough information about the home before they moved in to decide if it was the right place for them. Care Homes for Adults (18-65 years) Page 11 of 29 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. The approach of the service in planning for the needs of the people they support means that the person can be confident that their needs will be responded to with detailed, accessible and meaningful plans that place them at the centre of the support they receive. Evidence: The care plans of two people, who live at the home, were sampled. The care plans were person centred and contained very clear and specific information covering all areas of daily life. The manager wrote in the AQAA, the views of the people we support are promoted and incorporated into everything we do through the medium of the person centred plan, which is a process of life planning, which ensures that the person is central to all decisions made on their behalf, and it is owned and controlled by the person assisted by a nominated link worker (and sometimes their circle of support). Each plan is unique to the individual person we support and records their views, lifestyle and choices. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: These plans had been regularly reviewed and updated by the manager and the persons key worker. Detailed guidelines and strategies were contained within the plans giving staff full information on how to support the people who use the service. Communication strategies were in place to help staff to understand the best way of involving the individual in daily life. The needs of people supported by this service were complex and the information within peoples plans provided very clear information of how the person makes their needs known and how staff should respond to these needs. Since the previous site visit, and as a result of listening to the people who use the service, 60 minute plans had been developed to document short-term goals and Essential Life, Health Action, and Activity plans had also been introduced, and were produced in communications styles, accessible to individuals. Pictures, symbols and photographs were used to illustrate each of the areas in the plans such as relationships, important information, things I do, communication and places I like to go to. A separate health action plan also followed the same accessible format to present the information in a meaningful way to the individual. Circles of support explored the aspirations of the people they support with the people, who are important to the individual, and know them well. This approach was intended to help the person to plan for their future, review their support, and keep their plan up to date. Two staff members spoken with confirmed that the care plans were always clear and current, ensuring that the people living at the home were receiving the care they needed. The organisation runs a diversity forum that is open to all members of staff and all the people who use the service, to allow free-wheeling discourse on equality and diversity, the manager stated, and this acts as a driver to promote positive change across the service. The AQAA included many examples of the promotion of equality and diversity including Everybody Counts training, references to the home being multicultural, and arranging regular inter-cutural days, in which individual staff members, the people living at the home and visitors from different cultures and enthnicity actively encourage others to share their beliefs, cuisine and dress. Risk assessments were also recorded in a person-centred way and covered personal care, the activities of daily living, medication and activities. The risk area was recorded, the reason for making the decision to take the action, the positive outcome of taking the risk, any anticipated negative outcomes, the actions to minimise the risks and clear instructions to the staff of action to take to ensure the people who use the service would be protected from harm. Care Homes for Adults (18-65 years) Page 13 of 29 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. The people living at the home are supported to engage in a range of activities that take account of their needs and preferences. They are supported to maintain personal relationships and be part of the local community. Their rights are recognised and they are offered a healthy diet which reflects their individual taste and dietary needs. Evidence: On the day of the site visit, two people were accompanied to visit a local pub for lunch and another person went out shopping with support. Several people spent some time in the sensory suite throughout the day and one person had a visit from a physiotherapist. The activity plans of two people were sampled showing that they regularly participated in activities within the home and in the community. One to one support was scheduled over four sessions per week for the two people, and hydrotherapy, aromatherapy, music sessions, trips out, visits from relatives and the physiotherapist, enjoying the Jacuzzi, food preparation, shopping, participating in Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: room clean, video evening, personal choice and relaxation were some of the activities recorded. The home had been provided with a vehicle, which was adapted to take wheelchairs, to enable the people to access the community. People, who completed surveys with support, confirmed that they could do what they want to do during the day, in the evening and at the weekend. The manager confirmed that relationships were promoted and most of the people living at the home had regular visits from relatives. Care plans included circles of support, which identified important people in the lives of the people who use the service and the roles those people play. Friendships were encouraged and two people, who were good friends, had taken a holiday together last year. Prior to this holiday, the manager stated, one of the people had been reluctant to stay away from the home and didnt like crowds, but they had enjoyed the trip to Butlins, had taken part in the activities, and were planning another trip to Cornwall. Photographs showed the happy and smiling friends enjoying the entertainment. People were encouraged to follow their interests and one person