Care Home: 4 Ashley Drive

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What the care home does well Systems are in place to ensure that prospective service users are fully assessed prior to admission to ensure that the home can meet their needs and to consider compatibility with other service users living at the home. Risk assessments are in place which are kept up to date and reviewed and promotes service users safety. Service users are supported to maintain contact with family and friends. Service users have access to health care professionals which promotes their health and well being. The home has had a service user that they supported with a range of community health professionals in providing end of life care to with positive feedback received on how well they managed that. Systems are in place to enable service users to raise complaints and to safeguard service users from potential abuse. Staff are suitably recruited, inducted and trained which safeguards service users. The home is well managed, monitored and audited to promote service users health, safety and well being. What has improved since the last inspection? Medication practices have improved and is now well managed to safeguard service users. The complaints procedure has been updated to ensure that service users have access to up to date contact details. This needs to be updated again with the Commissions new contact details. Improvements have been made to the environment of the home and as a result the home is clean and comfortable which enables service users to live in a safe, warm and homely environment. Improvements have been made to recruitment practices which safeguards service users. The organisation and manager of the home have kept the Commission informed of changes within the home and events which affect the well being of service users, which promotes their safety and well being. The manager has been proactive in obtaining aids and equipment to promote service users independence and in enabling service users to become more involved in all aspects of their care. What the care home could do better: Care plans must be further developed to clearly and specifically outline the care and support required by service users in meeting all of their identified needs to ensure all of their needs are met in a safe and consistent way. Service users care plans must evidence how service users are being supported to make choices and decisions in all aspects of their life with records maintained to evidence this to promote service users self worth, life skills and independence. The registered manager must ensure that measures in place to reduce risks are implemented to promote service users safety. Individual records of activities provided should be maintained to evidence that service users have access to a range of activities on a regular basis. Service user plans should outline family involvement to promote family contact and involvement. Accurate records of meals provided and eaten must be maintained to evidence that service users have access to a varied and nutritious diet. Staff should include the use by date on food items in the fridge to ensure that food is disposed of within the recommended guidelines on food items. Care plans must outline the support required by individuals in meeting their health needs with accurate records maintained of routine health appointments. The organisation should explore with the company that provide specialist feeding equipment the frequency of such training and reassessment of staffs competencies. Records required for regulation should be reorganised and made more accessible to safeguard service users. Individual risk assessments must be put in place to assess if access to latex gloves poses any risks to individual service users. Key inspection report Care homes for adults (18-65 years) Name: Address: 4 Ashley Drive Tylers Green Buckinghamshire HP10 8BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Maureen Richards     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: 4 Ashley Drive Tylers Green Buckinghamshire HP10 8BQ 01494814569 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.turnstone.org.uk Turnstone Support Name of registered manager (if applicable) Miss Patrice Hosier Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the follwing gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disabilities (LD) Date of last inspection Brief description of the care home The service is located in Tylers Green and is a domestic dwelling that has been adapted into accommodation for six people. There are three bedrooms with en-suite facilities on the ground floor and a further three bedrooms on the first floor. The upstairs rooms are accessible by a staircase and not suitable for people with mobility issues. Communal accommodation is comfortable and includes a sizeable kitchen and dining area. There is a pleasant rear garden which is accessible to people with physical difficulties. The home is approximately seven miles from the town centre and there are local facilities within walking distance. The home has its own vehicle and people using Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 6 0 6 1 2 2 0 0 8 Brief description of the care home the service are able to access public transport. current range of fees. Please contact the Provider for the Care Homes for Adults (18-65 years) Page 5 of 35 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: This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a questionnaire known as an Annual Quality Assurance Assessment document was sent to the registered manager for completion alongside comment cards for distribution to service users, staff and visiting professionals. Any replies that were received have helped to form judgements about the service and are reported on under the relevant sections of the report. Service users were assisted by family members to complete the surveys. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussions with the service manager, staff on duty, introduction to the service users, observation of practice, a tour of the environment and examining records required for regulation. Care Homes for Adults (18-65 years) Page 6 of 35 Feedback on the inspection findings and areas needing improvement was given to the service manager during the course of the inspection. Requirements from the previous inspection have been complied with and this inspection has resulted in six requirements to further improve practice. The service manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 35 Care plans must be further developed to clearly and specifically outline the care and support required by service users in meeting all of their identified needs to ensure all of their needs are met in a safe and consistent way. Service users care plans must evidence how service users are being supported to make choices and decisions in all aspects of their life with records maintained to evidence this to promote service users self worth, life skills and independence. The registered manager must ensure that measures in place to reduce risks are implemented to promote service users safety. Individual records of activities provided should be maintained to evidence that service users have access to a range of activities on a regular basis. Service user plans should outline family involvement to promote family contact and involvement. Accurate records of meals provided and eaten must be maintained to evidence that service users have access to a varied and nutritious diet. Staff should include the use by date on food items in the fridge to ensure that food is disposed of within the recommended guidelines on food items. Care plans must outline the support required by individuals in meeting their health needs with accurate records maintained of routine health appointments. The organisation should explore with the company that provide specialist feeding equipment the frequency of such training and reassessment of staffs competencies. Records required for regulation should be reorganised and made more accessible to safeguard service users. Individual risk assessments must be put in place to assess if access to latex gloves poses any risks to individual service users. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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. Systems are in place to ensure that prospective service users are assessed prior to admission to enable the service to meet their identified needs. Evidence: The home has had no new admissions in the previous twelve months. The Annual Quality Assurance Assessment document confirms that when a new referral is made to the home a Turnstone Assessment will be carried out in conjunction with the Social Service assessment to ensure that the home can meet the service users needs.Each service user will be introduced to any new person moving into the home before a move takes place to ensure that they are happy with the new person moving in. The home has a copy of the organisations referrals, assessment, and start of service policy which was reviewed in August 2009. This policy outlines the process and provides prompts for staff to explore specific needs. The organisation has a comprehensive assessment tool which is completed by the service manager and the registered manager during the process of assessment. Completed surveys received from service users confirm that two service users were Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: asked to move into the home and were given enough information about the home to help them decide if it was the right place for them. Two service users indicated they were not asked if they wanted to move into the home and was not given enough information about the home with one person commenting that this was prior to Turnstone taking over the management of the service. Care Homes for Adults (18-65 years) Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans do not address the support required by individuals with all aspects of their care which potentially does not promote continuity of care and service users health, well being and safety. Risk assessments are in place to promote service users health and safety however measures in place to reduce risks must be implemented to further safeguard service users. Service users involvement in decision making is being promoted however support plans do not evidence that service users are supported to make decisions and choices in their every day life, which potentially does not promote service users independence and involvement in all aspects of their care. Evidence: Three service users support plans were viewed. Two of the files viewed included a Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: photograph and a personal details information sheet which outlined ethnicity,religion,what the individual likes to be known and next of kin details. All of the files evidenced service users consenting to photographs and videos and an indication as to whether the service users could sign their care plan or not with coloured stamps being used for two support plans viewed to indicate service users awareness of it. Two of the care plans views outlined the support required in relation to personal care during the day and at night with guidelines in place for all service users on how they like to be supported when things go wrong. One of the support plans viewed was for a service user with high care needs however the support plan in place did not reflect this with no guidance in place on the level of support required with personal care on getting up and during the day. This must be addressed. Support plans included an outline of service users known likes and dislikes and in one file viewed an outline of objects of reference used by that individual. Support plans did not outline the level of support required in relation to other aspects of support for example health needs, life skills, involvement in household tasks, activities, religious needs and communication and this must be addressed to ensure that detailed and specific person centred care plans are in place to support individuals with all aspects of their life. All of the support plans viewed