Care Home: 3 Mallard Close

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What the care home does well One person had moved into 3 Mallard Close shortly before we visited the home. Their needs had been assessed before the move, so that a decision could be made about whether the home would be suitable for them. This person had made some introductory visits to the home. The outcome of the visits and the assessments had been written down. This meant that staff had good information about the person when they moved in. People have individual plans which provide staff with good information about what they like to do and how they should be supported. Risks are being assessed, which helps to ensure that the people who use the service are safe when in the home and out in the community. Staff support people at the home with their individual interests. One person is particularly keen on knitting. Lessons have been arranged so that they can learn more about this and improve their technique. This person also liked to cook. They helped to prepare the meals and told us that they had made `Beef Wellington` recently. Everybody at the home can make suggestions about what to have on the menu. People benefit from the individual support that they receive with their meals. Meetings are being held when the people at the home can talk to staff about their goals and new things they would like to do. One person had bought a smoothie making machine and has other goals which involve going to interesting places outside the home. Staff help people with making arrangements for seeing health care professionals, so that their specialist needs are met. There are procedures in place which help to protect people from harm and help to ensure that any concerns are well responded to. The accommodation is homely and well maintained. People have been well supported with decorating and personalising their own rooms. Overall, people are supported by competent staff and live in a well run home. What has improved since the last inspection? There is better information available about financial matters, such as what the fees cover and what people need to pay for out of their own money. The home had recently changed to a monitored dosage system for medication, which we were told was an improvement on the previous arrangements. Improvements have been made to the home environment. The lounge has been redecorated. This is a light and comfortable room which has been well furnished. The grounds have also received attention. Garden furniture has been bought and some new features created. There are plans to redesign parts of the garden, so that it is easier for people to use. The area at the front of the home has been landscaped and the layout improved so that it is a better area for parking. Some information, for example the agenda for Tenants meetings and the home`s complaints procedure, has been produced using pictures and symbols. This is a more user-friendly format for the people who live at the home. Staff members have attended a day`s course about equality and diversity. This training helps to ensure that staff understand the rights of the people who use the service and support people in a way which respects their different needs. What the care home could do better: We were given information in the AQAA about the home`s plans for the year ahead and the areas in which it could improve. These included providing more recreational activities for the people who use the service. It was also reported in the AQAA there are plans to enhance the home`s Statement of Purpose, by adding photographs and including more information. The organisation has been looking at how information generally can be made more accessible to people. There has been some progress with this, for example by having a more user-friendly complaints procedure. We have recommended that the personal records in relation to the people who use the service, such as their care plans and PCPs, also receive attention. These plans are generally lengthy, written documents. Although informative for staff, different formats should be looked at which would be more accessible to the people who use the service. We have also recommended that the risk assessment process is reviewed. This is with aim of having a more person centred approach, and ensuring that information about risks is included within people`s individual plans. Health Action plans still need to be completed with the people who use the service. The manager has undertaken training to be a health plan facilitator, in preparation for this. We were told that staff members are also to receive this training. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 3 Mallard Close 3 Mallard Close Bowerhill Melksham Wiltshire SN12 6TQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 2 8 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: 3 Mallard Close 3 Mallard Close Bowerhill Melksham Wiltshire SN12 6TQ 01225707215 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ordinary Life Project Association care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 3 Mallard Close is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). 3 Mallard Close is a detached, two storey property in a residential area on the outskirts of Melksham. The accommodation includes four single bedrooms, a lounge with a dining area, a kitchen and a separate utility room with laundry facilities. The lounge has patio doors to a garden at the rear of the property. One of the bedrooms is on the ground floor and is next to a shower and a toilet. Upstairs there is a bathroom and a separate toilet. There is an office and sleeping-in room for the use of staff. People who live at the home receive support from the homes manager and a Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 2 2 Brief description of the care home permanent staff team. The fees range from £694.89 - £831.03 per week. Information about the home is available in a Statement of Purpose. Copies of inspection reports are available from the OLPA office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. Inspection reports can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 32 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: Before visiting 3 Mallard Close, we had asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. The AQAA told us about what has happened during the last year and about their plans for the future. We sent surveys to the home so that these could be given out to the people who use the service and to staff members. This was so that we could get their views about the home. We had surveys back from two people who use the service and from two staff members. