Care Home: 11 Allenby Road

What the care home does well 11 Allenby Road provides a homely environment and a relaxed atmosphere for residents to enjoy. Residents` own rooms are very personalised and comfortable, and the home is clean and fresh throughout. The staff should be complimented for their efforts in this regard as they do all the cleaning. The communal areas are arranged to suit current residents` needs, and more work is underway on the gardens at this home. Care planning arrangements are well developed and the manager has rewritten all the guidance for staff on how residents would like their personal care to be delivered. This is now both clear and very detailed about residents` preferences. The home has scored excellent on the Standards relating to residents` lifestyles. There is a good range of activities available, and residents are supported to keep in touch with their families, for example staff taking them out to have lunch with a parent. Residents who do not attend day services also have a selection of worthwhile and interesting activities they are involved in. The home environment is arranged to maximise service users` involvement and independence. The newly refurbished open plan kitchen and dining room allows residents to sit together, and to take part in some of the domestic activities such as laying the table and emptying the dishwasher. The lounge area is well used for both watching TV and taking part in other activities and games. The home felt quite `busy` throughout the day and this was still the case as the inspector was leaving: a member of staff was seen playing the guitar for a resident who was clearly enjoying rock music in the lounge; two others were in their rooms listening to their own music; another was sitting in the office talking with staff; and another was talking with staff in the kitchen as they prepared the meal. What has improved since the last inspection? One Requirement made at the last inspection regarding residents` finances has now been met, as has the one Recommendation on the same subject. A new manager had been appointed and she has already registered with the Commission. She has since completed the Registered Managers Award, and has an NVQ 4 in care. The complete refurbishment of the kitchen diner is new since the last inspection and has greatly improved the space and opportunities offered for residents. They have had completely new appliances in the kitchen and have bought a new flat screen TV for the lounge. Some internal redecoration and refurbishment has taken place, including new blinds for the lounge, and new furniture is on order for several residents` bedrooms. The manager said a lot of work has also been done on the gardens, clearing away greenery and creating space for raised vegetable and herb beds, and this work is expected to be completed by the summer so that residents can enjoy the outdoorspaces at the home. What the care home could do better: The home received one Requirement following this inspection, and this relates to reviewing how they monitor health and safety shortfalls to ensure any potential risks are identified and dealt with as soon as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: 11 Allenby Road 11 Allenby Road Maidenhead Berkshire SL6 9BF The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Dickens Date: 1 3 0 5 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 29 Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for Adults (18-65) 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. Care Homes for Adults (18-65 years) Page 3 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 4 of 29 Information about the care home Name of care home: Address: 11 Allenby Road 11 Allenby Road Maidenhead Berkshire SL6 9BF 01628783573 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): s.humphrey@owl-housing.org Owl Housing Ltd Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : learning disability Additional conditions: The maximum number of service users to be accommodated is 6 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection: Brief description of the care home: The service is operated by Owl Housing Ltd and is registered to provide accommodation and care for up to six service users between the ages of eighteen and sixty five, who have a learning disability. Most of the service users also have associated physical disabilities. Most of the current service users all moved in together from the same hospital and have lived at the home since 1996. The accommodation is provided in a purpose built single storey unit in a residential area of Maidenhead. The premises are owned by a housing association. The home is staffed 24 hours a day. There is disabled access to all relevant areas of the building and each service user has their own bedroom. The property has its own garden with level patio areas, and is within easy reach of transport, local shops and leisure facilities. 3 1 0 5 2 0 0 7 Number of places (if applicable): Under 65 6 Over 65 0 care home 6 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service How we did our inspection: This Inspection took place on 13th May 2009, and took 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector, and the Registered Manager, Mrs. Helen Hopkins, represented the home. The inspector looked around the home and asked to see care plans, staff records, and the Annual Quality Assurance Assessment (AQAA) which the manager sent to the Commission before the inspection. The inspector met those residents who were at home and spoke with 4 members of staff during the day. A total of 4 surveys were returned to the Commission from residents, and staff. Health and social care professionals were contacted by telephone. Responses from these surveys and telephone interviews were used in writing this report. Current fees at this home start from around 1225.00 per person per week. Please contact the home for more details about fees. Care Homes for Adults (18-65 years) Page 6 of 29 The inspector would like to thank the residents, staff and the manager for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? One Requirement made at the last inspection regarding residents finances has now been met, as has the one Recommendation on the same subject. A new manager had been appointed and she has already registered with the Commission. She has since completed the Registered Managers Award, and has an NVQ 4 in care. The complete refurbishment of the kitchen diner is new since the last inspection and has greatly improved the space and opportunities offered for residents. They have had completely new appliances in the kitchen and have bought a new flat screen TV for the lounge. Some internal redecoration and refurbishment has taken place, including new blinds for the lounge, and new furniture is on order for several residents bedrooms. The manager said a lot of work has also been done on the gardens, clearing away greenery and creating space for raised vegetable and herb beds, and this work is expected to be completed by the summer so that residents can enjoy the outdoor Care Homes for Adults (18-65 years) Page 7 of 29 spaces at the home. 