Care Home: 1c Tollgate Road

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What the care home does well People are supported by an established and committed team of staff who know them well, which benefits their care. People living here have complex needs such as sensory impairments, learning disability, physical disability and communication difficulties. This means that staff have to constantly use their skills of observation and interpretation to make sure people`s needs are met, and they do this well. The home is welcoming, provides a positive atmosphere and is a comfortable and homely place to live, ensuring individuals feel safe and secure. People are encouraged to lead positive lifestyles and try out new experiences. Staff are creative in finding ways of achieving this and are flexible in their approach, providing an individualised service. People can be confident that their health needs are closely monitored and kept under review. The team work in partnership with health and social care professionals; ensuring people`s health and wellbeing is promoted. 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. What has improved since the last inspection? A new art coordinator has been employed and he has further developed the art studio that many individuals access. People have also been provided with opportunities to visit a tactile art exhibition in Gloucester and stately homes with different sculpture trails. This has increased their presence in the wider community and taken into account individual choice, interest, abilities and their changing needs. 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. People using the service have become more involved in recruiting new staff. This ensures they are involved in the process and play a role in choosing the people they want to support them. People have been supported to redecorate their own bedrooms by choosing colours, furnishings and personalising them with photos and things that are important to them. Individuals have been supported to have a holiday of their choice. One person told us it was her dream to go to Les Vegas. This decision was supported as part of her person centred plan and she enjoyed a holiday of a lifetime. Discussions with her clearly evidence it was her dream come true. What the care home could do better: The home is considered to be performing well with no requirements made as a result of this inspection. We did suggest that care records be streamlined and better organised so that information can be easily used by people who are not familiar with the individual to deliver a personalised and consistent service. The home has no vacancies however the manager needs to make sure that information, such as a guide, is developed and available for people looking for a service in the event a vacancy becomes available. The home should be visited monthly by a senior manager who works for Vision Homes and a report made on the findings of their visit. This is to make sure that the organisation knows what the service is doing well and what they have to do, if anything, to make it better in the bests interests of the people who live there. Key inspection report Care homes for adults (18-65 years) Name: Address: 1c Tollgate Road 1c 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 1 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: 1c Tollgate Road 1c Tollgate Road Ludlow Shropshire SY8 1TQ 01584877166 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 1C 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 at the rear. 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 5 and a half hours. People who live and work at the home did not know that we were coming. The last key inspection of this service was undertaken on 16th January 2007. Annual service reviews were undertaken on and 4th December 2007 and 27th November 2008. These reviews did not involve a visit to the service but a summary of new information given to us, or collected by us annually since the last key inspection. These reports are available from the provider. 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 Care Homes for Adults (18-65 years) Page 6 of 31 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 the opportunity to observe people being supported by the staff on duty. We held a group discussion with six staff and spoke with the manager and a senior manager of the service. We also looked at some parts of the home, reviewed the homes quality assurance processes and sampled a number of records to include complaints and protection, staff training, recruitment and health and safety records. 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 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? What they could do better: The home is considered to be performing well with no requirements made as a result of Care Homes for Adults (18-65 years) Page 8 of 31 this inspection. We did suggest that care records be streamlined and better organised so that information can be easily used by people who are not familiar with the individual to deliver a personalised and consistent service. The home has no vacancies however the manager needs to make sure that information, such as a guide, is developed and available for people looking for a service in the event a vacancy becomes available. The home should be visited monthly by a senior manager who works for Vision Homes and a report made on the findings of their visit. This is to make sure that the organisation knows what the service is doing well and what they have to do, if anything, to make it better in the bests interests of the people who live there. 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. Some information about the home is available however this requires further development to ensure in the event of a vacancy prospective residents have information to help them make an informed choice about whether the service is able to meet their individual needs. Evidence: All of the residents have lived at the home since it first opened in 1991. Therefore the home currently has no vacancies. In the event of a vacancy the home has some information available 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 told us that she would make sure a guide is made available. There have been no new admissions to the home therefore we were unable to assess the organisations admissions procedures on this occasion. However the manager confirmed that the necessary assessments would be obtained to include undertaking her own assessment of need to ensure only people whose needs can be met are Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: offered a service. 