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what to focus on when we made an unannounced visit to the home on 28th August 2009, at 10am. We spent time with the three people Care Homes for Adults (18-65 years) Page 6 of 32 who were living at the home and we met with staff. We were shown around the house and looked at a number of records. During the afternoon, the people who use the service went out with staff. We later returned to the home in order to complete the inspection. The previous inspection of 3 Mallard Close took place on 30th August 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? There is better information available about financial matters, such as what the fees cover and what people need to pay for out of their own money. The home had recently changed to a monitored dosage system for medication, which we were told was an improvement on the previous arrangements. Improvements have been made to the home environment. The lounge has been redecorated. This is a light and comfortable room which has been well furnished. The grounds have also received attention. Garden furniture has been bought and some new features created. There are plans to redesign parts of the garden, so that it is easier for people to use. The area at the front of the home has been landscaped and the layout improved so that it is a better area for parking. Some information, for example the agenda for Tenants meetings and the homes complaints procedure, has been produced using pictures and symbols. This is a more Care Homes for Adults (18-65 years) Page 8 of 32 user-friendly format for the people who live at the home. Staff members have attended a days course about equality and diversity. This training helps to ensure that staff understand the rights of the people who use the service and support people in a way which respects their different needs. 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 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 32 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 32 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. Information is available about 3 Mallard Close, which helps people to make an informed choice about where to live. Peoples needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. Evidence: There was a Statement of Purpose, which gave details about how the home is being run and the services that are provided. We were told in the AQAA that there were plans to enhance the Statement of Purpose by including photographs and some further information. Information for the people who use the service was included in a Service Users guide. We saw at the last inspection that the guide did not include details of what the fees covered and what people had to pay for out of their own money. We looked at the guides again during this inspection and saw that information about this had been included. For example, it was reported that OLPA paid an allowance for meals bought outside the home, but the person who uses the service would have to Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: make up the difference if their meal cost more than this. It was also stated that if somebody wanted to have organic food then they would need to pay the difference in cost compared to normal house purchases. There were three people living at the home at the time of our visit. We met with one person who had moved in during the last two weeks. They had visited the home on two occasions before moving in, so they could have a look around and meet with the other people. Notes of the visits had been made and kept on the persons personal file. The notes included a number of things that had been learnt about the person during the visits. For example, they liked the homes cat, did not like their meals to be rushed, and appeared to get on with the other people at the home. This helped to ensure that staff had good information about the person when they moved in. We read that the homes manager and an OLPA service co-ordinator had carried out a pre-admission assessment of the persons needs and current circumstances. OLPA had produced an assessment form for this purpose. The information was clearly recorded, although the form had not been signed by the assessors. The assessment covered a range of areas, including health; mobility; relationships; looking after yourself; and finance. There was a statement on the form which emphasised the importance of considering issues relating to diversity when undertaking the assessment. We saw that comments in the Other Issues section of the form had been made in relation to sexuality and faith needs. This information helped to ensure that staff had the knowledge that they needed to provide support in a person centred way. Care Homes for Adults (18-65 years) Page 12 of 32 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 have individual routines and receive support with making decisions. They are asked about their needs and goals, which are then reflected in individual plans. Risks to people are assessed, which helps to ensure that they are safe in their daily activities. Evidence: The people who use the service were doing different things when we arrived at the home. One person was having breakfast and we were told that they liked to take their time with all their meals. The other two people had already had breakfast. One person was watching television and somebody else was getting ready to go out shopping with a staff member. People told us about their individual interests