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 websitewww.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 10 Individual needs and choices (standards 6 – 10) ................................................... 12 Lifestyle (standards 11 – 17) .............................................................................. 14 Personal and healthcare support (standards 18 – 21) ............................................. 17 Concerns, complaints and protection (standards 22 – 23) ....................................... 19 Environment (standards 24 – 30) ........................................................................ 21 Staffing (standards 31 – 36)............................................................................... 23 Conduct and management of the home (standards 37 – 43) ................................... 25 Outstanding statutory requirements..................................................................... 27 Requirements and recommendations from this inspection ....................................... 28 Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assessed prior to being offered a place at this home, and now all residents have a copy of their terms and conditions on file. Evidence: There have been no new admissions to this home since the last inspection when the home had been rated as good on this Key Standard. The previous report noted The home makes sure that people admitted are properly assessed. The inspector at that time saw copies of the care managers assessment, and the assessment carried out by the home and confirmed that planning meetings had been held. The AQAA notes that prospective residents have a selection of trial periods, varying in length and time duration. The AQAA also notes that staff attend various meetings with all involved in the transition. During the inspection it was confirmed they have a policy and procedure for new admissions. Surveys from service users noted 2 out of 3 had been asked if they wanted to move in. One wrote I was asked if I wanted to move in and it was decided that the house was suitable for my wheelchair and with service users I was friends with. The AQAA stated that residents did not have contracts or terms and conditions. This was explored during the inspection and the manager said she had not seen these documents on residents files. She was asked to follow this up, and the next day obtained copies of each residents terms and conditions from computer records. One resident who deals with their own affairs had their own copy given to them immediately, and the manager said the others would be given these with their Key Care Homes for Adults (18-65 years) Page 10 of 29 Workers who would go through their terms and conditions with them. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care plans reflect their assessed and changing needs, and they are encouraged to make choices and take reasonable risks as part of their daily lives. Evidence: Three care plans were sampled and the inspector found that residents needs were reflected in their care plans. The plans had been generated from each residents assessment and were kept under review. The manager has recently streamlined the care plan format which now summarizes each persons main care needs with a detailed description about how they like to be supported. These are typed up and in an easy to follow format so that staff can be very clear about the support they are providing. The manager was asked to think about improving the format to make plans more accessible to residents and she had some thoughts about how she would do this. The level of detail about how support should be delivered to each resident was very good and covered all essential areas including health, personal care, communication guidelines, social activities and mobility. There were good behaviour support guidelines in place and these were seen to be followed by staff during the day. Care reviews seen on the computer and in printed format were in a very user friendly format with photographs of each resident involved in the activities that were being reviewed, e.g. college courses, outings in the minibus, what they did whilst at home, Care Homes for Adults (18-65 years) Page 12 of 29 and their holidays. The latest reviews had been carried out this year but some were overdue for the 6 monthly review which was highlighted to the manager. She said she would ensure from now on that care plans were reviewed every 6 months as recommended in the NMS. Plans describe any restrictions placed on service users and the manager was asked to contact the Deprivation of Liberty Safeguards co-ordinator at the local authority to seek advice in relation to one resident who it was noted would leave the building if the doors were not secured. The manager telephoned the inspector the following day to confirm this had been done. Residents at this home are encouraged to make decisions for themselves, and examples of the choices they should be offered are noted in their care plans. These guidelines remind staff to ask residents what they would like to wear, and how certain aspects of their personal care should be delivered. Choices made by residents are recorded. for example the daily notes reflect what activities residents have or have not participated in. One resident manages their own finances and this was outlined by the manager in relation to the support they need from staff. Other residents have someone else who has made a legal arrangement to manage their money including some residents who are assisted by the local authority. Limitations on choices are noted, for example as described above regarding one resident who needs the door to be kept secure for their own safety. Residents have a weekly tenants meeting where