Care Home: 1 Moor Lane

What the care home does well The manager said through the AQAA that providing a well equipped home with a homely atmosphere to empower and encourage the independent skills of the people living at the home and meeting their individual needs is what the home does well. A relative at the home during the inspection made the following comment ` I am really happy with the care provided to my family member living at the home, I have no issues and if there are I can speak to the manager.` The interaction between the staff and people at the home was observed. Members of staff were seen offering people choices and giving them the opportunity to respond. Members of staff were observed coaxing people to engage with them and to participate in community based activities. Through conversation with the staff that there is a clear understanding about the needs of people that may challenge the service and there is an ethos of diversion and diffusion. What has improved since the last inspection? This is the first inspection for this home. What the care home could do better: There are five requirements arising from this inspection and are based on reviewing, developing systems and processes that improve the standards for1 Moor LaneDS0000072644.V376316.R01.S.doc Version 5.2 the people at the home. These include reviewing the Statement of Purpose and further developing care planning and associated risk assessment processes. Medication and recruitment will also benefit from further development. The Statement of Purpose will benefit from being reviewed. Information about the range of needs and the way behaviours that challenge are managed at the home. This will ensure that people wishing to live at the home can be reassured that their needs can be met by the skills at the home. The information included within the support plans must be drawn together to form an action plan. Within the action plan, the individual`s likes and dislikes must be incorporated. Evidencing that people have a say about the way their care is to be delivered. Risk assessments must include action plans that follow DOH guidance for those individuals that at times exhibit violent, aggressive and inappropriate behaviour. This will ensure that people benefit from consistent positive behaviour management. The manager must ensure that staff record medications administered including the reasons for not administering the medication. This will ensure the safehandling of medicines. The manager must ensure that the recruitment process is robust. References must be validated to ensure that staff employed at the home are suitable to work with vulnerable adults. Key inspection report CARE HOME ADULTS 18-65 1 Moor Lane 1 Moor Lane Backwell Bristol BS48 3LL Lead Inspector Sandra Jones Key Unannounced Inspection 24 & 30th March 2009 10:00 th 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 2 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 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Moor Lane Address 1 Moor Lane Backwell Bristol BS48 3LL 01275 465560 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.concensusupport.com Consensus Support Services Ltd Mrs Terina Noke Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 8. Date of last inspection Brief Description of the Service: 1 Moor Lane is a detached property, situated in close proximity to shops. It is arranged on one level with two, four bedded self-contained wings that blend well with its local residential environment. The aim of the home is to provide holistic care and support to eight adults with learning disabilities in a service led environment. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This key inspection was conducted unannounced over two days in March 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the home was opened and this information was used to plan the inspection visit. This included the Annual Quality Assurance Assessment (AQAA) and notifications from the home. ‘Have your say’ surveys were sent to the home to seek feedback about the service from people living at the home, staff and health and social care professionals that visit the home. However, the home did not receive them. We are reassured that people at the home would be supported to complete the surveys had they reached the home. At the time of the inspection there were five people accommodated and these individuals were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. Face to face discussion occurred with the manager, deputy manager, senior support worker. Interaction between staff and people living at the home was also used to support the findings of this inspection. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are five requirements arising from this inspection and are based on reviewing, developing systems and processes that improve the standards for 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 7 the people at the home. These include reviewing the Statement of Purpose and further developing care planning and associated risk assessment processes. Medication and recruitment will also benefit from further development. The Statement of Purpose will benefit from being reviewed. Information about the range of needs and the way behaviours that challenge are managed at the home. This will ensure that people wishing to live at the home can be reassured that their needs can be met by the skills at the home. The information included within the support plans must be drawn together to form an action plan. Within the action plan, the individual’s likes and dislikes must be incorporated. Evidencing that people have a say about the way their care is to be delivered. Risk assessments must include action plans that follow DOH guidance for those individuals that at times exhibit violent, aggressive and inappropriate behaviour. This will ensure that people benefit from consistent positive behaviour management. The manager must ensure that staff record medications administered including the reasons for not administering the medication. This will ensure the safehandling of medicines. The manager must ensure that the recruitment process is robust. References must be validated to ensure that staff employed at the home are suitable to work with vulnerable adults. 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. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (1) & (2) Quality in this outcome area is (good) The home’s admission process is effective and ensures that people can make decisions about moving into the home. Once additional information is added in the Statement of Purpose about the range of needs that can be met at the home and about the way behaviours that challenge are managed, people wishing to live at the home will be reassured that their needs can be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The updated Statement of Purpose defines the organisations aims, which is to provide holistic care and support eight adults with learning disabilities in a service led environment. It is also states that the service can meet the needs of people with learning disabilities that have complex needs including autism spectrum disorder and behaviours that challenge. The Service User Guide is symbolised with pictures and words to ensure that the people for whom its intended can understand it. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 10 The admission criteria included in the Statement of Purpose should expand the information about the range of needs that can be met at the home. This will enable people wishing to live at the home to make decisions about moving into the home. It is nevertheless stated that to establish that the person will benefit from living at the home, introductory visits and trial periods are offered. The manager must specify the criteria for living at the home which must include the assessments conducted to determine that the staff have the skills and resources to meet the needs identified. The approach used to meet the needs of the people that challenge must be included to reassure people moving into the home that there is a ethos of diverting and diffusing aggressive and violent behaviours. There are five people currently living at the home and their case files were examined to establish the admission procedure followed at the home. Records examined provided evidence that staff conduct assessments of needs before admission to the home. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (6), (7) & (9) Quality in this outcome area is (adequate). Care planning, decision-making and risk taking is essential for individuals to achieve independent lifestyles. For people to have their needs met in an individualised and consistent manner, action plans must be developed from the support plans in place. People benefit from positive behaviour management and their risk assessments must show how behaviours that challenge are managed. This judgement has been made using available evidence including a visit to this service.. EVIDENCE: Support files are currently held in the individual’s bedroom ensuring the people have access to their care files. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 12 ‘About me information held within the care notes defines the individuals life that includes their preferred lifestyle and future aims and goals. The information becomes more detailed and moves into family dynamics and daily routines. How the person communicates and personal care form part of the information about the person. The manager then explained the care planning approach at the home, we were told that the manager and deputy or registered individual undertake the person’s initial assessment of needs and from the information gathered, support plans are devised. Support plans then evolve during trail periods, which are compiled by the deputy with keyworker from the review meeting. Feedback about the care planning process was sought from the senior support worker on duty. This member of staff said the role involves, monitoring care plans, undertaking monthly reviews and writing risk assessments. Support plans are written in a person centred approach where the individuals like, dislikes and preferred routines are incorporated into the support plans. Essential information about the person with their preferences are included which are signed and dated. Support plans are clear about the person’s capabilities, their likes and dislikes. However, action plans are not incorporated. Information must be drawn together to form a plan that will guide the staff to meet the need in person centred approach. Action plan that are person centred where the individual’s likes, dislikes and preferred routines are included and specific, will ensure that consistent care is provided. While it is perceived, the person will have their needs met in the way they wish it to be delivered. Support plans are reviewed monthly and show that individuals changing needs are monitored. The review format directs staff to assess the progress made in each areas of need, which include medication, accidents and appointments. It focuses on staff’s observation of interaction between them and people at the home and is clear that more details about the person is needed. Achievements and changes are listed but they are not always transferred onto the care plan. For example, the importance of one person carrying around an object or staff resting their hand over one individual’s hand while they eat. Four people at present exhibit behaviours that challenge and include selfharming. The manger said that diffusion/diversion is the approach used and physical intervention is only used as a last resort. There is an organisational Restrictive Physical Intervention policy, which is to be further developed to fulfil the ethos of the home. The manager explained that the deputy manager conducts behaviour risk assessments with support from the Community Learning Disability Partnership Team (CLDPT). Risk assessments are clear about behaviours exhibited, triggers and preventative measures. However, action plans included within the risk assessments would benefit from further development. The manager must ensure that risk assessments follow DOH 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 13 Guidance for Restrictive Physical Intervention. Risk assessments must contain strategies that prevent the behaviours that may cause the use of physical intervention. Preventative measures in diffusion/diversion techniques, emergency and planned physical intervention must be specific so that the circumstances for the use of physical restraint can be monitored and where necessary investigated. The senior support worker on duty was consulted about the approach used for people that may exhibit