Care Home: 2 West Road

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What the care home does well All potential service users have their needs fully assessed over a period of time with a gradual introduction to the home and other service users before they move into the home. The new care planning system in person centered and contains all the information the staff would need to know how that person likes to be supported. Staff provide good support to the service users, helping them to make decisions about their lives, the activities that they take part in and to maintain contact with their families. One service users comment said `I will tell staff if I do not feel well or do not want to go to activities`. Each service user has a varied programme of activities throughout the week and are supported to maintain contact with the friends and family.Service users are provided with an annual holiday of their choice and additional staff supports this. Comments on a relative`s survey returned to CQC told us that `The home is very responsive to my sons` highly individual needs and always treat him with respect`. A nutritious diet is provided and service users choose and plan their own menus and shopping lists and accompany staff to do the shopping. The home also provides good support to meet the personal and health care needs of the service users and medication is stored safely and administered by suitably trained staff. A structured programme for a range of training is in place to ensure that the staff can meet the needs of the people living in the house. The manager promotes the health, safety and welfare of the service users and staff. A comment from a member of staff said `I am very happy working at West Road and have development and training planned through regular supervision from the manager who I meet with every two months`.Another staff member said that `West Road is a very good place to live and to work`. What has improved since the last inspection? The home has a registered manager who has reviewed and introduced a new care planning system which would inform staff how that person wishes to be supported in their daily activities of living. The home has given the service users more opportunity to access activities during the weekends. The adult protection training in now more in-depth and give staff a clear understanding of how to recognise and report abuse. The home has had a new kitchen and wet room fitted. The company has introduced an induction programme that ensures that all new staff have completed all mandatory training before they commence employment at the home.The manager has put in better recording systems and information is readily available for gathering evidence. What the care home could do better: Develop quality assurance questionnaires for the service users and their families as part of measuring the quality of the service provided. Key inspection report Care homes for adults (18-65 years) Name: Address: 2 West Road 2 West Road Hedge End Southampton Hampshire SO30 4BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 0 6 0 8 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 30 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 30 Information about the care home Name of care home: Address: 2 West Road 2 West Road Hedge End Southampton Hampshire SO30 4BD 02380470557 02380462201 westrd@iliace.com winchesterroad@ilg.co.uk Iliace Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 2 West Road is a care home registered to provide care and accommodation for four adults with learning disabilities between the ages of 18 and 65. The service is one of several provided by Iliace Ltd in the local area. The house is situated in a cul-de-sac in a residential area of Hedge End, which is between Southampton and Portsmouth, and close to nearby facilities and amenities. The house is detached and has a large enclosed rear garden, which has a lawn, shrubs, flowerbeds and a patio area that is Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 4 Brief description of the care home accessible to everyone living in the home. Each resident has a single bedroom and there is a large communal lounge with a dining or activity area and a kitchen / diner. A car is provided at the home, which is used to take the residents out and about when there is a registered driver working in the home. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We got our information to write this report in lots of different ways. We checked to see if anyone had made a complaint to us about 2 West Road and found that they had not. We also looked at any information the home had given us about what might have happened since we last visited. We used some of the information that Neil Larner gave us about the home. We got this information in a big form the registered manager has to fill out each year called the Annual Quality Assurance Assessment (AQAA). It tells us what the staff are doing to make it a good place to live and if there is anything they want to do better. One of our inspectors visited the home on the 6th August 2009 and stayed for 6 hours. During the visit she was able to speak with of the people who live in the home and ask them what it was like to live there. She was also able to see how the people who live Care Homes for Adults (18-65 years) Page 6 of 30 there spend the day and what they do with staff. She was able to talk to two staff about what it was like to work at 2 West Road. Some time was spent looking at the records for three people who live in the home. This was to make sure everyone knew how the person liked to spend their time and what help they needed from staff to let them do these things. Other records were looked at to make sure the home was safe to live in. We distributed surveys for comments to eight(8) staff, five(5) visiting professionals, three (3) service users and four (4) relatives. We received two surveys back from service users, four staff surveys, two relatives and two visiting professionals. Comments received were very positive and indicated that service users are happy living in the home and that staff feel they get lots of training and are well supported by the manager. