Care Home: 109-111 Mollands Lane Project

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What the care home does well 109-111 Mollands Lane offers residents a very well maintained and comfortable environment where they are clearly at home. There are clear support plans that show that the person has been asked about the support they need and how they would like to receive it. There are clear guidelines for staff on how to support people to develop and achieve their goals while keeping them safe. Staff and residents check these regularly to make sure that they are working well. Residents and staff are treated as individuals and differences are valued and respected. Residents are positively supported to lead an active lifestyle of their choice and are helped to learn the skills they need to develop confidence and independence, both at home and in the community. Family, friends and professionals are welcomed and there are good communication systems. Robust recruitment procedures safeguard residents. The manager and the staff have a positive approach to training and development to ensure staff have the skills to support quality care outcomes of people using the service. Staff are rewarded for good service and clearly feel valued and part of a team. There is an experienced and enthusiastic management team who have a clear view of how they want the service to be and how to achieve it. Effective systems are in place to gather the views of the people who live at home and other stakeholders through meetings and surveys. People feel listened to and involved. What has improved since the last inspection? The management team have responded positively and effectively to the requirements identified in the last inspection report. A detailed care plan was available on all resident files sampled, including a recently admitted resident. Individual care needs are better identified in the care plans, providing more information and guidance to help staff to meet people`s needs. The registered person has visited the home monthly and written a report to show that they have checked that the home is being well run and that residents are well looked after. Records were available in the home as required so that robust recruitment procedures were evidenced to safeguard residents. Improvements have been made to the premises to keep it well maintained. In response to resident feedback additional facilities have been made available to residents including wireless access to the Internet, cable television in their bedrooms, a pool table and a karaoke machine. The manager has maintained clear records of staff training. Nine staff were identified to complete NVQ qualifications which were achieved this year. The service were winners of Thurrock District Business Awards for staff development and training in March 2009, an achievement there are very proud of. The service has recently achieved Investors in People Award. What the care home could do better: The information in the AQAA could correspond better to the relevant sections of the National Minimum Standards to demonstrate more clearly what the home do well and their evidence to show this. Surveys received from health and social care professionals did not indicate any areas that could be improved. In response to this question, one person said "I am pleased with the service they provide" and another person said "I have not identified anything at this moment in time. I have recently completed reviews and the service users and their families are happy with the Satash placements". Surveys received from staff in relation to what the service could do better included the comments " the residents could involve in the community more to be valued as a citizen", "personally not a lot as we have a great team here and we work really well", "I don`t think we missed anything out" and "Satash community home at the moment could not do anything better as everything about the home is good, I just hope in the future nothing will change, but I cannot see that as the management are very good, and always around". Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 109-111 Mollands Lane Project 109-111 Mollands Lane South Ockendon Essex RM15 6DJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 1 8 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: 109-111 Mollands Lane Project 109-111 Mollands Lane South Ockendon Essex RM15 6DJ 01708856592 01708856592 satashcommunitycare@hotmail.co.uk www.satashcommunitycareprojects.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Satash Community Care Project Limited care home 8 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 8 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability Code LD Date of last inspection Brief description of the care home 109-111 Mollands Lane are two adjoining semi-detached properties in a quiet residential area. 111 Mollands Lane was originally registered to provide care to four younger adults who have a learning disability. In June 2007 the adjoining, and almost identical, property was registered as part of the project to give an additional four Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 Brief description of the care home single bedrooms. There is one ensuite bedroom on the ground floor in each house along with a large lounge, separate dining room, kitchen and a small office at the front. There are three further bedrooms upstairs in each house, two of which are ensuite and there is an additional separate bathroom. The two houses are registered as one facility and will be referred as one premises. There is adequate private parking to the front of the property and a large garden, which is accessible to residents at the rear. There is a covered area on the patio with a table and chairs available for residents who wish to smoke. The weekly fees range between £1050 and £ 1200 per week as confirmed by the registered person at the site visit. Additional charges/costs are incurred by residents relating to chiropody, purchase of personal toiletries, college course fees and some activities. The registered manager advised that the home provide twenty pounds per resident per week towards activities and generally residents pay for anything in excess of this. The home however pay for all holiday and transport costs and have their own vehicles. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was undertaken on 7th August 2007. An Annual Review of the service was undertaken in July 2008. This site visit was undertaken over a seven hour period on one day as part of that key inspection. Time was spent with the manager, residents, staff and the registered provider and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has improved and what they plan to do better. The AQAA contained an adequate level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to Care Homes for Adults (18-65 years) Page 6 of 29 residents, staff, care managers and health professionals. Completed surveys were received from seven residents, five staff and three health/social care professionals. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. Information and comments noted from some records are reflected in this report. The manager was present during the entire site visit, and the registered provider for available for some of the time.The outcomes of the site visit were fed back and discussed with the manager and registered provider and opportunity given for clarification where necessary. The assistance provided by all those involved in this inspection process is appreciated. What the care home does well: What has improved since the last inspection? The management team have responded positively and effectively to the requirements identified in the last inspection report. A detailed care plan was available on all resident files sampled, including a recently admitted resident. Individual care needs are better identified in the care plans, providing more information and guidance to help staff to meet peoples needs. The registered person has visited the home monthly and written a report to show that they have checked that the home is being well run and that residents are well looked after. Records were available in the home as required so that robust recruitment procedures were evidenced to safeguard residents. Improvements have been made to the premises to keep it well maintained. In response to resident feedback additional facilities have been made available to residents including wireless access to the Internet, cable television in their bedrooms, a pool table and a karaoke machine. The manager has maintained clear records of staff training. Nine staff were identified to complete NVQ qualifications which were achieved this year. The service were winners of Thurrock District Business Awards for staff development and training in Care Homes for Adults (18-65 years) Page 8 of 29 March 2009, an achievement there are very proud of. The service has recently achieved Investors in People Award. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 have the information they need to make an informed choice about where to live and have their needs assessed prior to admission. Evidence: The manager advised that there have been no changes to the statement of purpose and service user guide since the last inspection or the homes registration. Both documents were displayed on a shelf in the hallway and residents demonstrated that they knew where and what these documents were. The managers AQAA does not refer to the assessment procedures or to any of the information provided to prospective residents as part of that process. There is a formal pre admission assessment format and procedure in place that involves all relevant parties, including professionals, the prospective person to be admitted to the care home and their family and/or representative so as to ensure that the management and staff team are able to meet the prospective persons needs. As part of this site visit, the care files for a person admitted to the service since the last inspection were examined. Records of a pre admission assessment undertaken by the Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: registered manager of 109-111 Mollands Lane Project at the persons previous placement were comprehensive and completed prior to their admission to the service. They were supported by information from the persons funding authority. There was evidence to show that as part of the admission assessment process people are given the opportunity to visit the service prior to admission and the transition period is thoughtfully planned on an individual basis. A copy of the contract between 109-111 Mollands Lane Project and the resident was available on file. It was supported in parts by pictures/symbols to make it more userfriendly and was signed by the registered person and the resident. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detailed care planning system is effective in involving users of the service in setting goals and managing risks and supporting people to be cared for consistently in the way they would wish. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to show how these are to be met by staff who work in the care home. The manager confirmed that information from the pre-admission assessment and placing authority is transferred so as to form the basis of the care plan and this was evidenced on the case file tracked for a more recently admitted resident. There was also evidence that the manager has actively contacted commissioning authorities to request annual reviews of each residents placement to ensure that it remained appropriate and effective for the person. The managers AQAA states that all care plans, support plans and risk assessments are reviewed regularly with the service user, key worker, health professionals and Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: reflect the care that is given. Records of support plans sampled showed that each person has a plan of care written from a person centred approach and supported by detailed risk assessments. There is noted improvement to the care/support plans since the last inspection. The support plans included the persons needs and also their abilities, encouraging and supporting people to take the necessary considered risks to maintain independence and develop skills. They provided staff with ample detail of how these are to be proactively managed. This ensures that staff working at the care home have the necessary information in order to meet peoples needs and that the delivery of care is appropriate. Care plans and risk assessments are also signed by staff to show that they have read and are aware of them. Care plans identified goals both for the long and short term. There was evidence of monthly review of both the care plan and risk assessments to ensure that the most current information is available on peoples needs and preferences. Residents have been involved in the production of the care plans and in reviews and one resident had typed up the minutes of their own input and views to their placement review. Care notes are written regularly by staff and were well detailed, providing an additional source of monitoring of how well the care plan is working. Care support plans, risk assessments, review documentation, daily care records, discussion with residents and observation at the site visit demonstrated that residents views are routinely sought as an integral part of practice and that they clearly participate in all aspects of life at 109-111 Mollands Lane project. 