menus are discussed for the coming week. Notes from these meetings were seen and they included a record of what choices residents had made in relation to meals and activities for the coming week. During the inspection, residents were heard to be given choices including where they wanted to spend their day, whether they wanted to join activities, or to go out. They were offered choices of drinks, food, and what music they wanted put on etc. Residents spoken with confirmed they could make choices. One had chosen to go out to lunch with their relative on the day of the inspection and told the inspector about this, with assistance from staff, on their return. Risk assessments are in place and there are some excellent guidelines for staff on known risks and minimising these as far as possible. Topics covered include for example epilepsy, behavioural support, administering medication, going out into the community, and safe bathing. There are separate guidelines for any overlapping areas, for example if someone had a seizure whilst bathing. Care plans and risk assessments reflect what independent living skills residents already have, and what they should be encouraged to do for themselves. The safety of residents was observed to be important to staff as they were heard to be making arrangements for taking some residents to the dentist and taking another out to lunch. General premises risk assessments are discussed under Standard 42 on health and safety. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by having an excellent range of activities, and they are supported to use the facilities in the local community. Family and friendship links are encouraged, and daily routines promote their independence. Mealtimes offer a pleasant experience and a healthy diet for residents. Evidence: There are a variety of activities on offer for residents at this home, including accessing local day services. The current day services timetable includes sewing, cookery, line dancing and art. Some residents use the WAMSAD facilities for sports and physical activities including 6 weeks at the ice arena. One resident whose file was sampled attends the sensory zone at the Magnet Leisure Centre. Not all residents use day services and the inspector asked to see the file of one of these residents to ensure they had access to a suitable variety of stimulating activities. Current activities for this resident included 1:1 crafts; attending the fortnightly session with the accordion player; board games and exercises; attending the weekly MENCAP evening; joining or observing the weekly cooking session at home; and trips out. The home has had the kitchen and dining area refurbished since the last inspection and now residents can take more of a part in meal preparation and helping with Care Homes for Adults (18-65 years) Page 14 of 29 associated chores. One resident had photographs of them helping to lay the tables and empty the dishwasher. The manager said some can butter the bread, and help with mixing and stirring, for example for cake making. The manager was able to demonstrate improvements in residents abilities and opportunities over time, for example one had now got a bus pass and there were photographs of them using public transport. One person who was nervous of being away from the home overnight so therefore was not able to have a holiday, was supported to stay for a night in a local hotel where they didnt actually feel as if they were away because they were just down the road. This worked so well that the resident has now had a week away, and has another holiday booked. As no surveys had been returned to the Commission from community professionals, the head of the learning disabilities team was contacted about this home following the inspection. He said that he thought the home were very proactive in terms of the community activities made available to residents, and he often saw residents from this home out and about in the local community. Residents who were able to, outlined what they did, one describing her current craft project which is making a model of a bird at day services. There are plenty of photos of the activities which residents engage in, and they were seen to enjoy looking at these photographs and being reminded of holidays and activities. The manager is obtaining personalised display boards to put outside each residents room to display some of their photographs. The AQAA states that residents use the local shops in town, visit the barbers and hairdressers, eat out at local restaurants, attend local clubs, and visit the theatre. They also go to the cinema and local pubs, and enjoy ten pin bowling. Residents at this home are encouraged to maintain family and friendship links. Three files sampled during the inspection each had a section which covered any existing family and personal relationships, and the support needed from staff to maintain these. There were plenty of examples of how staff assisted residents, including one being supported to attend a family funeral, and others having visits and contacts with friends and relatives. One resident had been supported to go out to lunch with a parent on the day of the inspection. Friends are invited to the home, and residents go out to other homes in the Owl group, for example they had all just been out to tea at Foxdown. Some residents also attend the MENCAP social evening each week. Daily routines allow residents to be as independent as possible, and care plans clearly state whether there are any restrictions on residents movements. Care plans also state how the resident should be supported and what they are able to do for themselves. Staff were noted to be respectful to residents and to knock on doors before entering. They sit and eat with residents at mealtimes, and were seen to include residents in conversations. There were no examples during the day of staff speaking with each other to the exclusion of residents. There were many instances of residents being made the centre of attention and made to feel important and listened to, when they entered a room or joined a conversation. Residents were seen to be offered choices about where they wanted to be within the home and what they wanted to do. Residents are encouraged to assist with some of the household chores, and the manager has plans to set up a vegetable and herb garden on the raised beds at the back of the home. This will enable residents to be involved in outdoor horticultural