Care Home: 6 Lilac Grove

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What the care home does well People are well involved in the assessment process, so that staff know what they need when they move in. People make lots of visits with their family to meet with people who already live there and the staff. If they need specialist healthcare, it is set up for them with local services before they come to live at the home. People have very detailed care plans which show staff how their needs must be met and regularly reviewed. People`s family are involved and kept up to date with developments. People are encouraged to develop and use more communication skills. People are encouraged to explore and get to know their environment and the locality. People have lots of opportunities to learn new skills, both at the home and nearby college. Risk assessment does not restrict people from experiencing new activities. People are encouraged to make decisions. An advocacy service is available if people need independent help with decision making. People`s private space is respected by staff. People enjoy a range of activities at the home and locally. People contribute to the monthly menu planning and enjoy a range of healthy food as well as treats. People have good access to healthcare professionals and specialists. Systems are in place so that staff safely administer people`s medication. People can make their views known in different ways. Staff know how to use the local safeguarding adults procedure. People live in a well maintained, comfortable, and clean environment. The environment is accessible to Deaf and visually impaired people. Staffing levels enable people to be well supported during the day and at night. Staff have good access to regular relevant training. All staff have been trained in British Sign Language. People have developed good relationships with staff. People are protected by a robust recruitment procedure. Health and safety is regularly monitored so that people are well protected. What has improved since the last inspection? The statement of purpose file has been updated to ensure that only current relevant information is available. People have had their files reviewed so that only current up to date information is available. Staff sign when they are talking in communal areas. This means that people are not excluded from any conversations and know what is being discussed.The home is better at telling us about significant events that occur, so that we know how these have been dealt with. What the care home could do better: Any amendments to care plans following review should be signed and dated for monitoring purposes. The date of opening medication with a limited shelf life should be written on the container, rather than the box which could be mislaid. The complaints procedure must be amended to include the information about the current registered manager and the Commission. This is so that people are aware of who to contact. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lilac Grove 6 Lilac Grove Trowbridge Wiltshire BA14 0HB     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: Sally Walker     Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Lilac Grove 6 Lilac Grove Trowbridge Wiltshire BA14 0HB 01225766200 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sense, The National Deafblind and Rubella Association care home 4 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home 4 4 4 6 Lilac Grove provides care and support to four younger adults with learning disabilities, sensory impairment and physical disabilities. There is one single bedroom with an en-suite shower and toilet to the first floor and three single bedrooms on the ground floor, one of which has an ensuite toilet and washbasin. There is a large wheelchair accessible bathroom with shower, bath and toilet to the ground floor. Also on the ground floor are a sitting room, adjacent dining room, kitchen, laundry room and a separate toilet. There is a conservatory, divided into offices. All the exits have level access or ramps. There is a reasonably large enclosed garden to the rear of the property. The front garden has been covered with asphalt to alleviate the local parking problem. The interior has been decorated to take into account the needs of people with a visual impairment with dark doors, frames and light walls. All staff are expected to obtain British Sign Language qualifications. The staffing rota provides for a minimum of three care staff during the waking day and one waking night staff with one staff Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home sleeping in. Staff carry out domestic tasks as well as care and support. The weekly fees for the home are between 660.00 and 1950.00 pounds a week depending on assessed need. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 14th May 2009 between 8.55am and 4.10pm. Mrs Victoria James, registered manager, was present during the inspection. We looked at care plans, risk assessments, medication, staff training and recruitment, menus and activities. We spoke with people who use the service and staff. We made a tour of the building. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We asked the home to fill out their AQAA (Annual Quality Assurance Assessment) so Care Homes for Adults (18-65 years) Page 6 of 32 they can tell us about their service. It was filled out in full and returned on time. Some of the information we received can be found in the body of this report. The last Key inspection was on 24th April 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? The statement of purpose file has been updated to ensure that only current relevant information is available. People have had their files reviewed so that only current up to date information is available. Staff sign when they are talking in communal areas. This means that people are not excluded from any conversations and know what is being discussed. Care Homes for Adults (18-65 years) Page 8 of 32 The home is better at telling us about significant events that occur, so that we know how these have been dealt with. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their families who are considering using the service have all the information they need when making decisions about coming to live at the home. Staff make sure they know as much as they can about people who want to live at 6 Lilac Grove. Evidence: Action had been taken to address the requirement we made at the last inspection that the statement of purpose file must either be reviewed and rationalised so that only relevant information is available, or that a copy of the document sent out by the organisations central referral team is available in the home. We saw that the file contained the relevant information. The statement of purpose and service users guide were available in pictorial format. No one had come to live at the home since the last inspection. We saw that the home had gained very detailed information from the last person who came to live there. This information was obtained from their family, carers, care manager and healthcare Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: professionals involved in their care. At the last inspection we saw that significant efforts were made to ensure that anyone who chooses the home has a good admission process and that all their needs will be met. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and aspirations are set out in their care plan. People and their parents are involved in regular care reviews. People are supported in decision making. Risk assessments do not restrict people from being involved in new activities or developing new skills. Evidence: Each person had an individual care plan detailing all aspects of care need, including mobility, communication profile, personal care, epilepsy profile, activities and medical needs. In the AQAA Mrs James told us that she plans to implement an improved care planning format that is more accessible to the DeafBlind person. Peoples social history inform the care planning process. Peoples preferred daily routines for personal care were identified. People go to bed and get up when they are ready, depending on what their daily programme is. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: There was very good information about how people communicated, with photographs of what each persons own signs meant. Care plans identified when people wanted to spend time alone in their room during the day. All staff had signed up to the care plans. There was evidence of regular review of the care plans with people, their relatives and care managers. Not all of the care plans showed the date on when amendments were made. All risks were identified with guidance on risk management and peoples ability to respond to any risks. People were encouraged to develop mobility and orientate themselves both around the home environment and the locality. Care plans identified how people with a visual impairment should be guided when walking. Some people have their own wheelchairs or canes to go out and about. People had access when needed to the local speech and language therapist and the organisations own behaviour specialists. The Department of Health guidance on physical intervention was available to staff. We saw evidence in care plans and daily reports that since the last inspection behaviours had significantly reduced, through management strategies and supporting people to be aware of the environment and what was happening. The care plans also identified short and long-term goals. There was good evidence of regular review of each persons care with their family and care manager as necessary. People are encouraged to make decisions about their lifestyle. People have access to local advocacy services if needed. Some objects of reference are used so that people know what is going to happen, for example, keys to the minibus for going out. The practice development worker told us that she planned to develop the use of objects of reference. Parents can be involved in decision making, for example, where people need dental treatment, cannot use a key to the front door or need staff to read their mail. Parents were informed of any significant developments as they occurred. It was clear that good relationships with families were established. Regular house meetings were held with minutes taken. Staff used pictures as aid memoirs for issues to discuss. The daily report sheets were set out in sections in relation to individual plans of care. There was good evidence that the care plans were being followed. Staff recorded what people had chosen to wear, what was eaten, whether medication was taken, peoples mood, how personal care was carried out and activities and achievements during the day. We saw how people with a visual impairment were supported to know the difference between day and night with a structure and different signs. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Action has been taken to address the good practice recommendation we made at the last inspection that staff should consider how people feel when staff use their voices rather than sign when communicating with each other in communal areas. Staff were seen to engage with each individual person either with British Sign Language, hand over hand signing or speaking. Staff did not talk exclusively with each other and included people in conversations. In a survey form one of the staff told us I feel we have enough staff but some of the individuals do not have enough one to one hours. I feel having two vehicles would benefit our home so that all individuals can have trips out on the same days and so there is not a chance that someone has to miss out because the vehicle is already being used. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a good range of activities and leisure facilities both at the home and in the locality. People keep in touch with their families. People receive support which is helping their communication skills and independence. People enjoy a healthy diet. Evidence: People are encouraged to be involved in a range of activities both at the home and in the locality. Records are kept of all activities that people are involved in. The home has appointed a practice development worker for 19 hours a week, to plan and oversee activities as well as improve staffs working practice. They told us about the different activities that people liked to do. People like going for walks, picnics, swimming, horse riding, trips to the pub, cinema and meals out. They told us that they planned group and one to one sessions after asking people what they wanted to do. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Mrs James told us that she was considering the use of a local hydrotherapy pool and engaging an occupational therapist. Most of the staff are female. Males who use the service have the company and support of a male member of staff for one day a week. The gentleman and the male staff plan what they are going to do for the day: trips out and specific activities. Mrs James told us that there were no local Deaf clubs. She said that people meet Deaf friends through their college courses. One course has a Deaf tutor so people are not restricted by staff having to go with them and interpret. Mrs James told us that the college offered various courses for people to do. She said the appointment of the practice development worker meant that people were doing different activities that were geared to what they could achieve. Some of the courses included cooking, woodwork and pottery. People were also supported with numeracy and literacy and learning new signs. One person told us about what they did at college. They also said they were happy at the home; they enjoyed the meals and had good relationships with the other people and staff. People were planning their holidays with staff. One person told us they were going on a holiday with their parent to Ireland. Staff told us that they were still deciding on another holiday to take this year. Another person told us they were going to Spain. Two people were going to a holiday cottage in Devon the following week. One of the staff who was going with the two people, told us about the accessibility of the cottage and the different things that people liked to do in the area. They had been several times before and were comfortable finding their way around the cottage. There was a Sense holiday planned for later in the year. However in a survey form one of the staff told us The service could offer more holidays for the individuals. People who may have a visual impairment have successfully orientated themselves around the home. The practice development worker was providing mobility training so that people can map the local area to access local shops and parks. Staff continued to enable people to develop new skills in preparing and cooking meals and learning new signs for more independence. People were encouraged to be involved in some domestic tasks with staff support, for example, washing up or doing their laundry. People maintained good communication with family. Staff supported people to make regular telephone calls, visits or email. There was a computer which people used. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: People used the homes own mini bus or use public transport. People contributed to planning the weekly menu and staff knew what people liked. Some people helped with the weekly food shopping. One of the staff was responsible for ensuring stock items were purchased each week. The fridge was well stocked and all items were dated when they were opened. The daily menu was displayed on the fridge. There were no special diets needed. The menus showed a range of healthy meals with salads, fresh fruit and vegetables. People were not restricted from having treats, chocolate and sweets. The main meal was taken in the evening and people chose from a range of snacks available every day for lunch. If people went out for a meal instead of having a meal at the home, this was paid for out of the homes budget. People liked to have different takeaway meals, a pub meal or go out for a picnic. People helped themselves to breakfast with staff support as needed. Some people made a packed lunch to take with them to college. People had their lunch as they came to the table. Those people who needed support with eating or drinking were seen to have individual support at the persons own pace. Staff ate with people who use the service. One of the people who use the service told us Today Im going to college to do cooking. I also do pottery and woodwork. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferred routines for personal care giving are set out in their care plan. People have good access to healthcare professionals. People can administer their own medication if they wish. Systems were in place to ensure safe administration and control of peoples medication. Evidence: Peoples medical history was included in their separate health care plan. Care plans identified peoples preferred routines for personal care and other routines throughout the day and night. There was very good information about how people expressed themselves when or if they were in pain. People had good access to healthcare professionals and records were kept of regular check ups, for example, with the audiologist and optometrist. People had agreed that staff, rather than an interpreter, could go with them when they attended reviews or when they visit their GP. This was because they felt more comfortable with staff who they knew. This had been agreed with all the parents. There was guidance about managing epilepsy. People were weighed regularly and any significant loss referred to their GP. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: One of the staff showed us the arrangements for administration and control of medication. People could administer their own medication following a risk assessment. Currently only one person was administering their own eye drops. The medication was kept in a locked facility in a locked room. Some medication with limited shelf life was correctly stored in the fridge. We saw that the date of opening was written on the box rather than on the container. Mrs James told us that a new drugs cupboard was on order, to comply with The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. Staff could only administer medication when they had undertaken training and were deemed competent. Competency was assessed every six months. Staff had received medication training from the supplying pharmacist. All medication was checked as it was received into the home by two staff who both signed the log. A record was kept of any unused or unwanted medication returned to the supplying pharmacist. Medication prescribed to be taken only when required was identified in the persons care plan. Care plans identified how people took their medication. If people had difficulties with swallowing tablets, liquid equivalents were requested. Peoples medication was regularly reviewed with their GP. Written confirmation had been sought from each GP with regard to taking some homely remedies. The data sheets for each prescribed medication were kept on file as was the homes medication policy. No controlled medication was prescribed. We saw evidence that one person had benefited from a reduction in medication, authorised through a consultant. There had been a recent medication error which the home informed us about. The matter had been investigated and an action plan put in place. In a survey form one of the healthcare professionals told us The service supported the client to all health appointments and consulted with all professionals appropriately. Training is sought appropriately and advice given acted upon. The client that I worked with required support and received this. They are aware of [the persons] interests and support [them] with leisure and educational interests. All staff are able to communicate with the client. Have not raised concerns. [Does well] Supports service users to access the community. Promote choice and independence. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems are in place to enable people to complain about the service. Staff are trained in the local procedure for Safeguarding Adults and know how to make referrals. People are protected by safe management of their finances. Evidence: The organisations complaints policy and procedure was available in pictorial format including a flow chart. The policy had been made available to peoples relatives. In the AQAA Mrs James told us that each person had a copy of the procedure in their own preferred style of communication. She went on to tell us that complaints were regularly discussed with people at meetings. We saw that the procedure referred to the previous manager and our office which is now closed. The homes complaints log had no complaints recorded since 2003. A copy of the local Safeguarding Adults procedure was available and all staff had training in abuse awareness. Further training was planned for October 2009. We asked staff about what they would do if they observed or received allegations of abuse. They were familiar with the local procedure for reporting abuse of vulnerable people. Agency staff were informed of the local procedure at induction. In a survey form one of the staff told us Report it to the relevant person - we have access to Senses designated persons and protection committee. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Peoples benefits are paid directly to the organisation with the personal allowance element paid into each persons own bank account. Only senior staff are able to act as appointees. People are encouraged to save in their own accounts which attract interest. Generally parents deal with peoples finances but people are encouraged to manage their own money. People can keep small amounts of cash in the homes safe. Only senior staff and the manager have access. Records and receipts were kept of all transactions. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, comfortable, and clean environment. The environment is accessible to Deaf and visually impaired people. Evidence: Two people showed us their bedrooms. They were individually decorated and furnished to reflect the persons personality. All the bedrooms are single accommodation, two have ensuite facilities. One of the bedrooms is on the first floor. People who may have a visual impairment are well orientated around the home. Doors are clearly visible in a darker colour to the walls. Door hinges have been guarded to stop people trapping their fingers as the doors close. Some doors may be locked if they contain potential hazards to visually impaired people. People have access to all parts of the ground floor. The home has a programme of redecoration, refurbishment and maintenance. The central heating boiler had been replaced. One of the bathrooms had been upgraded with a new bath and shower. Staff planned to provide tactile wall decoration on some parts of the bathroom for the benefit of those people with a visual impairment. Some of the carpets had been replaced with wooden flooring. This enables the DeafBlind people to feel any movement. There were also plans to upgrade the dining room, Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: sitting room and hallway. Mrs James told us that she had requested funds to make the garden more accessible with landscaping, a pergola and textured flooring. There was a trampoline which people enjoyed using for rebound therapy. The physiotherapist had trained staff to support people in the different exercises on the trampoline aimed at enabling people to experience different awareness of space. The home had a separate laundry room. Peoples individual clothing and bed linen is processed separately. Some people do their own laundry with staff support as needed. The night staff undertake the ironing. The washing machine had a sluice facility for dealing with soiled or contaminated laundry. Staff undertook cleaning as well as care. The waking night staff had a schedule of cleaning duties. Some people were supported to clean their own bedrooms. The home was cleaned to a good standard and we did not notice any unpleasant odours at any time. Disposable protective clothing and gloves were available to staff. Appropriate arrangements were made for the disposal of clinical waste. There were notices in the bathroom and toilets for good infection control practices. These were in English as well as sign. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels enable people to be well supported during the day and at night. Staff have good access to regular relevant training. All staff have been trained in British Sign Language so that they can communicate with the people who use the service. People have developed good relationships with staff. A robust recruitment procedure is in place. Evidence: The staffing rota provided for a minimum of three care staff throughout the day. At night there is one waking night staff and one member of staff sleeping in. People can see which staff are on duty each day from the photograph board by the front door. In the AQAA Mrs James told us that one of the people who use the service helps to change the photographs as part of their routine. She went on to tell us that regular visitors have their photographs on the board. There was some use of agency staff. All agency staff are inducted into the role and there was guidance on working with people who use the service, which agency staff had to sign up to. This included peoples personal profile, day and night routines, staff dress code and any tasks they were expected to carry out. There was a list of the British Sign Language communication which people use. A small group of agency staff Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: was used. They had worked at the home for