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 using the service are supported to lead an active lifestyle of their choice that respects their culture and diversity, to maintain relationships and to enjoy a varied and healthy diet. Evidence: People living at 109-111 Mollands Lane Project are actively encouraged and supported to take part in activities and to pursue hobbies and interests according to their personal preferences. Care plans demonstrate that time has been given to exploring peoples personal preferences with them and to providing opportunities for this to occur. Each resident has a weekly activity planner in an appropriate format and residents knew what activities they would have opportunity for and when. This was also flexible and a resident was observed to negotiate an opportunity to go out with another resident and a member of staff and then to choose to return home independently by public transport. Care plans and risk assessments were in place to Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: support the development of these skills. One resident works as a volunteer in a local business. Records and discussion with residents confirm they regularly participate in activities in the community and some residents are members of a local community social club. Residents also participate in tasks in the house including doing their own laundry, cooking and cleaning or washing the cars. One resident has responsibility with a designated member of staff for routine checks on the vehicles. Residents made drinks and snacks freely as they wished to and different people sat with us at times to help with the inspection. Residents worked with the staff to prepare lunch and the evening meal. A resident told us I like living here, the staff help me and they take me out, I go to college, I do literacy. Residents are also supported and encouraged to stay in touch with their family and friends. A resident told us that the home had recently supported them to spend time with their parents on a short break. Another resident has been away on holiday with their family and residents are going to Butlins in September as that was their choice. There had been a recent garden party to which relatives had been invited. Written feedback from relatives included the staff and manager have always promoted inclusion of service users. Staff are compassionate and treat any concerns with respect. We visit and are always made welcome. .. we are very fortunate that (resident) has this placement as the change in (them) is quite remarkable. Up-to-date communication technology has been used to support a review for a resident at the home whose parents live abroad, so they could be involved. Peoples differences were acknowledged and respected. Residents are supported to attend religious services of their choice and to be actively involved in other events within the church of their choice. The managers AQAA advises that the staff group is also diverse and between them they speak eleven different languages. Residents operate a rota in each house for cooking the evening meal and for other household tasks. Residents cooking on a particular day get to choose the main meal although alternatives are available. Diversity is respected and meals from different cultures are prepared and can be shared by residents who wish to participate. Care and health care plans identify any particular nutritional needs or issues and include risk assessments to promote safety in the kitchen. Residents spoken with told us that they enjoy the meals and that the food is good. 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 using the service are supported to have their personal and health care needs met, their privacy and dignity respected and their medication safely managed. Evidence: The manager operates a key worker system and the named worker was clearly identified in each persons file. Residents spoken with knew who their key worker is but also interacted freely with all staff on duty. Care plans sampled indicated the personal support needed and how the person wished it to be delivered. Key workers are actively involved in regular monthly reviews of the support plans with the resident to support consistency and participate in annual service reviews. Surveys received from residents indicate that they feel that staff treat them well and listen and act on what they say. Residents spoken with indicated that their privacy and dignity is respected at the home. One resident told us clearly that you should never go into somebodys room without knocking and waiting to be asked to come in. Each support plan sampled includes a section on health care needs. These refer to routine issues such as appointments with the dentist and optician but also those specific to peoples individual health care needs such as asthma management. The Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: managers AQAA confirms that service users are supported to attend specialist health clinics as required including such as for asthma, diabetes and weight management. Surveys received from health and social care professionals indicate their view that the services assessment arrangements ensure that accurate information is gathered so that the right service is planned for residents, their social and health care needs are properly monitored, reviewed and met by the service, that staff and the manager have the right skills and experience for this role and that peoples privacy and dignity is respected. A comment in a health professional survey was I am pleased with the service they provide and a comment on what the service does well happy to bring patients to the surgery and interested in their welfare and treatment. Recorded feedback from relatives noted they are so devoted and helpful to (resident), arranging medical attention for them and their condition is now improving markedly. A sample of medications and associated records were reviewed and found to be well organised and managed. Medication Administration Recording sheets showed no omissions indicating that residents have their medication as prescribed. Clear records of medication received are maintained as well as those of medication returned. Surveys from health and social care professionals confirm that the care service supports people to administer their own medication or manages it correctly where this is not possible. Protocols were in place to provide staff and residents with guidance on when to administer medication prescribed on an as required basis. This enables residents to receive their medication consistently when it is required and supports effective monitoring. A risk assessment supported a residents self-management of a prescribed medication. The long-term support plan for this person includes strategies for them to develop the skills to manage their medication safeley and independently. An up-todate signatory list was available to show the signatures of staff deemed competent by the manager to administer medication. Staff confirmed regular training and competence assessments, and evidence of staff training was seen on files sampled. The manager demonstrated that they have produced a folder of information on end of life care wishes, death and dying in a format that supports residents understanding. One resident spoken with confirmed that they had already worked through this with the manager and they had recorded their wishes and views for the future. It is planned that key workers will work with other residents to identify any views and preferences they may have and these will be recorded and respected. 