Care Home: 15 Hulse Road

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What the care home does well There were no requirements made at the last inspection. The statement of purpose and service users guide are in easily read formats. All of the documents and paperwork used by people are in the same large print and pictorial format. Mencap has comprehensive pre-admission assessment documents. Person centred care planning and review means that people are able to direct the care and support they are offered. Promoting people`s independence is seen as essential for quality outcomes for individual people. Risk assessment does not restrict people from doing things. The home looks for more ways to support people with being independent. Staff members look for new ways to support people with communication. People benefit from having full activity and work programmes. People choose different things that they do socially, on their own, with members of staff or with the other people who they live with. Everyone maintains good contact with their families and friends. People get involved with the running of the home and are involved in cleaning, cooking and shopping for food. People have a healthy diet. People are supported to use public transport independently. Everyone has a health action plan and they are supported to manage their healthcare needs well. People have good access to healthcare professionals. Systems are in place for safe management of people`s medication. People are encouraged to manage their own medication. People are supported to be confident in making complaints about the service, with good, accessible policies and procedures. People are protected by good safeguarding procedures for anyone who may be vulnerable. The home is well maintained, clean and homely, with systems for ensuring that everyone`s health and safety is considered. Staff members are experienced and knowledgeable about people`s needs. They are well trained and supported by management. Members of staff have good relationships with people who use the service. Mrs Blackmore is suitably competent, experienced and qualified to ensure that the home is run in peoples best interests. She works well with us and makes sure that we know about things as they happen in the home. Mrs Blackmore lets us know what she has done about things that affect people who use the service. What has improved since the last inspection? Staffing levels mean that people have support when they need it. Some people are looking at eventually administering their own medication with staff support. What the care home could do better: Toilet brushes should be stored dry, so that any risk of infection is reduced. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 15 Hulse Road 15 Hulse Road Salisbury Wiltshire SP1 3LU     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: Sally Walker     Date: 2 4 0 9 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 33 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 33 Information about the care home Name of care home: Address: 15 Hulse Road 15 Hulse Road Salisbury Wiltshire SP1 3LU 01722326490 Telephone number: Fax number: Email address: Provider web address: H5M049Piper@mencap.org.uk www.mencap.org.uk Name of registered provider(s): Type of registration: Number of places registered: Royal Mencap Society care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: No more than 2 service users in the age range 18 to 64 years may have both a learning disability AND a physical disability The Commission must be advised of any circumstances when named service users are unable to access first floor communal space. The Commission must be consulted if it is decided to use the communal space area for staff sleeping in and give prior approval for such a change. The maximum number of service users in the age range 18 to 64 years who may be accommodated in the home at any one time is 6 Date of last inspection Brief description of the care home 15 Hulse Road provides care and accommodation for up to six people with a learning disability. Up to two people may also have a physical disability. The service is run by Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 6 2 Brief description of the care home Mencap. This is a national voluntary organisation working in the learning disability field. They have a number of care homes and supported living facilities throughout Wiltshire. The home is located within level walking distance of the cathedral city of Salisbury. It is close to a range of amenities. These include shops, a cinema, a theatre, and a leisure centre. The building is an older property, located in a residential area. It has been extended on the ground floor. Peoples accommodation is arranged over three floors. There are five single bedrooms. Three of the bedrooms have en-suite facilities. Ground floor accommodation is available for anyone with some degree of physical impairment. There is no lift in the home. Fees charged for care and accommodation are based upon the assessed needs of individuals. Information for people who are considering moving in is given when they visit the home, and through discussions with Hulse Roads manager and other involved professionals. Copies of service documents, such as the statement of purpose and service user guide, are made available. Inspection reports are also available in the home, and are discussed when meetings are held with people who use the service and relatives. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place on 23rd September 2009 between 9.30am and 4.00pm. Mrs Judith Blackmore, registered manager, was on training that day so we returned on the 24th September 2009 between 9.30am and 4.25pm, so that she could give us access to confidential records and discuss developments in the home. We spoke with people who use the service and with two members of staff. We looked at care plans, goal planning, risk assessments, activities, rotas, menus, staff recruitment and training files and medication. We made a tour of the communal areas and two people showed us their bedrooms. We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. Care Homes for Adults (18-65 years) Page 6 of 33 As part of the inspection process we sent survey forms to the home for people who use the service, members of staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We looked at the information we had received since the last inspection so that we could decide which areas to focus on during the inspection. The last Key inspection took place on 27th September and 9th October 2006. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? Staffing levels mean that people have support when they need it. Some people are looking at eventually administering their own medication with staff Care Homes for Adults (18-65 years) Page 8 of 33 support. 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 33 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 33 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. Easily accessible information is available to anyone considering moving in to the home. Although no one had moved in for some time, Mencap has produced comprehensive documents for assessing all aspects of care and support needs before anyone moves in. Evidence: The statement of purpose, service users guide and tenancy agreement had all been produced in large print and pictorial formats. No one had been admitted to the home since April 2005. Mrs Blackmore told us that Mencap had recently introduced new pre-admission assessment documentation, entitled My Needs Assessment. In the AQAA Mrs Blackmore told us we involve the individual at every stage of this process and ensure they know beforehand how the process works. We work with other relevant agencies within the individuals support network to ensure all needs are met. A support plan is then drawn up which identifies all aspects an individual feels is important to their life. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: Mrs Blackmore showed us that each person currently living at the home had been involved in an assessment using the documents My Needs Assessment. Tenancy agreements had also been produced in this easy read format. Care Homes for Adults (18-65 years) Page 12 of 33 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. People benefit from having detailed person centred care plans which they are involved in compiling. Promoting peoples independence is seen as essential for peoples quality of life and experience. People are supported to make choices and determine how they live. Evidence: Each persons care and support plans were set out in their individual files which they kept locked in their bedrooms. Members of staff asked peoples permission to access these files. Care plans were in pictorial format and large print. Care plans showed long term and short term goals which people were working towards. Risk assessments related to different aspects of peoples needs and goals. Care plans identified what support people wanted or did not want staff to support them with, including personal care. All staff members signed up to peoples care plans and risk assessments. Most people who were funded locally had had a recent review of their care plans with their care managers. People reviewed their care plans every two months with staff Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: members. The review process was recorded in pictorial format and large print. Some people wrote in their daily reports about what they were doing. Care plans set out what choices people had made about different things in their lives, for example, religion and culture. People were supported to manage their own money and budget for their weekly expenditure. Peoples care plans showed what support people needed with using and understanding money and change. One of the staff members had set up a file of cards with pictures of different coins and notes in different amounts. This was so that people could hand these cards to shopkeepers and show that a receipt was needed. One of the members of staff told us that they had shown some of the staff in the local supermarket and bank, some of the Makaton signs that people used. This meant better communication. Care plans identified how each person communicated. Some people had sessions with the speech and language therapist. They were learning more Makaton gestures. Staff members also had training in Makaton. Some people had communication books which they took with them to day services, so that important things could be written down. The speech and language therapist was providing communication courses to staff members. In a survey form one of the healthcare professionals told us I often recommend that other care staff contact Judith Blackmore about their communication environment. There was a folder setting out peoples essential care needs for agency staff information. One of the members of staff explained to us about the computer system for translating documents into large print and pictorial format. One of the people showed us their care plan. Mrs Blackmore was reviewing peoples goals and aspirations with them. Care Homes for Adults (18-65 years) Page 14 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a full and active social life. There are lots of things that people do at the home and in Salisbury. Staff members support people to seek out new opportunities for work and leisure. Risk assessment does not prevent people from following an independent lifestyle and being involved in new or different situations. Evidence: One of the people who use the service told us what they liked to do and showed us their activity programme in their care plan. They also had their activity programmes on their notice boards in their bedrooms. Some of the activities were: reading, board games, photography, nail care, music sessions, jigsaws, hand massage and use of the laptop. There was a computer programme if people preferred to write letters in pictures and words. Peoples mail was given to them when it arrived. Staff members would support people with their mail if needed. People mainly went to work or day services during the week. At the weekends they pursued their own individual interests. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: There were records of what people particularly liked to do. Some activities were risk assessed, for example, using taxis or public transport alone. The assessments identified the benefits to people to be involved in the activity and the negative aspects such as loss of independence and how people may become de-skilled if they did not do the activity. People had been supported to be independent in using public transport or taxis to go to their day services, work or shopping. People allocated their money for all the daily activities they were involved in during the week. Some people played badminton and went swimming. People also enjoyed music and singing. Some people enjoyed going for walks. There was a leisure centre within walking distance which people used. They would also go to a cafe in a nearby supermarket. Staff members told us that people enjoyed going to the pub and playing golf. Some people were going to a concert in Salisbury the next weekend. Other people were either going to their family or out for a meal in a restaurant. People were also going to a Mencap ball the next month. One person told us about the ball gown that they were having made. One person showed us the photographs they had taken on holiday. People told us about their holidays and special excursions for birthdays; a cruise and a trip on the orient express to Cornwall. They told us they had been on holiday in a cabin and for a boat trip whilst on holiday. Another person told us about their involvement in different self advocacy groups locally. The local Community Team for People with Learning Disabilities offered counselling for sexual health. People were supported to have relationships. People were encouraged to remain in regular contact with family and friends, either by telephone, letter or visits. A calendar of events had been produced so that parents knew what people were involved in. In the AQAA Mrs Blackmore told us staff have developed an excellent rapport with all the extended families of our client group and have built a good working relationship with them; all staff has family charter training. People who use the service chose the weekly menu between them. There was a library of photographs of different meals to help people decide. Each person took turns to prepare and cook the main meal which they had in the evening. Each day a notice with a picture of the meal and a photograph of the person who was cooking it was put Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: on the notice board in the kitchen. This meant that a record could be kept of the meals. Other dishes were available if people did not like what the person doing the cooking had chosen. People were involved in shopping for food. There was a library of different ingredients that could be stuck to a Velcro shopping list in the kitchen. One of the staff members told us that people were encouraged to follow a healthy diet, so a pudding was normally only available on a Sunday. We saw that there was a large bowl of fresh fruit for people to help themselves to. People got their own breakfasts and made a packed lunch to take with them if they went to day services or work. There was a selection of things for people to make their packed lunches with. There were also different things in the fridge and store cupboards for people to make their own snack at lunchtime if they were at home. There were pictures on the fridges to show what was in them. People had takeaway meals as part of their menu selections. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported in managing their personal and healthcare needs. People have good access to healthcare professionals. Systems are in place for safe management of peoples medication. People are looking at managing their own medication. Evidence: People had all their care and health needs set out in their care plan. Everyone had a health action plan with details of key healthcare professionals who were involved in their care. There was information about regular appointments and any changes in healthcare. People were independent in their personal care and needed no staff intervention. Risk assessment showed how people were supported to bath or shower independently and how any risks were managed. There was information in peoples care plans about maintenance of any equipment people had, for example a hearing aid. Mrs Blackmore told us that people received very good support from their GPs who had a good understanding of the needs of people with learning disabilities. People could take staff members with them if they needed to go to the GP or hospital Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: appointments. There were pictorial communication sheets for people to take with them to hospital appointments, so that healthcare professionals could explain better what was happening. One of the GPs in a survey form told us looks after their clients very nicely. I dont visit often but am not aware of any problems. Another GP told us [Patient] receives excellent care. People were weighed monthly so they could maintain a healthy weight. Significant changes in weight would be referred to the persons GP. We looked at the arrangements for peoples medication. One person administered their own medication which was kept locked in their bedroom. They signed the medication administration record when they received and checked their medication when it was received from the pharmacist. Mrs Blackmore told us that all members of staff were responsible for medication. New staff members could not administer medication until they had been assessed as competent. Records were kept of all medication received into the home. Checks were