and the things they enjoyed doing. One person did a lot of knitting and crocheting and they made items for a charity. They also enjoyed cooking and going out. Somebody else had a favourite chair in the lounge and liked to watch television. They also liked to go out and visit different Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: museums Some of peoples usual activities were not taking place because of holidays. During the morning, staff talked to people about what they would like. They decided to go out during the afternoon and to try a new cafe. People told us that they met together at Tenants meetings to talk about things together. We saw minutes of recent meetings. People had talked about the meals; where they would like to go on days out; and how they were getting on with each other. We read that one person had said that they would like liver and bacon to be put on the menu. They later told us that they had had this meal. They also told us that they had helped to cook a Beef Wellington recently. There was a key worker system in operation. As part of this, each person who uses the service met with a staff member regularly to talk about things. Meetings were also being arranged when people talked about their personal goals for the year ahead. These were then recorded in a Person Centred Plan (PCP). The PCPs included Goal Review Sheets on which to record peoples progress, every three months, with meeting their goals. The person who had recently moved into the home did not yet have a PCP. We saw other peoples PCPs on their individual files in the homes office. One person also showed us a file with the same information that they kept in their room. They had a number of goals which had been agreed at a meeting in October 2008. These included having knitting lessons and learning to cook cakes. This person told us that they were now doing these things. We looked at another persons PCP, which included 15 goals that had been agreed in September 2008. These included getting a smoothie maker; having a vegetable plot; and visiting museums. A Goal Review Sheet had not been completed, so there was no record to show the persons progress with achieving these goals. However there was a second Goal Sheet, which included five of the goals and some entries had been made on a Goal Review Sheet. The homes records included a Risk Assessment file. This included a section on assessments that had been undertaken in connection with peoples individual activities. We read, for example that an assessment had been carried out in relation to one person going to a local shop on their own. The risks had been identified, although the risk assessment format did not refer to the persons rights, or the benefits to them of participating in the particular activity. We thought that this would show a more person centred approach to how risks are assessed. There was a space for people, including the person who uses the service, to sign the assessment forms, but this was Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: not happening consistently. Care Homes for Adults (18-65 years) Page 15 of 32 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. People are involved in the local community and have activities that they enjoy. They receive support, which helps them to maintain relationships and make choices in their daily lives. There is a varied menu and people benefit from the individual support that they receive with their meals. Evidence: As reported under the Choice of Home section, one person had moved into the 3 Mallard Close within the last two weeks. They were having a settling in period, during which time staff were getting to know the persons daily routines and the sort of things that they liked to do. This person was going out with staff on various trips, which helped them to get to know the local area. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Two people had lived at the home for a number of years and had well established routines during the week. One person told us that they went to a local college and to a day centre, but was on holiday from both these at the time of our visit. They told us that they also had unplanned time during the week when they did things at home or went out locally. This included helping with the food shopping and with recycling, and looking after the house cat. This person said that they had been able to go to a local shop and post office themselves, but this had recently closed unexpectedly. They had also visited some shops in the nearby town as they were hoping to have a part-time job. The other person was in their 80s and appeared to enjoy a more relaxed lifestyle in the home. They had a favourite chair in the lounge, which was well positioned for watching the television and for looking out on the garden. This person also attended a day centre and went to a Gateway Club once a week. They attended a service at a local chapel regularly. They also enjoyed visiting museums and their PCP included goals in connection with this. The people who use the service were looking forward to having a holiday in a caravan in Weymouth that is owned by OLPA. The home had its own vehicle for trips out. Each person had their own room where they could be private. It was seen during the visits that people had the freedom of the home and could choose where they wished to spend their time. We heard that people helped out in the garden and one person told us that they liked using this area. Information about peoples family details and relationships was recorded in their personal files. One person told us that they kept in close contact with a family member and staff helped them with the visiting arrangements. They also kept in touch on the telephone, as was evident during our visit. There was a dining area in the lounge where people could have their meals together. Information about peoples likes and dislikes was recorded in their individual records. There was also information about nutritional needs and one persons meals were specially prepared. People told us that they helped to choose the menu