Care Homes for Adults (18-65 years) Page 15 of 29 activities at the home. Meals are served in the new kitchen diner which can accommodate all residents and is suitable for those in wheelchairs as well as more mobile residents. The inspector was at the home during lunch and observed this to be a pleasant experience for residents. Staff eat at the table with residents, and are therefore on hand to offer support. Special diets are available, including pureed food and special eating aids are used, for example a plate with a raised rim to enable a resident to eat independently. The manager was asked to identify how many main courses on this weeks menu were homemade, and she said they are usually all homemade. She said they rarely buy ready or frozen meals and on the weekly menu on display it showed homemade dishes for this week included chilli con carne, chicken curry, a roast meal, and a fish pie. Residents are asked at the Sunday Tenants Meeting what they would like to eat for the coming week, and the meeting notes showed this had been recorded. The manager said they have a takeaway once or twice a month. Specialist advice is taken as necessary and the dietitian is involved where required. The manager gave an example of one resident who was underweight and special guidelines had been put in place about mealtimes, portion sizes, and special drinks. The dietitian was very pleased with the progress this resident had made and had now signed them off. 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. Residents receive personal support in the way they prefer and require, and their health needs are met. The arrangements for the administration of medication are satisfactory and the medicines policies and procedures in place should protect residents. Evidence: Three care plans were sampled during the inspection and these clearly showed residents likes, dislikes and preferences. Each contained information to guide staff about how to ensure residents privacy and dignity is respected. Personal care arrangements are flexible and support is given in private. Residents are dressed very individually reflecting their own personalities. Residents are offered a person of the same gender to support them with personal care. Aids and equipment are available such as a special bath, ceiling hoists, and mobility aids. Specialist assessments are sought as needed and the manager gave the example of one resident who has just been reassessed for a new wheelchair to meet their changing needs. Continuity of care is offered through key working systems and by individual care planning documents setting out residents preferred routines in some detail. All three surveys returned from residents had ticked Always in response to questions about whether staff treated them well and listened and acted on what they said. The manager of the learning disabilities team for the Royal Borough of Windsor and Maidenhead was contacted as no surveys had been returned to the Commission from professionals who work with residents at this home. He confirmed that the local authority are usually very happy with the care provided at 11 Allenby Road, despite Care Homes for Adults (18-65 years) Page 17 of 29 having some clients with quite challenging needs. He also commented very favourably on the current manager who he thought had a very good knowledge of service users needs. Healthcare arrangements are well organised at this home. Each residents review shows when they had their last appointments with the optician, dentist, chiropodist etc. On the day of the inspection two residents were being supported to go to the dentist for check ups. Good health records are kept and any visits and treatments by visiting professionals are properly noted. The manager showed the inspector a booklet made up for one resident who had needed to go into hospital and this set out their needs very clearly, and there had been a rota in place to ensure staff from the home were able to support them whilst in hospital. Excellent guidelines are in place for dealing with health conditions such as epilepsy. Records of medication, allergies etc were clear at the front of each care plan. The manager said the staff had struggled to get access to some community health services for their residents and gave the example of foot care where the manager and a staff member had gone in person and insisted on appointments being arranged. As several residents have epilepsy, the home ensures all staff have some knowledge and training on this subject, and training records showed that 7 of the current permanent staff have done external training on this condition. The shift plan covers who will support residents with their personal care, and who is the first aider on duty. The GP who visits five of the residents registered with his practice was telephoned following the inspection to get his opinion about this home. He said he visited every 68 weeks and had never had any reason to doubt that residents were getting anything other than good care. He said the home was always clean and tidy whenever he had visited. When asked if the home followed advice he gave, he said they always did, and staff would contact the surgery in a timely fashion if residents were unwell. He said staff tended to err on the side of caution if they were worried about a resident, and he was pleased with that policy. There is a policy and procedure in place for medication administration, and one person oversees the ordering and ensures unused medication is returned to the pharmacy. The manager checks the medication records daily, or her deputy does this in her absence. One medication session was observed and was satisfactory. There were no unexplained gaps on the medication records. The manager said medication procedures have been reviewed since a medication error last year. There is now more detailed information on the front of each record about how to administer medication to each resident, and staff have been retrained. There was no report from the community pharmacist to examine, but the manager said their last pharmacy visit was in October 2008 and the only recommendation was to replace the controlled medication book, and the pharmacist had left a new one at that time. The manager was asked to ensure there was more detailed guidance on when to give as required medication, to ensure all staff were doing this in a consistent way. This guidance should be signed off by the surgery who prescribed it. 