Care Home: 1b Tollgate Road

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What the care home does well People are given help to have their rooms as they want. The bedrooms we looked at were welcoming, bright and were individual to the person for example they had pictures and things like televisions, stereos that they enjoy watching or listening to and had lots of photos displayed of people they are close to. Staff work well with health and social care professionals to ensure peoples needs are kept under review. The manager and staff work well as a team and work in the same direction to make sure the service provides a person centred approach, which focuses on the individuals who use the service being central to everything. People living here can be confident that their needs are met because staff have lots of information about them and know and understand each person very well. People are well supported to keep in touch with people important to them such as friends and family. A relative told us that they are always made welcome when they visit the home, that they are kept informed of important matters and stated `I have complete and utter confidence in the staff, they are the most wonderful bunch of people I have ever come across and the manager is worth his weight in gold`. People are provided with a comfortable and homely place to live, where they feel safe and secure. Staff have supported people to personalise their bedrooms to reflect their individuality. Staff are provided with good training opportunities and on going support to ensure that they can meet the needs of the individuals they support and in a manner that respects their privacy, dignity and safety. Staff are recruited safely and receive good induction and training to carry out their roles. This helps to protect people who use the service and ensures that they can meet the needs of the individuals they support. What has improved since the last inspection? Staff have attended training appropriate to their role and relevant to the needs of individuals using the service. This has equipped them with the skills and knowledge to ensure peoples` needs are met safely and effectively. A member of staff stated `Training is first class`. People are encouraged to use their community more and partake in their chosen activities. They can also choose to spend time alone in the privacy of their own room or be with others in the shared areas of the home. Each individual now has a health action plan. These contain lots of information about their health needs and the support they need to keep healthy. A new art coordinator has been employed and he has further developed the art studio that many individuals access. One person said `More money has been spent in the bungalow to make it more homely for service users` What the care home could do better: The manager hopes to make more in-house activities available and develop the garden area for people to enjoy. The home should be visited regularly by people who work for Vision Homes. This is to make sure that the organisation knows what the home is doing well and what they have to do, if anything, to make it better. After our visit a senior manager called us to tell us that he understands the importance of the visits and will ensure that in future they occur as required. A service user guide should be developed so that people have information about the service provided at the home. Support plans could be written as if the individual is telling others about themselves. This would make them more personal to the individuals. Two people told us that carpets could do with replacing as they are soiled in some areas. One person said if staff are ill then their shifts should be covered and not make do with minimum staffing. One person said `There are many things that could be done better, however they are small in comparison to the opportunities offered by Vision Homes, this is by far the best place I have worked at for the benefit of service users` Key inspection report Care homes for adults (18-65 years) Name: Address: 1b Tollgate Road 1b Tollgate Road Ludlow Shropshire SY8 1TQ     The quality rating for this care home is:   three star excellent 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: Becky Harrison     Date: 0 8 1 2 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 31 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 31 Information about the care home Name of care home: Address: 1b Tollgate Road 1b Tollgate Road Ludlow Shropshire SY8 1TQ 01584877870 01584878063 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Vision Homes Association care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Date of last inspection Brief description of the care home 1B Tollgate Road is registered with the Care Quality Commission as a care home providing personal care and accommodation for up to five adults who are visually impaired and have additional physical and learning disabilities. The home is one of three bungalows, which were purpose built, on the same site in Ludlow, South Shropshire, and run by Vision Homes Association. The project was set up in 1991 in partnership with Bromford Corinthia Housing who own the properties. The home is close to local shops and facilities. Accommodation is provided across one floor making it accessible to people who use wheelchairs or have mobility difficulties. People have their own rooms; en-suite facilities are not provided. Shared areas include Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 Brief description of the care home a lounge/dining room, domestic style kitchen and a garden. Additional space is utilised in a nearby bungalow, providing a lounge and kitchen area for people to hold meetings, watch television, relax or have some quiet time. Parking is provided to the front of the home and shared with other properties within the complex. People are able to gain information about the service from the Statement of Purpose. Fees charged were not available at the time of the inspection therefore readers are advised to contact the provider direct for more information. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the service was undertaken by one inspector over 6 hours. People who live and work at the home did not know that we were coming. A range of evidence was used to make judgements about this service. The care received by two people was looked at in detail. This included looking at their personal records to include care, health and daily records and discussing their care with them or the staff who support them. This forms part of a key inspection and helps us gain information and understand the experiences of people who use the service and the quality of care they receive. Given the needs of the people living at the home, not all individuals were able to actively contribute to the inspection process or share their own experiences of living at the home. However we did speak with two people who use the service and had some opportunity to observe people being supported by the staff on duty. We spoke with a relative, the manager and some of the staff on duty, who also completed surveys for us. We also looked at some parts of the home, how the service Care Homes for Adults (18-65 years) Page 6 of 31 is monitored and sampled a number of records to include complaints and protection, staff training, recruitment and health and safety records. An Expert by Experience helped us with our inspection. This was someone with personal experience of using learning disability services who had been trained to accompany inspectors during a visit to a service. Experts by Experience observe what happens in the home, they talk with people about the service and provide us with a report of their findings, parts of which have been included in this report. The manager completed an Annual Quality Assurance Assessment (AQAA) document for us, as requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. The AQAA provided us with detailed information about the service and included improvements made in the last twelve months and areas for continued development. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? Staff have attended training appropriate to their role and relevant to the needs of individuals using the service. This has equipped them with the skills and knowledge to ensure peoples needs are met safely and effectively. A member of staff stated Training is first class. People are encouraged to use their community more and partake in their chosen activities. They can also choose to spend time alone in the privacy of their own room or be with others in the shared areas of the home. Each individual now has a health action plan. These contain lots of information about their health needs and the support they need to keep healthy. A new art coordinator has been employed and he has further developed the art studio that many individuals access. Care Homes for Adults (18-65 years) Page 8 of 31 One person said More money has been spent in the bungalow to make it more homely for service users 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 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 31 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 31 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. The service has some information available in the event of a vacancy to help prospective residents decide if the home is the right place to live. An assessment of their needs is undertaken with people close to them to make sure the service is able to meet their needs. Evidence: The home has a Statement of Purpose available to tell people about the service but has yet to develop a Service User Guide for prospective residents. This needs to be developed in the event of a vacancy to help prospective residents understand what the service has to offer. The manager agreed to develop one soon. We spoke with a relative of a person who lives at the home and they told us that the service was recommended to them and that they were given the opportunity to support their relative to visit and look around the home prior to admission to ensure it was the right place to live. All but one person have lived at the home for many years. The last person to move in was admitted in 2007. We spoke to the manager about the admission process, looked Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: at the paperwork on file about how the persons needs were assessed and also spoke with the relative of the individual concerned and staff on duty. All of the information we gained told us that the assessment and admission process was robust and that much work has been done and continues to be done to ensure the person settles and fits in with the people who have lived together at the home for a long time. This was acknowledged in the assessment undertaken which states that the settling period may be an anxious time for service users in 1B. The Expert by Experience told us On arrival I was greeted by a staff member who asked me and my supporter to sign in and use the hand gel provided. It was good to see this and it made a good first impression... I asked two staff members about the lady who had lived in the home the shortest amount of time. They explained she has the highest support needs of all the residents. It has taken the other residents some time to get used to the new person living with them. I thought it was not clear whether everyone was happy living together. It is important that people live with people they get on with. If there is a problem with a resident then this needs to be looked at. Care Homes for Adults (18-65 years) Page 12 of 31 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. Staff work hard to make sure people receive person centred care and are supported to, make decisions, take measured risks and achieve their personal goals. Evidence: The AQAA states We provide an individually designed service for each service user, to support each of them to reach their full potential at their own pace and respect their wishes by making positive choices. We looked in detail at the care experiences of two people who live at the home. They were unable to tell us about their individual needs so we spoke with a number of staff