Care Home: 160-162 West Wycombe Road

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What the care home does well The needs of prospective users of this service are carefully assessed to ensure that the home can meet those needs and the prospective user accept the offer of a place. The quality of care planning and link working is good and aims to provide users with the support they need. People living in the home are supported in making choices about their lives. The home maintains good liaison with local health and social services which ensures that users needs are met and, where present, risks are well managed. Users have opportunities to participate in a wide range of social, educational and leisure activities in the community. These include day and drop-in centres, literacy, numeracy and IT skills development, equestrian and horticultural activities, volunteer work, sports, cinema, and trips out to places of interest. These promote social, practical and intellectual skills and involvement in the wider community. There is ongoing contact with a local independent advocacy service. This facilitates the provision of support to users should they require it. What has improved since the last inspection? The home`s Statement of Purpose and Service User`s guide have been updated and provide prospective and current users of the service with comprehensive information about the home. A new manager and staff have been appointed and staffing has now stabilised thus providing users with greater continuity in their relationships with their link worker and other staff. A number of areas of the home have been redecorated and refurbished in consultation with users. This provides a pleasant environment in those areas for users living in the home. What the care home could do better: Managers need to continue to address the need to maintain a comfortable and pleasant environment for users. This is an older building, some areas of which are subject to heavy use, which will require further investment in maintenance and refurbishment if it is to provide an acceptable standard of accommodation. Managers need to ensure that the home`s practice in relation to the control, storage and administration of medicines meets current good practice guidance and takes account of recent audit activity. Managers should ensure that information required by the regulations with regard to the recruitment of staff is available from the day staff start work with users in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 160-162 West Wycombe Road High Wycombe Buckinghamshire HP12 3AE     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: Mike Murphy     Date: 1 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 160-162 West Wycombe Road High Wycombe Buckinghamshire HP12 3AE 01494451453 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ken.mcconaghie@hpcha.org.uk Hightown Praetorian & Churches Housing Association The registered provider is responsible for running the service care home 15 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum numbers of service users to be accommodated is fifteen (15). 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 category: Mental Health- not falling within any other category (MD) Date of last inspection Brief description of the care home 160 West Wycombe Road is a care home registered to provide care and accommodation to fifteen service users with severe and enduring mental health problems. The aim of the home is to provide longer-term accommodation whilst supporting service users to develop their skills to live independently. It is situated on a main bus route halfway between the busy commercial centre of High Wycombe and the picturesque National Trust village of West Wycombe and its surrounding Care Homes for Adults (18-65 years) Page 4 of 34 15 Over 65 0 Brief description of the care home countryside. The home is managed by Hightown Praetorian and Churches Association Ltd, which is registered with charitable rules under the Housing Associations Act 1985 and is a limited company under the Industrial and Provident Societies Act. The home consists of a two-storey building. There are thirteen bedrooms situated on the first floor, two bathrooms and a separate toilet. On the ground floor there are a further two bedrooms a bathroom, toilet, laundry room, two kitchens, a dining room, two lounges and a smoking area. Bedrooms do not have en suite facilities but are fitted with wash hand basins. The building is not accessible to wheelchair users and there is no passenger lift. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out by one inspector in September 2009. The inspection included an unannounced visit to the home on Friday 11 September 2009. The visit took place betwee 10.00 am and 7.45 pm. The manager sent us the services annual quality assurance assessment (AQAA) prior to the inspection. The AQAA was clear and and comprehensive and gave us the information we asked for. The inspection included consideration of the information in the AQAA. It also included discussion with the manager, the service manager, staff and users. We carried out a survey and received seven completed forms from users living in the home. We looked at the homes Statement of Purpose and its Service Users Guide. We observed activity in the home - especially how staff and users mixed together. Care Homes for Adults (18-65 years) Page 6 of 34 We inspected records. The records included support plans, medicines administration records, and staff records. We looked at things people told us about the home in a survey. We looked around the house and garden. We looked at the arrangements for administering medicines. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Managers need to continue to address the need to maintain a comfortable and pleasant environment for users. This is an older building, some areas of which are subject to heavy use, which will require further investment in maintenance and refurbishment if it is to provide an acceptable standard of accommodation. Managers need to ensure that the homes practice in relation to the control, storage and administration of medicines meets current good practice guidance and takes account of recent audit activity. Managers should ensure that information required by the regulations with regard to the recruitment of staff is available from the day staff start work with users in the home. Care Homes for Adults (18-65 years) Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 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. Prospective users of this service can be assured that their needs will be assessed and that the home will consider whether it can meet those needs before offering a place. Prospective users, their families and professionals supporting them will be provided with sufficient information to assist in deciding whether to accept a place should an offer be made. Evidence: The home has a statement of purpose and service users guide which is made available to prospective and current users of the service. Both documents were revised in July 2008. In both documents the home is referred to as 160. The statement of purpose outlines the service provided at 160, the homes aims and objectives, its facilities, the staffing structure, the arrangements for moving into 160, social activities, person centred planning (PCP), the processes for consulting service users, equality and diversity, fire precautions, protection from abuse, complaints, and, privacy and dignity. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: This is a comprehensive and informative document. The section on staffing will require updating - in particular to reflect the management position at the time of this inspection. The service users guide again outlines the service provided (under the heading What we offer), the assessment process, the aims and objectives of the home, the staff team, the building, bedrooms, meals, the kitchens, the laundry, telephone, visitors, meetings, complaints and concerns, activities, Health services, Your Link Worker, charges (fees), availability of staff, and, comments from service users. The final page provides contact details for the senior manager responsible for the service at Hightown Praetorian and Churches Housing Association, and the People Voices Advocacy Association. Contact details are not provided for the commission or for the local health and social care authorities. These are also named as organisations (in the case of health and social care authorities in the form of the care coordinator) a service user or their representative may wish to contact under the section headed Complaints and Concerns on page 5 of the version provided for this inspection. This too is a well written and informative document. It would fully meet the standard by the addition of information on staffing (as in the statement of purpose) and contact details for the commission and local authorities. Referrals to the home are accepted from the local community mental health team (CMHT). An enquiry may initially be made to the service manager by phone. If the enquiry is progressed then a more formal referral is made which will normally include a copy of the current care programme approach (CPA) care plan and an up to date risk assessment on the person. This is discussed with the area manager and home manager. Where the referral is accepted at that point then the matter is discussed with the referring care manager and arrangements are made for the home manager to visit the person at their present place of residence and carry out an assessment. The homes assessment form is usually completed at that time. The assessment form is a comprehensive document which covers a range of physical, psychological and social needs. The outcome is discussed with the service manager and area manager at the home. Where the matter moves forward to the next stage the prospective user and his or her care manager are invited to the home to view its facilities, and meet staff and current users. A decision is then made on whether an offer of a place is made and whether the prospective user wishes to take up the offer. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: Where all parties agree, an overnight trial admission is arranged. If this goes well then a one month admission is offered. At the end of that month a meeting is arranged between the parties to review the position. Three outcomes are possible from that meeting: (1) to offer a permanent place, (2) to extend the trial admission for a longer period, or, (3) to decide that the home is unable to meet the persons needs and refer back to the care manager. The information acquired during the assessment process forms the basis of a plan of care aimed at meetings the users needs. Staff skills aimed at meeting those needs are established through the organisations staff recruitment and development processes. Information on a local independent advocacy service is given in the service users guide. During the course of our visist to the home we met a user who had moved in since the last inspection. The user confirmed that they were given time to consider whether they wished to move to the home and that there had been good communications between the home and their social worker Care Homes for Adults (18-65 years) Page 13 of 34 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. A comprehensive and detailed support plan is in place for each user of the service. This supports the organisation of care and support directed at meetings the assessed needs of the user. it also supports the uers participation in the process. Evidence: A support plan is drawn up for each user of the service. A link worker (key worker) is responsible for co-ordinating the care of two or three users under the supervision of the manager and service manager. Support plans include a photograph of the user, basic information, risk assessments, key health information, a detailed plan of support covering a range of activities, Community Mental Health Team (CMHT) risk assessments, a copy of the persons care programme approach (CPA) care plan and notes of CPA review meetings, notes of six monthly reviews, notes of monthly link worker meetings, weekly reviews with the link worker, and daily logs (in which notes are made each day). Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Plans of support include , finance, self-esteem, employment, personal care, mental health, physical care needs, leisure, cooking skills, and family contact. Monthly reviews with key workers may include comment on, daily living, health care, personal care, lifestyle, and any significant events occurring around the time of review. Plans include space for comment by the service user. The home aims to work collaboratively with users and apart from informal day to day encounters between staff and users there is a meeting every morning, a monthly house meeting and a residents meeting which may include an advocate. Records included risk assessments carried out by the CMHT as well as those carried out in the home. Risk assessments included risks associated with deterioration in mental health (the most common concern), smoking, and working in the kitchen. Support plans showed evidence of ongoing active work between link workers and users. Entries were comprehensive and detailed. Service users confirmed that they were involved in their care plans and that link workers are supportive. Care Homes for Adults (18-65 years) Page 15 of 34 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. Users lead a varied and active lifestyle in accordance with their wishes. The home offers users opportunities to participate in a range of practical, social and intellectual activities and to be involved in the wider community. Evidence: The level of involvement in day time activities varies. Some users have quite an active programme across the week. Others prefer a more limited programme, spending much of the day around the home. The manager told us that a key aim of the service is to develop the potential of individual users. All users are encouraged and supported by staff to have some programme of activities. The particular mix of activities for individual users is decided at sessions with their link workers. Group activities are discussed and agreed at house meetings. Users are reminded of the main activities of the day at the morning meeting. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Some users have regular commitments such as working in a voluntary capacity with Age Concern, attending education classes, work skills, or a conservation group. Some go to day or drop-in centres in High Wycombe or Princes Risborough. Three users regularly spent time at MARES, an equestrian and horticultural skills centre near Amersham. We were told that people make use of the amenities of High Wycombe and surrounding areas including town centre and local shopping, a new cinema complex in the town centre, and a sports centre a mile or so out of town. The home has a TV, video/DVD and pool table. Some users were due to play a football match on the day of our visit to the home. Some users go to home matches of the local football team. Two users told us of their holiday in the Isle of Wight earlier in the year. Users are supported in maintaining contact with family and friends. Most users were in contact with their families. Meals are planned in consultation with users. The manager told us that the home tries to encourage healthy eating. Although the home made regular use of a national supermarket chain for basic supplies it was looking to increasing the range of fresh foods supplied by local suppliers. In line with this it now obtains its meat from a local butcher. The menu always includes a fish dish on at least one day a week and a roast based dish on Sunday. Breakfast is self-service - cereals, toast, preserves and hot drinks. Users arrange their own lunch, either in the house or wherever they happen to be at the time. Supper, prepared by users and staff, and served around 5:30 pm, is the main meal of the day. The dining arrangements at weekends can vary - on occasions users and staff may decide to have a barbeque or picnic. In responding to our survey users told us: The food is very good;They (staff) give us support in the things we can and cant do. We had a nice holiday; Good meals, Proper respect, Staff are helpful and understanding; They (staff) treat me well; I find them (staff) very helpful and help me in every way; and,There is nothing that they could do better. I find them very helpful. Now that staffing has stabilised the manager told us that over the next twelve months the home intends to work closely with users and other agencies to organise more activities and utilise local resources to prepare for the transition to the new accommodation when it comes on stream in 2011/2012. Care Homes for Adults (18-65 years) Page 17 of 34 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. The health and personal care needs of users of the service are met and promote positive heath and well being. The homes arrangements for the storage, control and administration of medicines are generally satisfactory and aim to ensure that users receive prescribed medication is a consistent matter. However, the home needs to give attention to some points of detail to ensure good practice in this aspect of its work. Evidence: All users are registered with a local GP. The home is in contact with four GP practices. The GP can facilitate access to general NHS services. All users are also registered with a local community mental health team (CMHT). The home is in