Care Home: 26 Tilmore Gardens

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What the care home does well Service users are involved in the planning of their care and wrote in their surveys that they can do what they choose during the day, in the evenings and at weekends. All the service users are involved in the daily routines of the home and most of them keep their bedrooms clean and tidy, launder their own clothes and are involved in preparing their own meals. The home has a minibus and a car to help service user to be involved in the community and to attend social events and go on holidays. What has improved since the last inspection? The people who live at the home have been involved in choosing new staff to work at the home. The people who live at the home have been growing their own vegetables in the garden. A new walk-in bath has been purchased to make bathing easier. What the care home could do better: Information about the home for new service users should be up to date and give them enough details to decide if the home is right for them. Local authority safeguarding procedures should be followed to protect the people who live at the home and the staff. Records should be kept of the staff training to show they have enough knowledge to look after the people who live at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 26 Tilmore Gardens 26 Tilmore Gardens Petersfield Hampshire GU32 2JQ The quality rating for this care home is: one star adequate 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: Christine Bowman Date: 2 3 0 9 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 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 © (2010) 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: 26 Tilmore Gardens 26 Tilmore Gardens Petersfield Hampshire GU32 2JQ 01730233124 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : norma.kutyauripo@sanctuary_housing.co.uk Sanctuary Care Ltd care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. 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 Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home 26 Tilmore Gardens is registered to provide personal care and accommodation to ten people with learning disabilities. The home is arranged in two houses, with an interconnecting door for staff. Each house has a kitchen, combined lounge and dining room, a bathroom and separate toilet. There is an enclosed garden to the rear of the home that service users are able to access. The home is located in a residential area of Petersfield. 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: one star adequate 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 Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home We visited the home and spent some time talking to the people who live there. We looked at some care plans. We checked the home had safe policies in place. Some people, who live at the home and some of the staff, filled in surveys to let us know what they thought about the home. What the care home does well Service users are involved in the planning of their care and wrote in their surveys that they can do what they choose during the day, in the evenings and at weekends. All the service users are involved in the daily routines of the home and most of them keep their bedrooms clean and tidy, launder their own clothes and are involved in preparing their own meals. The home has a minibus and a car to help service user to be involved in the community and to attend social events and go on holidays. Care Homes for Adults (18-65 years) Page 7 of 31 What has got better from the last inspection What the care home could do better Information about the home for new service users should be up to date and give them enough details to decide if the home is right for them. Local authority safeguarding procedures should be followed to protect the people who live at the home and the staff. Records should be kept of the staff training to show they have enough knowledge to look after the people who live at the home. Care Homes for Adults (18-65 years) Page 8 of 31 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Christine Bowman The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some accurate and up to date information is available to prospective service users to help them to decide if the home is able to meet their needs, but some of the information is not specific to this home or out of date, which could be misleading to prospective service users and their representatives. All the service users came to live at the home when it was under previous management and the home did not have a full assessment form to ensure sufficient information would be gathered about a new service user. Evidence: Seven of the nine service users currently living at the home, had been living there for sixteen years and the most recent admission was eight years ago. The AQAA recorded that there had been no new admissions since the previous site visit, two years ago, and described the admissions process in place, as completing a full assessment of need in conjunction with the prospective residents representatives, and visits to the home including overnight stays. All the service users, who completed surveys themselves or with the support of a relative, confirmed that they had enough information about the home before they moved in to decide if it was the right place for them, and that they had been asked if they wanted to move in. At that time, another organisation owned the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: home, so it was not possible to comment on the process as described by the manager in the AQQA, because no new service users had moved to the home under the present management. We asked for the assessment form used for collecting information about new service users to help the home to decide if their needs could be met there, and no form was available to be