were up to date and showed evidence of recent reviews. None of the service user plans viewed were available in a pictorial format or presented in individuals preferred way of communication to aid service users understanding. The Annual Quality Assurance Assessment document confirms that this is an area for improvement. Service users daily records are written in the first person and gives a detailed record of daily care and support given. Alongside this monthly summaries are completed with service users which gives an overview of individuals monthly progress in relation to most aspects of their lifes. Service users plans were found to be bulky, disorganised and information not filed in date order which made access to some of the required information difficult. As a good practice recommendation this should be addressed. Service user plans evidence service users making a choice of link worker and service users are supported in making choices in relation to evening meals. One of the service user files viewed evidenced an outline of objects of reference used by that individual however none of the support plans viewed evidences how service users are supported to make choices and decisions with every day tasks and activities. The Annual Quality Assurance assessment document tells us that an area for improvement is to source communication tools to enable service users communication and express decisions and this must now be developed on. The home has an advocate from Talk back that visits every other week and is involved in the transition for service users during the re provision and moving into temporary accommodation. The service manager confirmed that they are currently looking into advocates for two individuals and an independent Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: mental capacity assessment was carried out for one service user who choose to stay at the home and receive end of life care from staff at the home and other health professionals. Service users meetings take place regularly with minutes available to evidence this. The minutes of those meetings evidence service users individual responses to discussions and are starting to be developed in a user friendly format with this being an area the registered manager is keen to develop on. One service user feedback that they never make a decision about what they do each day, two service users indicated they sometimes make a decision about what they do each day and one service user indicated usually within their limits. One service user commented under what the home could do better is individual planning. This was not expanded on to enable it to be explored further. All of the service user plans viewed included a serious of individual and generic risk assessments in relation to risks posed to individuals. These were found to be detailed and specific and up to date and reviewed. One of the files viewed did not include a risk assessment for the use of bed bumpers. The service manager felt this was missed at the point of review and was accessed on the computer and put on file. A risk assessment was in place regarding the risk of infection in one service users PEG tube fed area with an indication for it to be cleaned monthly. The staff on duty were unaware of this and no record was maintained to evidence it was being cleaned monthly to prevent infection. A risk assessment was in place regarding the risk of weight loss for one individual however it did not outline the frequency of weighing and weight records indicated this individual was weighed in July and again in October. The service manager advised this was due to the home not having access to a weighing scales during that time which has now being addressed. This must be monitored and the registered manager must ensure that measures in place to reduce risks are implemented. One of the support plans viewed included specific guidance for that individual which was a restriction. This was signed off by the registered manager, service manager and care manager and kept up to date and reviewed. All of the support plans viewed included up to date moving and handling assessments. Care Homes for Adults (18-65 years) Page 15 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accurate records are not maintained to evidence that service users have access to a range of activities, family involvement, involvement in daily routines and are provided with nutritionally balanced meals which promotes individuals social integration, independence and well being. Evidence: All of the service users living at the home at the time of the inspection attend a local day centre facility. Two individuals have days at home during the week with one of those individuals having specific one to one time with staff included as part of their social services contract. As outlined under standard 7 support plans do not evidence how service users make a choice of the activity they want to be involved in. The October service users meetings minutes indicated that two service users wanted to go to a church service on a Sunday. One service users daily records indicated that they had gone to church on the previous Sunday whilst the other indicated they had not Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: gone but it did not indicate if they were given the option to go and changed their mind. The Annual Quality Assurance Assessment document tells us that two people regularly visit the local library and public transport is used by several service users. Five service users go to a night club in Milton Keynes which is run by Adults with Learning disabilities and one person chooses to attend the Gateway club each week. The manager has been proactive in obtaining equipment for one service user to enable them to be involved in evening activities. The Annual Quality Assurance Assessment document tells us that four service users have had a holiday in the last year and that the other two service users had holidays booked but due to ill health these had to be cancelled. Records of activities that have taken place are recorded on individuals daily records