Care Home: 77-79 Bath Road

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 77-79 Bath Road 77-79 Bath Road Old Town Swindon Wiltshire SN1 4AX     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: Elaine Barber     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: 77-79 Bath Road 77-79 Bath Road Old Town Swindon Wiltshire SN1 4AX 01793538074 01793538074 denny.davies@rethink.org 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) : Rethink care home 10 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 10 The maximum number of service users who can be accommodated is 10 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Mental Disorder, excluding learning disability or dementia (Code MD) Date of last inspection Brief description of the care home 77/79 Bath Road opened in 1994 and provides accommodation and personal care for up to ten people affected by severe mental illness. The home is run by Rethink, a national charity which provides a range of care and support services around the country. Bromford and Carinthia Housing Association owns the property. 77/79 Bath Road is located in the Old Town area of Swindon and there are a range of shops and amenities within walking distance. The property was originally two attached houses, which have been converted internally to provide accommodation on three floors. Each service user has their own bedroom and there are various communal rooms on the ground floor. There are gardens to the rear of the property and a small parking area at Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home the front.The fee levels vary from person to person, with an additional grant paid to the service by the local Primary Care Trust. Care Homes for Adults (18-65 years) Page 5 of 33 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: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We reviewed the contact that we have had with the home during the last year. This included several notifications about issues that affected the welfare of people who lived in the home. We made a visit to the home on 29th January 2009. We talked to four people who lived in the home, three staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 33 The judgments contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last key inspection of the home was on 6th February 2007. What the care home does well: People were given the information they needed so that they could make an informed decision about whether the home was suitable for their needs. A new statement of purpose and service user guide had been written which provided detailed information about the service provided. People who lived in the home had been consulted about the information that went into it and how it was presented. Each persons needs were assessed so that their needs would be met. Each person had a contract and service agreements so that they knew what to expect from the service and they knew what they had to pay for. Each person had a care plan. Peoples personal, social and health care needs were reflected in their personal plans so that these needs could be met. People were supported to make decisions about their lives such as what to do each day and how the home should be run. Risks were assessed and action was taken to reduce risks so the people could take risks as part of an independent lifestyle. People could exercise independence in the home and had opportunities for personal development. They went out when they chose and moved around freely within the house. People made drinks and snacks when they wanted and did their own laundry with support. People benefited from the support they received, which helped to maintain relationships and develop individual skills. They kept in contact with family and friends as they wished. Peoples rights and responsibilities were recognised within the daily routines. People were offered a varied diet and enjoyed their meals. Each person was registered with a GP and saw other health care professionals when they needed to. This meant that peoples personal and healthcare needs were being met. The homes medication procedures and practices encouraged people to take responsibility for their own medicines and exercise independence. Information was available to people about the complaints procedure so that they knew how to make a complaint. There was a procedure about safeguarding adults and staff had received training so that people were safeguarded from abuse. The home was close to local shops and within walking distance of the town centre so that people could go out easily. There were three large lounges and each person had their own room so that the accommodation was meeting peoples needs. The home was well maintained so that people lived in a homely, clean and spacious environment. At the time of our visit the decorators were painting some of the rooms. Improvements were being made to the decor and furnishings so that people would benefit from living in a more comfortable home. People were supported by sufficient staff who were trained and qualified to meet their needs. There were three staff on duty during the day and two sleeping in at night. Eighty per cent of the staff had a National Vocational Qualification (NVQ) at level 2 or above. Staff had all the required basic training and more specialist training so that they could meet peoples specific needs. New staff had the appropriate checks before they started work and they were protected from being supported by unsuitable staff. Care Homes for Adults (18-65 years) Page 8 of 33 The manager and deputy had relevant qualifications and experience. They were also supported by other managers in the organisation so that people benefited from a well run home. There were quality assurance systems based on peoples views for monitoring and improving standards in the home. Several improvements had been identified in the last year based on peoples views. There were health and safety policies and procedures, staff had received appropriate training and equipment was serviced. There was a fire risk assessment and there were fire safety checks. These measures made sure that the health and safety of the people who lived