Care Home: 40 Cody Road

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What the care home does well The home assesses if it can meet the needs of people who wish to use the service prior to them moving in and supports them to become familiar with their new surroundings and others living in the home. A person centred approach is used in respecting the people who use the service wishes, decisions and aspirations. Care plans and risk assessments are individualised and provide clear information on how the people wish to be cared for and supported. It encourages them to develop and maintain their independence, integrate into their local community and maintain contact with family and friends. The staff ensure the physical and psychological needs of the people who use the service are being met, providing them with support to access health care professionals such as GP`s, dentists, specialist health care professionals such as community nurses and epilepsy specialists. The home listens to the needs, wishes and concerns of the people who use the service and acts promptly to deal with any concerns or complaints they or their representatives may have. The staff are trained to protect the people who use the service and to inform someone immediately if they are concerned that they are at risk of harm. 40 Cody Road is a single storey purpose built home which offers a homely, safe and welcoming environment, which is spacious, tastefully decorated, furnished and designed to meet the physical needs of the people who live in the home. Individual bedrooms are personalised and decorated to the persons liking. The manager and staff are skilled to meet the needs of the people who use the service, they go through an interview and induction process followed by mandatory training such as moving and handling and fire safety, and specific training such as safe practices in medications, abuse awareness, communication, managing challenging behaviours and epilepsy. What has improved since the last inspection? Prior to this unannounced inspection visit an annual service review (ASR) was undertaken. Information gathered to complete the ASR did not change our opinion of the service. A previous unannounced inspection carried out on 8th January 2007 told us the service provides good outcomes for the people who live at 40 Cody Road. Two recommendations were made. One was in respect of the service considering adapting the complaints procedure in an accessible format to meet the diverse communication needs of the people who use the service. The other asked the service to consider developing a staff training matrix to demonstrate what training staff have received, when they received the training and when they are in need of refreshers. There is evidence that both these recommendations have been considered andactioned. What the care home could do better: The home demonstrates that it meets the National Minimum Standards and Care Homes Regulations in all areas of this report. The AQAA tells us where the home is striving to do better and how they are going to achieve this in the next twelve months. One recommendation and requirement was made following this visit to the service. It is recommended that the home seek advice from the Fire Safety Service in respect of the homes evacuation procedures for people who are physically disabled and the procedures for visually checking fire fighting equipment. To ensure potential risks to people who live in the home are minmised the registered manager is required to ensure that all staff who work in the home have been correctly recruited. This must include obtaining written evidence and/or documents to demonstrate that relevant checks have been carried out. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 40 Cody Road 40 Cody Road Cove Farnborough Hampshire GU14 0DE     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: Christine Walsh     Date: 0 6 0 1 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 37 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: 40 Cody Road 40 Cody Road Cove Farnborough Hampshire GU14 0DE 01252372057 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sarah.pilgrim@new-support.org.uk Dimension (NSO) Ltd Name of registered manager (if applicable) Mrs Sarah Jane Pilgrim Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home 40 Cody Road is a purpose built bungalow offering accommodation for up to five persons with a learning disability all accommodated in their own bedroom. The home, which is managed by Dimension (NSO) Ltd. who are also responsible for operating similar services located in the South of England, is situated close to Farnborough town centre with access to local amenities and transport. The nearby towns of Aldershot, Camberley, Fleet, and Farnham are all easily accessed using either public or the homes own vehicle. Care Homes for Adults (18-65 years) Page 4 of 37 care home 5 Over 65 0 5 Care Homes for Adults (18-65 years) Page 5 of 37 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, Regulatory Inspector. Mrs Sarah Pilgrim the Registered Manager assisted on the day of the inspection visit. It was Mrs Pilgrims second day back from maternity leave. The deputy manager who managed the home in the registered managers absence also assisted with the inspection. Care Homes for Adults (18-65 years) Page 6 of 37 The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to visiting to the home and helped in gathering evidence to write this report. The AQAA told us that it considers the diverse needs of the people who use the service by continuing to to promote peoples individual needs. This is done by staff attending Person Centred Planning and Everybody Counts training. The AQAA tells us it encourages Encouraging the people who use the service to attend diversity events, giving them a taste of different cultures and ensuring the services diversity policies are carried out. The information gathered to write this report was based on viewing the records of the people who use and work at the service, speaking with the people who live at 40 Cody Road, staff and observing care and support practices. To overcome the barriers for people who have communication difficulties the