and on monthly summaries as opposed to on a separate record on individual files which would enable you to see at a glance the range of activities being offered and participated in. As a recommendation of good practice the registered manager should consider implementing this. On the evening of the inspection some service users were supported by staff to go bowling. One service user feedback that they can sometimes do what they want during the day, in the evening and at the weekend. One person indicated yes they can do what they want during the day, in the evening and at the weekend according to their day service schedule. Two service users feedback that they cannot do what they want during the day, in the evening and at the weekend. This was not expanded on as to why. One person indicated under what the home could do better is to be taken out on trips. Another person commented that what the home does well is taking service users out on trips as a group and individually. Staff commented under what the home could do better is to let service users do more for themselves and more day trips. Another staff member commented that the home should provide a mini bus so that all service users can fit in so that they can go out together as a group as opposed to waiting to go on trips when a service user is out with their family for the day making it one less. The Annual Quality Assurance Assessment document tells us that the registered manager recognizes that improvements are needed to further develop activities and tells us that what they could do better is to ensure activities become part of service users weekly routines and to work towards more activities with service users at different times Some service users have family involvement and individuals were supported by family to complete surveys in respect of this inspection. The Annual Quality Assurance Assessment document tells us that service users are supported to maintain and develop relationships with friends and family members. Support plans include next of kin contact details but do not outline important people in service users lifes and the support required by individuals in maintaining those links. As a recommendation of good practice this should be addressed. Written feedback from one service user included a comment that their parents always feel welcome and communication with Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: the team is good. Their quality of life is much better with Turnstone. The provider meets with families on a quarterly basis to enable them to raise any issues. Records were available for the meeting that had taken place in April 2009. Staff are encouraged to seek service users permission to enter their bedrooms although when the service users are out at day centres during the day this is difficult to maintain. Service users are supported to open the front door to visitors although during the inspection it was observed that this was on ad hoc basis and was dependent on the staff member on duty as opposed to daily practice. This was feedback to the service manager to address with the individual staff concerned and to ensure that it is reinforced to staff to promote the philosophy of the home and service users involvement in the home regardless of whether the manager, service manager or an inspector is in the home. The service manager confirmed that service users have a key to the front door with the Annual Quality Assurance Assessment document indicating that what the home needs to do better is to support service users to use their own door key. Service user plans outline service users preferred form of address but does not outline the support required by individuals in managing their post. As a recommendation of good practice this should be addressed. Service users can choose when to be alone or in company and when not to join an activity. The daily records support this. Service users have access to all areas of the home dependent on their mobility. The service manager confirmed that service users are provided with three meals a day with snacks and drinks available throughout the day. Records are maintained of meals eaten and cooked food temperatures however these were found to be incomplete and disorganised. This must be addressed to evidence that service users are being provided with nutritionally balanced meals. The service manager confirmed that service users have a choice of cereals and toast for breakfast with the opportunity to choose their own lunch and a choice of two dishes for the evening meal. Records are maintained to confirm that service users are given a choice for the evening meal although this appears to be limited to choosing from a picture or by showing the service user what is available which is not the cooked choice. There are no records maintained to indicate how individuals make breakfast and lunch choices. The service manager confirmed that this is an area that the registered manager is keen to develop and plans to introduce tasting and sensory sessions to further promote service users choice of meals. The service manager and the Annual Quality Assurance Assessment document confirms that staff are spending time with service users at meal times. The support plans viewed did not include guidance on the support required by individuals with their meals but did include risk assessments in relation to choking where this was identified Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: as a risk for individuals. As part of the development of the support plans, support plans to outline the support required by individuals with meals. Service users did not make any comments in relation to the meals provided. The fridges, freezers and cupboards were well stocked. Staff had added the date of opening to items in the fridge and staff should include the use by date to ensure that food is disposed within the recommended guidelines on food items. Care Homes for Adults (18-65 years) Page 19 of 35 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 personal and health care needs are being met however improvements are required