who support them and also looked at their care records. Information seen on both files was detailed and contained lots of guidance for staff to follow ensuring their personal and healthcare needs are met in a way that they prefer. Staff spoken with demonstrated a clear understanding of their needs and felt that they have enough information available to ensure people receive their care and support in a consistent manner. They were able to provide very specific details about how individuals are supported. We also saw information about how people prefer to communicate, their key words and what they mean. There was also detailed Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: information about their visual impairment and the support they need to maintain their safety. The Expert by Experience told us I asked about care plans. I was told that every resident is fully involved in creating their care plan. This is good. It is important that people are involved. Residents are also involved in regular reviews of their care plans which is great. Each resident has a daily review sheet which are reviewed on a monthly basis. This will show any changes that need to be made to the care plans. The plans will show any regular activities the residents do. For instance one person goes swimming every week. People living here find it difficult to verbally tell their support staff what they want however they can make their needs known using other methods. Staff have spent time and made considerable efforts in learning about the different ways individuals communicate either through noise, body language and gestures. One person was vocal throughout our visit but all staff spoken with understood what the person was doing or wanted. During our visit people were offered choices to include activities, drinks, lunch, staying in their own room or being with others. Guidelines for one individual about supporting him to select his clothes was very detailed ensuring choice is offered. The Expert by Experience said With 2 people being out and the other 3 residents being in their rooms I spoke to staff about key workers. I was told that three residents have key workers. The key workers are chosen by the residents. I was pleased to hear this. The other two residents have advocates. One of the advocates visits often and knows the resident very well. It was not clear how often the other advocate visits. Staff said that any concerns residents have are taken into staff meetings. There are no residents meetings but staff explained that they talk to residents about anything going on in the home. It is very important that residents know what is happening as it is their home. Individuals are encouraged and supported to take reasonable risks and there were risk assessments available for the two people whose care we looked at in detail. Areas identified included tasks undertaken for example in the kitchen and activities in the community in addition to mobility, finance and medication. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a lifestyle based on their personal preferences. They are supported to keep in touch with people close to them and are provided with healthy meals according to their dietary needs and preferences. Evidence: People living here benefit from high staffing levels which enable them to partake in activities and live a lifestyle that is varied and suited to their needs and preferences. Two people require 2 to 1 support when out in the community and the other three individuals require 1 to1 support. The AQAA states The service users within the home are treated as individuals and not grouped together...The service users have and continue to build up a presence within their community and are known by others within the community. The Expert by Experience said The home is close to Ludlow town centre. Residents Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: are supported to either walk or get a bus into the local town. The area is very rural so bigger towns are quite far away. Three residents have cars and they can be taken to some of the bigger towns in the cars if they want to go out. It was nice to hear this happens. A staff member told me that many of the local shops are small businesses like butchers and a bakers. The residents regularly visit these shops and are well known in the community. I think it is great residents are supported and that they have the opportunity to become part of the local community. I also found out that each resident has their own mobile phone. This is used when they are out in the community. If residents are unable to speak then I do not think mobile phones are the best idea. Maybe the money could be better spent on something else? I asked whether the activities people do are flexible. Staff said people have activities in their plans but these can be changed, and people can decide to do things whenever they want because there is always enough staff and transport to do this. I thought this was great. When I arrived seven staff were on duty. I was told that all the residents would be going out at some point during the day. Two were going Christmas Shopping all day in Kidderminster. Two people were going to a local art studio which residents are able to use at any time. One resident would be going for a walk. A staff member told me that people go out at least three to four times each week. I was pleased to hear this as it is important people are out in the community and not in the home all day. It was good to hear that each resident chooses their own holiday. One resident had been to Disneyland Paris earlier in the year. Another had been to London to see a musical. I was pleased to see pictures in the home of the residents on holiday or doing activities. This gave the home a personal feel. The bedrooms of the two people whose care we looked at in detail are designed to support the individual to enjoy an enhanced lifestyle. This is particularly important given people can choose to spend long periods of time in their rooms, as observed during our visit. For example they have things that they enjoy around them