home plans to develop more pictorial information. A tour of the home took place and documents relating to health and safety were viewed. The people who live at 40 Cody Road are referred throughout the report as the people who use the service as stated in the AQAA and as confirmed by the managers. What the care home does well: What has improved since the last inspection? Prior to this unannounced inspection visit an annual service review (ASR) was undertaken. Information gathered to complete the ASR did not change our opinion of the service. A previous unannounced inspection carried out on 8th January 2007 told us the service provides good outcomes for the people who live at 40 Cody Road. Two recommendations were made. One was in respect of the service considering adapting the complaints procedure in an accessible format to meet the diverse communication needs of the people who use the service. The other asked the service to consider developing a staff training matrix to demonstrate what training staff have received, when they received the training and when they are in need of refreshers. There is evidence that both these recommendations have been considered and Care Homes for Adults (18-65 years) Page 8 of 37 actioned. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 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 37 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. The home ensures the people who wish to move into the home have their needs assessed prior to admission to ensure it can meet their needs. Evidence: The AQAA (Annual Quality Assurance Assessments) tells us in the event of a vacancy the service will invite the person to visit the service, joining others who live in the home for tea and over night stays so they can decide if the home is the right place for them to live. The AQAA goes onto tell us they work closely with health care professionals to ensure the people who use the service receive a high standard of care. The home tells us it could do better to recognise peoples potential and opportunities to move on if they wish. They plan to do this by continuing to consult and reviews peoples needs and aspirations to ensure they are met. This was tested by viewing the assessment records for three people who use the service, one of which was viewed in depth. Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: The pre-assessment documents for one person was viewed in depth providing detail of their assessed and current needs, including personal, cultural, social, physical and specific health care needs. The manager spoke of the assessment process, which includes meeting with the prospective person, relatives and existing staff. Care management and health care professionals assessments are obtained where required. The manager stated that following a trial period of four weeks a review takes place with the person, their relatives and representatives. his is to establish if the home is successfully meeting their needs, and if they are happy to remain in the home. Care Homes for Adults (18-65 years) Page 12 of 37 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. The home ensures the people who use the service have their needs met using a person centred approach and are supported to have a say about how they wish to receive their care and make decisions about their everyday lives. Risks to the health and welfare of the people who use the service are minimised by using a risk management approach. This involves assessing the level of any risks, and recording measures which can be taken to reduce those risks, wherever possible. Evidence: The AQAA tells us it does well to have person centred plans in place for all the people who use the service. It goes onto tell us that each person who uses the service has a link worker and annual reviews take place with their care managers. The AQAA tells us in the last twelve months they have focused staff training based on the individual needs of the people who use the service and will continue to improve in areas of alternative communication. Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: This was tested by viewing personal plans, including risk assessments and daily notes of three people who use the service. Where possible we spoke the people living in the home, observed behaviours, spoke with two members of staff and viewed Have Your Say comment cards. Each person who uses the service has a personal plan of their own which provides information on social interaction, health and wellbeing, keeping safe, personal care, communication, behaviours, independence and daily notes. Care plans provides detail on how the person needs assistance, which allows for consistency of care. The home recognises the rights of the person who lives in the home to request who they would like to support them with their personal care, including the gender of the member of staff and this is recorded in personal plans. This demonstrates the home recognises and respects the persons dignity, privacy, equality and diversity. Care plans are linked to risk assessments, which provides detail of any risks and the action needed by staff to minimise the risks. The information is written in plain English and easy to follow. Each person who lives at Cody Road has a person centred plan that has been devised using communication tools that best supports them to understand and develop a life history (Life Mapping), express their goals, wishes, desires and how these will be met in the future (Futures Planning). We were informed by care staff that these are in the process of being reviewed with the person who uses the service and where appropriate their family and/representative. There was evidence of monthly reviews taking place, which includes reviewing how the person wishes to be supported with their personal care, everyday life skills and accessing activities. A pathway is devised how future goals and dreams will be achieved and monthly reviews tell us if these have been achieved and in some cases how successful the activity was. Photographs provided us with evidence that some goals and dreams are being met. A member of staff told us: The information held in the personal plans tells us what the person likes, dislikes, what is achievable and their limitations. This allows us to support them to do the tings they like to do. It was observed through discussions, observations and interactions between the people who live at Cody Road and staff that there is relaxed and a respectful approach to meeting their needs. People appeared happy and one person told us that they liked living at Cody Road. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: It was observed during the course of the visit that people who use the service are encouraged to make decisions about how they wish to spend their day, what activities they wish to engage in and making everyday choices such as what they would like to eat, drink and wear. Care Homes for Adults (18-65 years) Page 15 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The home ensures the people who use the service have their rights respected, are provided with opportunities to make decisions and develop individual living skills. Evidence: The AQAA tells us it does well to support the people who use the service to access the community, and supported to access the community by people who live in their local community. The AQAA tells us in the last twelve months the people who use the Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: service have had more opportunities to access the community on a one to one basis rather than in groups and feels it could do better to support people to make Wrong Choices and take more risks. This was tested through observation on the day of the visit, where possible speaking with the people who use the service, speaking with staff and the manager. Viewing daily activity plans, person centred plans and menu options. The manager spoke of how the service plans to further develop the homes internal and community based activities, demonstrating that she is aware of person centred planning and the importance of listening to the wishes and decisions made by the people who use the service. The manager admits that this is an area where the service can strive to further improve. The manager informed us through the person centred planning process, which includes life mapping and working closely with family and friends they have been able to find out a lot more about the people who live at Cody Road. This has and continues to enable them to look at alternative opportunities in daily and future activities. The manager went onto tell us they have good links with their local community and a number of people who use the service regularly attend church services. The home has access to transport which is designed to support people with limited mobility. Personal plans detail the persons weekly activities, hobbies and interests, which includes visiting families, computer training, aromatherapy and attending day services and church services. Other activities include people developing independent living skills such as assisting with cleaning their bedrooms, cooking snacks and when possible assisting with preparation for the main meal of the day. Assisting with shopping and collecting their prescriptions from the doctors. The manager gave an example of how they had supported a person who uses the service to test out if they would like to chose swimming as an activity. This was ocnsidered to assist the perosn to undertake helathy lifestyle activities. The manager told us how the risks were assessed and perosn gradua;l;y intorduced to athe acticitiy, which eventually the perosn clearly said they diod not wnat to participate. This deomonstrates that the home is pro active in considering alternative activities for the people who live in the home. The service has been designed to meet the physical and sensory needs of the people who live at Cody Road. Individual bedrooms are equipped with personal entertainment and sensory equipment, such as music systems, televisions and special lighting. In Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: addition the home has a sensory room where the people who use the service can either take time to relax or stimulate their individual senses. The people who use the service are supported to maintain contact with their family and friends. The manager informed us that the service has developed positive relationships with families and friends and encourages an open door visitors policy. The manager went onto tell us that next of kin are kept informed of their relatives wellbeing, bearing in mind the wishes of the people who use the service. The service supports people who live at Cody Road to have a say in their daily lives and decision making. This was observed on the day of the visit, with people being encouraged to do things for themselves and make decisions about what they would like to do. Staff were observed interacting in a respectful manner and supporting people to make informed choices. Some people who use the service are unable to verbally communicate their choices. The home has developed a picture communication board which provides people with information in order to make choices about meal times, daily activities and who is working in the home. The home recognises this is an area where further improvements need to be made and will resource other professionals to assist in this area of need. During the pre assessment process people are asked for their menu likes and dislikes, the support they require to eat their meals and their dietary preferences. There is evidence that people are regularly weighed, special equipment is supplied and when there are concerns about a persons eating habits and seating positions referrals have been made to the appropriate professional. The majority of the people who live at Cody Road have lived their for a number of years. The staff tell us they have come to know and understand their likes and dislikes of the people they support and will offer an alternative if they know there is something on the menu that someone may not like. The manager told us that where possible the staff will support the people who use the service to be involved in the process of planning and preparing meals. We were informed by a person who lives in the service that they enjoy making cakes. Care Homes for Adults (18-65 