to the recording of this information to provide consistent care and to promote service users health and well being. Medication is well managed to safeguard service users. Evidence: Two of the three support plans viewed outlined the support required by those individuals in meeting their personal care needs. As outlined under standard 9 moving and handling risk assessments are in place for service users who require support. Times for getting up and going to bed are flexible dependant on individuals weekly day centre programme. Service users were involved in choosing their link workers with records on file to evidence this. Service user plans did not include service users communication profiles and did not evidence how service users make choices in relation to their clothes, hairstyles and appearance. Service users plans include an outline of service users likes and dislikes and they are provided with the appropriate aids and equipment to promote their independence. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: All of the service users are registered with a local General Practitioner. The Annual Quality Assurance Assessment document tells us that what the home can do better is to support service users to attend the local surgery instead of the General Practitioner coming to the home. Service users have access to a range of health professionals with records maintained on the outcome of the appointment. Those records were disorganised and not filed in order which resulted in a delay during the inspection in accessing the required information. This should be addressed to ensure that access to the required information is made more accessible. One service users records viewed indicate they have had access to other health facilities for example a dentist however up to date records are not being maintained to evidence that all service users have access to routine health appointments for example dentists, opticians and well person checks. The monthly summary completed with service users by staff outline any health appointments that have taken place that month but is not easily accessible to see at a glance when routine appointments took place and when check ups are due. Support plans do not outline the support required by individuals in meeting their health needs and to attend appointments. The Annual Quality Assurance Assessment document indicates that plans for improvement are to introduce an annual health check for each person and to have health care plans in place for all service users following a health review for each individual. This must be addressed as a priority with records also being maintained to evidence that service users have access to routine health checks. The home have some service users who have seizures with a protocol in place on how this is to be managed. The home has a service user who requires peg feeding. Staff involved in setting this up and disconnecting it are trained by the supplier of the equipment with certificates of training provided to evidence this. As a good practice recommendation the organisation should explore with the company the frequency of such training and reassessment of individuals competencies. The service users support plan include guidance in relation to problems that may arise with peg feeding but does not include specific details on setting it up, flushing it through and disconnecting it. This must be addressed as part of the development of support plans. One of the staff on duty trained in this procedure was able to talk thorough the procedure. Service user plans viewed indicated that service users were weighed on an ad hoc basis. The service manager advised this has been addressed and that the home has now sourced their own weighing scales. One service users plan viewed included a bowel chart but there was no risk assessment or support plan to indicate why this was necessary. As a good practice recommendation this should be addressed to promote service users privacy and dignity. The home has had a service user that they supported with a range of community health professionals in providing end of life care to with positive feedback received on how well they managed that. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: None of the service users are self medicating. Service users medication is kept in their bedrooms in individualised locked cabinets with the key to the medication cupboard kept secure. Service user plans include an agreement for staff to administer their medication with a medication risk assessment in place to address any potential risks. The medication administration records included a photograph of the individual and showed no gaps in administration of medication. Service users medication files include detailed protocols on the administration of all as required medication which is signed by the General Practitioner. The home do not use any homely remedies. All medication received into the home was signed for with records maintained of disposal of medications. All staff involved in medication administration attend safe handling of medication training and are assessed and deemed competent prior to being expected to administer medication with annual reassessments of competency carried out to promote good practice. This training was up to date for staff involved in medication administration. Two staff are involved in the administration of medication where possible with a record made when this was not the case. A requirement was made at the previous inspection that staff witnessing or administering controlled drugs are to sign the controlled drugs register to ensure proper records are kept. The controlled drugs log indicates this is being complied with. A further requirement was made that the controlled drugs cabinet is to be secured to a wall or other permanent fixture to ensure safe storage of medication. This has been complied with. One service user commented under what the home could do better is communicate about changes. Feedback was received from two Social and Health Care professionals involved with the home who was happy with all aspects of