made at staff handover periods. Staff members had received medication training from the supplying pharmacist. Most peoples medication was stored in a monitored dosage system put up by the pharmacist. There was a controlled medication cupboard which met the requirements for storage of this medication. No one was prescribed controlled medication. Care plans had photographs of which medication people were taking and details of any special prescribing instructions. If people had medication that was only to be taken when needed, the reasons were detailed in their care plan. There was information about how people experienced and expressed pain, with what medication to be taken. There was a record of different homely remedies which had been agreed with each persons GP. Data sheets, supplied with peoples medication, were kept, so that information was readily available about each different medication, side defects and special precautions. Mrs Blackmore told us that other people had goals to administer their own medication. Risk assessments had been carried out so this could be started gradually with people. There had been a medication error just before we inspected. Mrs Blackmore told us what had happened, why and the result of her investigations. She told us about changes to the administration system that she had made as a result of her findings. Mrs Blackmore told us that the staff involved had been interviewed and retrained in Mencaps medication administration procedure. The person who uses the service suffered no ill effects and their GP was informed of the incident. There was guidance to staff in the medication administration record on what to do if an error occurred. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: Mrs Blackmore told us that staffs on going competency to administer medication was continually monitored formally throughout the year. This took the form of three monthly questionnaire, watching administration and random questions. The organisation had issued guidance about responding to any swine flu pandemic. Care Homes for Adults (18-65 years) Page 20 of 33 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 know that they can make complaints about the service and have different opportunities to do so. People are protected by members of staff who know about safeguarding people who may be vulnerable. Evidence: The home had given each person a copy of Mencaps complaints procedure. It was in an easily read format with a pre-paid envelope addressed to the head office. This meant that people could make complaints directly to the organisation as well as to the manager. The home had also adapted the complaints procedure so that it was in large print and pictures. This was the format used for all of the documents in the home so they were more accessible to people who live there. Staff members told us that people were reminded about making complaints at their meetings. Staff told us that if people could not tell them about something they were unhappy about, they would notice their mood, behaviour and general well being. They would then try and find out what the matter was. Mrs Blackmore told us that people were receiving training in managing conflict. We looked at the complaints log. There had been no complaints about the service since 2007, before Mrs Blackmore came to post. Mrs Blackmore told us that complaints were discussed with people at their house meetings and reviews. Mrs Blackmore has informed us about incidents which have occurred since we last Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: visited. She also told us about good support people had received from a local advocacy service. Some people had had training on personal safety and stranger danger through their day services. Staff had carried out risk assessments with people about opening the front door to strangers. One of the members of staff gave us an example of challenging one caller who had a negative attitude with regard to peoples equality and diversity. Some people had strategies for behaviour management in their care plans. Mrs Blackmore told us that behaviours had decreased to the extent that they were very rarely displayed and we saw evidence of this when we visited. Mrs Blackmore told us about the work the home had done over the past two years to reduce peoples anxiety through better communication and understanding. All staff members and Mrs Blackmore had received training in deprivation of liberty safeguarding standards. Mencap had introduced its own policy for its homes. People were supported to manage their money and budget for large purchases, such as holidays. People had their own savings accounts. Some money was held on peoples behalf. There were records and receipts of all transactions and two staff signed when transactions were made. Members of staff and the manager regularly checked that the money and the records were right. Staff told us about risk assessment with anyone who may be vulnerable with managing their own money and risked abuse from others. One member of staff had produced cards with pictures of different sums of money which people were likely to use when they went shopping. The cards were to be shown to shopkeepers so that they knew what change should be given and that a receipt was needed. This meant that people were more independent when using local facilities. We asked staff members about what they would do if they observed or were told about abuse of people who use the service. They were quick to describe the local safeguarding reporting procedure. They also described Mencaps policy and training they had undertaken in safeguarding vulnerable people. They showed us the local booklet entitled No Secrets in Swindon and Wiltshire which was available in the office. Mrs Blackmore showed us the protocol she had set up with the local safeguarding unit about reporting any abuse. She went on to say that she had provided the police at the safeguarding unit with some of the symbols and photographs used as communication aids for people with learning disabilities. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well maintained, safe, clean and homely environment. Evidence: Although the home is registered for 6 people, one of the double bedrooms was used as a single. There was a bathroom on each floor. There was a main sitting room and dining room on the ground floor and a small quiet room on the top floor. Since the last inspection the garden had been landscaped. People were involved in gardening and staff supported them. There had recently been a garden party and people invited their family and friends. The home was cleaned to a high standard. However we saw that toilet brushes were stored with the brushes in water. We said that the brushes should be stored dry, to reduce any risk of contamination. Mrs Blackmore told us she would address this matter and remind staff members of the Health Protection Agencys guidance to care homes on infection control. There were lights which would flash if the fire alarm sounded, to assist those people with hearing difficulties to know that they needed to evacuate from the building. The homes fire risk assessment had been reviewed in March 2009. There was a fire pack Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: which held important things and information needed to be taken out if there was a fire; a phone and important contact numbers, keys and a torch. Radiators were guarded to guarantee low surface temperatures and reduce any risk of scalding. People had individual risk assessments about their awareness of fire safety and evacuation. This included what support they may need in the event of a fire. Temperatures of the hot water outlets to baths were regularly tests to reduce peoples risk of scalding. There were disposable non latex gloves and aprons for everyones protection. People were involved in domestic tasks and there was a rota for shopping, cleaning and laundry. People also had delegated responsibility for checking the first aid box and checking some of the fire equipment. One person was responsible for taking items to the recycling unit. People also answered the phone and the door to callers. Staff members told us that people were encouraged to do these things for themselves. In the AQAA Mrs Blackmore told us staff respect the privacy of the tenant, staff ring the door bell on arriving at the house and the tenants lets the staff in. Care Homes for Adults (18-65 years) Page 24 of 33 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. People benefit from having members of staff there when they need them. Staff are experienced and well trained. Members of staff are well supported by management. A robust recruitment process means that people are protected from anyone unsuitable to work with people who may be vulnerable. Evidence: There was a rota with pictures of staff members so that people knew who was on duty at different times of the day. One person had a copy of the staffing rota because they liked to know in advance who was supporting them during the week. The rotas showed that there was a minimum of two staff during the day. At night one of the staff members slept on the premises. Mencap ran an on call system so that staff could access managerial support when needed. We saw that people had good relationships with members of staff. Staff worked in a sensitive, friendly and professional way with people who use the service. Staff members included people in all conversations. Action had been taken to address the good practice recommendation we made at the last inspection in October 2006, that there should be continuing review of the staffing arrangements for the home. This related to support needed as peoples routines had Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: changed at the time and they were spending more time at the home. We saw that a member of staff was employed to support one person with their job. In the AQAA Mrs Blackmore told us we now have continuity with an established staff team. One staff change in the last 12 months who was replaced within two months. In a survey form one of the staff members told us a staffing shortfall had meant less choice or support for leisure activities. Interviewing currently on going so should resolve issue. Another staff member told us in a survey form: interviewing in progress. So hopefully permanent staff. Then tenants can have more support and change of faces. Mrs Blackmore told us that there was one part-time post that she was currently recruiting to. Mrs Blackmore told us that Mencap was updating many of its policies which were introduced to staff members at staff meetings or by training sessions. One of the members of staff told us about their previous experience working in care homes and in the community. They had an NVQ Level 3 in care. They told us that they had good access to training and were asked about training needs during supervision. They told us they had undertaken updated training in first aid, moving and handling, infection control, food hygiene, health and safety, fire prevention, protect and respect, medication, bereavement, working and personal safety, managing behaviours, autism and epilepsy. They told us they had received a good induction when new to post. Another staff member told us they had received a good induction. They told us about their previous experience of working in schools. They had attained an NVQ Level 2 in learning support and said Ive had lots of training in the last two years. Two staff members were undertaking NVQ Level 3 and one had the award. Two staff held NVQ Level 2. This meant that 100 of staff had at least NVQ level 2. Training provided by the organisation and other trainers was posted on the staff notice boards. Mrs Blackmore kept a matrix of mandatory and essential training, showing when updates were needed. Training certificates were on staffs individual files. Mrs Blackmore told us that workshops had been arranged for staff in