such as their music, televisions and tactile stimuli. The Expert by Experience said Two of the residents remained in their room for the time I was visiting. One gentleman had not slept the night before so he was in bed. The other lady likes listening to music in her room. Staff said she spends a lot of time in her room. She only really stops listening to music if she is going out or eating meals. It would have been nice to speak to people who live in the home as its hard to tell whether people really like it by just asking staff. I found it hard to speak to residents as some were out and others were happy in their room. I had to rely on talking to staff. The AQAA states We, as a staff team, try to keep family relationships on going by acting on behalf of the service users with letters, cards and presents at key times in the year. This is all with service user involvement of what is occurring and their wishes Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: adhered to. This was an accurate reflection of information recorded on the files of the two people whose care we looked at in detail and confirmed in discussions with a relative, who was extremely complimentary about how staff make them welcome and involve them in all aspects of their relatives care. A member of staff told us that one of the people we looked at in detail is well known amongst the church community and has developed good relationships. The Expert by Experience said At lunchtime a staff member supported one resident to eat lunch. Before this the staff member explained to me how the person communicates as she can be quite loud. I thought it was great the staff member gave me this information. I was also really impressed with the level of support the staff member offered to the lady during lunch. After lunch the same resident was asked whether she would like to sit in the living room or return to her room before she went out. I noticed that staff were very patient and gave the lady lots of time to make a choice. Care Homes for Adults (18-65 years) Page 17 of 31 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. Peoples healthcare needs are well known and met and they receive personal support from staff in the way they prefer. The home has good systems in place to make sure people receive the right support from healthcare professionals and are safeguarded by the medication arrangements in place promoting their health and welfare. Evidence: Care records seen provide staff with guidance about how individuals prefer their personal care needs to be met. We spoke with staff about the needs of the two people whose care we focused on and learned that staff have an in-depth understanding of how both people prefer their care to be given. The AQAA states Where personal care is needed our approach is to be aware of dignity and independence to encourge individual sevice users to play an active part in this private task. Staff inform the service user of what is occuring and interacting with sensativity and compassion. The new Health Record provides staff with very detailed information about individuals and what action they would like to be taken to meet their general, specific and changing health needs. They also detail diet, healthy lifestyle, peoples medication, professionals involved and any complementary health therapies and frequencies. The Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: AQAA states With the development of health action plans this has been a valuable tool with regard to keeping checks on service users general health.The action plan covers check-ups so nothing gets forgotten about and appointments can be made more easily because the information is in one place. There was lots of information on the care files for the two people whose care we looked at in detail about routine healthcare appointments such as doctors, optician, dentist, chiropodist and the outcomes recorded. One person was supported to attend a meeting with lots of health professionals about whether it was in his best interests to have some much needed dental work because he was unable to consent to the treatment. The manager felt strongly about the person attending this meeting and advocated on his behalf to make sure his best interests were represented. Staff we spoke with felt the home meets peoples health needs well and that they have developed good working relationships with health professionals. A relative told us Im impressed with the staff if they suspect anything slightly wrong with X health; they make sure she gets the right attention. The AQAA states All our staff have up to date training in the safe handling of medicines and improved skills in moving and handling techniques. Removing elements of anxiety with personal tasks and instilling confidence of the service user group overall. People living here require help to manage their medication. The home operates the Monitored Dosage System supplied by a well known chemist. A member of staff explained the systems in place that ensure people get their prescribed medicine safely. We looked at the medication for the two people whose care we looked at in detail. Records sampled were satisfactory and medicine stored as required. We did advise that staff write the date of opening any eye ointments on the carton so that they know when ointments need to be disposed of. It was reported that there have been no errors with people receiving their medication as prescribed and staff told us that they receive training to make sure they have the skills and knowledge to safely administer medication. Staff competency assessments have recently been introduced to ensure only staff that are competent to administer medication do so however these were not looked at on this occasion. Care Homes for Adults (18-65 years) Page 19 of 31 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. Staff are able to recognise if individuals are unhappy with any aspect of the service they receive therefore residents can be confident that their feelings are recognised and responded to. The home has procedures in place to safeguard people from potential abuse