each week and could talk about the meals at the Tenants meetings. One person was having their breakfast when we first arrived at the home. Staff were aware that this person liked to take time over their meals and were respecting this. Care Homes for Adults (18-65 years) Page 17 of 32 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. Peoples health and care needs are being met. People are protected by the way that their medication is managed. Evidence: The people who use the service were up and about when we visited the home. Personal support was limited to verbal prompting and encouragement to complete certain tasks. A staff member nicely spoke to one person about the need to wear suitable clothing when leaving the house to go out. Each person who uses the service had a care plan on their personal file. The plans consisted of a number of forms and statements which provided information about the personal support that people needed. Statements had been written about gender and the provision of personal care. The care plan forms and statements covered a lot of different areas, but were not consistently dated. This meant that it was not always clear when the information had been written and how up to date it was. However, care plan review sheets were being used for recording changes that had been made to the plans. These showed a number Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: of changes that had been made during the last year. We also saw occasions when the content of the care plans had been updated, for example in relation to medication, although this was not shown on the care plan review sheets. Guidelines for support had been produced in areas such as nail cutting, bathing and managing certain behaviours. Nutritional assessments had been undertaken. One person had an individual menu plan which included blended foods, which helped them to maintain their nutritional intake. A staff member told us, for example that when meat such as a roast was prepared, it was then blended to include in the persons meal. This persons weight was being monitored to help identify any significant changes which might need to be followed up. We read in their personal file that this person had seen a doctor earlier in June 2009 who was pleased with their weight and overall health. Peoples personal files included forms for the recording of visits to doctors, dentists and chiropodists. A number of visits had taken place in the last few months, including appointments with GPs for routine check ups. We read that staff were following up the health needs of the person who had recently moved into the home. This person had visited an optician and an assessment with a specialist nurse was being arranged. The people who use the service did not have Health Action plans, although we were told that staff members were shortly to receive training as Health Action plan facilitators. People received support from staff with the safekeeping and administration of their medication. They had signed forms giving their consent for this. There were suitable storage facilities for the medication that was being prescribed. The storage arrangements did not comply with the requirements for controlled drugs, although we were told that these drugs were not currently being kept in the home. A medication file was kept in the office, which included a copy of OLPAs medication procedure. There was other guidance for staff, such as the need to be aware of expiry dates and information about the medication that people were prescribed. Staff members received training before being able to administer medication to people. Records were being maintained for the receipt and disposal of medication. Records of the administration of medication were up to date. The home had recently changed to a monitored dosage system, which we were told was an improvement on the previous Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: arrangements. Care Homes for Adults (18-65 years) Page 20 of 32 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. People are listened to and encouraged to express their views. There are procedures in place which help to ensure that any concerns are followed up and people are protected from harm. Evidence: OLPA had produced a complaints procedure and a copy of this was available in the home. The Service Users guides also contained information about how to make a complaint. We were told in the AQAA that one improvement made during the last year had been to design a complaints procedure leaflet in large print with symbols. There were also plans to hold a workshop for the people who use the service. This would be in order to aid their understanding of the complaints procedure. In their surveys, the people who use the service confirmed that they knew who to speak to if not happy with something. One person commented that they could speak to the house manager, staff or head office. They also told us that they could fill in a form to make a complaint. We were told in the AQAA that no complaints had been received during the last year. People could also raise any issues or concerns during their key worker review meetings or at the Tenants meetings. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Staff members had attended a course on Abuse Awareness, as part of OLPAs in-house programme of mandatory training. We had recommended at the last inspection that the arrangements for training are reviewed. This was so that staff had the opportunity to attend further training which would keep them up to date with the procedures for safeguarding adults. Staff members could now attend refresher training and we were told in the AQAA about a new e-learning training package which included the subjects of safeguarding adults and mental capacity. OLPA had produced polices and procedures in relation to the safeguarding of vulnerable adults. These referred to the local multi-agency procedures for the reporting of concerns and allegations of abuse. We were told in the AQAA that each staff member had been given a copy of the No Secrets booklet, which summarises these procedures. They had also been given a copy of the General Social Care Councils Code of Practice. There have been no safeguarding adults referrals or investigations during the last year. We were also told that there had been no incidents involving the use of restraint. The people who use the service received support from staff with the management and safekeeping of their personal money. This included advice about budgeting. A staff member told us about how peoples personal money was being kept safe and accounted for. Receipts were being obtained when staff supported people with their shopping, and records kept of transactions involving peoples money. The people who use the service signed a record to confirm when took out their money for personal use, such as when going to the Gateway club. We saw that peoples money was being kept individually in locked facilities. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely and well maintained environment. The accommodation is kept clean and tidy. Evidence: 3 Mallard Close is in a well established residential area. The house did not stand out as being a care home and its appearance was in keeping with the neighbouring properties. There were a few community facilities in the immediate vicinity, although people went to one of the nearby towns for most of their shopping. We were shown around the home. People had been well supported with personalising their rooms, so that they reflected peoples preferences and interests. There was one bedroom on the ground floor, which had a WC and shower room next door. There was a bathroom and WC close to peoples rooms on the first floor. The person who had recently moved in had been asked to choose the decor for their bedroom. The room had then been painted and a new carpet fitted to replace the vinyl floor covering that was there before. 3 Mallard Close was an ordinary domestic property and had been decorated and furnished in a homely way. There was a kitchen and a separate utility room. Risk assessments had been undertaken and safety measures implemented, which helped to Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: ensure that the kitchen was a safe area for people to use. The home used the Safer food - Better business system for the monitoring of standards in the kitchen. There was one communal room which served as a lounge and dining area. It had been redecorated since the last inspection and new sofas bought. This was a light and comfortable room, with patio doors to the garden. People told us that they liked the garden. Garden furniture had been bought during the last year and some new features created. There were plans to redesign parts of the garden, so that it would be easier for people to use. This included having some raised beds. The area at the front of the home had been landscaped and the layout improved so that it was a better area for parking. . The home looked clean and there were no unpleasant odours. Staff members took the lead in cleaning the home. There were rotas and job lists for particular tasks, such as cleaning in the bathroom and the kitchen. The people who use the service helped with cleaning their own rooms. The people who use the service told us in their surveys that the home was always kept fresh and clean. One person commented I like to tidy my room. Laundry facilities were available in a utility room. This meant that the laundry could be kept separate from the kitchen and dining areas. OLPA had produced guidance for staff about infection control and communicable diseases. Food hygiene and infection control were included in the staff training programme. Care Homes for Adults (18-65 years) Page 24 of 32 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. People are supported by competent staff who have been safely recruited. Evidence: We were told in the AQAA that no staff had left during the last year, and no new staff had been recruited. OLPA had produced a procedure for Recruitment, Selection and Appointment. We have looked at the recruitment of staff at a previous inspection and found that appropriate checks on staff had been undertaken. In their surveys, the staff members confirmed that their employer had carried out checks, such as CRB (Criminal Record Bureau) and references before they had started work. We asked staff in their surveys if their induction had covered everything they had needed to know to do the job when they started. Both staff members had responded Very well to this question. When we asked staff What does the home do well one staff member commented The home is always up to date with training. We also asked staff in the surveys What could the home do better. One staff member commented 24 hours is a long shift when you are lone working. We looked at the deployment of staff during our visit. Lone working was an established practice when there were two people living at the home. Additional staff were deployed at specific times during the week. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: We talked to staff, who said that staffing levels were currently being reviewed in the light of a third person moving into the home. We were told in the AQAA that there were plans to increase the number of recreational activities that people are involved in. This, together with the support that people need with achieving their personal goals, will also have an impact on how staff will need to be deployed in the future. It was reported in the AQAA that new staff would be enrolled on the Learning Disability Qualification (LDQ). The homes manager was an LDQ marker. After induction, staff would then progress to National Vocational Qualification (NVQ) at level 2. All the current staff had achieved their NVQ at level 2. OLPA employed a training officer who planned the organisations programme of mandatory training and arranged for staff members to attend external courses. There was a training plan in the home, which showed the dates for mandatory courses. This helped to ensure that staff kept up to date with their mandatory training and attended refresher courses when needed. We spoke to a staff member who confirmed that they had attended the mandatory courses. We had recommended at the last inspection that the provision of training is reviewed, to ensure that it included subjects relating to equality, disability awareness and diversity. The staff member said that they had attended an Equality and Diversity training day in July 2009. This training had been arranged with an external consultant. It was reported in the AQAA that this training had been arranged for all staff. We were told that all staff had also attended a two-day workshop on Death, Dying and Bereavement. Staff members had their own individual training records. We looked at one staff members record. This showed that since the last inspection they had attended courses in fire; manual handling; health and safety; infection control; and medication. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a well run home. Procedures are in place, which help to ensure that improvements are made and people benefit from a safe environment. Evidence: Ms Godsell has been the manager of 3 Mallard Close since 2005. Prior to this, Ms Godsell had gained management experience while working in another care service. Ms Godsell has completed the Registered Managers award and achieved a NVQ in Care at level 4. The records that we saw were mostly being well maintained and there was an organised approach to the administration. Records in relation to the people who use the service, such as their care plans and PCPs, were contained in personal files that were being kept securely. The plans were generally lengthy, written documents. They were informative for staff, although the format may not be meeting the individual needs of the people who use the service. The organisation has been looking at how other information, such as the complaints procedure, can be made more accessible to Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: people. People were able to pass on their views during meetings that they had in the home. Quality assurance systems have been developed over recent years and Ms Godsell has taken the lead in producing development plans for the home. We saw an Annual Development Plan for the home which was dated September 2008. This included the headings of House environment; People supported; Training; Budgets; and Food. We thought that this was a very comprehensive document. Objectives had been identified and there were sections for recording the action that was being taken to meet these. The plan did not show how feedback from the people who use the service and from other parties had contributed to the objectives. This would have shown that the plan reflected peoples views and suggestions. There were objectives in relation to the people being supported, which concerned people visiting places. This was also reflected in their individual goals. A senior manager from OLPA visited the home regularly and produced reports about the conduct of the home. We met with one of the managers when we visited the home and talked about the process. The home looked well maintained. We were given information in the AQAA about the arrangements being made for servicing equipment and appliances in the home. This included, for example the testing of portable electrical equipment. A fire risk assessment had been undertaken. This looked at the hazards in different rooms and areas of the home. A fire log book was being maintained which showed that regular checks were being made of the homes fire alarm system and emergency lighting. There was also a carbon monoxide detector which was being regularly checked. Other risk assessments had been undertaken in relation to the home environment. These covered a varied range of activities and facilities, such as radiators, uneven surfaces, and the storage of hazardous substances. Dates had been recorded to show when the assessments had been reviewed since they were first undertaken. The risks were being reviewed regularly, but they had not yet been reviewed following a persons recent move into the home. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 That peoples individual plans include information about the risk assessments that have been undertaken and the outcome of these. Alternatively, a system of crossreferencing could be used between the individual plans and the risk assessments. This is so that all the information in relation to a particular need is in one place, or can be readily identified. That the risk assessment process is reviewed. This is with the aim of having a person centred approach, in which the benefits of a particular activity are considered in addition to the hazards. The care plan review sheets should be consistently completed to show when the contents of the plans have been changed. This is to ensure that there can be no misunderstandings about when the plans have been updated and contain new information. That Health Action plans are completed in conjunction with the appropriate healthcare professionals. That a cupboard which meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe Page 30 of 32 2 9 3 18 4 5 19 20 Care Homes for Adults (18-65 years) 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 custody) (Amendment) Regulations 2007 is installed in the home. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. 6 39 That the Annual Development plan shows how feedback from the people who use the service and from other parties has contributed to the objectives. This is to ensure that the plan reflects peoples views and suggestions. That the way in which peoples individual plans and records are produced is reviewed. This is with the aim of having the information in formats which are more accessible and userfriendly for the people who use the service. That the risks assessments are reviewed as soon as practicable after a person has moved into the home. 7 41 8 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: 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 © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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