years) Page 18 of 37 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. The home ensures the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they need and prefer. Evidence: The AQAA tells us that it does well to ensure staff are trained in specific health care needs such as managing catheters and enemas. It goes onto tell us that it has good relationships with health care professionals but recognises it could do better to train more staff in specific areas of managing health care needs. This was tested by observation, viewing three peoples personal plans, medication administration records, speaking with staff, registered manager and viewing Have Your Say comment cards. The personal plans provide detail on how the persons who use the service wish to spend their day including what time they like to get up, go to bed and to bathe. A member of staff said they are aware of persons individual support needs as they are Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: encouraged to read, be involved in developing peoples person centred plans, and be involved as a keyworker to support them with their everyday needs. The three personal plans which were seen provided evidence that they are reviewed regularly, and where possible the person is involved in the review of their plans. The member of staff went on to demonstrate that they have an understanding of the values of caring for people and the importance of ensuring the diverse needs of the people who use the service are respected. The manager informed us that the home has very good links with primary care and specialist health care teams. Personal plans demonstrated that the health care needs of the people who live at Cody Road are regularly monitored and reviewed by the persons general practitioner and where there are specific health care needs by the appropriate health care professionals, such as psychiatrists and consultants to name a few. Personal plans provide information on the persons specific health care needs, what action is required and how staff must attend to these health care needs. The manager informed us that staff have received specific training such as epilepsy, administering invasive treatments and catheter care. This is to ensure where possible they minimise the risk of unnecessary illness and anxiety. The manager went onto tell us that the people who use the service are encouraged to access their local GP surgery and play an active in the consultation process. Where this is not possible the manager informed us the GP or other health care professionals will visit the home and carry out the consultation with the person in the privacy of their own room. This was evidenced at the time of the visit when a health care professional visited the service. Outcomes of such consultations are clearly recorded in the persons notes with detail on any action required by staff. The home has systems in place for the administration of medication. The home uses a monitored dosage system, which is supplied by a well-known high street pharmacy. Medications are received, stored, administered and disposed of using systems as stipulated in the Royal Pharmaceutical Guidelines. Both the manager and a member of staff told us that they receive regular medication training. This was further evidenced in staff training records viewed at the time of the visit. Procedures observed demonstrated that staff are aware of the importance of administering medications safely and correctly. People who require As Required medications have detail care plans in place to inform staff when the medication should be offered or in some cases it must be given if the persons health is at risk. Where invasive treatments are required there was evidence that health care professionals have been involved in the development and regular Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: review of the care plans. In addition to clear care plans and specific training the home provides useful information for staff on specific health care conditions. This is seen as good practice. Staff who were spoken with said they were fully aware of their responsibilities to ensure they are fully aware of the current health care needs of the people who live at Cody Road and actions they must take to maintain the persons health and welfare. Discussion took place with the manager with regard to the need to train more staff in specific areas of health care such as catheter care. The manager was informed that the Commission for Social Care Inspection cannot stipulate how many staff are trained but the registered manager and providers must be confident the home can meet the numbers and needs of the people who live at Cody Road approapriately. Care Homes for Adults (18-65 years) Page 21 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home listens to and acts upon the concerns raised by the people who use the service. The home ensures the people who use the service are safeguarded from the potential risk of harm. Evidence: The AQAA told us that each person has a complaints procedure which is both written and pictorial and staff receive training in abuse awareness. The AQAA goes onto tell us that it could do better to develop Circles of Support. Circles of Support is a term used to develop, expand and improve relationships for individual people who use the service. The people involved in developing relationships with the person who uses the service is to befriend, advocate and provide independent support. The manager told us that they are in the early stages of developing Circles of Support for the people who live at Cody Road. Thie AQAA was tested by viewing the homes current complaints policy, the complaints log book, behaviour support plan for a person who uses the service, speaking with staff and viewing Have Your Say comment cards. Following the last visit to the service is was issued with a recommendation to develop Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: a complaints procedure in an accessible format for people who have limited communication and comprehension. The home has taken on board the recommendation and developed an accessible complaints procedure. The homes complaint procedure details how the