liked to attend tea dances at Princes Hall in the town and the manager stated that they sometimes bring friends home to tea. Another person had an interest in aeroplanes, attended the Farnborough air show, loves watching football matches on the television and sometimes goes to matches. Two people were scheduled for one to one sessions with an art therapist, who encouraged their creative abilities, and the results of these sessions were displayed in one persons room, which was viewed, and in the summer house. The work was so good that one of the people had won an art competition, which promoted their self-esteem. Photographs displayed of a popular event, Mullers Ark visit, showed people smiling and laughing as they held small animals such as rabbits and kittens and watched the visiting ducklings. Relatives and friends are also invited to these and other events scheduled throughout the year, which encourage socialisation the manager stated. Daily routines in the home promoted the independence of people who use the service. All the people, who lived at the home, had complex needs which made taking part in household activities, such as preparing meals and cleaning their bedrooms, physically difficult. The manager stated, and care plans confirmed, that the people living at the home took part by observing such activities and by the staff interacting with them as they completed the tasks. Staff observed supporting the people, who lived at the home, did so with respect. A pictorial menu enabled the people, who lived at the home, to make choices with respect to their meals. The menus, which were seasonal, included a wide range of choices and were well-balanced. The manager stated that, we respond flexibly and Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: offer other choices if the person does not want the meal they have chosen on the day. Records were kept of the likes and dislikes of the people living at the home to inform all the staff. On the day of the site visit, a person was observed being supported to eat their lunch, which was home-made vegetable soup and sandwiches. The member of staff completed this task in a sensitive and caring way, allowing the person plenty of time to enjoy the experience. One person had a special need with respect to accessing their dietary needs. Records confirmed that the staff had received training to support them and that a dietician, and the community nursing service had been involved in setting up this support, which had resulted in less time spent in hospital. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from the staff according to their needs and preferences, their healthcare needs are met in individual ways, and safe procedures are in place to promote their access to medication. Evidence: Person-centred plans illustrated how the people, who live at the home, were involved in making decisions about their lives. The decision-making agreements, which included photographs, informed the staff of how the individual was to be involved, how they should provide the support, and made it clear, who would make the final decision. Action plans instructed the staff of what the desired outcomes for the people receiving the support should be and their method of approach. One persons action plan included explaining what is about to take place, preparing the equipment, the number of people necessary for support, that reassurance should be given at all times and to ensure that the individuals, privacy and dignity is maintained at all times. Key workers were allocated to individuals to provide consistency and continuity of care and due to the good retention of staff, these relationships had been built over a period of time. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Records were kept of appointments with healthcare professionals and all the people living at the home had health action plans, showing how they were supported to live a healthy lifestyle. The two health action plans sampled, showed that the people were supported by a General Practitioner, a dentist, community nurses, a physiotherapist, a chiropodist, an occupational therapist, an aromatherapist and healthcare specialists based at a NHS hospital and that regular health checks had been undertaken. Early in the year, the manager stated, two people who live at the home had been referred for a stay in hospital, and despite the snow, staff had attended to provide continuity of support. The regional director had written to the team to thank them for their hard work and commitment in supporting the people through their stay at the hospital, and there were letters of appreciation to the staff team from grateful relatives. The medication administration records (MAR) of two people, living at the home, were sampled. Information was clearly recorded and a sample of staff signatures was kept to identify the staff member responsible for administering the medication. The staff training matrix recorded six-monthly medication assessments of the permanent staff qualified to administer medication. Photographs of the individuals with their MAR sheets ensured that the right person would be identified, and a description of the medication, informing the staff of any potential side effects, was available. Records were kept of medication received and returned to the pharmacy to ensure all drugs were accounted for. A local pharmacy supplied the medication which was blisterpacked for safety and convenience. Controlled drugs were stored appropriately in a secure metal cabinet, and a controlled drugs register recorded a running total of drugs administered. This record was double signed for security and a stock check confirmed the totals to be accurate. The manager stated that she audited the medication on a daily basis to ensure the people living at the home had received their prescribed medication. Care Homes for Adults (18-65 years) Page 18 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to raise issues if they have concerns about their care and the home responds positively, regarding them as opportunities for improvement. The home has safeguards in place to protect the people who live there from abuse, neglect and self-harm. Evidence: The policy of the home, as set out in the statement of purpose, encouraged stakeholders to