and staff receive training in adult protection, ensuring people who live at the home are protected. Evidence: People living here have access to a complaints procedure although they may find it hard to make a formal complaint because of their complex needs and limited verbal communication. However they are supported by a team of staff who have known them for a long time and residents are able to make their needs known for example through body language, gestures and noises. Information about how individuals communicate their needs, their likes and dislikes were seen detailed in their care records so that staff can ensure people are happy with the service they receive. Staff spoken with told us about how they recognise if people are happy or sad and it was clear that they know and understand the individual needs of the people they support very well. No referrals have been made under local safeguarding procedures since our last visit. The home has a copy of the local multi-agency procedures to follow if abuse were seen or suspected although we advised the manager to obtain the revised copy so Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: that staff have the most up to date information. The AQAA states Staff have protection of vulnerable adults (POVA) training each year so that awareness of abuse is always present in their minds and they would act up on it. This was confirmed in discussion with staff we spoke with. People living here require support with managing their finances and staff considered procedures in place are robust to ensure people are protected from financial abuse. Records and receipts are kept for all transactions. The Expert by Experience told us Each resident has their own bank account. Staff support them to get money from their accounts. It is important people have control over their own money where possible. In their rooms residents have a book which shows how much money they have, and what their money is spent on. Although the people do need support it is good they are made aware of their money. Care Homes for Adults (18-65 years) Page 21 of 31 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 are provided with homely, clean and safe environment to live where they feel safe and secure. Evidence: The home is a purpose built level access building that opened in 1991 and is close to shops, facilities and other homes. We had a brief tour of the shared areas and the bedrooms of the two people whose care we looked at in detail. We found bedrooms very personalised and shared areas well decorated and furnished. Staff told us how they ensure people know their way around the home by the different objects of reference for example the different textures in the carpet, doorways and keeping furniture in the same places so people understand their environment. The AQAA reports future improvements include making the immediate environment more accessible by developing the garden at the back of the home for service users to enjoy.We are planning to lay flags and build a wall so the home has a patio area. The Expert by Experience said I was a little surprised to not see any hand rails to support people. I think it could have been adapted a little better for visually impaired people. The home has one large living area for all the residents. I thought this could be difficult at times especially if everyone was at home. However, I was then taken to another building where residents can go if they want some time to relax on their own. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: It is a large living room which has a TV, a sofa, and chairs. This is a nice area for people to go and stops the main house getting too crowded. Concerns were expressed about the bath not being accessible for one individual who has mobility difficulties. The manager reported it had not been ruled out about changing the bath for the person concerned and reasons for this were shared with us. Systems are in place to ensure people are provided with a clean and safe environment to live. Checks are carried out and repairs attended to. The home was found generally clean and safe and staff have the necessary aprons, gloves and other personal protective equipment available and any visitors to the home are requested to use hand gel provided. Care Homes for Adults (18-65 years) Page 23 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a skilled, committed and competent staff team who are provided in sufficient numbers to meet their changing needs. The procedures for the recruitment of staff are robust and provide safeguards for people living at the home. Evidence: People living here have complex needs and therefore need a lot of support to make sure that their physical, emotional and social needs are met. Therefore this service provides high staffing levels. The Expert by Experience said I found the staff to be very approachable. They were happy to answer my questions and they were also interested in what I do. However, I did think the number of staff was very high. For most of the visit a couple of staff members seemed to have very little to do. Another staff member came and spoke to me. He explained he was the Visual impairment officer for the home. He told me that staff have lots of training about supporting people who are visually impaired. New staff have very detailed training over the first three months they are working in the home. Current staff also have refresher training every two years. I thought it was great that training is so detailed and taken so seriously. We spoke with several staff on duty about the needs of the two people whose care we looked at in detail, about the support they provide and the training they receive in Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: order to make sure they have the skills and knowledge to provide a quality service to the people living at the home. Staff spoke very positively about their work, the people they support and the organisation. It was reported that all but one member of staff have obtained a care qualification known as NVQ at level 2 or above in care. This exceeds the national