Care Home: 85 Cambridge Road

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What the care home does well Prospective service users can be confident that the home can support them. This is because they have opportunities to visit and `test drive` the home and because the home carries out an accurate assessment of their needs that they, or people close to them, are involved in. The staff work hard to ensure that service users` needs are appropriately assessed and that their care is planned to ensure that these needs are met, whilst encouraging and enabling service users to maintain their independence where possible. Service users are supported and encouraged to make personal choices and decisions about their own lives and to participate in the day to day running of their home. Service users surveyed all answered that they had been asked if they wanted to move to the home and that they felt they had received enough information prior to moving in. Two social and health care professionals were contacted for additional information and both felt that the home has always provided a good standard of personal care and support and that the staff manage the complex needs of the service users living there well. In answer to the survey question: `What does the home do well?` comments received from service users included: `The home allows me to make a lot of choices e.g. choice of food, activities of the day, independent movement in the house` and `The home offers me a variety of activities e.g. day care centre, having lots of drives out.` Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere and all interactions observed between the management, staff and service users evidenced that the home has a close and caring staff team. What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides service users with a comfortable and homely environment in which to live. In their AQAA, to demonstrate how they have improved in the last twelve months, the service manager stated: `All service users have a person centred plan in place. `Choosing my link worker`. Choosing where to go on holiday. Behaviour specialist involved within the service and working with staff to develop service users` communication boards. Introduction of the pictorial information to aid service users understanding. The organisation have a service users` involvement person in post for two days a week. Have worked with other health professions to map out service users conditions. Safeguarding of Vulnerable Adults training update for staff.` Positive comments were received about improvements at the home from the two social and health care professionals spoken with in relation to this inspection. Comments made included: `The new manager is very good`; `Since the change to the new manager there have been quite a lot of improvements, with staff more willing to make improvement`; `I have seen a lot more development work in the past two months. I feel there is a lot more team work and that staff are `singing from the same hymn sheet` more. Overall I am very hopeful and, although service users were always well cared for, service users may now be offered opportunities to develop to their full potential, although this will take time.` What the care home could do better: No requirements or recommendations were made as a result of this inspection as the acting manager and service manager demonstrated a clear understanding of areas they plan to improve on, for and with the service users, plus the steps they need to take to maintain and add to improvements already made. As part of the home`s improvement plan for this year, the acting manager and staff have already identified that a more varied and individualised activity programme needs to be developed with each service user in order to fully meet their social care needs, both inside and outside the home. In their AQAA the service manager identified the following areas as things they could do better: `Through the re-provision process identify the longer term support package of each service user. Expand and develop communication tools. Development of support plans in a more service user friendly way eg. pictorial representation. Have information in a format that meets the communication challenges of service users. Present annual reviews in a personal format for each service user. Develop communication boards so a wider choice can be offered. Review, as part of the reprovision, the environment for each service user. Maximise the use of the garden.` In their AQAA, the service manager identified the following areas for improvement over the next twelve months: `Pictorial representation on all service users` paperwork. To have communication boards in place to support service users in taking control of their lives. Pictorial rotas in place for service users that wanted/require them. `Things you need to know` plan in place around meal times for each person. Individual medication files for service users. Individual medication cabinets in service users` bedrooms where required. Service users to have own medication stored in their rooms. Service users to have own monies and files stored in their rooms. Add more `personal touches` to the home. Training service users to interview at the first stage in recruitment. Training staff in specialist training such as Makaton, autism, epilepsy. Recruit to vacancies. Have a registered manager in post.` Key inspection report Care homes for adults (18-65 years) Name: Address: 85 Cambridge Road Crowthorne Berkshire RG45 7EP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 2 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 85 Cambridge Road Crowthorne Berkshire RG45 7EP 01344780183 01753747399 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Turnstone Support Ltd The registered provider is responsible for running the service care home 5 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection Brief description of the care home 85 Cambridge Road is registered to provide care and support for up to five adults with learning disabilities. The home is within walking distance of Crowthorne village centre, with a range of cafes, pubs, and shops. Fees at the home are £1389.06 per week. This information was provided on 20th July 2009. 