complain if they were not satisfied with the service. The home regarded complaints as making a positive contribution to the improvement of the service. Informal and formal processes were described, giving timescales for the resolution of any investigation carried out, and keeping the complainant informed and involved. A flowchart clarified the process, complaints forms were available to capture the information, and a risk assessment was carried out on receiving a complaint, to ascertain if the issue should be referred to the local authority Safeguarding Adults team. The people, who lived at the home, were provided with an accessible complaints procedure, illustrated with colourful drawings, and written in large print. Photographs of the manager and all the staff encouraged the people living at the home to share issues, which caused them to feel unhappy, angry or scared. They were informed that they could bring things up in the regular residents meetings or talk to someone they trust. All the people, who lived at the home, confirmed in the surveys they completed Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: with support, that they knew who to speak to if they were not happy, and that they knew how to make a complaint. The AQAA recorded that there had been no complaints over the last twelve months and that no safeguarding referrals had been made. A copy of the local authority safeguarding adults policy and procedures was available at the home, and local policies, based on them, informed the staff of action to take, with respect to protecting the people who lived at the home from abuse. The staff training matrix recorded that safeguarding adults training had been updated annually to keep them informed. Two staff spoken with confirmed they were aware of what action to take if an allegation of abuse was made. Care Homes for Adults (18-65 years) Page 20 of 29 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. The people, who live at this home, benefit from a well-maintained, comfortable and homely environment, which meets their needs and, which is clean and hygienic. Evidence: The home, which consisted of two adjoining bungalows with separate addresses and their own front doors, was located on a residential street on the north side of the town of Aldershot. There were local shops close by for the people, who lived at the home, to use, and the town centre provided a range of shops and public services. The home was similar to other residential bungalows in the street and the exterior was wellmaintained. There was a car parking area to the front of the home, and a wisteria covered pergola, potted plants and hanging baskets provided a colourful welcome at the front doors. The managers office, which was very well-organised, was situated on the central link between the bungalows, and a shared sensory suite, equipped with colourful bubble tubes, music, lights, tactile pictures and mobiles, offered a pleasant shared space for relaxation to the people, who lived at the home, and it was well used throughout the day. Three people had their own bedrooms in each of the bungalows and those viewed had been pleasantly personalised and were equipped with specialist equipment as Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: required for the individuals needs. All the people who live at the home had mobility needs, and the home was adapted to promote their mobility and independence, by having ramps instead of steps for wheelchair mobility, hoists, handrails, and assisted toilets and baths. The communal living spaces, which included the lounge and a large kitchen with a dining area in each of the bungalows, were well-equipped with good quality furniture. New flooring had been laid in the kitchen and dining areas since the last site visit. A large widescreen television and DVDs provided entertainment and lamps, framed pictures and occasional tables made the lounges feel homely. Throughout the home, there were potted plants, and photographs were displayed of people enjoying trips to places of interest, such as zoos, and taking part in social gatherings. A pleasant array of summer bedding plants enhanced the garden for the enjoyment of the people living at the home, and since the previous site visit, a summerhouse had been erected, providing a comfortable place for people to relax in and enjoy the garden. Artwork, which had been created by a person living at the home, was displayed on the walls. Decorated cushions and a mobile enhanced the environment and were also the result of one to one art and craft sessions. The manager wrote in the AQAA, We are planning ways to re-landscape the garden, making it easier for the people we support to access and enjoy (including incorporating a sensory garden and a water feature). The proposed further re-development of the garden will bring it in line with modern sensory garden guidelines. The home was beautifully clean and fresh throughout and the utility room contained all the necessary equipment for laundering the service users clothes and bedding. The Control of Substances Hazardous to Health (COSHH) cupboard was secure to protect the people living at the home, and appropriate hand washing facilities were provided, including liquid soap, paper towels and foot-operated bins to prevent the spread of infection. The AQAA recorded that all the staff had received training in the prevention and control of infection, and people, who completed surveys with support, all confirmed that they thought the home was always fresh and clean. An environmental health visit from the local borough council in June, had allocated the service an excellent rating, and noted that the home provided, a high standard of cleanliness. Care Homes for Adults (18-65 years) Page 22 of 29 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. The people living at the home benefit from being supported by a safely recruited staff team, who provide consistency and continuity of support and are well-trained to meet their needs. Evidence: The AQAA recorded that, seventy five percent of the sixteen staff members, had achieved a National Vocational Qualification (NVQ) in Heath and Social Care at level 2 or above. Over the previous twelve months, no staff had left the employment of the home, resulting in consistency and