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. People can be confident that their assessed care needs are met. They are enabled to make decisions and take risks as part of their everyday lives because staff actively promote their rights, choices and independence enabling them to lead the lives they wish. Evidence: We looked at all the care documentation held on behalf of two people who live at the home. We saw lots of information about peoples needs to include their health and personal care needs, preferred routines, activities, how they communicate and their likes and dislikes. There was evidence that peoples needs are reviewed by people close to them such as relatives, professionals and staff. The formal review documentation seen for one person reported that their needs continue to change and new staff are given full instructions on how to handle her and how to use equipment needed to ensure her ongoing safety. It also stated Staff appear to act in a very positive manner in meeting her needs. Each individual currently has a number of files and although information was available it was not easily accessible, however all six Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: staff spoken with considered they have sufficient information available for the delivery of care and they demonstrated a good understanding of the individual care needs of the two people whose care we looked at in detail. We were present at the staff handover when the manager and existing staff briefed staff coming on duty at 11am. They discussed all of the individuals, the care they had received, activities, health issues and the shift plan. This provided staff coming on duty with a detailed account of peoples current needs and any identified changes. Not everyone that lives at this home is able to verbally communicate their needs. Therefore staff are reliant on other ways to support people with their preferred communication methods, for example through the use of gestures and body language etc. One person uses Braille as a method of communication and we were advised that two staff have received training in using Braille and that this had been useful in the development of her person centred plan (PCP). The AQAA states All service users take part in developing a plan that suits their individual needs and personal aims and goals, making decisions about their lives with support staff giving them informed choices. PCPs are as big or small, and in a format that individual service users wish them to be. One person showed us their PCP which was a tactile mountain that shed been supported to make. She told us about all the things that she wanted to do and shared with us her achievements to date to include attending an ABBA concert, redecorating her bedroom, shopping and buying things for her room and going on a holiday. None of the people who live at the have an active advocate although we were advised that an independent advocacy service visits the home on a regular basis and if it was identified that an individual required crisis advocacy that this would be immediately actioned. Families are actively involved with individuals and staff represent peoples best interests. Staff were observed interacting with the people they support in a friendly and professional manner. They were seen to offer choices and give individuals time and encouragement to respond. Daily records provided evidence that people are giving choices and encouraged to make decisions as much as possible. People are encouraged to take reasonable risks to lead the lives they want, whilst ensuring their safety. Risk assessments were available providing staff with instruction on how to manage any identified risks such as community activities, activities for daily living, moving and handling, finances and health matters for example epilepsy. These evidence that individuals are not stopped from taking risks but that staff have guidelines to follow to minimise the risk of harm, while providing individuals with opportunities for personal development. A good example of this was seen during the inspection when an individual was supported to do some baking in the kitchen. She was supported to fully partake in the activity under close staff support due to visual Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: impairment and was assisted with the task using hand over hand technique, promoting her independence and minimising risk as much as possible. Care Homes for Adults (18-65 years) Page 15 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 full, stimulating and healthy lifestyle based on their personal preferences. Routines are flexible and support is provided to promote peoples rights, independence and to maintain relationships important to them. Evidence: The AQAA states Service users are treated as individuals, their differing choices of how to live their lives in communal living are upheld, promoting their right to privacy within their home.... The manager stated that few group activities are offered as this is against the ethos of the service, instead through the use of person centred plans people are able to live a lifestyle that is varied, active and suited to their individual needs and preferences. During our visit people were engaged in activities both in and outside of the home. For example attending a health appointment, going for local walks and baking mince pies Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: for a forthcoming fund-raising event. Activities seen for the two people whose care we looked at in detail, included going to hairdressers, reflexology, swimming, personal shopping, Christmas shopping, dance and exercise to music, massage and the art studio which incorporates the arts not only at the studio but also in the wider community. The manager reported that people have also attended a tactile art exhibition held in Gloucester, which they very much enjoyed. The AQAA states Staff are always very supportive of service users needs to how they wish to live. On a weekly basis visiting complimentary therapists visit the home and include, reflexologist, masseur, chiropodist, music therapists, Sherbourne (dance and exercise to music) and extend exercise. One person we spoke with said her dream was to go to Las Vegas in America which she achieved with staff support. She said she had a fantastic time. Staff have the overall responsibility for the cleaning of the home, however some individuals are able to participate at varying levels and staff encourage and promote this as much as possible. Records and observations made demonstrate that routines are flexible. Contact with family was recorded in the daily records sampled and confirmed through discussion with the staff on duty. Individuals have been supported to purchase and wrap Christmas presents for their family and friends. Minutes of reviews and thank you cards evidence relatives are very satisfied with the care provided to their family members living at home. The AQAA states Service users are involved with the planning and preparing of their meals and drinks, all service users are supported to access a healthy eating plan to meet their needs and choices. This was evidenced in a record seen and observations made. During our visit two people were supported on a 1:1 ratio at different times to bake mince pies for a forthcoming fund-raising event. Staff worked positively with the individuals concerned promoting their independence as much as possible whilst making the activity fun. Menus seen evidence people are provided with meals that are varied and nutritional. One person whose care we looked at in detail has very specific dietary needs due to a health condition and staff spoken with demonstrated a sound understanding of what the person can and cannot eat and how her vegetables have be prepared. We saw that staff ensure that people with swallowing problems are assessed by the speech and language therapist so that they supported to eat safely. 