personalisation and death, dying and bereavement. The staff members told us about their personal development plans and appraisals. Staff discussed training needs in supervision. As well as mandatory training in food hygiene, infection control, first aid, moving and handling and fire prevention, staff members also trained in epilepsy, mental health, risk management, Makaton, behaviour management, working with families and protection. We looked at staff recruitment files. The organisation collated information about potential candidates and Mrs Blackmore decided who would be interviewed. People Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: who use the service were involved in the interview process. They told the manager how candidates had responded to their questions. People had received training on being involved in the recruitment process. All of the documents and information required by regulation had been received before anyone started work. No one started work until checks on their suitability to work with vulnerable people was determined. Risk assessments were carried out with staff members for different tasks or health matters. Members of staff were regularly supervised and regular staff meetings were held, with minutes published. Supervision contracts were in place and there was a diary of supervision dates for the coming months. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is suitably experienced, qualified and competent to ensure that the home is well run. The manager looks at different ways to improve the service for people who live there. The home is run in peoples best interests. People contribute to the homes continuous improvement plan. Systems are in place to make sure that everyones health and safety is assured. Evidence: Mrs Blackmore had run the home for nearly three years. She had worked for the organisation for nine years. She was registered as manager in October 2007. Mrs Blackmore had the Registered Managers Award and NVQ Level 4 in management and care. Mrs Blackmore kept herself up to date with current good practice with regular training. She had recently trained in recruitment and selection, safeguarding vulnerable people, performance management, coaching for managers and employment issues. She told us she was considering doing a degree in social care in the near future. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: Mrs Blackmore works well with us and has let us know when things happen in the home that have affected the people that live there. She also lets us know what she did about these things, so that they were put right. Each member of staff had a delegated area of responsibility, for example, the staffing rota. Mencap carried out the quality audits of the service. Part of the audit included finding out about what peoples views were in a document entitled What Matters to Me. Findings were included in the Continuous Improvement Plan which was reviewed regularly. The monthly unannounced visits by the area manager, required by regulation, also generated an action plan setting out the managers planned improvements. In a survey one of the people who use the service told us I think it runs smoothly. People met regularly with the manager and staff to discuss different aspects of the home. Mrs Blackmore told us that she was considering supporting people to chair their own meetings. Mencaps new critical incident reporting format was used for incidents, accidents and near misses. Safeguarding issues were also reported via this process. Mrs Blackmore showed us the must read file where staff members were made aware of any changes in policies or other management issues. There was also good information about use of positive language when referring to people who use the service or others. There was information for staff about equality and diversity. In the AQAA Mrs Blackmore told us that diversity is one of Mencaps key strategic priorities. We have developed policies and processes to ensure that in both our recruitment and our service delivery, diversity is promoted. Mencap has a dedicated diversity officer and there is a steering group of staff from across the organisation who meet to share good practice and oversee the implementation of our diversity policy. One person told us about the service of the central heating boiler that was being carried out that day. We saw that repairs were carried out immediately when people told staff members that things needed fixing. For example, a new washing machine and a chest of drawers were purchased on the day we visited, because repairs could not be carried out. There were picture cards to put on things that could not be used or were in need of repair. There was a list of different jobs and checks that had to be done regularly; each day, every week or monthly. These were either carried out by people who use the service Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: or members of staff. These checks included the electrical equipment, thermostatic controls to the hot water supplies and fire safety. There was a maintenance guide on how to access contractors and servicing details. There were generic risk assessments for different areas, for example, use of equipment and tasks. There were also risk assessments specific to the home, members of staff and the internal and external environment. All staff were expected to sign up to the risk assessments. There was information from the housing association which owned the building, on safe management of water systems to reduce the risk of legionella infection. The housing association also carried out regular safety checks on the building, the gas supply and the fire safety arrangements. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 Toilet brushes should be stored in a dry condition. To reduce any risk of cross infection. Care Homes for Adults (18-65 years) Page 32 of 33 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). 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