some time and were well know to people living there. There was an on call system for out of hours emergencies. The Sense local office obtains the initial information about potential candidates for posts and Mrs James makes a short listing and interviews with her manager. In the AQAA Mrs James told us that interview questions are now more value based than knowledge based. All of the information and documents required by regulation were in place. No staff commenced work without checks on their suitability to work with vulnerable people. All new staff are inducted. The induction record covers all aspects of the work, including working with each individual person, working with DeafBlind people, health and safety, conditions of service, expectations of the organisation and staff conduct. One of the newer staff told us they felt they had received a thorough induction. They told us they had shadowed another member of staff for a week and were shown how to work appropriately with different people and about Deaf culture. They went on to say that they had received all of the mandatory training soon after starting in the job. Staff have good access to training provided by the organisation or sourced locally. One staff told us There are lots of courses. Another staff told us about training in epilepsy. All staff are expected to learn British Sign Language. Both senior staff have attended training in equality and diversity. The organisation publishes planned training for the year. Mrs James keeps a matrix showing mandatory training and when staff need to be updated. Staff were required to undertake training in health and safety, moving and handling, food hygiene, managing behaviours, adult protection, sexuality and relationships, values and beliefs, medication, infection control, working with DeafBlind people and communication. Staff had also received training in deprivation of liberty safeguards. All staff were expected to undertake NVQ training. One staff had NVQ Level 3 and two were undertaking the qualification. All staff had an area of management responsibility delegated to them, for example, medication, food and menus, staffing rota and health and safety. Staff told us that they received regular supervision. They said that regular staff meetings were held with minutes kept. They said they all contributed to the agenda and all action points were followed up. One staff told us The manager is easy to talk to. In a survey form, one of the staff told us Shadow shifted as to get to know the Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: individuals individual needs. Have yearly training updates on all relevant aspects of my job role. I have monthly supervisions. Another staff told us I feel our service is very person centred and cares for all needs that the individual requires. We have a good working team that are happy and enthusiastic. Another staff told us Induction modules were quite comprehensive and are ongoing in further modules. I would like more training on race and ethnicity. The manager is always available for informal chats between meetings and supervisions. Meetings can be difficult in terms of space and getting the whole team together while stiff remaining available to the individuals we support, yet confidential. It seems to be not always possible to cover shifts especially at short notice. [Do better] Promote choice more effectively. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people who use the service. Mrs James keeps herself up to date with current good practice with regular training. Peoples views are taken into consideration both at the regular meetings and as part of the quality assurance audit. The organisation has systems in place for regular review of health and safety. Evidence: Mrs James has managed the home since 2006. Previously she had worked at the home in a senior role for 3 years. She has worked for Sense for 8 years. She has had previous experience of working with older people in a nursing home and care home. Mrs James has NVQ Level 4 in management and care and the Registered Managers Award. She keeps herself up to date with current good practice by attending regular training offered by the organisation. She told us she was considering undertaking NVQ Level 5 in management. The organisation carries out an annual quality audit. Mrs James and staff are Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: interviewed as part of the assessment. People and their relatives are asked to fill out a questionnaire. When all the information is collated, Mrs James produces an action plan with timescales. This is monitored by her manager. People are also asked their views at regular house meetings. Minutes are written up in British Sign Language (BSL) with photographs. In the minutes file there were discussion sheets in English and BSL so that people could be prompted where necessary to talk about different issues. Staff regularly check various areas of health and safety on the organisations check lists. Risk assessments have been carried out on the environment, Control of Substances Hazardous to Health, activities both in the home and the locality, tasks and use of any equipment. Risk assessments relating to each person were identified in their care plan. Each person had an individual risk assessment in relation to evacuation in the event of a fire. The organisation contracts for maintenance of services and equipment. Action had been taken to address the requirement we made that we are informed without delay of any events in the home set out in Regulation 37 and the Safeguarding adults procedure. This related to allegations that two staff had used peoples money to pay for their own items during a holiday. The home had failed to report the incident and had started their own investigations. The matter has now been fully investigated and is now resolved. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 22 The complaints procedure 31/07/2009 must be amended to include the information about the current registered manager and the Commission. So that people are aware of who to contact. 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 2 6 20 Any amendments to care plans following review should be signed and dated for monitoring purposes. The date of opening medication with a limited shelf life should be written on the container, rather than the box which could be mislaid. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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