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? The home has a registered manager who has reviewed and introduced a new care planning system which would inform staff how that person wishes to be supported in their daily activities of living. The home has given the service users more opportunity to access activities during the weekends. The adult protection training in now more in-depth and give staff a clear understanding of how to recognise and report abuse. The home has had a new kitchen and wet room fitted. The company has introduced an induction programme that ensures that all new staff have completed all mandatory training before they commence employment at the home. Care Homes for Adults (18-65 years) Page 8 of 30 The manager has put in better recording systems and information is readily available for gathering evidence. 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 30 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 30 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. People wishing to use this service benefit from having a comprehensive pre-admission assessment of their needs before moving into the home. Evidence: The AQAA says that the organisation have a team who play a key part in finding the right home for the service users. The team carry out individual assessments to ensure that the service can meet their needs. A sample of three service users files were viewed. These demonstrated that the service undertakes a very detailed assessment to ensure the potential service users needs will be met and that they will integrate into the existing home life with ease. Following an initial referral the manager and placement co-ordinator for the organisation will visit the person who has been referred, to carry out an initial assessment. This process can last for up to two days and involves current carers, family and other professionals involved with the persons care. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: A report is then generated and recommendations are made along with costings of the placement. A transition programme for that person is planned with a gradual introduction to the home and the periods of time they stay increases gradually. The home was in the process of this programme for a service user from another home in the same organisation. There was evidence of his assessment and his gradual introduction to the other service users and the home. He had attended social gathering and had been on holiday with one of the residents and is familiar with the other service users and the home. The manager told us that the gentleman is looking forward to moving into the home permanently to be with his other friends. Care Homes for Adults (18-65 years) Page 12 of 30 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 living in the home know that their goals and changing needs are reflected in their care plans and are helped to make decisions about their lives, even if it involves taking risks. Evidence: The AQAA states that over the last year all service users have actively participated in person centered planning meetings. This has resulted in the key worker and the service user being bought closer together and has given the service user the opportunity to discuss their aspirations and goals and how they can achieve them. We viewed the three care plans for the people living in the home. The care planning system is in the process of being changed and the manager told us that to date only one of the service users care plans and records had been fully converted to the new system. The system used in the past was in four sections and information contained in these is comprehensive but fragmented and was recorded in four different folders. The new system is called Essential Life and brings together all the information into one Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: file and is person centered and service users are encouraged to be fully involved to help complete the records. The care plans set out the goals and aspirations that the service user has expressed. All documentation is presented in a picture format to support service users to understand what information they are sharing. There was evidence in one service users care plan that he had written the plan himself to describe how he wants his support given, and this had been signed by him. Care plans are reviewed regularly or if the service users needs change. All service users goals and aspirations for the future along with care needs are reviewed yearly by the care manager,the service users, the key worker, their family or advocate and others involved in their care. The home undertakes a six monthly review of care plans and this is usually undertaken with the manager,the key worker,the service user and the family. The manager told us that in most cases there is a lot of family involvement with the service users. Daily diaries are kept for each resident in a separate file and these contain specific monitoring records and how they have spent their day generally. The residents are supported to take risks within their lives and care plans contain risk assessments, which are well documented and sets out assessed hazards and the necessary actions to be taken to minimise the risk of harm, whilst allowing the service user to be as independent as possible. A survey returned to CQC by a service user said most of the things I do I always have support to assist me. If it is for my best interests sometimes they need to tell me not to do things that will harm me. The manager told us that currently there are no service users who present with challenging behaviours but all three residents have a behaviour risk assessment which identified a low risk for all residents. There is no physical restraint used in the home but staff have attend the SCIP-r training (Strategies for Crisis Intervention and Prevention) to enable them to support residents who may be physically aggressive. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social activities and family contacts are well supported and reflect service users interests and choices. Service users are encouraged to choose a balanced diet and are provided with varied and nutritious meals. Evidence: The people living in the home are encouraged and supported to take part in a range of educational and leisure activities, although there are now fewer educational services available to them. None of the service users were currently in formal education at college or employed. The AQAA told us that the home is hoping to network with local employers and organisations to investigate employment opportunities for the service users in the coming year. Each service user has a programme of what activities they undertake. All three service Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: users have individual programmes each week. At the time of this visit all three service users were out for the day at the beach and were meeting up with other residents from other homes to enjoy a day crabbing and having a picnic lunch. The manager told us that this takes place most weeks and is a popular activity in the finer weather. The home has transport and this is used to take service users out on outings, shopping or transporting them to wherever they wish or if the have any community appointments. The programme of activities for the three service users were varied and they appear to be out and about or undertaking activities, most days of the week. The AQAA told us that the service users now has more activities available to them at week-ends and meet friends in the community. Two service users attend an activities centre once a week. Other activities listed are swimming, archery, rambling, cookery and one service user attends the Beneficial Foundation twice weekly, which is a voluntary group who run a shop and a gardening project. The service user told us that the he enjoyed attending this once a week and enjoyed the gardening. One of the service users meets up with a girl friend once a week for a drink and this is all documented in a care plans. The occupational therapist has visited the home to assess one service user who has communication difficulties. She has assessed and worked with this person and has written a report, that was seen by us, planning a programme for providing guidelines for staff and giving training on how to stimulate and engage with the service user in the activities. There were various photograph albums and photographs in service users rooms of outings the service users had been on and looked to be enjoying themselves. There were albums of photographs of the holidays two of the service users go on each year together. The manager told us that they are encouraged to take holidays and one service user goes more than once a year, the third service user chooses not to go away. The organisation contributes a sum of money towards a holiday for each service user. A survey returned by a professional commented that the home treat each person as an individual with separate needs and that it could do better by employing more staff to allow people to go out socialising separately. From observation there did not appear any negative effect on the service users for being together for social activities. Two of the service users visit and stay at their family homes regularly and they are driven to their homes by staff in the homes transport. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Each service user has a key to their rooms and one service user chooses to keep his door locked when he is not in the home. We met all three service users at the end of their days outing and they were happy and eager to chat to all the staff. There was good interaction between staff and service users and they communicated with their key workers about their day. One service user was asking to go to the local library to collect DVDs and this was agreed with his key worker and a time was negotiated. Another service user was choosing to be alone in the lounge area. Staff were observed to be interacting and speaking with service users in a respectful manner and deferring to their opinions about certain things. At the time of this visit the home was clean and fresh. The service users are supported to clean their rooms and do their laundry, staff make sure the communal areas are clean. One survey comment said I help staff to clean the home the other survey indicated that the home is always clean and fresh. The home has a planned menu, which is decided on by the people living in the house once a week and is displayed in the kitchen. The menu takes into account the service users likes and dislikes and provides a varied and balanced diet. The service users said the food was good and they could always have something different if they did not want what was on the menu for that day.Mealtimes are flexible to fit in with their various daily activities. Having decided at their weekly meeting what they would like the menu to be for the coming week, the shopping is then done at a local supermarket by staff and two of the service users. The kitchen was well stocked with a variety of good quality food, the food budget and invoices evidenced this. Most days the service user choose to have cereal for breakfast but have the choice of a cooked breakfast. They have a sandwich lunch and a cooked evening meal. They enjoy an occasional take away meal and service users told us that their favourite is fish an chips. Two of the service users enjoy attending an activities centre twice a week to do cooking and eat what they have cooked at the lunchtime. Service users enjoy helping to prepar the meals and staff supervise the cooking activities. Risk assessments are in place for service users using kitchen equipment. Service users weights are monitored and recorded monthly and it was identified that one service user was putting on too much weight and it has been discussed with him and documented in the care plan that he has agreed to cut down on eating the biscuits and crisps. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff provide good support to meet the service users personal, emotional, health care and medication needs. Evidence: Service users living in the home told us that staff provided support in the way they wanted it. In two of the service users surveys returned to CQC indicated that they felt that the staff treated them well listened to them and acted on what they said. One service user comment said I like it here, great management and I can do what I want with or without support. Another comment said Most of the things I do I need support to assist me. Each of the service users in the home have a personal file that contains all medical and health care plans. Records of all visits to the GP, dentist, optician, and visits from the occupational therapist, psychiatrist, the speech and language therapist and any other medical interventions that take place. Records demonstrate that medication reviews by the GP are done 6 monthly. The home is also visited by the Behaviour Support Team, which is part of the organisation and are involved with the service Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: users and