contact with two CMHTs. The CMHT provides access to specialist mental health services including psychiatrists, community psychiatric nurses (CPNs), social workers, and psychologists. Dentists are accessed either through a local NHS centre or privately. An optician will visist on request. Chiropody, like dentistry, is accessed either through a local NHS centre or privately. Support plans included evidence of liaison with local GP and CMHT Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: services. Medicines are prescribed by the users GP or psychiatrist. Most medicines are dispensed by Boots Chemists but on occasions the home may use a local pharmacy. Medicines are recorded on receipt in the home and on return to pharmacy. Four users has been prescribed Clozapine and were being monitored by the hospital in accordance with the monitoring arrangements for this particular medicine. Depot (long acting) medicines to be administered by injection wer either administered at The Valley health centre or by a CPN visiing a user in the home. Medicines are stored in metal cabinets in the office. The temperature of the medicines storage cabinets is recorded daily. Medicines requiring cool storage are stored in a small household refrigerator in an office. Staff training in the administration of medicines is provided at the training department at head office. Staff competency is assessed by the manager in the home. All staff involved in the administration of medicines are required to have an annual update session. Four users were managing their own medication at the time of this inspection. The homes arrangements were audited by a Boots pharmacist in May 2009. A number of good practice recommendations were made which required action and monitoring by managers. The recommendations included the signing of the Homely Remedies policy by a GP and dating all liquids and creams when opened. Examination of the homes arrangements on this inspection found practice to be generally satisfactory. It was noted that some handwritten entries on medicines administration records (MAR charts) had not been signed, dated and countersigned. This would be good practice. This omission mainly related to Clozapine which is transcribed from the medicine label on receipt into the home. The medicine is only dispensed after a satisfactory blood test. The Homely Remedies protocol was not readily accessible at the time of the examination. Reference texts for staff and users appeared to consist of the patient information leaflets supplied with medicines and a British National Formularly (BNF). The latter was not readily accessible at the time of inspection. The home did not have a copy of the Royal Pharmaceutical Society of Great Britain guidance for the administration of medicines in social care service or of our guidance on the administration of medicines in care homes. A good current textbook on medicines for the general reader would Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: also be a useful reference for staff and users. Users were satisfied with the homes arrangements for meeting their healthcare needs. They were happy with liaison between the home and staff from the CMHT and said that they felt the support they received in managing their medication was fine. They also expressed satisfaction with the support provided by link workers. Care Homes for Adults (18-65 years) Page 20 of 34 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. Complaints and matters relating to safeguarding vulnerable adults are generally well managed and protect the interests of users living in this home. Evidence: The home is required to conform to the complaints policy an procedures of Hightown Praetorian and Churches Housing Association. On page five of the service users guide users are informed that Hightown has a complaints policy which all staff are aware of and must follow. A copy will be given to you when you move in and the policy will be explained to you. The guide goes on to say that users may make a complaint or raise a concern with any member of staff, with the service manager or with senior managers during one of their visits to the home, by telephone or in writing. They are informed that they may also raise their concerns with a local advocacy group, their care coordinator, or with the commission. Contact numbers for some of these are given at the end of the document. The statement of purpose also includes a reference to the homes arrangements for dealing with complaints. During the course of the year preceding this inspection the home recorded five complaints from service users. These were discussed with managers during the inspection visit. We received one complaint about this service during this time. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The home had recorded one compliment in March 2009. The manager was notified that during the course of a meeting of a local organisation it was noted The excellent work which you and your colleagues do was remarked on. The home is subject to Hightown policy on the prevention of abuse of vulnerable adults (now safeguarding vulnerable adults). The policy was last reviewed in 2007 and is due for review again this year (2009). The managers told us that the home had not made any safeguarding referrals over the last year. Two matters, described as borderline issues during our visit, were discussed with the manager. These concerned staff misconduct which it was felt, did not amount to abuse requiring referral to the local authority. Both appeared to have been dealt with appropriately by managers. Although these matters were dealt with effectively by the home, managers are advised to consider the homes and organisations threshold for reporting such matters to safeguarding authorities. The home did not have a copy of the current Buckinghamshire joint agency guidelines on safeguarding vulnerable adults. The