minimum standards and demonstrates that the organisation is committed to ensuring individuals are supported by a qualified workforce. The AQAA states The organisations training programmme is extensive and beneficial to the welfare of the service users and the service.We listen to staff and develop training in areas that are complimentary and extend overall knowledge base of the staff group. Comments received from staff include: I have never worked in a place thats been so good at making such a difference in supporting service users to lead a full life. We support a lovely bunch of individuals and I feel very passionate about getting them out and enabling them to lead full lives. Training is a great enabler and empowers individuals to do that much more Ive worked in many places but no where have I seen the staff ratio that it is here, it provides opportunities for service users to lead independent lives I think people have a really good quality of life here. The level of support is completely different from anywhere else Ive seen. The training is brilliant, I love it here Files for two staff recently recruited were looked at and contained the information required by law. The AQAA states We have a rigourous interviewing procedure that has recently been changed to reflect and involve the service users wishes and they are taking an active role in the interview process. We spoke with a member of staff who has been recruited since the last inspection and they confirmed that the organisations recruitment procedures are robust. New staff shadow shifts until they are 100 confident in their role and considered competent before left to work unsupervised. Care Homes for Adults (18-65 years) Page 25 of 31 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. People benefit from a service that is well managed and promotes a high standard of care. The home is managed and maintained in a manner which ensures the safety of residents and the staff team. Evidence: The manager has been employed by the organisation for 12 years and has been in post as registered manager since 2004. He has the qualifications and experience required to effectively manage the service and has undertaken additional training relevant to his role to include training in the Mental Capacity Act Awareness but has yet to look at principals around Deprivation of Liberty and how this legislation may affect people who live at the home but confirmed that no one is having their liberty deprived. The manager has a good understanding of the strengths and areas for improvement and has developed positive working relationships with staff and people who use the service. Comments about the management of the home include: Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Stephen is approachable. I can go to him for anything. The manager is worth his weight in gold. I cant praise him or the staff higher, everybody has got a good word about Vision Homes and its the best thing we could of ever done for our X (relative) Thirty satisfaction surveys were distributed in December 2008 to family, friends and advocates of people who use services provided by Vision Homes Association. This was part of the organisations quality monitoring procedures to gain peoples views about the services provided. We were provided with a copy of the report dated January 2009 and comments about this particular service were very positive and include: We are more than pleased with the standard set at Vision Homes and our feedback each week from our daughter endorses our views We are impressed with Visions Homes Associations dedication to keep on top of issues relating to health We are pleased and grateful for the kindness and care shown The service has also received a number of letters and comments include: We would like to take this opportunity to pay tribute to the wonderfully dedicated staff at Vision Homes who look after our friends daughter. Although X has only been in their care a short time, the difference we see in her is amazing, she is happy, contented and has adjusted well to her new home...the staff are patient, caring and committed to those they care for As Xs extended family it is very reassuring that she is living at Vision Homes You should all be very proud of all that you have achieved and continue to achieve at Vision Homes, it is always a joy to visit ...I say a big thank you to you all and hope the excellent working relationship we have built will continue to flourish Monthly visits to support the performance of the home, as required by Regulation 26 have not been undertaken at the required frequency, with only one report being available for 2009. This is of concern given a requirement was made as a result of the last inspection. This shortfall was acknowledged by a senior manager who committed Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: to address this issue to ensure that in future they occur as required and will continue to be above and beyond the day to day input of the senior management team within services. The manager completed an AQQA which was detailed and provided in a timely manner. This document tells us that there are systems in place to manage the home, that policies and procedures are up to date and regular health and safety checks are undertaken to maintain a safe environment for people to live and work. Staff spoken with confirmed that they are in receipt of training to ensure peoples safety such as health and safety, first aid and food hygiene. The manager confirmed that there are no outstanding requirements made by the Fire or Environmental Health Departments. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 1 A Service User Guide should be developed to provide information to prospective residents about what the service offers in the event of a vacancy becoming available. Regulation 26 visits should take place monthly and a report produced based on the findings to support the performance of the home. 2 39 Care Homes for Adults (18-65 years) Page 30 of 31 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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