Care Home: 1 Chantry Close

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What the care home does well New people would be supported to visit and try out the service before moving in. People are asked about how they want to be supported. People are supported to have their health and physical care needs met in the way they prefer. People can spend time doing things they like at home and in the community. People are supported to stay in touch with their families and friends. People have a comfortable, clean and safe home that meets their needs. Each person has their own single bedroom with their own things. People have a choice about meals and enjoy their mealtimes. People`s medication is looked after safely. People like the staff who support them. All the staff are qualified. People feel their views are listened to and they all have an advocate to support them. What has improved since the last inspection? People have newly written care plans explaining their needs. Each person now has a health action plan to help them keep well. Better records are being kept about people`s money to help protect them. Staff have been given extra training to help them do their job well and protect people. Fire safety in the home has been improved. Senior staff in First Key are spending more time at the home. What the care home could do better: People could be better helped to make plans for the future so they fulfil their ambitions and develop skills. People should be able to have a keyworker who helps them plan the support they want. Staff should be trained on Autism and more guidance on supporting the person with this condition should be in their care plan. Information should be presented in a more accessible way to help people understand it. Staff should all be able to use basic signs to help communicate with two people. Some records could be improved to better protect people and show how people are being helped to stay safe. Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Chantry Close 1 Chantry Close Tenbury Wells Worcestershire WR15 8QE     The quality rating for this care home is:   two star good 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: Jean Littler     Date: 2 3 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 Chantry Close 1 Chantry Close Tenbury Wells Worcestershire WR15 8QE 01905611147 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.scope.org.uk SCOPE care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 4 Date of last inspection Brief description of the care home Chantry Close was opened in 1994 and is part of a local community project set up by SCOPE called First Key Worcestershire. SCOPE is a national organisation and a registered charity providing a range of services for people with cerebral palsy and other physical disabilities. The local office is at Unit 3, Lowesmoor Wharf, Lowesmoor, Worcester WR1 2RS (telephone no 01905 611147) and the registered manager, Mr Andrew Deakin, is based there. The home provides accommodation with personal care for four adults who require care due to physical disabilities and may also have a learning disability. The house is situated in a quiet road in the centre of Tenbury Wells, which is a busy market town. It has a very pleasant outlook towards the parish church and the river beyond. The property is owned by a housing association who have Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home responsibility for its ongoing maintenance. Information about the home is provided in a statement of purpose and service users guide, which are available from the home and 1st key office. The fees in 2007 ranged between £37.343 up to £52.000 per year. People have to pay for personal items and services such as hairdressing, newspapers and magazines, personal shopping, travel and telephone calls and chiropody. Funding for activities and holidays is agreed between First Key and each service users funding authority. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out this Key inspection over four and a half hours. We spoke with two staff and looked at some records such as care plans and medication. One person showed us around the home and let us see his bedroom. We carried out an Annual Service Review in March 09. This showed that Good outcomes were still was being provided for people in the home. At this time representatives of people who live in the Home filled out surveys to give us their views. The manager, Mr Deakin, sent information to us in the AQAA, which is the Annual Care Homes for Adults (18-65 years) Page 6 of 29 Quality Assurance Assessment. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: People could be better helped to make plans for the future so they fulfil their ambitions and develop skills. People should be able to have a keyworker who helps them plan the support they want. Staff should be trained on Autism and more guidance on supporting the person with this condition should be in their care plan. Information should be presented in a more accessible way to help people understand Care Homes for Adults (18-65 years) Page 8 of 29 it. Staff should all be able to use basic signs to help communicate with two people. Some records could be improved to better protect people and show how people are being helped to stay safe. 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 9 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 10 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 interested in the service are given information about the home to help them decide if they may want to live there. Their needs are assessed prior to a placement being offered. Evidence: A new person moved in just before the last inspection and he reported then that he was given information about the home and asked his views about moving in. He visited with his keyworker and then stayed overnight so he could meet the other residents and staff. Staff at the home were able to look at his care plan before it was agreed that he would move in for a trial stay. A review meeting was held at the end of the trial period with him and other relevant people to formally agree the move becoming permanent. The existing people in the home were consulted as part of the process. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are recorded in their care plans but specialist areas can be further developed. They are enabled to make decisions and choices in their daily lives and routines. They are encouraged to take reasonable risks to be independent and live interesting lives. Evidence: Two peoples care records were sampled. The plans have recently been rewritten into a new format. This is person centred in style but the information is not presented in an accessible format for those who do not read well. There is a pen picture that gives information on the persons background and a summary of their needs. This format does include some symbols with the text. Mr Deakin reported in the AQAA that people have been fully involved in drawing up and reviewing their plans. The plans included appropriate information about peoples preferred daily routines and support needs. Risks have been assessed and reasonable safety measures put in place. One persons moving and handling assessment had been reviewed several Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: times, however, there was no mention of the current difficulties that have led to an occupational therapy assessment being carried out. A risk for another person had not been properly assessed and a requirement was made that this be addressed. Mr Deakin promptly added information into the care plan and forwarded copies to us. Another person is on the Autism Spectrum. His care plan stated he needs lots of emotional and communication support, daily structure and he has a short attention span. There was very little information about how these needs are being met and staff have not had Autism training. The relationships section of his plan was blank. Forming and sustaining relationships is one of the most difficult areas for people with this condition and a clear plan should be in place. Information did not seem to be being presented to him in other formats to reinforce the verbal communication and aid his understanding. As suggested at the last inspection a communication assessment, by a speech and language therapist with ASD knowledge, should be considered. Staff record the main events of each day such as activities, family contact and health issues. These notes provide useful information to monitor the wellbeing of the person. Staff said review meetings are held every six months. The last review meeting minutes seen on one file were from September 2007. On another they were from March 2008. Minutes had not been presented in an Easy Read format to assist people to understand what has been written about them. Full records need to be held in the home to ensure staff are aware of what they should be working towards with people. It was not obvious from the plans if there were current personal goals that people wanted staff support with, for example trying a new activity, learning a new skill etc. One man has his clothes locked away as he pulls them all out when looking for an item. This is a good example of where a plan should be in place to enable this restriction to be lifted. The staff team is small and it is clear that staff and residents know each other very well. Staff said there is no formal keyworker system in place. This seems to be based around staff wanting flexibility about who goes out with people on their one to one keyworker days. Keyworkers could still be in place to take the lead on care planning and reviewing, family liaison etc. whilst keeping flexibility for outings. Keyworking is considered to be good practice and may help support the person centred planning and health action planning processes. Staff were observed to enable people to make decisions and choices during the day, for example, what they wanted to eat and what activities they were doing. People confirmed that staff enable them to make up their own minds and respected their wishes. Staff gave examples of how they provide information to people so they can Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: make informed choices. Staff have attended Mental Capacity Act training but because people have a good level of understanding staff are not making decisions on their behalf. Care Homes for Adults (18-65 years) Page 14 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. People are enabled to go out and pursue activities they enjoy and are meaningful to them. They are encouraged to mix within the local community and staff also support them to maintain links with their family and friends. People have a choice about the food provided and enjoy their meals. Evidence: Mr Deakin reported in the AQAA, that people are encouraged to be as independent as possible to make their own informed decisions and choices. Positive relationships with advocates, friends and family are actively encouraged. People are supported to access the local community facillities and flexible and innovative responses are made when they want to change activities. Everyone had plans for how they were spending their day. One man was out for lunch with a worker. One person attends a workshop regularly and three people have Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: started taking part in an Age Concern activity group near by. One of the workers is a community development worker who works 22 hours a week. She works as a second worker to facilitate outings. Some people use their allocated time for set activities such as recycling and others decide from week to week what they wish to do. There can still be spontaneous outings when there is only one worker on duty as most people go out locally alone or stay in the house if the worker goes out with someone for a short trip. People confirmed that they choose how to spend their time and have busy lives that they enjoy. Each person also has a day once or twice a month, (a keyworker day) when they plan what they want to do and spend the day with one of the staff e.g. going clothes shopping and having a meal out. People choose if and where they want to go on holiday. Two people planned and enjoyed a trip to Morocco last year. Another is going with a worker and her advocate to a safari park and the coast. The fourth is going to Cyprus. Residents meetings are held so ideas and views can be discussed. People