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 20th July 2009 starting at 10am. The acting manager and the service (area) manager were present as the representatives for the home. It was a thorough look at how well the home is doing. It took into account detailed information provided by the representatives and any information that CQC/CSCI has received about the service since the last inspection on 2nd August 2006. People who live at this home prefer to be referred to as service users. For clarity and consistency this term will be used throughout this report. On the day of this visit all of the five service users were involved in the inspection and information was also gained from three on duty staff. Prior to the inspection, survey forms were sent to the home to distribute to service users, staff and social and health Care Homes for Adults (18-65 years) Page 5 of 32 care professionals, no survey forms were returned. On the day of the visit we took along survey forms for service users and staff. Four of the service users completed and returned forms with assistance from staff and four staff members completed and returned survey forms on the day. We also contacted two social and health care professionals by telephone for additional information. Some of the comments made to us on the day of the visit and made on the survey forms are quoted in this report. Not all service users are able to communicate verbally and observations of the interactions between staff and these service users were also used to form the judgements reached in this report. In April 2009 we requested that the home send us their annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the home. It also gives us some numerical information about the home. The AQAA was not returned by the due date and we had to contact the provider a second time. The completed AQAA was then returned to us by the service manager the week before the inspection. When received, it was clear and gave us the information we asked for. Service users care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the home is meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the service users and staff for their time, assistance and hospitality during this visit and the service users, staff and social and health care professionals who provided additional information and participated in the surveys. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides service users with a comfortable and homely environment in which to live. In their AQAA, to demonstrate how they have improved in the last twelve months, the service manager stated: All service users have a person centred plan in place. Choosing my link worker. Choosing where to go on holiday. Behaviour specialist involved within the service and working with staff to develop service users communication boards. Introduction of the pictorial information to aid service users understanding. The organisation have a service users involvement person in post for two days a week. Have worked with other health professions to map out service users conditions. Safeguarding of Vulnerable Adults training update for staff. Positive comments were received about improvements at the home from the two social and health care professionals spoken with in relation to this inspection. Comments made included: The new manager is very good; Since the change to the new manager there have been quite a lot of improvements, with staff more willing to make improvement; I have seen a lot more development work in the past two months. I feel there is a lot more team work and that staff are singing from the same hymn Care Homes for Adults (18-65 years) Page 7 of 32 sheet more. Overall I am very hopeful and, although service users were always well cared for, service users may now be offered opportunities to develop to their full potential, although this will take time. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission procedures at the home ensure that service users needs and aspirations are fully assessed prior to admission to make sure that their needs can be met. Evidence: Since the last inspection, one new service user has moved into the home. The pre admission assessment paperwork was sampled for this person and it was seen that comprehensive assessments had been carried out, involving the service user and all relevant social and health care professionals. The assessment process had been started six months before he eventually moved in and care had been taken to ensure a smooth transition. It was also seen that other service users, already living at the home, had been consulted and their views taken into account. In the AQAA, to demonstrate what the home does well, the service manager stated that: Turnstone has an assessment, referral and start of service policy. Service users are invited to visit the home with relatives and meet the service users and staff during the assessment process. If the service user wishes to proceed with the assessment, Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: and support is agreed, transition plans are put in place. The support package is then reviewed after 6 weeks. This statement was supported by our findings on the day of this visit. Service users surveyed all answered that they had been asked if they wanted to move to the home and that they felt they had received enough information prior to moving in. Care Homes for Adults (18-65 years) Page 11 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. The home has individual plans of care that each service user has been involved in making and that reflects their changing needs and personal goals. Service users are able to make decisions about their life, with support if they need it, this is because the staff promote their rights and choices. Service users are supported to take risks as part of an independent lifestyle. This is because the staff have appropriate information on which to base decisions. Evidence: Care plans for two service users were sampled and both were seen to be based on an assessment of needs and to include risk assessments and the personal wishes and preferences in how individual service users would like to be supported. The acting manager is currently in the process of updating all care plans and has almost completed the two sampled. There is a new Things you need to know section at the front of the two files sampled. This sets out details of the persons daily routine, from getting up in the morning to going to bed at night, setting out the times of various activities, what people are able to do for themselves and what support they need Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: and/or want, together with their preferences of how they like things done. Actions that staff need to take to minimise any identified risks are also included. The care plans were drawn up with the service users and are reviewed formally once a year, or more often, if needs change or a new concern arises. The staff document daily on separate diary sheets for each service user. The staff team have also started work on identifying personal goals and aspirations with each service user. Four completed service user survey forms were returned on the day of this inspection. All service users stated that they could do what they wanted to do during the day, in the evening and at weekends. When asked on the survey form if they made decisions about what they do each day, two service users answered always and two answered usually. On the day of this visit, service users were seen to be choosing what they did and where they went within the home. Staff were seen to be helpful and offered assistance where needed or requested. It was also observed that staff had a good rapport with service users that