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. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because there is good evidence of multi agency working promoting their health and welfare. Evidence: The AQAA states the service does well by Supporting service users to maintain a healthy lifestyle through exercise, healthy eating, stimulus and holistic therapies. Care documentation sampled included information about peoples health care needs and the support they need to ensure their personal care needs are met in a way that they prefer. People are supported to maintain a positive self-image and were dressed in clothes that were appropriate for the time of the year and which suited their personalities. Records held for the two people whose care we looked at in detail confirmed that individuals are supported to have preventative health checks such as seeing the doctor, chiropodist, dentist etc. The AQAA states We prepare service users in advance about any visit to gps hospital, dental appointments, giving clear, relevant explanation as to why they are attending appointment, dates, times and who will be Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: supporting them to the appointment. The manager is in the process of updating health action plans, which is a personal plan about what an individual should do to maintain good health. An updated version was seen on one of the files sampled and was detailed. Staff spoken with demonstrated a good understanding of the medical conditions of one of the people whose care we looked at in detail, knowing what health problems are associated with this, ensuring blood sugar levels are tested as required and that the person receives the assessment and treatment they need. Improvements stated in the AQAA include To continually be aware of changing needs of service users due to age and health issues, and specific training for staff to keep up to date on what support will be required. The manager confirmed that there are policies and procedures for the management of medication within the home. We looked at how medicines are managed and found all records to be up-to-date and accurate. The manager described the ordering and return system to us and reported that the home uses the monitored dosage system supplied by well known chemist. A pharmacist from this chemist has recently undertaken a medicine audit and the manager stated that everything was absolutely superb and no issues were identified. Protocols are in place for people who require medication as and when required. We advised the manager to obtain a photograph of individuals and retain these on their medication administration records for good practice. The manager reported that one person did not receive their lunchtime medication as prescribed. The manager confirmed that this had no adverse effect on the individual concerned but action had been taken to prevent it from happening again. Staff confirmed that they receive training in the safe handling of medication. Staff competency assessments have recently been introduced to ensure only staff who are competent to administer medication do so, providing greater safeguards for people who require support with their medication. 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. 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: The AQAA states Service users are given the information on how to complain, and listened to if they make a complaint it also reports that the policy has been developed in an easier format with input from people who use the service and that people have time alone with their families and advocates, to give them the opportunity to speak to someone other than their staff group about any concerns they may have. Not everyone who lives at the home has verbal communication skills however staff are alert to changes in peoples behaviours and this knowledge can contribute to keeping people safe. We have not received any concerns or complaints about the service since our last inspection and there have been no complaints received by the home. This indicates peoples continued satisfaction with the service the home provides. The home has a copy of the local safeguarding procedure although we advised the manager to obtain the revised edition. The manager confirmed that no referrals have been made under local procedures since our last visit and staff confirmed they have received training in adult protection. This should ensure staff are aware of the various aspects of abuse and are able to recognise the signs to ensure peoples protection. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: People 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 made however we advised the manager to ensure money is checked on a more regular basis and that two signatures are obtained wherever possible to prevent minor omissions and provide greater safeguards. 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 benefit from a homely, clean and safe environment that is suited to their needs. Evidence: 1C Tollgate Road is a purpose built level access building close to shops, facilities and other homes. People have their own bedroom, which have been redecorated to their choice over the last year. People we spoke with told us they are happy living there and that they like their bedrooms. We looked at the shared rooms and the bedrooms of the people whose care we looked at in detail. The home was very welcoming, shared areas well equipped and provide soft furnishings, photographs and ornaments. Bedrooms seen were personalised and equipped to meet peoples individual needs. People appeared comfortable and relaxed in their surroundings. The AQAA states The home is well decorated and provides any aids to allow as much independence as possible, ie guide rails, hoists, bath/shower chairs, high/low bath and seating suitable for each individual. Plans for the next 12 months include to replace the lounge carpet and redecorate the hallway. Shared space is somewhat limited, as identified at previous inspections however the AQAA reports Service users use their bedrooms, when they want to listen to music or TV or just have some privacy and quiet time. The manager confirmed that there are no outstanding requirements from the fire or environmental health departments. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The AQAA states Staff maintain the cleanliness and homeliness of the home to a very high standard, and always respect the fact that it is someones home. This was clearly evident in observations made during our visit. Substances such as cleaning products that could cause harm to people are safely stored and personal protective equipment such as gloves and aprons were readily available. The manager reported that staff receive training in infection control. 