people who use the service can make a complaint and what action must be taken to resolve it. The deputy manager told us the home has not recieved any complaints in the last seven months and the registered manager said she couldnt remember the last time the home recieved a complaint. The registered manager verbally described the action the home would take if they recieved a complaint and how this would be recorded. Comment Cards recieved from people who use the service tell us that they feel they are treated well and staff will advocate for them if they are feeling unhappy or wish to raise a concern. A staff member told us they know what to do if they receive a complaint and a relative indicated in their comment card that they know how to make a complaint. A member of staff told us that the home encourages open discussion with the people who use the service and some staff know how people are feeling through their behaviours and the individual way people communicate. The registered manager told us that the home is lucky to have staff who have worked in the home for a long time and have got to know the people who live in the home very well. She went onto tell us that night staff are encouraged to work days in order that they can get to know the people better and understand their behaviours. The staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. A member of staff spoken with at the time of visit confirmed that they had received training and was aware of their roles and responsibilities in maintaining the health and wellbeing of the people who use the service and reporting incidents of concern. The manager informed us the service is introducing a new round of training known as Our Approach (an alternative form of abuse awareness training, which includes the Mental Capacity Act and Deprivation of Liberty). Two members of staff who were spoken with at the time of the visit told us that they had attended the Our Approach training, which was an intensive four day course. They told us that it reinforced what they already know about safeguarding and introduced them to the Mental Health Act and person centered pathways. The people who use the service are supported with the management of their money, and their care plans detail the level of support required. The home has good systems for managing and monitoring peoples spending, and supports them to develop their personal skills in managing their own money. At the time of the visit staff were Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: observed accounting for expenditure that had occurred during the day. This took place with two staff at the handover period. Monies were counted and checked against each persons cash book. Both members of staff sign to indicate they have checked and agreed balances. Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the people who use the service live in a warm, comfortable and clean environment that meets their physical and social needs. and the home ensures its staff receive appropriate training to minimise the risk of cross infection. Evidence: The AQAA told us they have done well to provide a purpose built bungalow to meet the high support needs of the people who use the service, which has an accessible safe garden and a homely environment. The people who use the service are supported to to chose how they decorate their individual rooms. The AQAA goes onto tell us that it could do better to be more rigorous in their dialogue with the housing association that owns the home to address repairs more quickly. This was tested by touring the home, seeking the permission of a person who lives in the home to view their bedroom, speaking with the registered manager and viewing staff training records. 40 Cody Road is a purpose built bungalow managed by New Support Options and owned by an independent housing association. The home has been designed to meet the physical and social needs of the people who live there and each person has a room Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: of their own. Bedrooms and bathrooms have been designed to meet physical needs of the people who live in the home, such as adjustable beds and hoisting equipment in bathrooms. The bedrooms are personalised to reflect the persons interests and personality. The bedrooms viewed at the time of the visit were observed to be clean, tidy, comfortable and tastefully decorated. The deputy manager who showed us around the home told us that the people who live in the home were supported to choose the decoration of their room and where possible are encouraged to keep their room clean and tidy. The home has an enclosed garden which is accessible and has room for relaxation and fun. The registered manager told us that the home has appointed a handyman who is responsible for maintaining the garden and the upkeep of the home. The registered manager informed us the housing association is responsible for the maintenance of the building and ensuring contractors visit the service at set times to check electrical and gas appliances and fire safety equipment. The home has a contract with the housing association for general repairs, the contract tells the service the appropriate timescale required to respond to repairs. The registered manager provided evidence that the housing association does not always respond as stated in the contract. A record of calls and responses is kept. It was noted some minor repairs were required to some areas of the home such as the toilet by the utility room is in need of some refurbishment. The deputy manager told us that this had been reported to the housing association. The AQAA tells us it plans to revamp the sensory room and replace the carpet in the lounge. The new furniture in the lounge was observed to be comfortable, tasteful and in keeping with the decoration. There was evidence that the service provides detergents, equipment and protective clothing to guard against cross infection. The AQAA tells us that most staff have received infection control training. Speaking with staff at the time of the visit confirmed that they had received training and are aware of the importance of maintaining a safe and hygienic environment. The home has a