manager told us that he would obtain a copy a copy the next day. All staff providing support to users are required to attend training on responding to violence and aggression.The organisation also provides training on mental health awareness. The home does not act in the capacity as Appointee for service users. It does have facilities for the safe keeping of small amounts of money for individuals. Records are maintained and together with cash balances are checked at staff handover each week, by the manager at least once a month, and during the course of proprietors visits. In one case the home had entered into a more regular agreement with a user and Buckinghamshire County Council which was aimed at helping the user to manage money over the course of the week. Care Homes for Adults (18-65 years) Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the accommodation is variable. While most areas provide an adequate standard of accommodation, there are some areas which fall below this and which compromise the homes aims of maintaining good standards in its environment. Evidence: The home is located in a mainly residential area about three quarters of a mile from the centre of High Wycombe. The nearest rail station is High Wycombe. There are regular buses to High Wycombe. There is limited car parking to the rear of the building and in nearby streets. The home is an older style, two-storey, detached house. The quality of the accommodation varied from adequate to poor. The home is not suitable for a wheelchair user. The ground floor accommodation comprises, the entrance hall, dining room, kitchen, training kitchen, games room, smoking room, lounge, laundry, office,WCs, and some bedrooms. Stairs lead to the first floor. The first floor accommodation comprises WCs, two bathroom with baths and electronic showers, and bedrooms. All bedrooms are single. None of the bedrooms have en-suite accommodation. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: The dining room is a pleasant room which has been refurbished since the last inspection. The games room had a pool table and was in a satisfactory condition. The smoking room, which was probably the busiest room on the day of our inspection visit, was in a poor condition. It is acknowledged that maintaining the quality of the accommodation in this area will present a challenge to managers. Managers told us that this room had been redecorated within the last twelve months and that an extractor fan had been fitted to improve ventilation. In spite of this however, this room presented a very drab appearance. Some of the furniture and floor covering could do with replacement. The extent of natural lighting to the ground floor corridor varied and some areas were rather dark, adding to the drab appearance of some areas of the home. The lounge was quite a pleasant room. It had a TV, DVD/video player, stereo music centre and a good selection of VHS video tapes. There was also a fish tank. Furniture was adequate for current needs. The quality of the flooring varied. The kitchen is a good size and was clean and in good order on the day of our visit. Standards of maintenance and hygiene in this area were good. The training kichen is relatively small but is suitable for current needs. One service user was cooking her evening meal towards the end of our visit and was finding the kitchen perfectly suitable for her needs. The quality of the bathrooms on the first floor again varied. One bathroom is for female use - although it still had a male and female logo on the door - and was satisfactory. The other bathroom on that floor could do with some redecoration. Flaking paint was noted. There may have been some mould on some areas of tiling. Both bathrooms had paper towels but one had a towelling towell, a potential source of cross infection in a communal area. Most of the rear garden is given over to car parking. There is a good sized patio area to the side of the house with areas of seating and a barbeque. There is an area of lawn to the front of the house which overlooks the main road. The gardens have a washing line and shed. The home is located on raised ground on a steeply sloping site. The neighbouring properties are commercial - a hotel and offices. Users expressed mixed views on the environment. Those who had been resident for sometime seemed quite happy. Others briefly commented on how untidy it can be at times - a bit of a mess - but gave us the impression that any defiencies in the environment were more than compensated for by the benefits they gained from living there. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Standards of housekeeping were considered good and most areas visited were clean, tidy and in good order. There are three factors to consider with regard to the environment in this home. Firstly, it is an older style property and the quality of the accommodation varies considerably throughout the house. Maintaining consistent standards can pose a challenge in such a property. Secondly, most users living in the home were reported to smoke. This places additional pressure on the management of those areas where smoking is permitted - the smoking room and patio. In particular those areas are likely to suffer more wear and tear and require a higher level of maintenance and housekeeping. Thirdly, the property has a limited life. The service is included in a reconfiguration of Hightown Praetorian and Churches Housing Association accommodation in Buckinghamshire. Over the next couple of years the service is expected to be relocated to new build accommodation elsewhere in High Wycombe. These points were discussed with managers during the course of our inspection visit. Managers acknowledged that the quality of the accommodation did vary and that they were addressing that. Managers assured us that the development of the new service in the next year or two