Care Home: 55 Amis Avenue

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What the care home does well Staff at the home continue to work in partnership with occupational Therapists, Physiotherapists, Speech and Language Therapists and all other specialist health care services for the benefit of the residents living at the home. Information is available for prospective residents and their families to read that would help them to decide if the home was the right place them. The needs of prospective residents would be obtained prior to being offered a place to ensure that their needs could be met at the home. Care plans are in place that reflect the assessed needs of residents, and they are supported to make decisions about their lives. Social, cultural and recreational activities meet the needs of individual residents. Personal support provided to residents meets their preferences, and their physical and emotional needs are met. Residents and their relatives have access to a complaints system that enables them to raise concerns, and be confident that their concerns would be addressed. Residents are protected from abuse through the home`s Safeguarding Policies, Procedures and staff training. On the day of the site visit the home was exceptionally clean, tidy and free from any odour. Staff at the home are trained, skilled and in sufficient numbers to support the people who use the service. Residents are protected by the organisation`s recruitment policy and procedures. The arrangements for the day to day management of the home ensures that the home is appropriately managed. What has improved since the last inspection? No requirements were made during the last key inspection, however, several good practice recommendations were made. The Statement of Purpose and Service User Guide have been further developed and include photographs of the home and activities that take place. The home has now changed their vehicle to one that is wheelchair accessible. The Complaints procedure includes the correct contact details for the Care Quality Commission. Paper towels are used in the communal toilets, bathroom and shower room. What the care home could do better: The manager should ensure that all the information relating to the care support plans are kept as one working document in one file. This also includes risk assessments. The manager should ensure that all information relating to the health care needs of residents is kept in one working file. Key inspection report Care homes for adults (18-65 years) Name: Address: 55 Amis Avenue 55 Amis Avenue New Haw Addlestone Surrey KT15 3ET     The quality rating for this care home is:   three star excellent 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: Joseph Croft     Date: 1 9 0 4 2 0 1 0 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 55 Amis Avenue 55 Amis Avenue New Haw Addlestone Surrey KT15 3ET 01932350929 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Welmede Housing Association Ltd The registered provider is responsible for running the service care home 6 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: The maximum number of service users who can 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 following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Dementia - DE Date of last inspection Brief description of the care home 55 Amis Avenue is a care home for adults with a primary condition of learning disabilities. People using this service are mixed gender and may have dementia, physical or sensory disabilities as secondary conditions. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 6 6 Brief description of the care home The home is operated and managed by Welmede Housing Association. The property is a large, detached, single storey bungalow that has specialist adaptations and equipment to meet the homes stated purpose and needs of people currently living in the home. It is domestic in scale and character and located in a residential area, central to the village of Woodham and near the town of Addlestone. Local shops and other community amenities are within walking distance. Bedroom accommodation is all single occupancy without en-suite facilities but includes washbasins. All areas including the garden are wheelchair accessible. Facilities include a spacious bathroom with adapted bath, a separate shower room and there are two toilets. There is a good size, combined lounge/dining room, which opens onto a small sun lounge and in turn this leads to a pretty, enclosed garden. There is parking space for two or three cars at the front of the premises. Fee charges are £1500 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 the service is Three star. This means that the people who use the service experience Excellent quality outcomes. The Care Quality Commission (CQC) (us,we) undertook an unannounced site visit to the service on the 19th April 2010 using the Inspecting for Better Lives (IBL) process. The site visit took six hours, commencing at 10:00 and concluding at 16:00. The manager was not present at the start of this visit, but did attend the home at approximately 11:00. The manager assisted with the site visit until 13:00 when herself and all the staff team attended a pre-planned mandatory training. Therefore we were only able to have limited time with the manager and care staff. This also meant that feedback could not be provided to the manager at the end of the site visit. This took place by telephone. The key standards for younger adults were assessed during this site visit. The Care Homes for Adults (18-65 years) Page 6 of 31 inspection process included a tour of the premises, and the viewing and sampling of the following documents: Statement of Purpose, Service Users Guide, menu, medication records, care plans, Health Action Plans, records of health care appointments, staff recruitment and staff training files. Informal discussions took place with the manager and deputy manager, and formal discussions took place with one member of staff. Due to the complex needs and communication difficulties, we were only able to have a limited conversation with one resident, who was able to convey that they liked living at the home, they do activities that they choose, they help with cooking and the laundry, the food is good and the staff look after them well. They also showed us their bedroom and conveyed that they chose the decor, and they like having their own things in their bedroom. During discussions