in the home and the staff were promoted and protected. What has improved since the last inspection? What they could do better: The care plans could be made more person centred to make sure that the things that were important to people happened. The care plans should include information about age, race, ethnicity, disability, gender, faith and sexual orientation to make sure that each persons diverse needs are met. More information about peoples strengths and abilities and lifestyle should be recorded in the care plans. Improvements need to be made to the recording when additions are made to the medication records and when medication is given to a person to manage themselves to make sure people are kept safe. A record should be kept when recruitment checks, such as references, are received so that it is possible to tell that all checks are received before a member of staff starts work and people are protected from being supported by staff who may be unsuitable. Care Homes for Adults (18-65 years) Page 9 of 33 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 10 of 33 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 11 of 33 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 were given detailed information about the service provided so that they could make an informed decision about whether the home was suitable for their needs. Each persons needs were assessed so that their needs would be met. Each person had a contract and service agreements so that they knew what to expect from the service and they knew what they had to pay for. Evidence: The manager told us in the AQAA that the service user guide to the home had been re written and contained much more information than before. They said that it also included pictures of the staff and their background so that new residents could identify staff more easily, and also contained pictures from holidays and activities that residents were happy to provide for use in the guide. The manager said that the new guide to the home was given to existing residents in draft form to have a look at and make any comments in a residents meeting. They said that all those present felt it would be very useful to both new and existing residents. When we visited the home we looked at the new statement of purpose and service user guide. We found that it was Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: very detailed, well presented and clear. The manager told us that it was given to anyone who was thinking about moving into the home. We looked at three personal files. Two people had moved into the home several years ago and their needs had been assessed when they moved in. One person had moved into the home recently. The professionals involved with the person had provided information about their needs. The home had also completed an assessment of their needs. Each of the three people had a contract with Swindon Borough Council and the home, contract agreement with Rethink and a tenants agreement with the housing association which owned the building. Care Homes for Adults (18-65 years) Page 13 of 33 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 personal, social and health care needs were reflected in their personal plans so that these needs could be met. People were supported to make decisions about their lives and to take risks as part of an independent lifestyle. Evidence: The manager told us in the AQAA about the homes approach to equality and diversity. This included training for staff about equality and diversity issues to be completed within the 6-month probationary period. They told us that there was a diversity lead within the service who attended quarterly meetings with other diversity leads to share good practice ideas. They said that all staff are aware of and understand policies relating to diversity such as code of conduct, equality and diversity, equal opportunities. The recruitment process promoted equal opportunities and complies with all laws relating to discrimination. There was a cultural competency checklist to help staff assess whether the home was meeting their targets. When we looked at the statement of purpose we saw that it provided information about local places of worship Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: for several different faiths. When we looked at the care plans we found that some information about peoples diversity needs was recorded but this was not done in a consistent way. For example one persons views about religion and their mental health needs were recorded in their care plan. Their nationality and their gender was recorded in their personal file and the fact that they were blind in one eye. Any issues relating to their visual disability, gender and ethnicity were not reflected in their care plan. We looked at three care plans. We saw that these covered different aspects of peoples needs, arranged under headings such as communication, personal care, mental health and mobility. One section of the care plans included information about the intervention of staff and the type of support that was needed. The plans were focused on tasks required to support the person and did not include their strengths and abilities which would make the plans more person centred. The records showed that the care plans were being regularly discussed and reviewed during meetings between the service user and their key worker. The main points of these keyworker sessions were recorded, together with any changes to the care plan that had been agreed at the time. Several care plan forms had been updated in January 2009. There was also a section on the care plan forms to record the persons views. We made a recommendation at the last inspection that peoples views are consistently recorded in the care plans. We saw that two peoples views were recorded consistently throughout their care plans. However, we saw that on some forms for one person the section to record views was blank. Sometimes a record was made that the person had declined to give their views. Peoples main aspirations and needs were highlighted in the records. At the beginning of each care plan we saw that there was a record of the objectives that