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 living at 109-111 Mollands Lane Project can expect to have their concerns listened to and acted upon and feel confident that they will be safeguarded by competent staff who are supported by clear policies and procedures. Evidence: In the AQAA, the manager states that all service users are respected and listened to if they have any concerns or complaints, are shown how to access the complaints procedure and will be supported to utilise this without prejudice. 109 111 Mollands Lane project has a clear complaints procedure that was displayed in the entrance hall. A more user friendly version of the complaints procedure was also displayed in the hallway and in each residents bedroom and included in the service user guide. Residents spoken with were aware of the complaints procedure and how to raise any concerns. Information in all of the service user surveys received confirmed that they would know how to make complaint and that they would know who to speak to if they were not happy. In discussion, the manager reconfirmed the information in their AQAA, that there have been no complaints received and no safeguarding referrals made relating to the service since its registration. The Commission has not received any complaints or concerns regarding the service. Surveys received from social and health care professionals indicate that the service always respond appropriately if they, or a person using this service, raise any concerns. All surveys received from staff confirm Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: that they know what to do if someone has concerns about the home. There are appropriate safeguarding policies and procedures in place. The managers AQAA advises that new staff and students are requested to watch the safeguarding DVD on their first day of shift/induction and are then required to attend the local councils half day training. The managers AQAA also indicates that service users are requested to watch the DVD on safeguarding from time to time to ensure that they fully understand what constitutes abuse. This knowledge would support people to be clear about what behaviour is acceptable and what is not. The training matrix clearly identifies that all staff except one relief staff member had attended training on safeguarding. This was also evidence on the staff files sampled. Both the manager and the staff spoken with were able to demonstrate a good understanding and awareness of safeguarding procedures. There are clear policy and procedures regarding residents money. The manager looks after some money for residents. Records of money looked after for one person were sampled with the assistance and agreement of the resident and the system found to be satisfactory. Safe storage was available and records of money paid out were supported by individual receipts and two signatures, one of which was that the resident. A care plan was in place in relation to finance with long and short-term goals, supported by risk assessment. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of 109-111 Mollands Lane live in a clean, comfortable environment that is clearly recognised as their home, and meets their needs. Evidence: 109-111 Mollands Lane are well maintained and well presented properties. Furniture and furnishings are modern and of a good quality. There is ample communal space for residents with a large lounge, separate dining area and kitchen in each of the houses. There is a large shared garden at the rear, which is accessible and well maintained. Residents also have use of a covered patio area that provides an additional area to relax. Following a suggestion by a relative, an area of the garden has been made available to residents who are interested in growing flowers and vegetables. A storage shed is available along with an outside water supply which one of the residents regularly uses to wash the vehicles. Both houses also have ample space for parking in a secure front garden. Residents used the space within the houses with ease and comfort. People chose where to spend time, for example inside or out, or to watch television in the lounge or sit with us to participate in the inspection. A number of residents showed us their own bedroom, all of which were personalised. Most residents have their own ensuite shower or bath room. Residents spoken with confirmed they had a key to their own Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: room. Another resident told us they preferred their door to be kept open and this was respected. Residents spoken with also told us that they liked their own bedrooms, had made them the way they liked them, could choose to spend time there or in the lounge, kitchen or garden as they chose. A karaoke machine has been provided as this was requested by residents. A pool table has also been provided at residents request and was seen to used and enjoyed. Carpets have been replaced due to wear and tear. A new flatscreen television has been provided in one of the houses. Sky TV has been provided in residents bedrooms on their request. The home was clean and free from odours. Surveys from residents said that it is always fresh and clean. Systems were in place to monitor health and safety and no health and safety concerns were identified at this site visit. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident they will be supported by a competent and effective staff team that are safely recruited and provide residents with consistency and continuity of care. Evidence: The manager advised that, in addition to the manager, the current staffing day staffing levels are two care staff each side (in 109 and 111) and one awake staff each side at night and that this was appropriate to meet the individual needs of the people living at the the home. A number of relief staff are employed to provide cover for example for holidays and sickness. The manager advised that this means they do not use agency staff and so are able to provide familiar people and consistent care to residents. There was a demonstrated positive approach to training and development both by the registered persons and the staff who work at the home. The training matrix provided by the manager indicates that fifteen of the current twenty three care staff (including relief staff) achieved NVQ level 2 in health and social care and six had additionally achieved NVQ level 3. One staff member is undertaking