behaviours that challenge. It was stated that staff are trained in Positive Behaviour Management (PBM) and the ethos of this approach is to identify the cause of the behaviour so that it can be addressed. For example, staff observe specific behaviour exhibited and with the person develop a framework of acceptable behaviours. The people currently accommodated at the home have communication needs and support plans about the way the person communicates are in place. Essential information about the way the person shows pleasure and preferences are included. As previously mentioned, the information would benefit from being more detailed. The senior support worker was consulted about the staff’s responsibility to empower people to make decisions. We were told that people are given every opportunity to make decisions and where people lack capacity, multi-agency ‘best interest’ decisions are made on behalf of the person. It was further stated that people at the home use their preferred method of communication, which include Makaton, body language, and communication books, objects of reference and are given two choices. It is evident from the observations between staff and people at the home, that there is an emphasis on empowering people to make decisions about all aspects of their care. Staff were observed giving people physical choices and allowing the person to make choices. The manager confirmed that pictures, objects of references and physical choices are used by the staff to ensure people at the home can made decisions about the way their care is to be delivered. It was also stated that for house meetings to be meaningful, they are in the form of ‘story telling’ about the individual’s experiences. Management of risks and risk assessments are conducted to assess the level of risk involved in the activity. Within the management assessment, the known situations, activities or behaviours that may cause harm, damage to the property or distress to the person are included. Risk assessments are then devised and include eating and drinking, bathing and using lap belts and bed rails. Members of staff record the individuals daily diet, personal care provided, communication and activities undertaken. There is additional space within the daily reports for staff to expand information about behaviours exhibited, accidents and activities. Reports generally list the meals served, personal care 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 14 tasks and activities undertaken. Decisions made by the person are not always recorded. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: (12), (13), (15), (16) & (17) Quality in this outcome area is (good) Individuals at living at the home are supported to maintain appropriate and fulfilling lifestyles in and out the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Employment, education, hobbies and interests form part of the care planning process and each person has an activity rota that includes in-house and community based activities. Records show that people attend colleges, clubs, go on walks and have a variety of relaxation therapies. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 16 The senior support worker agreed to give feedback on the arrangements in place for people to lead independent lifestyles. We were told that each person has an activity timetable so that people at the home can experience varied activities. The home provides transport to activities, outings and shopping trips. In terms of supporting people to be recognised in the local community, the support worker said that local shops and facilities are used which ensure people are regularly seen in the community. The arrangements for people to maintain contact with family and friends are included in the Statement of Purpose. The importance of maintaining these links are recognised through the procedure and confirms that visiting is open at all times. The support worker on duty explained that visitors are welcome by the staff, visits can occur in bedrooms for additional privacy. We were also told that people go away on holiday with their relatives and one person spends the weekend with their family. A relative visiting the home during the inspection confirmed that visiting is open, the staff welcome visitors and they are informed about important issues. The Service User Guide says that the aim of the home is to develop the individual’s independent living skills so that people can lead the life they choose. The senior support worker on duty said that there is an expectation that people living at the home participate in household chores. The Privacy and Dignity policy is included in the Statement of Purpose, which states that respecting people’s rights is part of the induction for new staff. Examples provided describe the ways the individual’s privacy will be respected. We were told that personalising people’s bedrooms; seeking the individual’s preferences with appearance, diet and a person centred approach to developing support plans ensure that people at the home are respected as individuals. The senior support worker told us that all staff are expected to undertake cooking and the people living at the home are encourage to assist with meal preparation. At each end of the house there is a fully equipped kitchen and there is a good range of fresh, frozen and tinned foods. The records of meals served show that people have a varied diet. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (18), (19) & (20) Quality in this outcome area is (good) The home provides appropriate personal and health care to the people at the home. Gaps in the recording of medications must be addressed to ensure that people at the home benefit from safehandling of medications. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individuals personal care needs form part of the individuals support plans and as previously mentioned, support plans are clear about the person’s capabilities, their likes and dislikes. However, action plans are not incorporated. Information must be drawn together to form a plan that will guide the staff to meet the need in person centred approach 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 18 Health care files are separate from support plans and include personal details, professional contacts, with medical history and health care need. The health care management support plan describes the support needed from the GP, social and health care professional. Nutritional assessments are completed for each person and the total score will determine the action needed to maintain a healthy lifestyle. Moving and handling risk assessments are also conducted and the action plan depends on the level of risk and support needed by the person. For individuals that have mobility impairments more detailed risk assessments are in place and state the techniques and equipment needed to conduct manoeuvres safely. Waterlow assessments that assess the potential for the person to develop pressure areas are completed and action plans reflect the level of risk. Documentation from health care professionals show that people at the home have access to specialist care. Staff record health care visits, the reason for the visit and the outcome. Health care was discussed with the senior support worker. We were told that the people at the home are accompanied on health care and medical advice is recorded on consultation sheets, communication books and passed on during handovers. It was also confirmed that senior support workers monitor that medical advise is followed. Medication is administered through a monitored dosage system and staff that have attended competency training can administer medications. Gaps in the administration records were found and the manager must ensure that appropriate codes are used to explain the reason for not administering the medication. Medication profiles in place inform staff about the purpose of the medication, the best method of administration and possible side effects. A record of medications no longer required is maintained and the pharmacist signs the record to show receipt of the medication for disposal. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (22) & (23) Quality in this outcome area is (good). There is a prompt response to concerns and in-house policies show a commitment to safeguarding people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Complaints procedure is included in the Statement of Purpose and a symbolised copy, with pictures and words included in the Service User Guide. The procedure informs the complainant on the timescales for responding to their complaints, the steps to be taken to resolve them, with the organisations and CQQ contact details for unresolved complaints. Two complaints were logged at the home since it opened. One was made on behalf of the people at the home and CQC was copied into the complaint made by a relative about the standards of care provided. The manager, convened a meeting with the complainant, health and social care professionals to resolve the issues raised by the relative. While agreements were reached during the meeting, formal minutes from the social worker remain outstanding. The manager must ensure that the minutes are provided so that the complaint can be resolved within the timescales given. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 20 The senior support worker was consulted about the way people are protected from abuse. We were told that generally complaints made at the home are from relatives. The organisations Safeguarding Adults and Whistleblowing policies are in place and show a commitment towards protecting people from abuse. However, these policies and procedures do not follow good practice guidelines. In the meantime the manager has developed in-house Safeguarding policies to ensure Local Authority’s ‘No Secrets’ procedures are followed. The manager was instructed by CQC during the inspection to refer one person to Safeguarding Adults. The Local Authority lead for Safeguarding Adults has passed it to the CLDPT team for investigation and CQC must be informed about the outcome of the investigations. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (24), (26), (28) & (30) Quality in this outcome area is (good) The property is bright and decorated to meet the age group and the needs of the people accommodated. The people living at the home were observed using all parts of the property including the garden. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 1 Moor Lane is a detached property, registered to accommodate eight people with learning disabilities. Situated in close proximity to shops, it is arranged on one level with two, four bedded self-contained wings that blend well with its local residential environment. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 22 Bedrooms in both units are single en-suite, lockable with furniture and fittings that are above NMS. It was evident from the tour of the property that people are encouraged to personalise their bedrooms and their personal belongings reflected their lifestyle. Each unit has a kitchen and communal space that includes lounge and dining room which allows for people to sit together or undertake solitary activities. One wing is more secure, where the office is sited and benefits from a lounge /dining room and an additional large relaxing space. The property is bright and decorated to meet the age group and the needs of the people accommodated. The people living at the home were observed using all parts of the property including the garden. There is a laundry on each unit, with sluicing facilities. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (33), (34) & (35) Quality in this outcome area is (good). Staff are competent and skilled to meet the stated purpose of the home and the assessed needs of the people living there. For people to benefit from staff that are suitable to work with vulnerable adults, the recruitment process must ensure that references are validated This judgement has been made using available evidence including a visit to this service.. EVIDENCE: Staffing levels were discussed with the manager who told us that staffing levels are flexible and led by the needs of the people at the home. At present there are four staff per shift with additional staff for the individuals that have 1:1 staff support. At night two staff are awake and once there is full occupancy, the staffing levels at night will increase to three waking. The manager and deputy provide management presence, with the manager 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 24 working supernumerary and the deputy having two days allocated for administrative tasks. The manager said that two staff were recently employed and a