sampled. We requested the information available to prospective service users, and a statement of purpose, which had been reviewed within the previous twelve months, was supplied. This document informed prospective service users that, if they would like to live at Tilmore Gardens, that admission follows an assessment of need by the Social Services Department for the area in which they live. The complaints procedure was not included in this document as required, and the contact details of the Care Quality Commission were also not included to inform service users, their representatives and the staff. The scheme is registered with the National Care Standards Commission the document recorded, but this organisation ceased to exist almost five years ago. A one-page leaflet illustrated with colourful photographs of the service users, smiling and socialising in the garden and in the home, and completing a jigsaw puzzle, had been produced. It gave a brief description of the home, the facilities, the organisation and places of interest in the area. A service user comment of, great facilities and a lovely atmosphere, this is a nice place to live, had been included. This document informed prospective service users that, all Sanctuary Care Homes are registered with the Care Quality Commission, but no contact details were included. Other information available was a well illustrated brochure completed by the organisation, Sanctuary Care, which informed us that they were dedicated to the care of older people. A file of information available in large print,which including the philosophy of care of the Sanctuary Care Group, was not specific to this home. The responsible individual, in their response to this draft report, confirmed that service users have access to the complaints procedure, which does include the contact details of the CQC. The statement of purpose, however, should be a stand-alone document and contain all the required information so as to inform and not mislead propective service users and their representatives. He also informed us that the service users have been involved in making a DVD to be completed in January 2010, which involves individuals giving feedback about living in Santuary Care homes and about the support they receive, to inform prospective residents. They also confirmed that an assessment form is available to homes as standard. 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 who use the service benefit through being fully involved in making decisions about their lives, and playing an active role in planning the care and support they receive. Evidence: Three service user care plans were sampled at this site visit and all had been reviewed within the previous six months. Good background information was included with respect to the service users religious and cultural needs and the involvement of health and social care professionals. Important information about family relationships, health, behaviour, hobbies and interests, likes and dislikes, allergies and medication needs were recorded to inform the staff. The manager wrote in the AQAA, we treat all service users as individuals and their care plans are completed in a person-centred way, in which they are fully involved in all decisions about their care. The person-centred plans were not in the main file and were not made available until late in the day. One service users Personal Planning Book sampled contained symbols and photographs and explained the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: individuals communication needs, from their point of view, to help the staff to understand them. Important people in their life were included, in circles of support, and their life story. Health needs and keeping safe were included and a very detailed list of things they like, and like to do, and things they dont like. Their hopes, dreams and aspirations for the future were included. Plans for holidays and trips had been explored, and this service user had planned a trip to Devon, seen a musical recently, and was planning to go to a live show. The manager wrote in the AQAA, each service user is allocated a key worker to support them in decision-making about their care and with making choices. One service user, who did not have family involvement, and whose communication was limited, had been allocated an advocate to ensure their best interests would be taken into consideration in planning their care. Risk assessments covered the activities of daily living, included a description of the activity, the benefit to the service user of taking part in the activity, a description of the risk involved and the level of risk. Clear instructions to the staff were included, to show how risks could be minimised to protect the service users from harm, whilst supporting them to remain as independent as possible. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide good support for people to take part in suitable activities, to maintain relationships with family and friends, and to have a balanced diet of food they enjoy, but the provision of specialist support for service users, whose needs have changed was not sufficiently clear or appropriate. Staff members work in a manner that respects the rights and responsibilities of the people who use the service. Evidence: Most of the service users had their own timetables, which included for almost all of them, time throughout the week at the day service On Track. This service offered a variety of opportunities including rural skills, gardening, cooking, drama, and art and craft for the service users to participate in. One service user did voluntary work in a bookshop and another had a work experience placement at a playgroup in the local community. On the day of the site visit, two service users were at the day service and one was at work experience. One service user should have been at the day service, but were at home for the