NVQ level 2 and three staff are currently undertaking NVQ level 3. The managers AQAA tells us that in August 2008 nine staff were put forward and subsequently completed NVQ training in health Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: and social care. As a result of this the service won a Thurrock and Essex Business Award for staff training and development and achievements were recognised by Thurrock Council and Palmer Colleges who were the judges in that category. Files were reviewed for two staff recruited since the last inspection. This was to assess if appropriate references and checks have been undertaken to ensure that prospective staff are suitable people to care for the residents at 109-111 Mollands Lane Project. Both contained evidence of required information, checks and identity being undertaken prior to employment commencing to evidence robust recruitment procedures. This is a noted improvement from the last inspection. It was also noted positively that letters to prospective candidates inviting them to interview advised them that service users would be part of the interview panel. An induction programme including Skills for Care Common Induction Standards was available. Induction training ensures that staff are aware of the needs of the residents they are to care for and how to meet these. Each staff member has a Personal Development Plan, and individual training record and training evidence file that were seen to be well organised and managed. The two staff files sampled demonstrated that staff had up-to-date training on the basic relevant topics such as fire safety, emergency first aid, safeguarding, medication, moving and handling and health and safety. There is also ongoing training provision relating to food hygiene and infection control. Other training certificates as seen on files included communication in learning disabilities, challenging behaviour, understanding mental health, leadership and management, care planning, documentation workshop and managing activities, people and resources. There was evidence of planned and regular staff supervision which was clearly recorded. Records demonstrated relevant content, including care practice issues and training and development and that were signed by both parties. Staff spoken with and information from staff surveys confirmed that they are provided with appropriate induction, training and information on service users that is relevant to their role and helps them to understand and meet the individuals needs. Minutes of staff meetings were available and these demonstrated that appropriate information and topics are discussed with the staff team. Surveys received from staff indicated that staff feel valued by their employers and enthusiastic about the ethos at the home. One person said I have worked in care for 25 years and I must say this is the best care in the community I have ever seen, and about time, this is what every home should be about, top marks. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living at 109-111 Mollands can expect a safe, well managed service that listens to their views and has systems in place to ensure they continue to get things right. Evidence: The manager is suitably experienced and qualified. The outcome of this inspection process clearly demonstrates that they have achieved the goal identified in their AQAA, that is to provide a service that is person centered, that is led by the service users, with staff who support them to achieve their goals and aspirations. Staff are provided with positive and enthusiastic leadership along with encouragement and support for training and development. As an incentive and reward, longer serving members of staff have been given an additional days annual leave. A staff member advised that the recent pay increase in the current climate is appreciated and supports the maintenance of a good staff team. The service has recently achieved Investors in People Award. All comments regarding the management team at 109-111 Mollands Lane Project were Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: positive. Comments noted from relatives during reviews include staff and manager have always promoted inclusion. Residents spontaneously told us that they really liked the manager, that she listens to them and helps them. A staff member commented the management is very supportive. A letter of compliment received from a social care professional stated the home is very well managed .. the manager and her staff work in a very person centred way, residents are treated as individual people, their views are listened to both individually and at residents meetings and the staff try hard to meet all of their issues in everyday life. Systems are in place to gather the views of people who use the service and other stakeholders. Surveys are sent to residents annually, the most recent available were from December 2008. Surveys were also received from social workers, relatives and friends. All contained positive feedback with comments such as looked after well, lots of activities, could part of the garden be used to grow flowers/vegetables and caring nature of staff. One resident is co-chair of the local Learning Disability Partnership. There are regular and detailed reports of the required monthly visit by the registered person to review how the service is running. This is a noted improvement from the last inspection. Minutes of staff meetings and staff development meetings were available and were signed by staff to confirm they had been read. Minutes of monthly residents meetings were available that are supported by pictures and symbols and were signed by residents. These included information on recent changes regarding the Commission. Residents were aware of the inspection process generally, knew the lead inspectors name for the service, understood the rating system used by the Commission and one resident was keen to know if the home had achieved three stars. Aspects of health and safety reviewed were found to be well managed. One member of staff has designated responsibility for in-house health and safety and they are supported by a designated resident. A random selection of service and maintenance records were made available by the resident to be sampled and were assessed to be in good order. Fire drills undertaken record staff names to evidence they have attended and included more recently appointed staff. Records also demonstrate that the fire fighting equipment, emergency lighting and fire alarms are checked regularly to ensure they are in good working order. There are monthly health and safety checks that include temperature of both hot and cold water outlets and weekly health and safety checks that include control of substances hazardous to health (COSHH) and fire checks. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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