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 have confidence in the home because they are supported by a skilled and competent staff team who can meet their changing needs. New staff have the necessary pre-recruitment checks undertaken ensuring peoples safety and welfare. Evidence: Staff spoke positively about their work and demonstrated a good understanding of the individual needs of the two people whose care we looked at in detail. It was reported that 75 per cent of the permanent staff team 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 providing a qualified workforce, benefiting peoples care. The AQAA states Staff are very highly trained professional people who have an empathy and understanding, particularly with service users communication difficulties. They have the ability to identify and act upon any issues that service users may be trying to communicate Staff told us: Its a marvellous place to work and so rewarding Its wonderful Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Id have no problems putting a relative of mine in here...I have never known service users get so much out of life Staff spoken with considered that staffing levels are flexible and meets the assessed needs of the individuals living at the home although felt that an extra member of staff at tea time would be beneficial. Some expressed concern about the long shift patterns given the complex needs of the people they support. We were advised that the organisation is reviewing this in the best interests of people living at the home. Files for two staff recruited in the last twelve were looked at and contained all the information required by law. The manager was confident that the organisations recruitment procedures are robust. It was reported that the locality of the home presents some challenges in recruiting staff. The manager stated There has been an increase in applicants however Vision Homes will not take on anyone just to fill the gaps...second best will not do. It was reported that the home currently has no vacancies although the organisation intend to recruit for relief staff in the New Year to cover holidays, training and sickness. The manager reported that new staff shadow shifts until they are 100 per cent confident in their role and then existing staff shadow them to make sure they are fully competent before left to work unsupervised. Staff told us that they are provided with training in safe working practices such as manual handling, first aid, fire safety and food hygiene in addition to training that is specific around the needs of the individuals they support such as epilepsy, sighted guide skills, supporting a visually impaired person who uses a wheelchair, eye care, diabetes, depression and older people. This ensures that staff are equipped with the skills and knowledge to meet the needs of the individuals in their care and ensure the persons health, welfare and safety. Some staff have received training in the Mental Capacity Act so they know what course of action to take, have an understanding of the assessment processes and are clear of their legal responsibilities. 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 management style based on promoting independence and rights and enabling people to live a lifestyle of their choice. The home is maintained in a manner, which ensures the safety of the people living and working at the home. Evidence: The manager has been in post since 2003 and discussions with her clearly evidence her commitment to providing a quality service to the people living there. She is also very appreciative of her staff team and what each of them bring to the service. She stated I love my job, everyday is a new challenge...we see people not disabilities and I have trust in this organisation. The manager has the experience and qualifications to manage the service and has undertaken additional training to update her skills and knowledge base 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. Staff were complimentary about her management and leadership skills and discussions with them indicate that they are well supported. Comments include: Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: If Ive got an issue, the door is always open and the manager always listens and gives you time I think the manager provides very good support to staff and service users She is fair The AQAA states The service as a whole provides a suitable , stimulating, comfortable happy home and staff that are highly trained to provide continuity in all aspects of their lives. 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 given a copy of the report dated January 2009 and comments about this particular service were very positive and include: The support and care of the staff is outstanding. They are one and all sympathetic, efficient and totally committed. Their energy and resilience is beyond all expectation. They are incomparable Whenever we visit the mood of the bungalow is very cheerful and up-beat The quality of the food is excellent, mainly fresh food and a good all round diet The report states that the questionnaire will be reviewed and redrafted prior to its next circulation in order to try and make it clearer and more user friendly. In addition to the above comments the home has received a number of compliments through thank you cards and letters which clearly evidence peoples satisfaction with the care provided to individuals living at the home home. These include: You are a wonderful team and you make sure that all their needs are met with kindness and good humour beyond what is normally expected of anyone. All the staff seem to pull together to make residents happy in their surroundings and in their various and varied pursuits within their capabilities. You deserve our everlasting thanks and appreciation We would just like to praise you on the standard of care X receives from your staff. She is always very well supervised, looked after and understood. Well done, keep up the excellent work Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: There was evidence that visits to support the performance of the home, as required by Regulation 26, are clearly not being undertaken at the required frequency. This is of concern given we spoke with the Responsible Individual following the inspection of a sister home on the same site in May 2009 and were given 100 assurance that these visits would be undertaken with immediate effect. The provider must therefore give this priority in order to help assess how the service is currently performing and aid future planning. The manager committed to reviewing record management systems such as residents files, staff files etc to ensure information is easily accessible. Health, safety and maintenance checks are undertaken to ensure that the equipment is safe and in full working order. Staff confirmed that they receive training in safe working practices for example moving and handling, fire safety, first aid and food hygiene. This helps ensure they and the people they support are kept safe. Service certificates were available in addition to other safety records required. 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 servce offers in the event of a vacancy becoming available. Care records should be streamlined and better organised so that information is more readily accessible for staff supporting individuals. Regulation 26 visits should take place monthly and a report produced basedon the findings to support the performance of the home. 2 6 3 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). 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. 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