would not have any significant effect on the maintenance budget of 160 West Wycombe. User didnt comment too much on the environment in their response to our survey. Of seven forms returned, three said that the home was always fresh and clean, one didnt answer that question, one ticked usually, and one ticked sometimes. One user wrote (in answer to What could the home do better?) Cleaning the home better. It is very difficult to keep clean with thirteen other residents. the staff do their best. Care Homes for Adults (18-65 years) Page 25 of 34 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. The organisation generally maintains good standards of practice in staff recruitment. However, the home is unable to provide evidence of full conformance to the minimum standards and regulations and therefore, evidence that users are not being placed at risk through its staff recruitment practices. Arrangements for staff induction, training, development and supervision are good and aim to ensure that users are supported by appropriately skilled and supervised staff. Evidence: There had been quite a few changes in staffing since our last key inspection of this service in 2007. Managers told us that new staff were settling well into their jobs and they expected staffing to be more stable over the next two years than between 2007 and 2009. The personal qualities, experience and qualifications of new staff are assessed during the process of recruitment. Staff skills are further developed by the organisations programme of induction, training and development and its arrangements for staff supervision. In broad terms the present staffing provides for three staff in the morning, three in Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: the afternoon and evening, and one sleep-in staff member at night. The actual numbers of staff on duty is adjusted to take account of activity in the home. Most users are out during the day with the home getting busier from mid afternoon onwards. The home is supported in the recruitment of new staff by the organisations Human Resources (HR) department based at its head office in Hemel Hempstead. Over the 12 month period preceding this inspection the home had appointed one manager, three support workers and one domestic assistant. All applicants for posts are required to complete an application form, provide two references (one of which needs to from their most recent employer (where practicable)), proof of identity,and an enhanced CRB certificate. Some staff may be appointed under POVA First arrangements. Staff recruitment files are held at the HR offices at head office. A form listing the essential information required is held in the home. The information relating to support staff recruited since the last inspection was examined. The results were variable. In one case the information was not available in the home although the member of staff had been in post for over a week. The information was brought from the HR office by the manager by late morning. References had been received for all staff. Some forms did not have a recent photograph attached. We were informed that photos had been taken but had not been downloaded from the camera. One file did not have the outcome of the preemployment medical assessment on record. Staff training is organised by the training department at head office. This department organised training at induction, mandatory/essential, basic and update levels. New staff are required to complete their induction training by between three and six months after starting employment. They may cover all of the mandatory/essential training during this time but this may depend upon the availability of courses. The mandatory/essential list includes:Fire Safety, Food Hygiene, Manual Handling, Emergency Aid, Infection Control, PCP (Person Centred Planning), Lone Working, Diversity, Mental Health (two day course), Violence and Aggression (two day course), Positive Approaches, Medication, and, Safeguarding of Vulnerable Adults (Abuse). Training approaches include attendance at courses run at head office and Elearning computer based sessions in the home. Additional training is provided for managers. Some staff have attended training run by the Community Mental Health team on the subject of Mental Health Awareness. The organisation has good arrangements in place for NVQ training. Because of staff turnover over the past year or so this is is just below the NVQ2 minimum of 50 . The Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: home expects to exceed this over the next year. Individual supervision is well established in the organisation. Sessions are held every four to sox weeks. Sessions are planned and structured and notes are taken. Supervision addresses a range of issues including performamnce, development, current issues and checks on car insurance and MOT status where required. Staff seen during our visit confirmed a structured recruitment process and a programme of induction and supervision. The actual training received seemed dependent more on the timing of courses rather than the needs of the service. Managers were seen as helpful and supportive. We were told that staff and users Get on pretty well and that there was a focus on supporting users. Communications were said to be good and one person gave us an example of a prompt and positive response by the manager to a matter of concern which the staff member had raised with him. Staff expressed a positive view of changes in the home since the beginning of the year. Standards of work were considered to have improved, there seemed to have been a positive change in culture - it was said to be now be more open and staff were said to be more approachable. Communication was said to be good. Care Homes for Adults (18-65 years) Page 28 of 34 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. The management and administration