the person wanted to achieve from their care. At the time of our visit, one person was involved in a self-care programme and was taking responsibility in areas such as preparing their meals and looking after their own medication. People were supported to make decisions about their lives. We saw minutes of residents meetings where people made decisions about the running of the house. People had keys to their bedrooms. We saw information that told people that they would be given a front door key if they needed to come in late. We noticed that people chose where to spend their time. During the day most people had gone out to various activities. When they came home they spent time in the lounges or in their rooms. We talked to one person who told us that they liked to go out independently and that they had been out to the shops on their own three times that day. At the time of our visit Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: the whole house was being redecorated. The manager told us that people had chosen the colours for the shared areas in the residents meetings. She showed us a record of the colours that people had chosen for the shared areas and for their bedrooms. One person told us about the colour they had chosen for their room. We saw that peoples files included crisis self-management forms. The plans included personal information about peoples backgrounds and their wishes in different areas. Risk assessment forms had been completed in a respect of various hazards, including smoking. Control measures had been identified on the assessment forms, which helped to ensure that people could act independently. Most people were managing their own personal money. Their personal files included guidance about how they could access this independently and any specific arrangements that had been agreed. Some people received support with the safekeeping of money and records were kept of deposits and withdrawals. We looked at some of these records and saw that they were properly recorded. We made a recommendation at the last inspection that a second staff signature is obtained whenever possible if a person chooses not to sign their personal money account sheet. We saw that most people signed their record when money was given to them. Two staff signed the record for one person when money was withdrawn. Care Homes for Adults (18-65 years) Page 16 of 33 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 could exercise independence in the home and had opportunities for personal development. People benefited from the support they received, which helped to maintain relationships and develop individual skills. Peoples rights and responsibilities were recognised within the daily routines. People were offered a varied diet and enjoyed their meals. Evidence: When we visited the home in the morning most people were out. Staff told us that they had gone out to various activities. A member of staff told us that one person was involved in a programme of activities run by MIND and had gone horse riding that day. We met this person later in the day and they told us that they also went to art classes and showed us some of their paintings. The manager said that they were going to hang one of the paintings on the wall. The person said that they intended to paint Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: more pictures so that they could be hung once the house was redecorated. A member of staff showed us around the house and garden. They told us about the vegetable plot that had been dug and planted by the people who lived in the home. The manager told us in the AQAA that people had eaten many vegetables picked straight from the garden. Another member of staff told us that several people were involved in gardening and two people wanted to grow flowers. We saw one member of staff putting together a programme of activities for people in the house during the following month. Two staff said that they planned to play board games and cards with people during the evening of our visit. Two people told us that they were going to play on a games console after tea. A staff member said that people went out to the shops and to cafes for coffee. During the morning one person went out with the cook to do the food shopping. Staff told us that people walk into town and to the local shops. They said that staff take people out in ones and twos to town to shop or for coffee and to Bath for day trips. One person told us that they liked to go out shopping. Another person told us that they had been out to the shops on their own three times during the day of our visit. A third person told us that they had been out to play snooker. A fourth person told us that they went out on their own to shop for their food. Information about how people kept in contact with their family and friends was recorded in their care plan. This included any support from staff that they needed to keep in contact with friends and relatives. People could meet with visitors in the communal areas or in the privacy of their own rooms. We saw that people were involved in the routines of the home. A staff member told us that some people cleaned their own rooms and did their own laundry with varying degrees of staff support. We saw people preparing drinks and snacks in one of the kitchens. A member of staff showed us a large vegetable patch and said that people grew their own vegetables. One person told us that they liked growing vegetables and another person told us that they wanted to grow flowers. We saw that staff only entered peoples rooms with their permission. Each person had a key to their room. We saw information in the records that said that people would be given a key if they were going out and would be back late. We saw that there was a varied menu. A member of staff told us that people chose the meals in residents meetings or they asked people on a one to one basis. They also told us that the cook always offers an alternative if someone does not like the planned meal. We saw that fresh vegetables were being used and fresh fruit was available in a fruit bowl. People told us the they enjoyed the meals. One person was cooking and Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: shopping for themselves as a move towards more independent living. People could prepare snacks when they wanted. Care Homes for Adults (18-65 years) Page 19 of 33 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 personal and healthcare needs were being met. The homes medication procedures and practices encouraged people to take responsibility for their own medicines and exercise independence. Improvements need to be made to this aspect of medicine management to make sure people are kept safe. Evidence: When we read the care plans we saw that these included sections on personal care and physical care. There was guidance for staff about people who would need prompting with personal care, for example with having baths and shaving regularly. There was a keyworker system and there was a mix of male and female staff. We made a recommendation at the last inspection that consideration is given to having some headings under the personal care/physical care sections of the care plans to act as a prompt in ensuring that all areas are included, for example nail cutting. This was because some people required support with toenail cutting and received assistance from people outside the home. It was not always clear from the care plans how people received support in this area of their personal care. We found that no changes had been made to the care plans to reflect this. The manager told us that they had Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: considered the recommendation but if no need was identified they would not carry it forward to the care plan. She also said that some people had podiatry provided by the health service. We saw that information was recorded in the personal files about how people were affected by mental illness and the impact this may have on their day to day routines. There were well established arrangements for service users to receive support from outside health professionals, including community psychiatric nurses. People were registered with local GPs. We saw from the records that people had appointments with the GP, dentist, nurse and community psychiatric nurse. One record seen included information about diabetes and how staff supported the person with this condition. The person was taking responsibility for monitoring their diabetes on a daily basis. Medication was stored in locked cupboards in a locked room. There was a separate controlled drugs cabinet. We observed staff administering medication to people. Two staff checked that they were giving the correct medicines, gave the tablets to a person then signed the medication administration record when they had seen the person take the tablets. We saw that the medication administration records were on the whole correctly recorded. However, sometimes there had been handwritten additions made to the records when an additional medicine had been prescribed. There was no signature of who had made the addition and no date so it was not possible to cross reference it with other records and show on whose advice the addition had been made and when. Some people had as required medicines and they had protocols for when these medicines could be given. Some people took homely remedies with the agreement of the GP. One person, who was working towards living more independently, took their own medicines. A member of staff told us that two members of staff put the tablets into a dosette box and checked that they were correct. The staff member said that a record was kept of this. We saw on the medication administration record for December 2008 to January 2009 a record stating All meds dispensed with the date of the week, the date they were dispensed and a signature of the staff member. On the medication administration record a symbol was recorded to show that the medicines were in a dosette box. However there was no record made when the dosette was given to the person and the person had not signed to say they had received it. There was no record of where the medicines were after they had been put into the dosette box. A member of staff told us that the person was used to this system and did not like to change. Care Homes for Adults (18-65 years) Page 21 of 33 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. Information was available to people so that they knew how to make a complaint. People were protected from abuse and harm. Evidence: There was information in the service user guide about the complaints procedure including how to make a complaint and the process for dealing with complaints. There was a complaints book to record any complaints and investigations but there had been no recent complaints. There was a policy and procedure about responding to allegations of abuse. There was information on the office wall about the multi-agency safeguarding adults procedure in Swindon and how to make a referral to the vulnerable adults team. When we looked at four staff training records we saw that all of them had received training about protection of vulnerable adults and this had been updated. A new staff member told us that they had received training about protection of vulnerable adults as part of their induction and they had also been on a one day course about prevention of abuse. There had been no safeguarding referrals. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation was meeting the peoples needs. People lived in a homely, clean and spacious environment. Improvements were being made to the decor and furnishings so that people would benefit from living in a more comfortable home. Evidence: 77 and 79 Bath Road had been converted from two houses to provide spacious accommodation for the people who lived in the home. The home was close to a range of local amenities and shops and within walking distance of the town centre. The home had three lounges and a separate dining room. We made a recommendation at the last inspection that environmental changes are made which will reduce the effect of smoking in the home and ensure that all no-smoking areas are kept smoke free. In response to this only one of the lounges was designated as a smoking area and a no-smoking policy applied to the rest of the communal space. There were mature gardens at the rear of the property. One of the staff members showed us around the garden and the vegetable plot. They told us that people grew vegetables and in the summer they played badminton and had barbecues. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The accommodation seen was generally clean, with no unpleasant odours. We made another recommendation at the last inspection that timescales are identified for the redecoration of the bathroom and toilet areas. This had been addressed. At the time of our visit the house was being redecorated throughout. The manager told us that the people who lived in the home had chosen the colours for all the rooms and she showed us a written plan for the colour of each room. One person told us that they had chosen the colour for their bedroom. The manager told us in the AQAA that all the pipework and some of the radiators in the home had been replaced last year and many of the carpets were also replaced at the time. She also told us that the residents had picked some new leather armchairs for the back lounge and also a new wood floor and coffee tables. We noticed that some of the cupboards in the small kitchen for drinks and snacks were broken. The manager told us that these were going to be replaced as part of the refurbishment. A member of staff showed us the laundry room which was separate from the other domestic areas. We saw that each person had a cupboard here with their name on it to help to keep their washing separate from other peoples. There was written guidance about good practice in infection control on the wall. The member of staff told us that some people could do their own laundry while other people did their laundry with staff support. They also said that some people cleaned their own rooms and some had staff support. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by sufficient staff who were trained and qualified to meet their needs. The recruitment practices protected people from being supported by unsuitable staff. Evidence: Three members of staff told us that there were three members of staff on duty throughout the day and two staff sleeping in at night. During our visit there were three members of staff on duty in the morning and in the afternoon. When looked at the rota we saw that there were three staff on duty during the day and two sleeping in at night. The manager told us that the home was fully staffed. We made a recommendation at the last inspection that action is taken as soon as possible to enable staff to progress and have the opportunity to undertake a relevant qualification. In the AQAA the manager told us that training within the organisation itself was much better and there had been a huge amount of training for the staff in 2008. 80 of the staff were now qualified to National Vocational Qualification (NVQ) level 2 or above and seven staff were starting NVQ level 3 in health and social care in Feb 2009. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: We looked at the recruitment records of three new members of staff. We saw that each of them had a completed an application form including a declaration that they had no convictions and a declaration about their state of health. Notes of their responses at interview were kept. Each of the staff had a letter in their file offering them a job and recording the date when they started work. Two of the staff had two written references and the dates on these showed that they were received before they started work. These two staff had Protection of Vulnerable Adults (POVA) first checks before they started work. Their offer letters stated that they would work under supervision until their Criminal Records Bureau (CRB) checks were received. The manager told us that they worked under supervision until their CRB checks were received a few days after they started work. The third member of staff had had both their CRB and POVA check before they started work. Two written references were received. One was clearly dated before they started work but the other had no date. The manager stated that it would have been received before they started to work with people. We made a recommendation at the last inspection that all types of training are recorded to ensure that there is good evidence of the training undertaking by staff. This had been addressed. A new staff member told us that they had a training profile. When they showed it to us we saw that it recorded all the training that they had received since they started work. We looked at other staff training profiles and saw that a wide range of training was recorded. In the AQAA the manager told us the training that had been completed over the last year. This included Difficult dangerous disturbing behaviour a two day external course which eleven staff completed. One staff member had completed a ten day intensive recovery champion course and was the in service recovery lead. Eight staff completed POVA training with Swindon College and six staff were completing safe handling of medicines distance learning course with Swindon College. All new staff completed mandatory training of first aid, food hygiene, basic mental health, corporate induction and health and safety. The manager reported that in total there were sixty nine training days for staff in 2008, which did not include any distance learning. A new staff member told us that the training that they had received since they started was very comprehensive. They had had an induction and training in first aid, food hygiene, health and safety, infection control, fire safety, protection of vulnerable adults, safe handling of medicines, and dealing with difficult, dangerous and disturbed behaviour. We saw some of their certificates to confirm this training and they told us that they were waiting for some others. We looked at the training profiles of three members of staff. They had all had induction Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: training, health and safety, food hygiene, first aid at work, violence and aggression, basic mental illness, protection of vulnerable adults, safe handling of medicines and fire safety. Two staff, had worked at the home several years and had also had training about aspergers, anti-discriminatory practice and some infection control courses. One of these staff had also had attended several courses relating to the supervision of staff. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a well run home. The health and safety of the people who lived in the home and the staff were promoted and protected. Evidence: The manager, Mrs Laurelli, had many years experience of working with people with mental health needs. Mrs Laurellis qualifications included a Professional Certificate in Management and an NVQ at Level 5 in Operational Management. The deputy manager had an NVQ Level 4 in Management and a City & Guilds Certificate in Advanced Management for Care. Rethink over-viewed the running of the home with monthly visits as required by regulation and through the organisations quality assurance system, which involved the carrying out of an audit to look at the homes performance in relation to some key principles and outcomes. We saw information about the most recent audit in the service user guide, which was available to all the people who lived in the home. The manager told us that people and their relatives had been given satisfaction Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: questionnaires and we saw that the results of the survey had been published in the service user guide. The manager also told us that people gave their views in house meetings and keyworker sessions. We made a recommendation at the last inspection that all the ways in which service users give feedback about the home and the service they receive are seen as part of quality assurance and then reflected in the homes annual development and improvement plans. This was being addressed. The manager told us in the AQAA that the AQAA will also form part of the homes business plan for the coming year. They also told us in the AQAA that they had made several changes as a result of listening to people. This included employing a gardening company to clear the bottom of the garden so that people could start their own vegetable patch. People requested a hand rail on one of the staircases and this was put up. People requested a buffet on boxing day rather than a meal and roast duck for New Years day and these were provided. A digital camera was purchased so that people could take photos. The length of time for a holiday was increased to a week and people enjoyed 7 days in Bournemouth. People had have been creating a lot of their own art and requested that it was displayed so a wall in the dining room was used to display pictures. We saw that there were several processes to ensure safe working practices. There was a health and safety folder with health and safety policies. Rethink conducted an audit of the health and safety measures. There were general and individual risk assessments and these kept under review. The general risk assessments had been updated in January 2009. A Top ten of risks had been identified, as well as other one-off risks, such as bonfire night, heat waves and passive smoking. When we looked at the training records we saw that all staff had training in health and safety, emergency first aid and food hygiene. A staff member told us that food temperatures were recorded on a daily basis. The Environmental Health Officer had visited in 2006 and recommendations had been addressed. We looked at the homes fire log book and saw that the checks of the fire safety measures were happening at the right times. On the day of our visit the fire alarm system was being serviced. There was a fire risk assessment. The manager told us in the AQAA the dates when equipment was serviced. We saw stickers on plugs, which told us when the portable appliances had been tested. We saw certificates to show that the boiler had been serviced and the electrical wiring had been checked. There were thermostatic valves on taps and water temperatures were checked to make sure they did not go above 43 degrees. The radiators were covered and windows were restricted. Care Homes for Adults (18-65 years) Page 29 of 33 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 33 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 20 13 Improvements must be made to the recording of medication when staff assist a person to manage their own medicines by putting the medicines into a compliance aid. Staff must make a record when they give the compliance aid to the person to manage themself. To make sure that they take the correct medication and they are kept safe. 23/04/2009 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 care plans should include information about age, race, ethnicity, disability, gender, faith and sexual orientation to make sure that each persons diverse needs are met. More information about peoples strengths and abilities and lifestyle should be recorded in the care plans to make them more person centred so that all peoples needs are met. Care Homes for Adults (18-65 years) Page 31 of 33 2 20 If staff prepare the compliance aid and give it to a person to manage themselves the person should sign the medication record to show they have received it. When hand written entries are made to the medication administration records the member of staff making the entry should sign and date the record and another member of staff should sign to witness the record. The registered person should make sure that the controlled drugs cabinet complies with the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody)(Amendment) Regulations 2007 so that any controlled drugs that are prescribed can be stored safely. When a person uses a compliance aid for their medication it would be good practice for the pharmacist to fill the aid. A record should be kept when recruitment checks, such as references, are received so that it is possible to tell that all checks are received before a member of staff starts work and people are protected from being supported by staff who may be unsuitable. 3 20 4 20 5 6 20 34 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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