separate laundry facility with a washing machine that can wash at high temperatures and has sluice facilities. The home has a clinical waste contract with the local council and ensures appropriate procedures are used when disposing of waste products. Care Homes for Adults (18-65 years) Page 26 of 37 Care Homes for Adults (18-65 years) Page 27 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the people who use the service are supported by competent and skilled staff in such numbers that meets their individual needs. Limited information held in the home on staff does not tell us that robust recruitment procedures are used to safeguard the people who use the service from potential risk of harm. Evidence: The AQAA tells us it does well to provide additional hours to meet the needs of a person living in the service, to have staff who are prepared to work flexibly and a service that provides mandatory, specific training and opportunities to gain a national vocational qualification (NVQ). The AQAA tells us that the home could do better to involve the people who use the service more in the recruitment of staff. This was tested by viewing staffing levels and observing staff practices on the day, viewing training and recruitment data, viewing Have Your Say comment cards and speaking with staff. The home was busy at the time of the inspection visit as the people who use the service were undertaking various activities with staff support. This included supporting them to access day services, community based activities and Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: supporting them in daily life skills such as personal care, preparing meals and social interaction. Staffing levels seen at the time of the visit, and by viewing a weekly duty rota told us there was sufficient staff to meet the current needs of the people who live in the home. The registered manager informed us that the home had recently obtained additional funding to provide extra support for a person in the evenings. This allows specific activities to take place and to meet the physical and social needs of other people who live in the home. The registered manager told us the home relies on relief staff who are employed by Dimensions (NSO) fill gaps in the duty rota and provide additional one to one support. A relief member of staff who was working in the home at the time of the visit told us she underwent the same training, induction and recruitment procedures as any other members of staff. She went onto tell us that despite being a relief member of staff which means she works in other services owned by Dimensions (NSO) she mainly works in Cody Road. She said she does this as she has a good rapport with both the people who live in the home and the staff. The home has designated night workers and the home is covered at night by one member of staff up and awake and another sleeping. The sleeping in member of staff can be called upon any time during the night to assist with meeting the needs of the people who live in the home. The registered manager told us she encourages designated night staff to do days from time to time to enable them to get to know the people and their particular routines, communication and personalities. The staff appeared organised and well informed of what was going on for each person at anyone time during the day. The staff routine includes a handover at every shift where as many staff as possible attend and give a handover of the health, wellbeing and activity of each person living in the home. Each member of staff is required to read the communication book and diary. Checks are also carried out to ensure correct procedures have been followed with regards to peoples personal monies. A member of staff told us. I feel we are kept very well informed and up to date with whats going on in peoples lives. The member of staff went onto say. Its our role as key workers to ensure we are fully aware of the needs of the people we support and take responsibilities in ensuring care plans are up to date, plan fro reviews Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: and attend them. Staff are encouraged by Dimensions (NSO) to undertake a national vocational qualification (NVQ) and will support them to undertake NVQ levels 2 and 3. Currently the home has more than 50 of its permanent staff trained or working towards a NVQ. The registered and deputy manager informed us that they are involved in the recruitment process and when vacancies arise they will have a say in who they feel will be the best person to work with the people who live in the home. They told us they recognise that the the people who live in the home should be iinvolved in the interview process and plan to do this the next time they need to fill vacancies. A member of staff told us that checks had been done before she started, she completed an application, attended an interview and during the induction process she was shadowed by member of staff who had worked in the home for a number of years. Dimensions (NSO) have a human resource department who manage the recruitment processes from agreeing adverts to gathering information about the person applying for a job. Original recruitment records are not held in the home. The registered manager is provided with a data sheet that should provide them with information when staff checks such as the criminal beaurue record (CRB) and protection of vulnerable adult (PoVA) check has been applied for and the date it has been received and when references have been received. Two new staff records were seen, they did not provide evidence that the member of staff had a CRB or a POVA check undertaken on them. It could not be established if the member of staff started working in the home before checks and reference were received. The data sheet had not been completed in full for both members of staff and had not been checked or signed off by the human resources department, the manager in charge at the time of recruitment and the member off staff. The registered manager was made aware of her responsibilities to ensure these records were maintained correctly in the home or provide evidence of original documents. We were informed by the registered manager