of this home promotes the provision of good quality support to users, their participation in day to day activities in the home, and their participation in a range of activities in the wider community. The homes arrangements for protecting the health, safety and welfare of users appear good. Evidence: The home has had a somewhat unsettled management and staffing history since the last inspection. Matters were said to have stabilised over the last ten months or so. The present manager had been in post four months at the time of this inspection. Prior to his appointment the manager had acted in the position for around four months. Before taking up a position in the home the manager had worked in a supported living project in High Wycombe for people with mental health problems. At the time of this inspection the manager had an application with us to be the registered manager for the home. He was also about to start the NVQ4 Registered Managers Award. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The manager is accountable to the service manager whose office is located in the home. The development plan for the home envisages significant changes under the Home Options project which involves a reconfiguration of mental health services accommodation managed by Hightown Praetorian and Churches Housing Association in Buckinghamshire over the next three years. For High Wycombe this involves the establishment of a mix of accommodation comprising independent supported living flats, shared supported living flats, crisis places, and residential care home places. The plans are at varying stages of development. Service users and staff were being kept informed of progress through periodic newsletters, the latest version of which was published in August 2009. Managers assured us that in the meantime Hightown would continue to invest in maintaining the present property. As evidence of this managers cited the redecoration of some areas of the home, the acquisition of new furniture in the dining room, the installation of a Dor Guard to the office door on the advice of the fire service, and new flooring in some areas. We understand that replacement of the boiler is also being considered. We were reassured by this because, as stated elsewhere in this report, the standard of the accommodation varies considerably. Improvement will require ongoing investment in maintenance but also in redecoration and refurbishment if acceptable standards for the people living there are to be maintained. Managers endeavour to maintain ongoing consultation with users and to involve them in the day to day running of the home and plans for its development. Apart from informal day to day encounters with users a number of meetings are held which offer staff an opportunity to engage with users in discussions on a range of subjects. There is a morning meeting held each weekday which focuses on day to day matters e.g. sharing news, discussing anything any user wishes to raise, daily chores, menus and peoples plans for the day. A more formal House Meeting is held once a month. A Residents Meeting, run by residents without staff involvement, is also held once a month. An advocate may attend that meeting. Staff attend at the end to discuss any issues raised by residents. The manager told us that a stakeholders survey had just been completed. A copy of the questionnaire sent to Family, Friends or Carers was supplied for inspection. Completed forms were returned to Hightown head office in Hemel Hempstead. The results of the survey were not available at the time of our visit. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: Proprietors visits (Reg 26 visits) should take place each month. We were told that things had become a little uneven over the summer. Visits had taken place in May and June 2009 but there were no records of visits since then. Managers expected such visits to get back into a regular schedule from September 2009 onwards. Arrangements for ensuring safe practice appear satisfactory but this was not a health and safety inspection. The home had received a visit from the fire service earlier in the year. It had also received an inspection from the environmental health department in August 2009 but had not yet received a report. It had however received a DVD on safe food practice from the department. Training in fire safety is provided by the organisations training department and via ELearning. Within the home new staff are informed of fire safety measures and evacuation procedures. Managers told us that the homes fire risk assessment, the structure of which is determined by head office, took account of the particular risks associated with users smoking in their bedrooms. Managers were required to attend a training course on Legionella run by the organisation. The manager told us that the homes water system had been checked for Legionella in 2008. Systems are in place for regulating and recording water temperatures. Testing of electrical portable appliances was carried out in November 2008. The homes fixed wiring was checked in 2007. Procedures are in place for recording accidents and incidents. A copy of each form is sent to head office for monitoring purposes and a check on such records forms part of the monthly proprietors visits. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 23 13 The registered must obtain a 31/10/2009 copy of the current Buckinghamshire joint agency guidelines on safeguarding vulnerable adults. To ensure that staff have ready access to current guidance on safeguarding adults. 2 24 23 The registered persons must 31/12/2009 ensure that the home is maintained in a good state of repair. To provide a pleasant and well maintained environment for users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 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). 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