care provided. One person commented that the home had recently managed a dying patient with the support of the hospice at home. They indicated under what the home could do better is that they need to be able to weigh the clients and they need to be aware of the demands of the primary care team who are unable to instantly respond. The other person fed back that what the home does well is meet individual needs and that having worked with the home for 6 years they had seen a marked improvement in the management, communication and leadership in the last year. Care Homes for Adults (18-65 years) Page 22 of 35 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. Systems are in place to enable service users to raise a complaint and to safeguard service users from potential abuse which promotes their safety and well being. Evidence: The service users guide include a pictorial copy of the complaints procedure with a service users complaints card made available to enable service users to raise a complaint to a senior manager of the organisation. The Annual Quality Assurance Assessment document tells us that plans for improvement are to make complaint making easier for service users so they are encouraged to make or raise any concerns or complaints. A requirement was made at the previous inspection for the complaints procedure to be updated with the Commissions current contact details. This was complied with but needs updating again to reflect the recent change in the Commissions contact details. The Annual Quality Assurance Assessment document tells us that the home has received no complaints in the previous twelve months and a complaints log is in place to record complaints received and the outcome. The Commission has received no complaints in respect of this service. The home has a number of compliments on file. Two service users fed back that they did not know who to speak to if they were unhappy but one indicated they knew how to make a complaint whilst one of those individuals indicated they did not know how to make a complaint. The other two service users fed back that they knew who to speak to if they are unhappy and know how to make a complaint with one of those service users indicating that staff would know if they were unhappy. Staff fed back that they know Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: what to do if someone has a concern about the home. The Annual Quality Assurance Assessment document confirms that the safeguarding of vulnerable adults policy was updated in April 2009 and the whistle blowing policy was updated in April 2008 with copies of the local authority safeguarding of vulnerable adults policy available at the home. The Annual Quality Assurance Assessment document indicates that the home has had no safeguarding of vulnerable adults referrals or investigations however a Regulation 37 report received by the Commission reported a potential safeguarding incident. The service manager advised this incident was investigated by the Organisation and she had not considered it to be a potential safeguarding incident. She agreed to review how this was overlooked and for a referral to be made in retrospect of the incident. This was confirmed as being actioned after the inspection. Staff at the home have safeguarding of vulnerable adults training with updates already identified and booked where this was required. Two staff on duty during the inspection demonstrated a good understanding of safeguarding and of their responsibility to report bad practices. None of the current service user group present with physical and verbal aggression. The Annual Quality Assurance Assessment document confirms that a supporting people who may challenge policy is in place. Specific training has been provided for some staff in dealing with autism which enable staff to support specific service users with behaviours that may challenge. All of the service user plans viewed included a money risk assessment with service users money kept secure. Service users money is checked daily to ensure any discrepancies are picked up quickly. Two service users money and records were checked and found to be correct and in order. The regulation 26 report evidences that service users money is audited as part of the Organisations monitoring of the service. Care Homes for Adults (18-65 years) Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not ideally suited to meet the needs of service users but is clean, comfortable and homely and provides a safe environment for service users. Evidence: The building is a detached property located in a residential street in Tylers Green. It is close to a parade of shops and nearby there is a branch library. The home is on a bus route to High Wycombe. There is a large front garden and a smaller enclosed garden at the rear. Parking is located at the side of building. Inside, there are three downstairs en suite bedrooms with one of those bedrooms opening into the sitting room. There is a separate single toilet downstairs and a shower room and bathroom upstairs. The lounge/dining area is a large open space with the kitchen leading off it. There are doors either end which lead to the staircases. A number of recommendations were made at the previous inspection to improve the environment in the communal areas. A recommendation was made to review the practice of leaving all the doors leading off the dining and lounge area open to keep this part of the home warm and comfortable and for the heating levels to be monitored and maintained at a level suitable to the needs of people using the service. On the day of the inspection the doors in to the communal areas of the home were open but despite this the lounge/dining area was warm and comfortable. A recommendation was made for the lino flooring in the dining area to be replaced with carpet to improve the environment Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: and make it more homely. This had been addressed. A recommendation was made that the communal areas of the home are to be made more homely through purchase of things such as pictures and ornaments. This