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. Residents can be confident their complaints would be taken seriously, and the policies and procedures in place should protect them from abuse. Evidence: Owl has a complaints procedure in place and there is a resident friendly format available. There have been no complaints in the last 12 months and two of three surveys returned to the Commission showed that residents would know who to speak with if they were unhappy. A third showed that the resident was unable to do this but staff were confident that they knew when this resident was unhappy or had any concerns, by their facial expression, body language and behaviour. The AQAA confirmed that not all residents could make a complaint but staff are able to identify when residents with communication difficulties are not happy by observation and following communication guidelines. The inspector observed that some other residents were very able to let staff know when they were unhappy or wanted something done, or something done differently. There have been no safeguarding adults issues relating to this home since the last inspection. The local authority policy is adhered to, together with Owls own policies and procedures on this issue. New staff are advised of adult safeguarding procedures during their induction and put on a training course as soon as the next course is available. The manager said all staff have done this training and some did the external course with the local council. Examination of staff training records showed all had done this training within the last 18 months. A previous Requirement regarding service users finances has now been met. The manager said service users no longer contributed to staff expenses on outings and this practice had ceased following the last inspection, and before her arrival. Both the manager and the deputy felt very strongly that service users should not have been asked to contribute in this way. Whilst the service supports one resident with their Care Homes for Adults (18-65 years) Page 19 of 29 finances, the others are assisted by a family member or the local council who have made a legal arrangement to manage their financial affairs. 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 benefit by living in a homely environment which is clean and fresh throughout. Evidence: A tour of the premises took place when all communal areas and three bedrooms were visited. 11 Allenby Road offers a very homely environment which is kept clean and fresh throughout. Bedrooms are personalised with photos, musical and other sensory equipment, and personal memorabilia belonging to residents. Those spoken with said they were happy with their rooms. The manager said several residents were about to get new furniture in their rooms and they had helped to choose this. Residents had special aids and adaptations as required, including ceiling hoists, special beds and chairs, and there is a special bath and a shower room with a walk in shower. The lounge had a large TV and comfortable sofas and chairs; this room overlooks one of the gardens. The kitchen area has been totally refurbished and now offers an open plan cooking and dining area. This allows residents to be more involved in meal preparation including laying the tables, loading and unloading the dishwasher, and buttering the bread for sandwiches. The residents had lunch during the inspection and it was observed to be a friendly and sociable affair with staff joining residents at the table. Staff do the cleaning between them and this is well organised on the daily shift plan. They should be congratulated for the high standard of cleanliness, and there were no unpleasant odours in any part of the home. The laundry area was clean and tidy and residents are encouraged to be involved in their own laundry if they can. A commercial washing machine allows washing at high temperatures as needed. There is a contract in place for the disposal of soiled waste. Care Homes for Adults (18-65 years) Page 21 of 29 The inspector saw two garden areas at the home, including one with a patio, gazebo and outdoor seating. The manager said this is well used by residents when the weather is nice. The other garden is overshadowed by a large tree which prevents anything being grown in the ground, and requires constant sweeping as debris from the tree, currently in blossom, drops onto the paved area. On the day of the inspection the manager outlined the ongoing work and plans for this area including using pots for flowers, and having raised beds for herbs and vegetables. The work is well underway and will be of great benefit to residents once completed. Premises risk assessments needed further work and this is discussed under Standard 42 on health and safety. 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 are supported by competent and qualified staff, and recruitment arrangements are satisfactory. Residents benefit by the well developed training arrangements run by Owl Housing, and by the staff support and supervision available at the home. Evidence: Staff were observed to communicate well with residents and were seen to be approachable and attentive to residents needs. A daily shift plan shows how staff are deployed each day in relation to working with individual residents, preparing meals and doing the domestic work in the home. All staff spoken with were knowledgeable on residents needs and the GP commented that staff always followed his advice in relation to residents healthcare. When speaking with residents, staff were aware of individual preferences, interests and goals. Currently 6 of the 9 permanent staff and regular bank staff, already have an NVQ qualification in care, and another is currently working towards this award. This exceeds NMS 32 which recommends that at least 50 of care staff should have this qualification. Three residents surveys returned to the Commission confirmed that staff Always treated them well, and listened and acted upon what they said. Recruitment files are kept in an orderly format and two files were sampled for the latest recruits. One had transferred from another Owl home and had a proforma on file confirming the necessary checks had been carried out including an application form, two references, two forms of identification, one being photographic identification, and their enhanced CRB check reference number. The other staff file also had a proforma showing the necessary checks were in