were not able to fully communicate their wishes verbally, where they indicated that they wanted assistance, this was quickly understood by the staff and the assistance provided. In the AQAA, to demonstrate what the home does well, the service manager stated that: Individuals are supported to choose their own link worker, records are kept of how the service user came to that decision. Individuals are supported to make choices on a daily basis on all aspect of their lives. This statement is supported by our findings on the day of this visit. To demonstrate what they could do better, the service manager stated in the AQAA that they could: Have information in a format that meets the communication challenges of service users. Present annual reviews in a personal format for each service user. Development of support plans in a more service user friendly way eg. pictorial representation. Plans over the next 12 months are: To have communication boards in place to support service users in taking control of their lives. Expand and develop communication tools. Makaton training for all staff. We were advised that the behaviour specialist from the local community team for people with learning disabilities is already working with staff to develop service users communication boards. At present there is a re-provisioning exercise being carried out where the local authority, the service users and staff at the home are working together to establish that the current service provision is best suited to meet the needs of each individual. All service users have been allocated an independent advocate to work with and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: support them during this process. Care Homes for Adults (18-65 years) Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team have started working towards improving the opportunities the service users have for personal development and identifying meaningful activities of their choice, both within the home and in the local community. Service users are supported and enabled to maintain and develop appropriate personal and family relationships. Their dignity and rights are respected. Service users have meals that are well balanced and varied, at a time and place to suit them. Evidence: The daily routines at the home reflect the requirement to promote independence, individual choice and freedom of movement. Service users spoken with confirmed they could choose what to do, when they wanted. This was also confirmed by observations made on the day of this visit. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: In the AQAA, to demonstrate what the home does well, the service manager stated that: Individuals are supported to access activities of their choice. 85 Cambridge Road has a house vehicle, staff also support people to access the wider community. Individuals are supported and encouraged to maintain contact with their families. Individuals are supported to choose an annual holiday. On the day of this visit some service users were busy getting ready and going out to planned activities and staff showed skill and organisation in making sure that things happened as planned, as well as making sure that staff were available to provide any personal support needed by service users who were not going out. However, the majority of service users at Cambridge Road need one to one staff support when going out and it was apparent that there were times during the day, when staff were out with service users, that the staff remaining at the home did not have time to engage in social activities with those service users that had stayed in. In answer to the survey question: What does the home do well? comments received from service users included: The home allows me to make a lot of choices e.g. choice of food, activities of the day, independent movement in the house and The home offers me a variety of activities e.g. day care centre, having lots of drives out. In answer to the survey question What could the home do better?, comments made on the survey forms by service users included: More activities, more going out in the summer time; I dont know what I want to do but the home could help me to find things that could be of interest to me and The home could assist me to discover out of home activities because I dont enjoy most of the time. Comments received on survey forms from staff included: Encourage more activities for service users; employ or encourage more drivers to take the service users out and More activities, more members of staff to do activities. As part of the homes improvement plan for this year, the acting manager and staff have already identified that a more varied and individualised activity programme needs to be developed with each service user in order to fully meet their social care needs, both inside and outside the home. We were told that staff have started working on this, looking for and identifying new activities in the local area for the service users to try out. The rota is planned to ensure that there is at least one driver on duty each day and the acting manager works supernumerary most of the time and is able to offer additional support where needed. The menu for the week of this visit was seen to be varied and well balanced, advice is sought from a local dietician, for individual service users, as and when needed. We were advised that service users plan their meals, with assistance and guidance from Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: the staff and picture cards of food have been introduced to enable all service users to participate and make choices. On the day of this visit service users were deciding when, and what, to have at lunchtime to fit in with their schedule for the day. Care Homes for Adults (18-65 years) Page 17 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. Service users receive personal support from staff in the way they prefer and want and in a respectful and sensitive manner. Their physical and emotional health needs are met because the home has procedures in place that staff follow. Sound policies and practices are in place for the administration and management of medications. Evidence: During this visit two care plans were sampled. At present service users do not have individual health action plans but it was seen that care plans were specific with information for staff to follow when supporting service users to manage any long term health conditions. Daily diary notes evidenced that staff take prompt action to deal with any new health problem that may occur. At present there is no system in place to track routine health appointments and check ups and it was discussed with the acting manager that such a system would be useful so that staff can be sure that routine check ups do not get missed. In one file sampled it was difficult to ascertain when the service user had last had a dental check up, the latest date we could find documented was in 2007. In discussion with the acting Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: manager it was highlighted that some of the service users choose not to go to the dentist for routine check ups and also choose to refuse support to brush their teeth. At present there are no specific preventative care plans in place to address the increased risk of dental decay, the acting manager plans to seek further advice and guidance in this area. Although there are no service users with a physical disability, the staff have noted that two service users are becoming more unsteady on their feet as they get older. Staff take care to make sure that they are supervised and prompted to take care in situations where they may be at increased risk of falls, for example, going up and down stairs. The acting manager has consulted with the local occupational therapist for an assessment of the home, to make sure that the facilities provided are still suitable for the changing needs of the service users. Contact details for the local falls prevention clinic were left at the home. Medication is provided mostly in the Nomad system. The administration of some medications was observed and the medication administration records (MAR), medication storage, policies and procedures were all sampled and found to be in good order. In the AQAA, to demonstrate what the home does well, the service manager stated that: Staff trained in administering of medication. Service user supported to attending medical appointment. Support service users in menu planning. Liaising with other professionals to ensure good health is maintained. Regular specialist health appointments are attended. Supporting service user with his medical condition. This statement is supported by the evidence seen at this inspection. During this inspection, all interactions observed between staff and service users were polite and respectful of peoples privacy and dignity. Staff never entered service users private rooms without knocking and awaiting permission to enter. All personal care was carried out behind closed doors. Two social and health care professionals were contacted for additional information and both felt that the home have always provided a good standard of personal care and support and that the staff manage the complex needs of the service users living there well. One person commented that since the acting manager started he has been far more involved and feels there has been quite a lot of progress made, with staff more willing to work together to make improvements. In answer to the survey question: What does the home do well? one service user commented: Personal care; good communication. Care Homes for Adults (18-65 years) Page 19 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. If service users have concerns they know who to talk to about it. Policies and practices are in place to protect service users from abuse and neglect. Evidence: The home has a complaints procedure in place that is provided to all service users and included in the homes service users guide. Service users surveyed all said that they knew who to talk to if they were not happy and that they knew how to make a complaint. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. All staff surveyed stated that they knew what to do if anyone raised concerns about the home. The acting manager advised us that all staff have had training on the Mental Capacity Act and are aware of what is expected of them. Training in the new Deprivation of Liberty Safeguards has been booked for all staff on upcoming courses. In the AQAA, to demonstrate what the home does well, the service manager stated that: All staff CRB checked. All staff undertake Safeguarding of Vulnerable Adults training. Every month the appointee bank balances are emailed to the head office. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Service users monies audit each month. This statement was supported by the findings on the day of this inspection. Care Homes for Adults (18-65 years) Page 21 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. Service users live in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. Evidence: 85 Cambridge Road is a five bedroomed detached house and is within walking distance of Crowthorne village centre, with a range of cafes, pubs, and shops. The home consists of five single bedrooms, one with en suite facilities. Three bedrooms are on the first floor and two on the ground floor. There is a large communal lounge and a separate kitchen. Service users spoken with expressed their satisfaction with the accommodation provided at the home. All of the service users surveyed said that the home was always fresh and clean. On the day of this visit we were shown around all areas of the home and grounds. The furniture and furnishings were seen to be of a good quality and specialist equipment is provided, if needed by the service users. Personal bedrooms were all seen to be personalised to the individual service users wishes. There is a private and well maintained garden at the back of the house. The service Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: users and staff work together in maintaining the garden. Laundry facilities are sited on the first floor with washing machines suitable for the needs of the service users at the home. In the AQAA, to demonstrate what the home does well, the service manager stated that: 85 Cambridge Road is a comfortable safe environment. Health and safety checks in pictorial formats are completed monthly with service users. Service users bedrooms are personalised and reflect peoples personalities, the rooms are lockable. Bathrooms and toilets provide the right level of privacy and dignity. Shared spaces are spacious to accommodate service users needs. Service users are supported to keep their home clean and tidy. Service users garden is accessible. This statement was supported by the findings on the day of this inspection. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. Care Homes for Adults (18-65 years) Page 23 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. The home has a staff training and recruitment programme which is designed to ensure that service users are supported by competent and qualified staff and that, as far as reasonably possible, they are protected from harm. Evidence: The staff team consists of the acting manager and eight support workers, one additional full time position and one part time position have recently been filled, with the home awaiting the completion of the required recruitment checks before the new staff start work. There are currently vacancies for a deputy manager and one nine hour night shift that are both being advertised. The staff rota evidenced that staff are provided in sufficient numbers to meet the personal and health care needs of the service users at the home. The morning (7.30am to 3pm) shift is covered by three support workers, three support workers cover the afternoon/evening shift (2.30pm to 10pm) and the night staff consists of one waking support worker with a