liaise with the key workers to plan strategies for behavioural problems. At the time of this visit one of this teams members was attending the home to discuss the service user who was transferring from another home to ensure the transition for him would be seamless and not cause any changed behaviour. The manager told us that service users have support from the Learning Disability Team if requested. The service users are transported and escorted by staff to any community medical appointments they have. The manager orders all medication and is training shift leaders to do this. He has introduced safe systems and maintains records of all medication received and records the medication returned to the pharmacy. Records of this were viewed by us. The manager also checks the prescriptions before they are sent to be dispensed. All medication was stored in a locked cabinet in the office, which was well organsied and clean with no over stocking of medications. The home uses a monitored dosage system for regular medication and all medication administration records (MAR sheets) that were seen had been signed when medication had been taken. The MAR sheet is also used to record medication coming into the home, providing an audit trail. Each service user has their own MAR sheet, which contains their photograph to ensure that staff know who they are supporting with their medication. All staff had completed medication training with Boots the pharmacist and the manager tests their knowledge and observes administration three times as an internal assessment. The training matrix evidenced that this training has taken place. There is also a sheet of names and signatures at the front of the MAR sheet folder, so that it is easy to know who has signed for what medication. At the time of this visit there were no service users choosing to manage their own medication but the manager told us that this would be possible if a service user was assessed as being safe and able to do so. None of the people living in the home were currently prescribed any controlled drugs and it was observed that the home did not have a controlled drugs cupboard fitted. The law changed in 2007 and said that if a care home should have any controlled drugs prescribed in the future they will need to obtain a cupboard that meets the requirements of the Misuse of Drugs ( Safe Custody) Regulations 1973 in which to store them. Care Homes for Adults (18-65 years) Page 19 of 30 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. Service users are confident their complaints will be taken seriously and acted upon. The home has good policies and procedures in place to ensure service users are protected from abuse. Evidence: The complaints procedure has been supplied to all of the people living in the home in an accessible pictorial format, as well as a pictorial reminder on what they can do when they are not happy.It is also part of the Statement of Purpose which is also produced in a pictorial format. The manager told us that any issues, concerns and complaints that are raised are dealt with within the timescale laid out in the procedure. The two returned surveys said By using Makaton signs I could talk to staff and the manager if I am not happy, the other indicated that he knew how to complain and had no communication difficulties and would be able to tell staff. Surveys returned from relatives said that they knew how to make a complaint. The complaints log was viewed and demonstrated that no complaints had been received by the service in the past year. The AQAA tells us that a revised complaints procedure will be implemented to include a photograph of the relevant staff member who would receive any complaints. The home has a safeguarding policy and procedure in place. Staff have undertaken Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: the adult protection training which is part of the induction programme and further training is given following induction. The training matrix evidenced that all staff have received this training. Surveys returned from staff indicated that they would know what to do if concerns about the home were raised. There was one safeguarding investigation recorded in the home, for which a Regulation 37 notice was received by the CQC. Risk assessments were undertaken correct procedures were followed with a meeting being held with the appropriate agencies that resulted in a satisfactory outcome. All staff recruited have had Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) checks undertaken and cleared before they commence employment to ensure the safety of the service users. Monies are held in the home for the three service users. These were viewed by us and demonstrated that all monies are kept in a safe and stored separately for each person in a security bag which has a new seal attached each time it is opened. All records of incoming and outgoing monies were accounted for.The records were checked against the monies held and these balanced. Care Homes for Adults (18-65 years) Page 21 of 30 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. The service users live in a well maintained home that provides a clean, comfortable and safe environment for them. Evidence: The home is a large detached property with spacious living accommodation. The home is well maintained and is pleasantly decorated throughtout with domestic and good quality furnishings. During the course of the visit we were able to see various parts of the home, such as the kitchen diner, sitting room, quiet room and three of the bedrooms. Each of the bedrooms has been decorated in the colour chosen by the service user. The service users have personalised their rooms which reflects their personalities and their favourite hobbies. The kitchen has recently been refurbished and the colours were chosen by the service users. One of the bathrooms is in the process of being refurbished and the home has had a wet room created from another bathroom. The service users are involved in all aspects of choosing colours, furniture etc for the home and have displayed their own art work on the walls. The home has a large enclosed rear garden, which service users are able to access. There are lawns, a patio with chairs and umbrellas and the borders are well stocked Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: with shrubs and plants. The manager said the service users were in the process of tidying the garden as the organisation has a garden competition this summer. The front garden has also been attractively filled with shrubs and flowers and hanging baskets. The home has domestic washing and drying machines in the laundry room, which is off the corridor so that dirty laundry is not taken through the kitchen to access the laundry room. Service users do their own laundry daily and bed linen is changed weekly. Ironing is undertaken by night staff. The AQAA told us that the home has regular health and safety checks to ensure the environment is maintained. There home has access to a maintenance team that are called on for general repairs and maintenance. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a staff group who are competent and have been appropriately trained. Robust recruitment practices protect the people living in the home. Evidence: The staff roster showed that there are two staff on each daytime shift and one staff member awake at night. The manager said that spare shifts are usually covered by staff from the home or other homes in the group. The notice board in the hallway has a pictorial roster system so that the people living in the home know who will be working with them for the day. The manager is in the home each day supernumerary to the staff on duty. The service users were out all day on the day of this visit and when they returned it was at a time of change over and the home seemed busy with a lot of staff present. The service users appeared relaxed and very familiar with the staff on duty and a good rapport was observed between the staff and service users who wanted to talk about their day and what they wished to do later in the evening. The staff recruitment files for the three most recently employed staff were viewed. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: These evidenced that CRB, POVA checks and two references are received before the person can commence employment. This was demonstrated on the day of this visit, the manager was awaiting one more reference from a recruit before he could make arrangements for the date to commence employ. The manager told us that the home is now fully complemented for staff. Surveys returned to CQC by staff indicated that all checks were taken up before they started employment and the induction training mostly covered everything they needed to know to do the job. The company have a training programme which includes external training in some subjects. The training matrix demonstrated that staff have attended a range of training. This includes the mandatory Health and Safety training, Moving and Handling, Fire, COSHH, First Aid, Food Hygiene, infection Control, Safeguarding, Mental Capacity Act, Makaton, Autism,Challenging Behaviours, Care planning, Medication training and SCIP-r. Staff spoken with said that they received good training, which helped them to meet the needs of the residents.Surveys returned from four (4) staff members said they have, two (2) said they feel they have the knowledge and support to care for the service users in residents, the other two said that usually they do. Comments on the surveys said I am supervised monthly by the manager when we talk about any queries or concerns and my training and development is provided. I am given good support. The organisation has arranged a training day for all staff specifically focusing in on equality and diversity to ensure they have the knowledge to implement this into their daily practice. All new staff have a three day induction training initially with the manager and then go onto the Learning Disabilities Awards Framework (LDAF) induction which is a national programme designed to ensure that all staff in learning disability services have the appropriate training. The AQAA tells us that five (5) of the eight (8) staff members have achieved the National Vocational Qualification (NVQ) at level 2 and above. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a well run home where their health, safety and welfare is promoted. Evidence: The registered manager Mr Neil Larner has been in post since April 2008 and is registered with the CQC. He is in the process of working towards the Leadership and Management Award. He has had a number of years working in care homes for younger people with learning disabilities or physical disabilities and brings practical experience along with management skills. The manager told us on the AQAA that he continues to work a number of care hours as well as management hours to monitor service users and ensure that staff are receiving appropriate support. The manager said he receives good support from the senior management staff and is able to speak with them whenever he needs to. Regular supervision meetings are held with the area manager who also visits the home each month to review the quality of service in the home by chatting with service users and staff and looking at different Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: parts of the home and records. The reports of the monthly visits do now reflect what is happening in the home and action is taken to remedy any defects or shortfalls that are noted. These reports are kept in the home and were viewed by us at this visit. Staff morale appeared good and staff appeared confident with their roles and responsibilities within the home. Staff and service users were seen to interact well, and it was apparent that they have all established good relationships. The AQAA acknowledged that the home could do better to have quality assurance questionnaires sent out to the service users and their parents or families and it has been recognised as an improvement to be made in the next year. The home has monthly staff meetings that are minuted and actions taken from issues raised are also recorded. The home has a fire risk assessment and regular checks are made of the fire warning system and the safety equipment which is recorded in the fire log along with the fire training records. The gas system is serviced annually and annual tests of portable electrical appliances are completed and were seen. Risk assessments have been completed for chemicals used in the home, which are stored in a locked cupboard. The temperatures of the fridge and freezer are taken daily and recorded. Accidents and incidents to service users and staff are recorded and reported appropriately and are analysed by the manager. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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