day for health reasons. Another service user had been diagnosed with dementia and their activity plan recorded that they no longer attended a day service. There was no Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: timetable detailing how their time would be spent, or how the one to one time allocated to them, would be deployed to support them. On the day of the site visit they were drawing. The three remaining service users were involved in the daily chores of cleaning and tidying their bedrooms, and one was doing their laundry. Individual timetables contained information about daytime organised activities but no details about how service users spent their time in the evenings and at weekends, or how time was spent at the home when not completing chores. The home had a minibus and a car at their disposal to enable the service users to access the community, and the day service and relatives also assisted with the service users transport needs. One service user spoken with said they liked the discos, which were held in Petersfield on Wednesdays once a monthly, and that they enjoyed attending the weekly social club. Some service users are involved in a group set up by the organisation, on behalf of all the service users in the area, to plan events such as the Olympics, which had taken place at a day centre in Hindhead recently, a staff member stated. Service users observed on the day of the site visit were very much involved in the running of their home. Some prepared their own sandwiches for lunch, one service user was observed washing and drying up their cutlery and crockery after lunch and another was doing their own laundry. Minutes of service user meetings, on the notice board of one of the houses, confirmed that service users took the minutes of meetings and recorded menu choices. Some of the service users had been involved in growing fresh vegetables in a plot in the garden for all to enjoy and one of the service users had recently chosen a pet rabbit. A special birthday celebration is being planned for one service user, and they are choosing a new outfit for the occasion, a staff member stated. Six of the seven service users, who completed surveys, recorded that they always make decisions about what they do each day, and one that they usually did. All the service users confirmed that they can do what they want to do during the day, in the evening and at the weekend. Service users care plans recorded involvement with relatives and friends and one service user visited their relative every month. A staff member confirmed that relatives were always invited to care plan reviews, and to social occasions organised at the home, such as the barbecue held recently in the garden for the service users, their relatives and friends. Service users, observed on the day of the site visit, were very much involved with the daily routines of the home, doing their own laundry, cleaning their bedrooms and setting and clearing tables at lunch time. Some had a high level of independence and used their own keys to the front door when returning to the home. Minutes of service user meetings posted on a notice board had been completed by service users, whose writing skills were proficient. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The menu was displayed on the notice boards in the two kitchens and had been written out by the service users. It is decided weekly, a staff member stated, so that everyone has a choice of the main meal over the week and alternatives are provided for anyone who does not like the main choice. Some service users had prepared their own lunch, which was sandwiches, fruit, and yoghourt. One service user needed a soft diet and their lunch consisted of well cooked mince, potatoes and vegetables, which was mixed up together so that none of the components could be identified or tasted individually. With some initial persuasion they fed themselves with a spoon and appeared to enjoy the meal. Support was given in a respectful manner. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal support needs are met because generally clear information is available for the staff to follow, which has been agreed with the service users. Safe procedures are in place to ensure medication is managed safely. Evidence: Records confirmed that promoting the service users privacy and dignity was included in the induction for new staff as an introduction to the caring role, and the staff observed working with the residents on the day of the site visit treated them sensitivity and with respect. A key worker system was in operation, but staff retention had not been good over the previous two years, undermining the continuity and consistency of the support offered to the service users. Some details with respect to the individual service users preferences in how their personal support would be carried out were included in their care plans to inform the staff. However, the one to one role in place for one service user was not fully explained and needs full support with respect to some aspects of their care did not give carers enough clarity. Staff members provided assistance to attend health checks, for example optician, dentist and the General Practitioner (GP). Records in service user files confirmed appointments had been kept and a weekly planner was used to plan health appointments. Correspondence was on file showing that the home liaised with relevant external agencies Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: such as the Community Learning Disability Team to promote the health and well being of people who use the service. Health related information was included in the care plans sampled, giving details of conditions, special diets and allergies, remedies and instructions to the staff on the action to take to support the service users. Medication was stored appropriately in a locked cabinet, and the senior member of staff on duty held the keys. Service users medication was blister packed and colour coded at the local pharmacy for safety and convenience, and a staff member stated that currently no service users took responsibility for their own medication. Medication administration records sampled had been completed appropriately, and photographs of the service users ensured their identity would not be mistaken. Observation of the administration of one service users medication over lunch confirmed this task was carried out appropriately. The staff training matrix recorded that the senior staff responsible for carrying out this task had been provided with externally accredited medication administration training to support them to do so safely. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place and service users confirm they are confident in its use. The organisation does not follow local authority policy and procedure to protect the service users and staff when allegations of abuse are made. Evidence: The home had a complaints procedure available, which sets out who will deal with a complaint and how long the provider will take to respond. The procedure had been supplied to all the service users in an accessible format and was also displayed in the home on a notice board. The seven service users, who completed surveys, or were supported by relatives to complete them, confirmed that they knew who to speak to if they were not happy and that they knew how to make a complaint. No complaints have been received since the last inspection. The home held a copy of the local authority safeguarding adults policy and procedure to inform the staff, and a senior member of staff stated that the protection of vulnerable adults training was included in the induction. A safeguarding referral had been made recently, and a notification informed us that the registered manager had been suspended. No details of the incident were included in the notification, and the manager was reinstated, prior to the Safeguarding Conference taking place, where the decision about whether or not the allegations had been vinicated, should have been made. This action does not protect the service users or the staff member, or comply with the local authority safeguarding policy and procedures. Care Homes for Adults (18-65 years) Page 20 of 31 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. Service users live in a comfortable, homely and safe environment, which meets their needs and is clean and hygienic. Evidence: The home was located in a residential area on the outskirts of the town of Petersfield, and the two adjoining house, which make up the home, were in keeping with other houses on the street. There was car parking to the front of the home for the homes vehicles and a few other cars, and parking was also permitted on the road side. The exterior of the home was well-maintained and there were some colourful pots of plants at the entrance to provide a cheerful welcome. Each house had its own front door, and the service users were provided with keys so they could let themselves in when returning from daytime activities. The two sitting rooms both had French windows opening onto the garden and there was a shared conservatory with cane furniture for the service users to relax in. The soft furnishings in one of the sitting rooms were a little shabby, but both the communal living areas were comfortable, homely and bright, and included dining areas. There were colourful table cloths on the dining tables, cushions on the chairs and sofas, and the lighting was domestic. Both the living areas had been provided with televisions, videos, DVDs and music systems. One of the sitting rooms had been provided with a very large Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: widescreen television, which the service users had requested, a staff member stated, and another identical one had been ordered for the other sitting room. There were magazines and books for the service users to enjoy and some knitting on a side table was in progress. A staff member stated that some of the service users had been involved in making knitted blankets for the residents in an older peoples home. The enclosed garden to the rear of the home was shared by all the service users. A summerhouse in the garden provided storage for games and other equipment. A large part of the garden was laid to lawn, planted with ornamental fruit trees, and divided by a large hedge to make outdoor interest areas. There was a variety of seating for the service users to choose from, an arbour, a swing, a fishpond, and a vegetable garden. Tomatoes, peppers, courgettes and lettuce had been planted to provide fresh vegetables for use in the kitchen. The home was on three levels, accessed only by narrow staircases, which potentially could be problematic as the service users needs change, and mobility becomes an issue. Bedrooms sampled had been appropriately personalised and two friends shared a bedroom on the top floor, which a staff member stated, had been their choice. Since the previous site visit, the AQAA recorded that a new alarm system had been installed to provide better security and that a walk-in bath had been provided to make bathing easier for the service users. New storage cupboards had been provided in one of the kitchens and in the office to improve the environment. The laundry room was shared by the service users and equipped with a washing machine, dryer and adjustable ironing board for their use. One service user was in the process of laundering their own clothes. A staff member stated that risk assessments are completed to make sure service users are able to manage this task safely. The home was wellequipped with hand washing facilities and liquid soap to promote good infection control practices, but paper towels and toilet paper could not be left where they were required due to the habit of one service user of tearing up paper and putting it down the toilet. All the service users and staff were provided with individual supplies of paper hand towels and toilet paper. This is not conducive to living an ordinary life and other methods of dealing with this problem should be explored. Infection control training was not up to date on the staff training matrix, but the AQAA recorded that the home had a policy for preventing infection and managing infection control, that they have used the Department of Health guide Essential Steps to assess the homes current infection control management, and that ten staff had received training on the prevention of infection and management of infection control. Six of the seven service users, who completed surveys, recorded that they thought the home was always clean and fresh and one that it usually was. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a staff team, who confirm they are well-trained to support their needs, but records do not confirm this. Recruitment procedures protect and involve the service users and ensure that only suitable people, whom they have been involved in choosing, work with them. Evidence: Since the previous site visit, two years ago, eight of the original twelve staff had left the homes employment, which does not provide the service users with consistency and continuity of support. The most recent AQAA recorded that there were currently ten permanent staff and eight bank staff working at the home. However, the staff training matrix recorded the names of only eight staff, as two of had left the homes employment at the beginning of this year. A senior member of staff stated that there were always three staff on the duty rota and sometimes more, but on the morning of the site visit until after lunch, there were two male staff looking after the needs of five service users at home, one of which, required one to one care. The most recent AQQA confirmed that there had been significant changes in the service users needs since the previous AQQA was completed a year ago, in that two service users had developed dementia and two service users now needed additional support with respect to their personal needs. No service user had required the support of two or more staff to help with their care a year ago, but currently the AQAA recorded that this help was required by three service users in the day and by four at night. A waking night staff member had been allocated for this Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: purpose and on-call support was available. The AQAA recorded that 50 of the permanent staff had either achieved a National Vocational Qualification at level 2 or above in Health and Social Care or were working towards one. Of the pool of bank staff only two of the eight staff had achieved this qualification and none of the remainder was working towards one. The responsible individual recorded in their response to the draft report that, at the time of the inspection, the bank staff were on a six month probationary period and would not have been put forward until after this had been completed. However, the organisation has agreed that staff can now be registered to undertake a NVQ after three months probation. Six of the seven service users, who completed surveys, recorded that the staff always listen and act on what they say, and treat them well, and one that they usually did. All of the seven staff, who completed surveys recorded that they thought there were always enough staff to meet the individual needs of the people using the service. Staff, observed on the day of the site visit, were sensitive in their interactions with the service users. Their manner was cheerful and friendly and they were kind, understanding and aware of the service users needs. The files of two staff recruited since the previous site visit contained all the checks and information required for the safety and protection of the service users.100 of the staff, who completed surveys, confirmed that their employer had carried out checks such as Criminal Record Bureau and references before they started work to ensure that only those suitable to work with vulnerable adults would be considered. Personnel files sampled were well-organised, contained a full employment history, with gaps explained and reasons for leaving former employment to confirm suitability. Interview notes and equal opportunities monitoring forms were included to confirm a fair approach. The AQAA recorded that the service users take part in the recruitment of all staff, to ensure that they liked the people who would be working with them, and one service user commented that this was something the home did well. The manager recorded in the AQAA that there was currently one in-house trainer and that all staff receive regular training, however the staff training matrix recorded only eight staff in addition to the manager. This document was not up to date and showed lapses in mandatory training. There were gaps in moving and handling, health and safety, fire safety, and infection control. Food hygiene, medication administration and the protection of vulnerable adults training was up to date for most of the staff, but the organisations renewal date for the protection of vulnerable adults training had not been adhered to by two years in two cases and not at all for staff employed this year. However, three shift leaders had up to date externally accredited training in First Aid and small number of staff had received training in person-centred care, communication, records and record keeping, challenging behaviour and the Mental Capacity Act to support the service users with their needs. Although the AQAA recorded that two of the Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: service users had been diagnosed with dementia and another service users care plan recorded they had an Autistic Spectrum Disorder, there was no record