are encouraged to take responsibility for as many aspects of their daily lives as they are able to, for example doing domestic tasks, their own laundry and banking. One person has a telephone in her room and two people have mobiles. There is an open and relaxed atmosphere and one man went confidently to open the door to a contractor. Representatives confirmed in surveys in March 09 that they are made welcome and are kept appropriately informed. Staff also support people to keep in touch with and make regular visits to relatives who live away. There is no computer for general use so people have not started to use webcams and Skype to communicate with relatives abroad as is the case in many services now. Staff reported that food is purchased locally and that people are enabled to choose what they want each day. They take turn choosing the meat for the Sunday roasts. People have agreed to have the main meal at lunchtime and snack teas. Staff said most meals are freshly cooked and they encourage people to have fresh fruit and vegetables and healthier food options. No one currently requires a special diet although some are encouraged to monitor their weight. Three people were observed to have a relaxed lunch together and all said they enjoyed it. One man had helped to prepare the meal. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being sensitively supported with their personal and health care needs and their medicines are being managed safely. Evidence: Mr Deakin reported in the AQAA that people are supported in their chosen manner to maintain their personal hygiene and health needs. Staff work at all times ensuring individuals needs and rights are observed, providing personal care and support with privacy and dignity. Care is delivered consistently by staff who have excellent knowledge of individuals needs. It is led by the service user and offered sensitively and flexibly in response to their changing needs. People spoken with confirmed that they are satisfied with how they are supported by the staff. The care plan sampled contained information about how they prefer to be supported and which areas they are independent in. Staff are provided with training about privacy and dignity and core safety issues such as moving and handling. There is always a senior to confer with in the organisation if staff need support about a health or care matter. Accidents are recorded and health concerns logged and monitored. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The two care plans seen showed people are being offered annual well person checks and dentals. One person explained that the chiropodist has signed him off and how the doctor had treated a problem with his foot. Another felt well supported with current health issues. Staff said they are conscious that people need to be given time to understand information about health conditions and treatment options before they can make their own informed decisions. One person goes to the doctors alone and brings a note back for staff with the outcome. Others need staff support with communication or access. Health action plans have developed since the last inspection to help ensure that a proactive approach is taken to staying well. One mans plan was not dated and the mens health section was blank. Details need to be added to show arrangements for testicular checks etc. Staff had recently attended a course on epilepsy and one said this had been enlightening. The team now plans to revise the care plan for the person who has this condition to incorporate what they have learnt. SCOPE has general policies and procedures for the management of medicines in their care services and there are also specific procedures for the Home that had been reviewed in 2008. Each person has a written profile of their prescribed medicine where any possible side effects are highlighted. Medication is stored in two places. Any stocks are held in a metal cabinet in the staff room and the medicines in use are held in a wooden cabinet downstairs. This is quite solid but as it is wooden it is not up to professional security standards. The records sampled showed that medicines were being administered correctly. A stock check is carried out each month and the pharmacist is asked to sign for any returned medicines. One person manages some of her own medications, although staff support her to obtain the medication and keep records of what is received. A risk assessment is in place regarding this. Staff said others do not want to get involved with self medicating. One person has recently been prescribed an as needed medication and guidance has been written about when this should be given and how many doses can be offered before the doctor is called. All staff have completed some training relating to medication. It has not been established if this is an accredited course. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to raise concerns and express their views and they have confidence these will be listened to. Arrangements are in place to help protect them from abuse. Evidence: Mr Deakin reported in the AQAA that SCOPE has a formal complaints procedure and that all staff have attended training on complaints. People said they are able to raise any concerns with the staff who they know very well. There are also external people involved who can advocate for them if necessary. There seemed to be an open atmosphere in the home and people clearly feel able to freely express their views. Surveys returned in March 09 showed they know who to talk to if they have concerns and they feel confident they will be supported to express their views. Representatives also confirmed they knew how to raise any concerns and felt these would be listened to. No complaints have been recorded in the home and none have been received by us since the last inspection. There are adult protection and whistle blowing policies in place and SCOPE has a Safeguarding department that support services if a concern arises. Mr Deakin reported that all new staff are informed of the above policies as part of their induction package. The four regular staff have been in post for many years and have received safeguarding training. One reported that she had attended a refresher