member of the management team on call and available if needed. Of the eight support workers, two hold a National Vocational Qualification (NVQ) level 2 in care, one support worker is currently undertaking the training and a further two Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: people have submitted their applications and are awaiting start dates We were advised that new staff will be expected to enrol for NVQ training on completion of their probationary period. During this visit the files of three recently recruited members of staff were sampled. All files were seen to contain proof of identity, two references, a completed application form, an enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks had been obtained. The home also verify an applicants reasons for leaving previous employment with vulnerable adults; ensure they obtain a full employment history and a written explanation of any gaps in employment. The home also ensure that they obtain written confirmation from agencies, for each agency worker supplied to work at the home, that all required recruitment checks and documentation have been obtained as well as details of the training and experience of the agency worker. Staff induction is in line with the mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. Staff are booked on additional training and updates as the courses become available. In the AQAA, to demonstrate what the home does well, the service manager stated that: All staff are interviewed by two trained managers. Service users are involved in the second interview process. All staff are CRB checked. All staff have access to regular training. One staff member represents the team on the staff forum. All staff are issued with a copy of the GSCC (General Social Care Council) code of conduct. New staff have a probation report completed. Staff are encouraged to do an annual questionnaire feedback and actions are incorporated onto the continuous improvement plan. Staff have an annual observation completed whilst they are working, feedback is given to staff. In their AQAA, the home have identified that staff need more additional training in areas specific to meeting the needs of the service users at 85 Cambridge Road e.g. epilepsy, autism, communication skills, and have included this need for training in their plans for improvement over the next twelve months. Of the four service users who completed survey forms, two said that the staff always listened and acted on what they said with two answering usually. All staff who completed survey forms confirmed that they are given training which is relevant to their role, helps them to understand and meet the individual needs of the service users and gives them enough knowledge about health care and medication. All Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: confirmed that the acting manager gives them enough support and meets with them to discuss how they are working. Additional comments on the staff survey forms included: Good training in social care and good management. Care Homes for Adults (18-65 years) Page 26 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. Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere. The home has a quality assurance and monitoring system in place that is based on seeking the views of the service users. Policies and procedures are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users and staff. Evidence: There have been a number of changes to the management and staff team at the home since the last inspection. A number of long term staff members have left, new staff have been recruited and the registered manager left the home in October 2007. An acting manager was then appointed and managed the home until May 2009. The current acting manager has been managing the home since the 20th May 2009 and there was a change of area service manager at the end of May 2009. Staff members spoken with during this visit felt that the staff team is now becoming settled and were positive about the improvements being made and planned at the home. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Positive comments were received about the management of the home from the two social and health care professionals spoken with in relation to this inspection. Comments made included: The new manager is very good; Since the change to the new manager there have been quite a lot of improvements, with staff more willing to make improvement; The manager is more up to date with the way things should be nowadays, I have seen a lot more development work in the past two months. I feel there is a lot more team work and that staff are singing from the same hymn sheet more. Overall I am very hopeful and, although service users were always well cared for, service users may now be offered opportunities to develop to their full potential, although this will take time. The acting manager and service manager demonstrated a clear understanding of areas they want to improve on, for and with the service users, plus the steps they need to take to maintain and add to improvements already made. Service users views are sought on a regular basis and monthly visits by a representative of the responsible individual take place as required. Service users have monthly meetings and regularly meet with their link workers. The organisation carry out a yearly survey each October, which seeks the views of service users, family, friends and other stakeholders in the community (i.e. district nurses etc.) Any areas for improvement identified are then included in the homes continuous improvement plan. On the staff survey forms returned, one member of staff commented that the home was good at: Discussing with and including service users in decisions and another that: The staff members and service users communicate freely with each other. One service user also commented that there was good communication. In the AQAA, to demonstrate changes made as a result of listening to the service users, the service manager stated: Choosing my link worker. Choosing where to go on holiday. Behaviour specialist working with staff to develop service users communication boards. Introduction of the pictorial information to aid service users understanding. All necessary health and safety checks are carried out by the staff at the home with documentary evidence inspected of routine fire practices and checks. Fire equipment checks, daily checks of fridge and freezer temperatures and a number of up to date maintenance certificates were seen. All records were up to date and well maintained. All staff receive training and updates in mandatory health and safety topics and were seen to be putting their training into practise as they went about their work. All interactions observed between acting manager, staff and service users were Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: inclusive, caring and respectful. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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