that staff undergo an induction into the service where they are supported by a named member of staff to become familiar with the needs of th people who live in the home, the ethos of the home and the way in which the home works day to day. Staff training records tell us staff receive training required by law (mandatory Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: training), such as moving and handling, first aid, fire safety and food hygiene. In addition they receive training specific to the needs of the people who live in the home, such as care of medicines, epilepsy, managing challenging behaviour, communication, dementia care and catheter care. A member of staff told us that staff are not forced to carry out invasive care such as catheter care and administering rectal diazepam if they do not feel confident to do this. The same member of staff said she felt she had received the right training to meet the needs of the people who live in the home and is well supported by the managers and her peers to enable her to do the job to the best of her ability. We were informed that staff receive regular one to one supervision where they discuss their strengths, areas that need building upon and the people who they are keyworker to. Supervision records confirmed that staff receive regular support from senior staff. In the absence of the manager the deputy manager has taken on this role. Care Homes for Adults (18-65 years) Page 31 of 37 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 manager manages the home with a skilled staff team who ensure the home is safe and run in the best interest of the people who live there. Evidence: The AQAA told us the staff team work with consistency for the people they support, they undertake comprehensive risk assessment and remain realistic in our expectations but supportive of new ideas. The AQAA tells us that the manager would benefit from a regular supernumerary day a week to keep up to date with paper work. This was tested by spending time with the manager, speaking with staff, viewing health and safety documents, quality audits and observing management practices throughout the day. On the day of the visit it was confirmed by the registered manager that she had very recently returned from maternity leave, and it was her second day working in the home. The deputy manager was asked to assist with the inspection visit as she would have up to date information. Through the course of the day the registered manager and deputy manager demonstrated that they have an Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: understanding of the needs of people who live in the home and of their roles and responsibilities in ensuring their needs are met. The number and level of good outcomes assessed at this key inspection demonstrates this. The outcome in relation to staffing has been assessed as only adequate. This indicates that the registered manager must ensure there is robust recruitment procedures. Two members of staff spoken with at the time of the visit both said they were pleased the registered manager has returned and complimented her on her lively personable approach, her enthusiasm and her caring nature towards the people who live in the home. A member of staff went onto say. Sarah makes sure she is kept up to date with new ways of thinking and legislation and will pass this onto us. The home has a number of quality monitoring systems in place which includes seeking the views where possible of the people who use the service, friends and family and staff. Staff meetings are held every three months and monthly reviews take place for people who use the service to evaluate achievements and personal goals. The home is visited once a month by a senior manager in the company who carries out an unannounced monitoring visit known as Regulation 26 visits. The visitor should speak to with the people who live in the home, check specified records and look at the premises. They must write a short report of the findings and a copy of the report must be provided to the manager. Copies of these reports were seen at the time of the visit. Records excluding those relating to staff were observed to be up to date and complete in full. There are systems in place for fire safety, and staff receive regular training. Regular checks are made on fire safety systems. A fire safety report dated August 2007 seen at the time of visit told us the fire safety officer was happy with the house procedures. After discussion with the registered manager regarding full evacuation and visually checking fire fighting equipment it is recommended that the Fire Safety Service is contacted. They are advised to do this to find out if the process for undertaking visual checks on fire fighting equipment and the procedure on evacuation for people who are physically disabled is correct. Products which may be harmful were securely locked away, as required by the Control Of Substances Hazardous to Health (COSHH) regulations. There are notices discreetly Care Homes for Adults (18-65 years) Page 33 of 37 Evidence: displayed around the home reminding people of good hygiene practices. The home has achieved an excellent standard for food hygiene and the home can demonstrate that all electrical and gas appliances, including small electrical appliances are regularly checked to ensure they are in good working order. Care Homes for Adults (18-65 years) Page 34 of 37 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 35 of 37 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 1 34 19 The service must ensure 11/03/2009 that a record of all documents required in regulation 17 schedule 2 are held in the home at all times. The service must demonstrate that they are undertaking robust recruitment procedures to protect the people who use the service from potential risk of harm. 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 43 It is recommended that the home seek advice from the Fire Safety Service regarding the homes evacuation process for people with physical disabilities and the process fro visually checking fire safety equipment. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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