further four staff will be recruited to meet the 1:1 needs of the people at the home. The personnel files of the two most recently employed staff were examined to establish the recruitment process followed at the home. Completed application forms in place require full employment histories, the names of two referees, one of which must be the most recent employer and declaration of criminal background. Criminal Record Bureau (CRB) disclosures were obtained and the two written references show that the recruitment process is robust. However, references are not validated for those provided through the Consensus standard reference forms. The manager must ensure that the authenticity of the reference is sought to ensure employees are suitable to work with vulnerable adults. Training was discussed with the manager and we were told that employees must complete the induction, attend mandatory training and vocational qualification that must be preceded by Learning Disability Qualification (LDQ). In terms of the staff’s skills to meet the specific needs of the people at the home, the manager said Autism Awareness, Positive Behaviour Management (PBM) and Dyspexia training form part of the induction programme for the home. Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DOLS) and Safeguarding Adults training is also provided. The in-house induction timetable shows that to ensure the staff have a good introduction into the organisations and the role and responsibilities of the post. This induction is organised over five weeks and included roles and values of the organisation, the needs of the people living at the home and mandatory training. The staff on duty were asked about the staffing arrangements at the home. The senior support worker told us that the induction programme was undertaken during the probationary period, specific training that meets the needs of the people at the home was attended and encouraged to undertake further vocational qualifications. The arrangements for vocational qualifications were discussed with the manager. The manager said that the role involves some assessments and observations of staff undertaking NVQ training. It was stated that at present three staff have NVQ level 2 and above and two are undertaking the training. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (37), (39) & (42) Quality in this outcome area is (good). Individuals can expect to live in a safe environment and can be re-assured that standards will be the subject of ongoing monitoring. The home meets its stated aims and objectives and meets the needs of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was consulted about the way the home’s aims and objectives are met. It was stated leadership is from the front with an open approach. Consistency of care is achieved through strong leadership that involves good 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 26 communication and ensuring the people at the home are safe and their liberty is not restricted. In addition, regular individual supervision of staff, where their performance is monitored and training needs are discussed ensure that standards of care are maintained. Staff at the home were consulted about the management style used to maintain consistency of care. The senior support worker on duty told us that individual line management supervision occurs six-eight weekly and focuses on performance and development of the role. It was also stated that managers’ have similar styles and there is a good working relationship with firm boundaries. The organisation operates a Quality Assurance system and an employee of the organisation audits the system. National Minimum Standards (NMS) are used to assess how well the home is meeting the standards. The manager said that a report follows the audit, which is discussed with the external manger and an action plan to meet any shortfalls is then devised. In future surveys will be used to seek feedback about the standards of care from people at the home and their relatives. An external company was used to undertake fire risk assessments that assess the potential of an outbreak of fire and is supplemented by the home’s risk assessment. The risk assessment undertaken by the manager is more detailed as it includes the check and practices that will be undertaken to reduce the risk of fire at the home. The manager ensures that there is compliance with associated legislation. A contractor conducts gas safety checks and portable electrical equipment checks of appliances brought in by the parents of the people living at the home. Facilities for the safekeeping of cash and valuables exists at the home and the balances of cash held on behalf of the people at the home were checked and were consistent with the records. 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 x 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Version 5.2 Page 28 1 Moor Lane DS0000072644.V376316.R01.S.doc N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 Requirement The Statement of Purpose will benefit from being reviewed. Information about the range of needs and the way behaviours that challenge are managed at the home must be included. Information included in the support plans must be drawn together to form an action plan. Within the action plan, the individual’s likes and dislikes must be incorporated. Evidencing that people have a say about the way their care is to be delivered. Risk assessments must include action plans that follow DOH guidance for those individuals that at times exhibit violent, aggressive and inappropriate behaviour. The manager must ensure that staff record medications administered including the reasons for not administering the medication. This will ensure the safehandling of medicines. The manager must ensure that the recruitment process is robust. References must be DS0000072644.V376316.R01.S.doc Timescale for action 30/08/09 2 YA6 12 30/09/09 3 YA9 13 30/09/09 4 YA20 13 30/05/09 5 YA34 19 30/05/09 1 Moor Lane Version 5.2 Page 29 validated to ensure that staff employed at the home are suitable to work with vulnerable adults. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 1 Moor Lane DS0000072644.V376316.R01.S.doc Version 5.2 Page 30 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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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