of training to support these needs and there was no record at all of the training for the bank staff. The manager stated that all the staff had completed a Learning Disability Qualification, but the certificates to confirm this had not yet been received from Head Office. The responsible individual pointed out in their response to the draft report, that the staff training matrix would not be updated until the certificates were received. All of the seven staff, who completed surveys, confirmed they are being given training, which is relevant to their role, helps them understand and meet the individual needs of the service users, keeps them up-to-date with new ways of working and five recorded that it gives them enough knowledge about health care and medication. There was evidence in the two staff files sampled that an induction had been completed and that this covered how the service users privacy and dignity would be protected, but did not include all the Skills for Care Common Induction Standards as recommended in the Care Standards. There were no individual training and development logs to show how the training needs of the staff had been met. The staff training matrix did not record an induction for any of the staff, but the seven staff, who completed surveys, recorded that they thought their induction covered everything they needed to know to do the job when they started, very well. Care Homes for Adults (18-65 years) Page 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is suitably qualified to run the home and service users views are taken into consideration in the development of the service. Systems are in place to promote the health, safety and welfare of the service users, but policies and procedures are not specific to the home. The staff are not regularly updated in some areas of mandatory training, to keep them informed of current practise to protect the service users. Evidence: Since the previous site visit on 3rd October 2007, the acting manager had been appointed to the management position, and had applied to the Commission for Social Care Inspection (CSCI), the body responsible for regulating the service at the time, and been accepted as the registered manager for the service.The registered manager had completed a National Vocational Qualification at level 4 in care and the Registered Managers Award to support her in her role. She stated that she had also accessed training through the local authority in care planning, the Mental Capacity Act, safeguarding adults, health and safety and is planning to do the medication training in order to cascade this training to the staff. She stated she had also undertaken training in person-centred planning for people with learning disabilities, undertaking investigations, Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: managing performance and appraisal, and legionella awareness. The home had conducted a quality assurance survey of its service users and the information had been collated and results published and illustrated with pie charts. There had been an 80 response with high levels of satisfaction with the environment, including cleanliness, maintenance and security and the facilities available. Service users either agreed or strongly agreed that they were happy with the food provided, that there was a good choice and that they can request the food that they prefer. The AQAA recorded that the service users are involved in monthly house meetings when they take turns to chair and write the minutes with assistance from the staff. As a direct result of listening to the service users, an activity room has been set up, and a knitting club, video club and library have been provided. Service users had been taken on a planned holiday to Devon, as they had requested. The AQAA recorded that equipment had been tested or serviced as recommended by the manufacturer or other regulatory body, and certificates sampled, confirmed that servicing had been carried out in a timely manner, for the protection of the people using the service and the staff supporting them. The AQAA also confirmed that the Control of Substances Hazardous to Health (COSHH) risk assessments had been reviewed and updated to safeguard the people living in the home. However, although the COSHH cupboard was safely locked to protect the service users, some substances were also stored in another cupboard situated above this cupboard, and this was not locked. A senior staff member took action to remedy this situation immediately to protect the service users. The AQAA recorded that policies, procedures and codes of practise in relation to health and safety had been reviewed within the previous two years to ensure the staff had been kept up to date with current legislation and practice. However, policies sampled were not specifically written for the home, but were organisational policies. Gaps left to be completed locally had been left blank on the policies and procedures sampled. The staff training matrix was not up to date and it was not possible to confirm that mandatory training had been updated on a regular basis. Where training had been accessed and updates had been included, these had lapsed in many cases. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes  No  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 Description Timescale for action 1 35 17 A record of all the training 21/11/2009 undertaken by the staff must be kept to confirm they have the right knowledge and skills to meet the needs of the service users. 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 Description 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 40 Policies and procedures should be relevant to the home and contain local information to inform the staff. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) 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. 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