course in January 09. No safeguarding concerns have been raised since the last inspection. Care Homes for Adults (18-65 years) Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comfortable and well maintained home within the community that is suitably adapted and equipped to meet their special needs. Evidence: Chantry Close is in a pleasant and convenient location, close to the centre of Tenbury Wells, whilst also having a view of a Church, the river and countryside. The town is within easy walking and wheelchair distance and has a good variety of shops, pubs and cafes, a leisure centre, cinema, library and other amenities. The property is owned by a social landlord, which leases it to SCOPE. The owners retain responsibility for its ongoing maintenance and upgrading. The accommodation is made up from two ordinary terrace houses joined together internally. The rooms are not particularly large. The table in the lounge-diner has to be pushed back against the wall when not in use and one person watches television from her bed as she cannot fit an armchair in her room. The garden is very small and more like a yard, however the communal car park area at the front by the river can be used. The house looked well maintained and clean. Some residents enjoy being involved with daily tasks. Staff said the smart leather furniture in the lounge was donated to them and a new dining table is on order. People said in their surveys and during the Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: visit that they are happy with their home and are well settled within the local community. People have single bedrooms with sinks but have to share bathroom facilities. The bedroom seen had been personalised, reflecting the persons interests. Some people have chosen to have a lock fitted to their bedroom door but people did say they respect each others private space. One person is a wheelchair user and he has a ground floor bedroom. There is a stair lift and grab rails but as the other bedrooms are upstairs they are not suitable for people with more severe physical disabilities. There is an accessible wet room on the ground floor for showers. One persons needs are changing and staff made a referral for occupational therapy input. This has resulted in a bath with a chair hoist being ordered. Other aids, adaptations and equipment are in place, such as, a call bell system, pressure mattress, and a light flashes in one persons bedroom when the fire alarm rings as he has some hearing loss. A light has recently been added to the lounge to alert him when he is downstairs. Mr Deakin reported in the AQAA that equipment has been serviced and tested and checks carried out on the fire alarm. The stair lift had been serviced in November 08. Staff showed records demonstrating that regular fire system checks are being carried out, including drills. The landlord carries out checks on gas and water systems. Staff are provided with protective clothing and systems are in place to help reduce cross infection. Environmental Health inspected during 2007 and have issued the Home with a 4 star rating. There is no sluice facility on the washing machine, but staff said currently one is not needed. Better arrangements for the storage of personal hygiene aids could be made to increase dignity rather than these being stored on open shelves. Care Homes for Adults (18-65 years) Page 21 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. People continue to be supported by a stable, experienced and effective staff team who know them well. Staff are well trained but there are still some areas of specific knowledge that can be improved. People are protected by the organisations recruitment procedures. Evidence: The staff team comprises of four support workers and a community development worker who takes the lead with activities and outings. They have all worked at the home for over three years, some residents have know members of staff for around twenty years and have been supported by them at Chantry Close since the Home opened. People seemed to relate well to the staff on duty and the three spoken with confirmed that they liked the staff and they treated them well and listened to them. A person who used to work regularly in the home provides relief cover if needed. There is a team coordinator who is office based with Mr Deakin, who has responsibility for this Home. The visitors book showed that she visits the home weekly and Mr Deakin visits more often when she is on leave. People living in the home and both staff spoken with felt the staffing levels are sufficient. There is a minimum of one worker on duty throughout the day and then additional hours are provided by the community development worker that are used Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: flexibly for health appointments and planned regular or one off activities that people have chosen. The rota showed the early, late and sleepover shift pattern but not the actual hours worked. Staff reported that they had insisted that a half hour handover period takes place between two thirty and three pm as they are lone workers, to ensure that information can be handed over effectively. There are no staff vacancies and had been no new staff for some time. This is positive and helps provide consistent support. It was again not possible to assess recruitment and induction arrangements. Mr Deakin reported in the AQAA that rigorous recruitment checks are carried out and that residents are invited to be on the panel during recruitment. It has been previously confirmed in this and the other First Key care homes that SCOPE operate thorough recruitment procedures. Mr Deakin reported in the AQAA that any new worker would be provided with a comprehensive induction programme which includes the common induction standards for care. This would then lead to them starting their NVQ Level 2 after a probation period. Current staff have all completed a relevant NVQ Award and one is an NVQ assessor. Staff confirmed that they have all attended the standard courses provided by SCOPE and the refresher courses to update their knowledge. Last year courses included fire, moving and handling, safeguarding, Mental Capacity Act, infection control and person centred