place and kept at head office. All staff have a 4 month probationary period and those new to this type of client Care Homes for Adults (18-65 years) Page 23 of 29 group also do a learning disability qualification. One staff survey was returned to the Commission and they confirmed that CRB and reference checks had been carried out. Owl training arrangements are well developed with a rolling programme of courses including adult protection, fire, health and safety, and moving and handling. One file sampled for a senior member of staff showed they had also done supervision and designated responsible individual training, so that they could be a shift leader. Those who administer medication also do medication training. There was evidence of induction for new staff and regular supervision sessions. The staff survey returned to the Commission showed that this member of staff thought their induction covered everything they needed, and they were given training to keep them up to date. They also ticked that they met Regularly with their manager for support and supervision. There is no central training matrix in place yet but the manager and her deputy have been working on this and hope to have it completed in the near future. This will allow them to see at a glance which staff have completed all their mandatory training courses, and when refreshers are due. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well managed home where their views are taken into account. Health and safety arrangements are well developed but need to be kept under review to ensure the safety of residents and staff. Evidence: The current manager has been appointed since the last inspection. She is qualified and competent and has an NVQ Level 4 in care, and the Registered Managers Award. She has overall responsibility for the home including staff training budgets, food budgets, and gardening arrangements etc. She does not however have responsibility for updating policies and procedures as this is done centrally by Owl Housing. It was highlighted by the inspector that many of the policies listed on the AQAA returned to the Commission, were overdue for review. The following had not been reviewed since 2006: Infection Control; Disclosure of Abuse and Whistleblowing; Health and Safety; and Fire Safety. A Recommendation will be made in this regard. The manager was observed to lead the team well and there is a friendly and happy atmosphere within the home. Staff were clear about their roles and the daily shift plan ensured all the residents needs, and those activities required to maintain the home, were carried out. The senior manager from the local authority learning disability team was complimentary about the management of this home and said the manager herself had a very good knowledge of residents needs. A number of quality assurance activities take place to ensure residents receive a good Care Homes for Adults (18-65 years) Page 25 of 29 quality service. The AQAA states that monitoring forms are sent out on a regular basis to those who visit the home such as professionals and relatives of residents, and also to day care services. Owl do unannounced Regulation 26 visits each month, and there are in depth reviews carried out on all residents. These were sampled and found to be thorough and contain goals for the coming year and a review of the previous years goals. The home also holds person centred planning meetings where families are invited to participate. Regular monitoring at the home includes health and safety checks, checking medicines and medication administration records, and regular fire safety monitoring. The home also has an annual development plan in place. The home manager is working on a new resident friendly survey format which will be more relevant to the residents at this home and she said this will be introduced once this round of residents care plan reviews are completed. Systems are in place for reporting health and safety issues and maintenance problems, and all staff have done health and safety training. Current checks and safety monitoring includes hoists being checked 6 monthly, Gas safety checks are carried out, and fire safety risk assessments are in place for individual residents. The premises fire risk assessment is overdue for review and the manager said she would deal with that straight away. There is a water services risk assessment in place to prevent legionella and regular monitoring of water outlets etc is recorded. The inspector noted that the laundry contains the cupboard for storing cleaning materials which is left unlocked when the laundry is in use. However, the inspector found the cupboard closed but unlocked when there were no staff in the laundry. The manager locked it immediately and instructed staff to keep it locked from now on. They are going to review where keys are kept to ensure they are accessible to staff, whilst keeping residents safe. The laundry risk assessment should cover the issue about whether the outer door of the laundry is to be locked or unlocked, and take into account that other people with learning disabilities, and some children, sometimes visit the home. It was also noted that there was surgical scrub hand wash in the bathroom which may pose a risk if swallowed. This also needs a risk assessment. The manager dealt with these shortfalls immediately though a review of current health and safety monitoring arrangements is needed to ensure such shortfalls are identified and dealt with in a timely way. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes No √ 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 1 41 13 Arrangements for monitoring 13/06/2009 health and safety within the home should be reviewed to ensure any shortfalls are identified and dealt with in a timely way. This is to ensure the safety and welfare of residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 20 Care plans should be reviewed on a 6 monthly basis as set down in the National Minimum Standards. There should be more detailed guidance for staff on when to administer as required medication, to ensure all staff are administering this in a consistent way. It is recommended that Owl Housing review their arrangements for ensuring policies and procedures are kept up to date as some of those noted in this report are now into their third year and overdue for review. 3 40 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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