has been addressed with pictures displayed throughout this area. The home has a large kitchen which is suitably equipped to meet the needs of six service users. The laundry is located in what was the garage and is accessed via the kitchen and outside. The service manager advised that that she was meeting with the health and safety executive the week following the inspection and would discuss with them what measures they need to put in place in relation to carrying laundry through the kitchen. A requirement was made at the previous inspection that soap and hand towels are to be maintained at all times in the laundry, bathroom and toilets to ensure that proper infection control measures are in place. This was found to be in place. Upstairs there are a number of bedrooms and the bedrooms viewed were clean and personable. Staff are responsible for cleaning at the home with cleaning schedules in place to support this however the cleaning schedules for the week of the inspection were missing. At the time of the inspection the home was clean and generally comfortable. The home is due to be refurbished with service users moving into temporary accommodation to enable this to happen. One service user feedback that the home is always fresh and clean whilst two service users indicated it is usually fresh and clean, one indicated it is sometimes fresh and clean. One person commented under what the home could do better is be more comfortable. Care Homes for Adults (18-65 years) Page 26 of 35 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. Staff are suitably recruited, inducted and trained which safeguards service users. Evidence: Some staff have specialist training in value based practice training, epilepsy, diversity awareness and autism awareness training. The Annual Quality Assurance Assessment document confirms that there is an National Vocational Qualification programme in place for care staff but does not tell us what percentage of staff have acquired this training. One service user feedback that staff always treat them well and usually listens and act on what they say. Three service users feedback that staff usually treat them well and usually listens to what they say. One service user feedback that staff sometimes listens to what they say. The rota indicates that there is two to three staff per shift with the registered manager rostered to work part admin and part support hours during the week. The home has separate night staff with a waking night staff member and a sleep in person on duty at night with back up management support available as required. At the time of the inspection the home had 142 hours care staff vacancies with regular agency and sessional staff being used to cover those vacancies. On the day of the inspection there Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: was three staff on duty which consisted of two regular agency staff and a sessional worker. The service manager made herself available for the inspection. The Annual Quality Assurance Assessment document tells us that the home has a pictorial rota so service users know who is supporting them. There was a board displayed at the entrance to the home with photographs of staff that were on duty that day. The home has regular team meetings with records maintained to evidence this. The Annual Quality Assurance Assessment document confirms that staff have the required recruitment checks prior to commencing work. A requirement was made at the previous inspection that recruitment needs to be improved to make sure that people are not placed at risk of harm. Where original documents of recruitment checks are kept away from the service, such as at head quarters, copies of documents are to be kept at the home or a verification sheet which confirms satisfactory checks. This will need to be signed by a person in authority who has seen the documents and can confirm that they are satisfactory. A further requirement was made that where agency staff are used to cover the rota, the manager is to ensure that detailed information is sent to the service before the worker starts at the service and provides confirmation of required checks and mandatory training. Two permanent staff files, one sessional worker file and recruitment check information of the agency staff on duty was viewed. Evidence of recruitment checks for sessional workers is maintained on a central database which is accessible from the home. The proforma did not make reference to visas or work permits and as a good practice recommendation this should be included. The files viewed confirmed that the required recruitment checks are being carried out with the required information being made available for agency staff. The information supplied for one of the agency staff did not evidence that two references had been obtained for that individual and the service manager agreed to follow this up with the agency. The requirements relating to recruitment from the previous inspection are assessed as being complied with. The Annual Quality Assurance Assessment document tells us that service users are involved in staff interviews. The training records viewed indicate that permanent staff have the majority of the required mandatory training with updates in the required training already booked where this was required.Staff have had some specialist training as outlined under standard 32. The electronic training records for the sessional worker viewed was not completed to indicate if they had all of the required mandatory training. Written confirmation was received after the inspection to confirm they had some mandatory training with the outstanding training booked. The information supplied by the agency outlines the training those individuals have with some agency staff attending specialist Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: training provided by Turnstone to support them in their role in working with individual service users. The home does not have a training matrix of the teams training. Individual records of training is maintained with training reported on monthly in the managers