planning. The training file was well organised. Staff had enjoyed the recent epilepsy course and felt they now had better understanding of one persons condition and associated behaviours. Staff should also be provided with autism training to given them better insight into another persons condition. Only two staff are confident at signing. Two people benefit from being signed to as part of their communicating effectively so all staff should be skilled in this area. Mr Deakin reported in the AQAA that there is always someone on call to support staff and they are provided with supervisions and an annual appraisal. Staff confirmed they felt supported in their role and had supervision every four to eight weeks. Team meetings are held regularly and the team coordinator is now attending more of these. Communication is reported to be good. It is a small team who have worked together for many years for the benefit of residents. Their commitment to providing a good service is apparent. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a service provided by a committed and experienced staff team. Management involvement has been increased which should help ensure standards remain high. Suitable arrangements are in place to keep people safe and their welfare is promoted. Evidence: The registered manager, Mr Deakin, is the community service manager for First Key Worcestershire and responsible for four services. The management arrangements are therefore unusual as he is based at the office and does not run the home on a day-today basis. There are three team co-ordinators who support him and one is linked to this service. She is responsible for monitoring the service delivery and managing the staff team. Mr Deakin is suitably experienced and both he and team coordinator have gained the NVQ Registered Managers Award. Mr Deakin said in the AQAA that he aimed for one of the management team to visit the service twice a week. This is not yet happening but management involvement and presence has increased. The team coordinator has been visiting at least weekly, Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: attending staff meetings and care reviews. Staff said some changes are being introduced such as the new care plans. The organisation has a quality assurance system that includes annual surveys for residents, staff and people with an interest in the service. The area manager is currently reviewing this process with the aim of making improvements. Feedback can also be gained from the resident and staff meetings that are held regularly. The providers monthly monitoring visits are carried out by Mr Deakins peers rather than senior staff in the organisation. The area manager reported recently that the time given during these visits for talking to residents and staff will be increased from April 09. It was not possible to see if this had been implemented as copies are not held in the home. Staff did not know why this was the case but they only receive a letter following each visit telling them if there are any action points. One person showed us his money tin. Although he is independent in many areas he has chosen for staff to keep this as he does not want the responsibility of it. The records were clear and showed that he only spends his money on personal items. Staff write a letter and he goes to the bank alone. The way receipts and records are managed has been improved since the last inspection. These are now collated each month. The team coordinator should demonstrate that she samples these regularly. Another persons inventory was dated 2003 and did not appear to have been updated to include her television, computer and new mattress. No notification of significant events in the home have been reported to us in the last year. General health and safety management systems are in place such as monthly safety audits and regular checks of water and fridge temperatures. All staff undertake mandatory safety training and refreshers have been provided though courses or DVDs. Mr Deakin reported in the AQAA that all equipment and fire prevention systems have been serviced regularly. The records in the home confirmed this and staff seemed well organised with safety routines. They had recently asked for the fire alarm to be connected to the call alert system so the call centre would immediately know when the alarm was ringing. This has been agreed as a way of increasing safety as staff are lone workers and people sometimes stay in the home without staff. As mentioned earlier the care plans need to demonstrate how obvious risks for individuals are being assessed and managed. Care Homes for Adults (18-65 years) Page 25 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 26 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 1 2 1 6 The Service Users Guide should be developed into a more accessible format. Ensure people are supported to make future plans to fulfil their ambitions, try new activities or learn new skills. These goals should be clear in their plans with agreed timeframes that are monitored through the review process. Develop a care plan that reflects how one person is supported with the challenges he faces from being on the Autism Spectrum. Enable people to chose keyworkers to take the lead in supporting them with planning the service they receive. Keep evidence that six monthly review and planning meetings have taken place and what the outcome and action points were. Health action plans should be fully completed including arrangements for mens preventative health checks. Provide accredited medication training for any staff who have not completed this. Provide more discrete storage for bulk purchased personal Page 27 of 29 3 6 4 6 5 6 7 19 20 27 Care Homes for Adults (18-65 years) 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 hygiene supplies. 8 9 33 35 Include on the rota the actual hours worked by all staff in line with the regulations. All staff should learn and become skilled at communicating with signs. Staff should be provided with autism training. 10 41 Update peoples inventories and keep them current to help protect their property. 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. 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