the manager made us aware of how difficult the first three months of 2010 have been on both staff and residents. This was due to the sad loss of two residents, one of whom had lived at the home for many years and built up good relationships with all the staff and residents. It was a particularly difficult time as the staff team provided end of life care to both residents, which meant spending a lot of time attending to, supporting and comforting each resident. It is acknowledged that this has been an extremely difficult time for all the people at the care home, and the priority for staff was to attend to the two residents, therefore, some of the paperwork has had to be overlooked, but to no detriment of residents living at the home. The staff are to be commended on how they have dealt with such a difficult time, and although the funeral of one of the residents had recently taken place, they were still committed to ensuring that the needs of the other residents continue to be attended to. We sent out surveys to residents and staff. At the time of writing this report we have not received any completed surveys. The manager returned the Annual Quality Assurance Assessment (AQAA) when we asked for it, and on this occasion it was returned to us within the time scale set. Information provided in the AQAA, and evidence gathered at the site visit have been used as a source of evidence in this report. We would like to thank the manager, deputy manager, staff and residents for their cooperation during this site visit. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives are provided with the information that will enable them to make a choice about living at the home. The needs of prospective residents would be obtained to ensure that their needs could be met at the home. Evidence: The home continues to be operating in accordance with its stated purpose and conditions of registration. The manager has updated the Statement of Purpose and Service User Guide, and both these documents include photographs of the accommodation offered, garden, the locality and places where residents choose to go. The Statement of Purpose and Service User Guide provide the information as required that would help a prospective resident and their family/relatives to make an informed choice about moving into the home. These documents include a copy of the most recent inspection report, a summary of the Complaints Procedure and the correct contact details for the Care Quality Commission. The manager told us that they had admitted two new residents during the last two Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: years. We viewed the pre-admission documentation for one resident. The manager had obtained a copy of the Community Care Assessment from the placing care manager. This included information in regard to the personal care, physical health, mental health, education, leisure, finance, ethnicity, religion and cultural needs. The manager told us that they had undertaken their own assessment of need, however, this had been archived and therefore was not viewed during this site visit. The manager told us that they would also request a copy of the care plan from prospective residents current placement when appropriate. We were told by the manager that prospective residents are encouraged to visit the home as many times as they would like. This provides prospective residents the opportunity to see the home, view the bedroom they would occupy and meet the current residents and staff. All placements are reviewed after six weeks and then six months. The manager was clear that the final decision for moving into the home would be that of the prospective resident. The manager told us that they have had a recent enquiry from a prospective resident from another of the organisations home that is due to close. The prospective resident has chosen to move into Amis Avenue, and they have already chose the decor for their bedroom. The Annual Quality Assurance Assessment (AQAA) informs that staff would liaise with prospective residents referred to the home, and would fully involve the resident and their relatives. For those without relatives, the service would access an Independent Mental Capacity Advocate (IMCA) to assist the resident with the decision making process. The manager and staff would work with the referring care manager, the key worker from their current placement, and other relevant professionals such as health care, physiotherapists, Occupational Health and Speech and Language Therapists to ensure that the home would be able to meet their assessed needs. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans that reflect their assessed needs. Residents are supported to make decisions about their lives and to take risks as part of furthering their lifestyle and independence. Evidence: During discussions, the manager and deputy manager told us that they are currently producing user friendly Person Centred Plans specific to each individual resident that would include photographs to enable them to have a better understanding of the document. The home has purchased a digital camera and a laminator for this, and it is the responsibility of the Deputy to produce these documents. The manager also told us that she is currently trying to streamline the Person Centred Plan, Health Action Plan and the Care Support Plan so that all these documents are kept together in one easy to use accessible file. However, this has been difficult to accomplish due to the recent deaths of two residents, and the priority had to be attending to the needs of each of these residents. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Each resident will be provided with their own copy of their Person Centred Plan when completed, and they will be able to keep these in their bedrooms. Two care plans were viewed during the site visit. Each included information in regard to their personal care needs, physical and mental health, medication, walking, posture, mobility, foot care, sleeping, communication, family and activities. The manager told us that all care plans are reviewed every three months. However, for one care plan we could evidence that it had been part reviewed in June 2009 and March 2010. There were no records of the three monthly reviews for the second care plan sampled. As stated in the summary of this report, the manager and staff were undertaking pre-planned training for the whole afternoon of the site visit. We briefly discussed this with the manager who reassured us that all care plans are reviewed on a three monthly basis, and these updates were stored in another cupboard. The manager confirmed this with us during a telephone conversation on the day following the site visit, and we were invited back to the home to evidence these documents. During the site visit we had separate discussions with the Deputy manager and one member of staff who both told us that all care plans are reviewed every three months. We evidenced in both care plans that annual reviews had been undertaken during the last year. As the home has a very good record of compliance, we accept that not all the information had been stored in one file, but the probability is that the required information would be available, however, the manager must address this issue to ensure that all the information required is collated in one working document. The home uses the key worker system where by one member of staff has the key responsibility for a named resident. During discussions with one member of staff it was clear that they had a good knowledge of the contents of the care plan for the resident they key worked with. We also noted that the risk assessments were not included in the care plans viewed, and again we were reassured by the manager that these had been produced and were stored in a separate file. This was recorded in the last key inspection report that risk assessments were stored in a separate file for operational reasons. The risk assessments viewed at that time gave clear guidance and risk management strategies. During our telephone conversation with the manager on the day following the site visit, we were reassured by the manager, as stated above, that it is her intention to collate all this documentation in one file. We were told that all risk assessments were being reviewed and this was being undertaken with the organisations health and safety officer, who we did meet at the care home on the day of the site visit. We were told that risk assessments included manual handling and moving, falls, fears of open spaces, panic attacks and activities in the community. One Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: resident uses a restraining belt in their chair. This was discussed with the manager who was advised to ensure that this is discussed with the appropriate people, and that a risk assessment must be produced. The manager informed us that by telephone that they had discussed this with the organisations Health and Safety office and the residents care manager, and a risk assessment has now been produced. Staff continue to offer choices to residents by using different forms of communication such as Makaton sign language, verbal communication, pictures and photographs. We were able to have limited conversation with one resident who was able to convey to us that they make choices of what they want to do and the food they wish to eat. Staff told us that residents also make choices during their monthly residents meetings when they are asked what kind of things they would like to do. Minutes of these minutes were sampled. The AQAA informs that each resident has a Care Support Plan that is reviewed on the minimum of three months, and residents and their relatives are fully involved in the review process. Residents are referred to members of a multi - disciplinary team of specialists that include Dementia Pathways, Specialist Community Assessment and Treatment Service, Speech and Language Therapists, Dietitian and the feeding team from the local hospital. The manager has identified, under plans for improvement during the next twelve months, that the documentation used at the home requires to be streamlined and old information in the care files to be archived. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. Social, cultural and recreational activities meet the needs of individual residents. Evidence: The four residents currently living at the home are white British, and they are supported by a multi-cultural staff team of male and female staff. Care plans sampled included information in regard to the residents cultural and religious needs, and the wishes of residents. All residents are Christians, and opportunities are provided for them to attend a Church of their choosing should they wish to. Each care plan viewed had a list of weekly activities that residents do, and other Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: activities undertaken were recorded in the daily notes maintained by staff at the home. Residents are provided with a wide range of activities both in the local community and at the home. These include attending day centres, reflexology, music, art and craft, bingo, bowling, the local theatre, cinema, going out to cafes, restaurants, pubs and other eateries. Holidays are arranged every year. Residents travel further a field at weekends, one of these trips recently included a day at Brighton where residents had fish and chips. One resident proudly showed us their photograph albums that included photographs of the many activities they had undertaken, including holidays in Cornwall, boat trips and holidays taken abroad. This resident was able to convey, when asked, that they like the activities they do at the home, and they can choose what they want to do. During discussions with staff it was clear how committed the staff team are to ensuring all residents have full access to activities in both the local and wider communities, which provides residents with the opportunities to meet other people who do not have the same disabilities as themselves. During discussions the manager told us that residents have not been offered keys to their bedrooms, however, this is something that will be attended to. Staff at the home support residents to maintain relationships with their family and friends. During discussions staff told us that there are no restrictions to visitors unless the resident requests not to see a visitor. Staff at the home take residents to their families when they choose to visit them, which is mainly weekends and holidays. Residents, who are able to, undertake certain chores at the home such as laying the table for meals and helping in the garden. Each resident has two set days when they do their laundry with staff support. During discussions staff told us that the aim is to support residents to be as independent as they can be. The menus maintained at the home were viewed. A variety of meals are offered that include fresh meat, pasta, fresh vegetable and fruit. The manager and staff told us that they have regular advice about the menus from a Dietitian who visits the home every six weeks. Evidence was also viewed that advice and input in regard to eating is provided by a Speech and Language Therapist. Residents weights are monitored, and records are maintained in their individual care plans. We were told that residents choose the menu each day, and we evidenced photographs of meals that are used to help residents choose. One resident has the responsibility for displaying the days meals in the lounge/dining room, and they showed this to us. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Specialist dietary requirements are catered for such as diabetes, and evidence was viewed of how this is being monitored by staff. During the site visit residents were provided with drinks and snacks, and were often asked if they wanted anything else. One resident was able to convey to us that they liked the food the have at the home. The AQAA informs that residents have a weekly programme of activities, that staff support residents to maintain contact with their family and friends and to spend quality time with hem, and that a healthy and balanced diet is provided. The homes ethos is to promote independence and autonomy, and residents have access to all the communal facilities that includes the kitchen. Evidence viewed during the site visit supported the evidence provided in the AQAA. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support provided to residents meets their preferences, and their physical and emotional needs are met. People who use the service are protected by the homes storage and administration of medication procedures. Evidence: The two care plans sampled included information in regard to how residents wish their personal care needs to be attended to. These were clearly detailed, and provided information of when to provide prompts and /or direct support. During discussions staff told us that residents are able to choose what time they go to bed in the evening, and the time they choose to rise in the morning. This was evidenced on the day of the site visit when one resident had their breakfast in bed and then, with staff support, had a leisurely bath before getting dressed. Staff told us that this is the choice of this particular resident. Staff also told us that they help residents to choose the clothes they like to wear through offering choices of clothes, communicating with residents and using pictures when required. We evidenced staff continuously monitoring each residents Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: appearance during the site visit, and prompting residents when certain things required attending to. The home has specialist aids as required for attending to each residents individual needs. These included hoists, wheelchairs, low profiling beds, specially adapted chairs and bath and a walk in shower. On the day of this site visit all staff were attending training in regard to manual handling. The manager told us that risk assessments for manual handling were in place, however, again these were stored in another cupboard. Two Health Action Plans were viewed. These provided information in regard to the health care needs of residents that included access to the GP, Dementia Pathways, Dietitian, Community Physiotherapist, Psychiatrist, Occupation Therapy and the specialist feeding team at the local hospital. Records of all medical appointments are maintained in the Health Action Plan. However, one resident had recently had a fractured leg, and whilst medical treatment had been provided, there was no information recorded in the Health Action Plan. There was a copy of the Regulation 37 Notification sent to the Commission. The day after the site visit the manager told us this information was also recorded in another file that was available for inspection if we were able to go back and view it. As stated throughout this report, the manager had made it clear to us that she needs to collate the information into one file, and this would be done as soon as possible. The manager told us that all residents have their medication reviewed on a three monthly basis with the exception of one, who has theirs reviewed every month, when the GP visits the home. When ever possible, residents are taken to attend their medical appointments. From discussions with staff and the viewing of records it was clear that residents have access to all the health care professionals as required. The AQAA informs that the home follows the organisations Medication Policy that was last reviewed in October 2007. The home has a long sustained record of full compliance for the safe management of medication. No resident is currently able to self administer their medication. Two records of medication were sampled during the site visit. These were accurately maintained and no omissions were noted. Medication is securely stored in a wall mounted metal cabinet, and two members of staff sign the Medication Administration Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Record sheets when medication has been administered. The manager has a book for the recording of when medication is returned to the local pharmacy, and maintains a separate record of the quantities of medication received. No resident is taking a Controlled Drug. The viewing of two staff training files provided evidence that they had received the required training in regard to the safe administration of medication. During discussions staff told us that all staff attend this training, and annual refresher training is provided. The AQAA informs that all residents have an up to date Health Action Plan, attend appointments with the GP and other specialist services that includes Specialist Community Dentist, Dietitian, wheelchair clinic and Consultant Psychiatrists. Two residents also come under the net of the Dementia Pathways and Specialist Community Assessment and Treatment Service (SCATS) Team. Specialist manual handling requirements for individual residents have been assessed by the Occupational Therapist and the Health and Safety Consultant employed by the organisation. Plans for improvement during the next twelve months include improving the Health Action Plans to introduce a more pictorial format so residents will be able to access them. Currently the home are waiting for an OT assessment so they can purchase a shower cradle with arm rests that would enable residents to access the shower as their mobility and posture deteriorates. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, and their relatives, have access to a complaints system that enables them to raise concerns, and be confident that their concerns would be addressed. Residents are protected from abuse through the homes Safeguarding Policies, Procedures and staff training. Evidence: The Care Quality Commission has not received any concerns, complaints or allegations in regard to the home during the last twelve months. The home follows the organisations Complaints Policy that was last reviewed in 2010. A copy of this document is included in the Service User Guide that uses pictures and key words. This policy provides the correct contact details for the Care Quality Commission and a time scale for responding to complainants. There is also a pictorial version of this document that is provided to residents. The AQAA informs that the home has not received any complaints during the last twelve months. During discussions staff told us that they can tell when residents are unhappy or sad through their body language, gestures, facial expressions, noises and moods. Staff told us that they would make a complaint on behalf of a resident if it was necessary, and would follow this up on behalf of the resident. The manager told us that they have a copy of the most recent local Safeguarding Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Team procedures, and staff at the home follow the organisations Whistle Blowing policy. The manager also told us that they follow the organisations Protection of Vulnerable Adults policy that was last reviewed in May 2008. The home has not received or dealt with any Safeguarding issues during the last twelve months. The manager told us that all staff have attended training in regard to Safeguarding Adults, and annual refresher training is also provided. Other training in this area includes dealing with Challenging Behaviors to ensure that residents are kept safe when displaying these type of behaviors. The viewing of two staff training files provided evidence that staff had received training in regard to Safeguarding Adults. During discussions with one member of staff, we were told us that they have regular training in this area of their work. They were knowledgeable of the procedures to be followed, including the managers responsibility to report all suspicions of abuse to the local Safeguarding Team and the Care Quality Commission, and stated that they would not hesitate in reporting bad practice. The member of staff was passionate about Safeguarding residents. All residents have their own individual Building Society accounts, and no member of staff is an appointee. Small amounts of money are held for each resident, and all transactions are signed by two members of staff. The manager told us that the money is checked at each staff handover, and monthly in-house audits are conducted. The organisation scrutinizes these records on a three monthly basis. The AQAA informs that all staff attend Safeguarding Adults training on an annual basis, and the local policies and procedures are followed. A copy of the complaints procedure is provided to relatives and the next of kin, and a user friendly copy is provided to all residents. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable, clean environment that encourages independence. Evidence: The accommodation is a large, detached, single storey bungalow that has specialist adaptations and equipment to meet the homes stated purpose and needs of people currently living in the home. It is domestic in scale and character and located in a residential area, central to a local village. Local shops and other community amenities are within walking distance. Bedroom accommodation is all single occupancy without en-suite facilities but includes wash basins. All areas including the garden are wheelchair accessible. Facilities include a spacious bathroom with adapted bath, a separate shower room and there are two toilets. There is a good size, combined lounge/dining room, which opens onto a small conservatory and in turn this leads to a pretty, enclosed garden. There is parking space for two or three cars at the front of the premises. Bedrooms were personalised and appropriately decorated in the colours of residents choosing. Each bedroom was appropriately furnished with pictures and family Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: photographs on the walls. Residents were able to have their own television and digital radio/music centres and all other personal belongings. One resident showed us their bedroom and was able to convey that they liked their bedroom, and the fact that they can have their own model airplanes on display. When asked the resident nodded to inform that they had chosen the decor for their bedroom. There is a large lounge/dining room that is bright and has appropriate furnishings such as a television, DVD player, comfortable chairs and a fish tank. The dining area includes a large dining table with six chairs. Staff on duty sit with residents at every meal to offer support and be part of the social occasion. There is a fitted kitchen that was exceptionally clean, and included fridge/freezers and ample storage for the fresh food bought. Records of daily temperatures of the fridge/freezer were maintained. There is conservatory that leads onto a small, secure well maintained garden that is wheelchair accessible. Staff and residents maintain the garden and have planted shrubs and other plants that make the garden a relaxed place to be. Bathrooms and toilet facilities were clean and hygienic, and had liquid soap and paper towels. Appropriate aids were available for use in the bathroom and shower for residents who required to use these. The carpeting at the home and the wall colours had been carefully selected to ensure they met the needs of residents with Dementia. Sun reflecting tube lights have been added to darker areas of the home to enhance lighting. The AQAA informs that the home has an Infection Control Policy that was last reviewed in 2005, and that all nine staff have attended training in regard to infection control. On the day of the site visit the home was exceptionally clean, tidy and free from any odour. The AQAA informs that the home has been refurbished to meet the future needs of residents living at the home. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are trained, skilled and in sufficient numbers to support the people who use the service. Residents are protected by the organisations recruitment policy and procedures. Evidence: There are nine staff currently working at the home that include of seven females and two males. The staffing consists of the manager, deputy manager, and seven senior staff. All staff are now employed by Welmede Housing Association Limited. Six of the nine staff hold the minimum of an NVQ level 2 and above. During discussions the manager and staff told us that there are two members of staff on duty each shift attending to the assessed needs of the four residents, and one member of staff works a straight shift of nine to five. All shift vacancies are covered by the homes bank staff or the organisations bank staff. The staffing is also supplemented with an average of fourteen to fifty hours per week with floating support staff from the activities and Dementia services of the orgnaisation. This ensures that residents are able to pursue meaningful leisure activities. The home has one waking night staff each night, and are able to utilise on call staff from another of the organisations care homes in the area. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Three staff recruitment files were sampled. Each included an application form with full employment history, two written references and proof of identification including a photograph. All of the staff files included the Criminal Record Bureau reference numbers. The AQAA informs that staff are provided with a copy of their job descriptions and new staff undertake induction training. Each member of staff has their own training and development file. Two of these files were sampled during the site visit. These provided evidence that staff receive regular up to date training that includes Diabetes, Dementia, Person Centred Planning, Bereavement and Loss and Challenging Behaviours. The AQAA informs that there is a staff induction package, CRB and POVA checks are undertaken, and all staff have individual training files with evidence of their training. The manager told us that they endeavour to conduct formal one to one supervision every six weeks. Staff training needs are identified through annual appraisals and supervisions. Supervision records, although not scrutinized, were evident in the two staff files that were sampled. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for the day to day management of the home ensures that the home is appropriately managed. There are systems in place for monitoring quality assurance, and policy and procedures of the organisation ensure the safety of residents and staff are promoted. Evidence: The home continues to be managed by a manager who is a Registered Nurse for Mental Health, holds the NVQ level 4 and the Registered Managers Award. The manager has eighteen years experience in managing care homes for people with Learning Disabilities. The manager attends all the mandatory training as well as keeping up to date with training that is relevant to her managerial role. The home has recently employed a new Deputy Manager who has sixteen years experience of working with peopele with Learning Disabilities and holds the NVQ level 3. As stated in the summary of this key inspection report, the manager was only available for approximately two hours on the day of the site due to pre-planned training that was taking place at the home on the day of the site visit. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Previous inspection reports inform that the home has undertaken quality assurance surveys of residents, relatives and other associated professionals. The AQAA informs that monthly audits are undertaken by the organisation, and some Regulation 26 visit reports were viewed on the day of the site visit. The manager has identified that the homes annual quality assurance audit and quality improvement plan needs to be completed for this year. Both the manager and staff of the home have been caring for two residents who were in the final stages of their end of life. During discussions with staff it was clear that they were very involved with these two residents, were extremely caring for them in their final days, and had been affected by the sad loss of each resident. The manager and the organisation had provided training for staff in regard to Bereavement and Loss, and the manager has been supported by the organisations area manager for the home. It is acknowledged that this was a difficult time for all staff, and that the care for these two residents had to take priority over any paperwork. The manager and the home have a very good past record of compliance, and therefore we are assured that the manager will ensure the identified issues in regard to the care records, risk assessments and quality assurance will be addressed. We did undertake two Annual Service Reviews for the service, one in 2008 and the second in 2009. On both occasions the manager was sent an Annual Quality Assurance Assessment to complete and return to the Commission within the timescales set. However, the manager failed to do this and was sent a warning letter for both incidents. However, the AQAA sent to the manager for this Key Inspection was fully completed and returned to the Commission within the timescale set. The AQAA informs that all staff receive the mandatory training as required, which is provided by the organisation. The sampling of two staff files provided evidence that mandatory training had been undertaken. During discussions, staff told us that training they receive is very good and annual updates are always provided. The AQAA informs that the Health and Safety maintenance checks of equipment used at the care home are reviewed in accordance with the manufacturers recommendations. We did evidence the Employers Liability Insurance that expires in June 2010. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The manager should ensure that all the information relating to the care support plans are kept as one working document in one file. This also includes risk assessments. The manager should ensure that all information relating to the health care needs of residents is kept in one working file. 2 19 Care Homes for Adults (18-65 years) Page 30 of 31 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). 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. 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