report. The Annual Quality Assurance document confirms that new staff complete the common Induction workbooks with the plans for improvement to improve the induction for new starters. Records viewed evidence that a new starter to the home was working through their common induction standards and an in house induction. The service manager confirmed that new staff work alongside experienced staff to support them in getting to know service users. The new staff member was not on duty on the day of the inspection to confirm this. The service manager confirmed that they have recently introduced a basic induction form for agency and sessional workers to evidence their induction into the home and this will be completed for new agency and sessional workers at the home. The service manager confirmed that staff are supervised regularly with this reported on as part of the managers monthly report. Written feedback from staff confirm that they are suitably recruited, inducted and trained. Staff members indicated they often and regularly get enough support from their manager and that there is usually enough staff to meet service users needs. Staff fed back that usually and sometimes the way they share information about the people they support work well. Care Homes for Adults (18-65 years) Page 29 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being effectively managed and monitored with health and safety checks and servicing of equipment in place to promote service users well being and safety. Evidence: The home has a registered manager who is working towards a National Vocational Qualification level 4 in management and care. She has the required mandatory training and deprivation of liberty and mental capacity act training. She has worked hard over the last year in improving the home and quality of life for service users. A completed Annual Quality Assurance Assessment document was completed by the manager prior to the inspection. The Annual Quality Assurance Assessment document outlines the progress made over the year and clearly outlines the areas for improvement. All of the requirements from the previous inspection have been complied with. Staff fed back that the manager is approachable and supportive to them in their roles. The organisation and the home has kept the Commission informed of notifications that affect the well being of service users as required under Regulation 37. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: The organisation carry out monthly Regulation 26 visits with detailed and thorough reports including an action plan available to evidence this. Alongside this monthly manager reports are completed with concerns, complaints, safeguarding, accidents, incidents, staff recruitment, training and supervision reported on. The organisation carry out medication audits and the landlord carry out quarterly health and safety checks and action sheet. The service manager confirmed that an annual stakeholders questionnaire and staff questionnaires were completed with the results of this not yet collated and made available. It was noted during the course of the inspection that some records required for regulation were disorganised and bulky which resulted in a delay in being able to access the required information. As a recommendation of good practice this should be addressed to ensure that records required for regulation are properly maintained. The majority of staff have up to date mandatory training with updates booked where required as outlined under standard 35. A sample of health and safety records were viewed and found to be in order. Accident and incident records are maintained with accident/incident forms completed by staff and signed off by the registered manager and service manager. An up to fire risk assessment was in place with weekly fire checks in place. A fire drill was carried out on the Sept 2009. Service user plans include risk assessments in relation to fire. The home has records in place to confirm up to date servicing of gas appliances, portable appliances, fire equipment and moving and handling equipment. Records are in place to evidence health and safety checks of bedrooms, communal areas and external areas of the home as well as water temperature checks, fridge and freezer temps and food probe checks. There was some gaps in the recording of food temperature checks and this should be addressed and monitored. During the tour of the home it was noted that latex gloves were left out in bedrooms and bathrooms. Individual risk assessments must be put in place to assess if this practice poses any risks to service users and action taken accordingly. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 1 6 15 Service users plans must 31/12/2009 clearly and specifically outline the level of support required in relation to all aspects of the persons care. To ensure that person centred care plans are in place to support individuals with all aspects of their life and to promote continuity of care. Service users care plans 31/12/2009 must evidence how service users are being supported to make choices and decisions in all aspects of their lifes. To promote decision making 2 7 16 3 9 13 The registered manager must ensure that measures in place to reduce risks are implemented. To safeguard service users 30/11/2009 4 17 16 Accurate records of meals provided and eaten must be maintained. To ensure that all service users are provided with a nutritionally balanced meal. 30/11/2009 5 19 13 Care plans must outline the 31/12/2009 support required by individuals in meeting their health needs with accurate records maintained of routine health appointments. Care Homes for Adults (18-65 years) Page 33 of 35 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 To promote service users users health and well being 6 42 13 Individual risk assessments 10/12/2009 to be put in place to assess if access to latex gloves poses any risks to individuals. To safeguard 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 Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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