continuity for the people living there. Photographs of the staff were displayed in the entrance hall, and an accessible rota, made the people living at the home aware of which staff were on duty. Observations of the staff on the day of the site visit, confirmed that they worked together well as a team and were committed to providing an excellent service to the people they supported. Interactions between staff and the people they supported were sensitive, caring and empowering. The staff personnel files, of the two most recently recruited staff, were sampled. The manager confirmed that she had been involved in the interviewing of prospective new staff at the home and that they were introduced to the people living at the home, although the human resources department, at Head Office, completed most of the Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: recruitment processes. Application forms had been completed and the required information had been supplied. However, the request for ten years employment history should be replaced by a full employment history with gaps explained to ensure that all applicants supply this important information to prove their suitability to work with vulnerable adults. All the important checks such as references and Criminal Record Bureau checks had been carried out prior to the offer of a post for the protection of the people living at the home. The manager confirmed that the staff had completed induction training in line with the Skills for Care Common Induction Standadrs or Topss England, which introduce new staff to the caring role, and promote the individual rights, of the people using the service, to have their equality and diversity needs respected. Staff files contained induction checklists and evidence of shadowing an experienced member of staff for a month. The two staff spoken with, confirmed that recruitment checks had been carried out, before they started work, and that they had completed and induction and mandatory training. A staff training matrix was in place, confirming that the staff had been regularly updated with respect to fire safety, manual handling, food hygiene, safeguarding adults, first aid and invasive training. Staff training and development files contained certificates for the mandatory training and specialist training to support the needs of the people living at the home. These included, autism and epilepsy awareness, challenging discrimination, nuitritional workshop, Makaton and person-centred approach. The AQAA recorded that there were plans for, further training for the staff in alternative communications techinques and to increase the number of staff undertaking NVQ at level 3 in care. The manager stated that the organisation encouraged and supported requests for training. All the people who completed surveys, with support, recorded that the staff always treated them well, and that they also, always listen and act on what they say. Care Homes for Adults (18-65 years) Page 24 of 29 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 people, who live at the home, can have confidence in the management to protect their best interests, listen to them and take into consideration their views in the running of the home. The environment is safe for the people and the staff because health and safety practices are carried out. Evidence: The registered home manager, Mrs Mary Whitford, had worked for the organisation for more than ten years, and had more than twenty years of experience in the social care field, in both the public and private sectors. She had been the manager of the home for the last five years and was well-qualified, having achieved a National Vocational Qualification at level 4 in care and the Registered Managers Award. Staff comments with respect to the management, included, Mary is a wonderful manager, she encourages you to grow, the manager makes sure everyone knows about any changes, the organisation treat the staff very well and we are encouraged to complete training, which is very good and I am well supported by a manager, who always finds time for me. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The views of people who use the service were obtained through staff interaction and this was fed back to the manager through team meetings, house meetings and also key worker and care planning reviews. The manager stated that the people who use the service were asked the ten big questions about living at the home and that positive feedback had been received. The AQAA recorded, monthly meetings are arranged for the people we support, where they freely discuss their views. They can have their advocates, family members or a nominated individual to act on their behalf and generally update the staff as to what they are feeling. The organisation has its own quality assessment process and the service was audited annually. Some feedback the home had received through their own quality assurance included comments from satisfied relatives and care managers including, thank you for looking after our son, while he was in hospital. We are glad he is now safe and well with you at Westbury, thank you for your support and kindness, thank you for making me so welcome, this is definitely my favourite placement ever, and thank you for supporting my son to send a mothers day card and flowers, it made my day so special. The AQAA recorded that equipment had been tested or serviced as recommended by the manufacturer or other regulatory body, and certificates sampled, confirmed that servicing had been carried out in a timely manner, for the protection of the people using the service and the staff supporting them. The Control of Substances Hazardous to Health risk assessments had been reviewed and updated to safeguard the people living in the home. Policies, procedures and codes of practise in relation to health and safety had been reviewed in a timely manner to ensure the staff had been kept up to date with current legislation and practice. The staff training matrix confirmed that mandatory training had been updated on a regular basis and future updates were included, confirming safe practise. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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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