Care Home: 87 Hazel Avenue

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What the care home does well Full and detailed information about the home is provided to the people who use the service and to prospective service users, illustrated with colour photographs and symbols and written in `user friendly` language. The home helps people with learning disabilities to `live the life they want`. Care plans are easy to read and person-centred so the support staff can follow them easily, and the people who use the service are involved in reviewing them to make sure their preferences and wishes are included. The people who live at the home live varied and interesting lifestyles. The provider company supplies a vehicle to enable them to have access to the community on a regular basis, and they enjoy holidays and day trips to places of interest. The home is purpose built and provided with specialist equipment, to support the people who live there, to live their lives as independently as they are able. A loyal team of support workers, who understand the needs of the people who live at the home well, provide them with consistency and continuity of support. The views of the people who live at the home are sought and taken into consideration in the development of the service. Comments made by the people who use the service in their surveys included, `I know the home does everything well`, `the home supports me well and is good at finding ways to help me express my feelings and to achieve my dreams and wishes`, and `the home gives me the support I want when I want it and the staff are friendly and helpful.` What has improved since the last inspection? Medication administration procedures had improved, and regular audits by the manager and the senior staff had been implemented, to ensure that all medication was accounted for and recorded for the safety and protection of the people using the service. Much had been done to enhance the environment since the last site visit. New furniture and carpets had been provided in the lounge, and the people who live at the home had had their bedrooms decorated to reflect their individual taste. There were no malodours throughout the home. The mould issue in the shower room had been rectified and a cleaning schedule was in place. Missing tiles had also been replaced, promoting the health and safety of the people who live at the home. What the care home could do better: No requirements have been made as a result of this key inspection. The three support workers, who completed surveys, all thought that one thing the home could do better, was to allocate more time for completing administration tasks to ensure records were kept up to date. The manager has identified areas of development in the AQAA for the improvement of the service for the people living there. Key inspection report Care homes for adults (18-65 years) Name: Address: 87 Hazel Avenue 87 Hazel Avenue Farnborough Hampshire GU14 0DW     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: Christine Bowman     Date: 0 3 1 2 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 29 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 29 Information about the care home Name of care home: Address: 87 Hazel Avenue 87 Hazel Avenue Farnborough Hampshire GU14 0DW 01252371730 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.dimensions-uk.org Dimensions (NSO) Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home First registered in May 1994, 87 Hazel Avenue is a care home offering accommodation for up to 5 persons with a learning disability and physical disability. The purpose built bungalow, which is situated within 1.5 miles of Farnborough town centre, is managed by Dimensions, who are also responsible for a number of similar facilities across the south of England. All service users are accommodated in their own single bedrooms. Shared, communal space includes a lounge, kitchen-diner, bathroom fitted with a special bath, shower room and garden. 2 7 1 1 2 0 0 8 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. Before we visited the home, we looked at the last inspection report completed after the site visit on 27th November 2008, and other information gathered about the service since that time. The manager sent us the Annual Quality Assurance Assessment (AQAA), when we asked for it. This document gives us up to date factual evidence about the running of the home, informs us of what they think they are doing well, how they have improved the service over the previous twelve months, and of their plans for further improvements. Three people, who live at the home, and three support workers, who work at the home, completed surveys giving us their views on the service provided at the home. The site visit was carried out over five hours and we met all the four people, who currently live at the home, the manager, the operations manager and four support staff. We looked at the service user guide, assessment documentation, support plans, medication records, staff development records, maintenance and other documents. We were not able to sample the staff recruitment files, because the key to the filing cabinet was not available, but Care Homes for Adults (18-65 years) Page 5 of 29 the information we needed to ensure staff recruitment had been carried out safely, to protect the people who live at the home, was sent to us the next day. We looked at all the communal areas of the home and sampled the bedrooms of two of the people, who live at the home. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: No requirements have been made as a result of this key inspection. The three support workers, who completed surveys, all thought that one thing the home could do better, was to allocate more time for completing administration tasks to ensure records were kept up to date. Care Homes for Adults (18-65 years) Page 7 of 29 The manager has identified areas of development in the AQAA for the improvement of the service for the people living there. 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 29 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 29 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. Full, detailed and accessible information is available to prospective clients and to the people currently living at the home, so they know what to expect from the service, and a full assessment of prospective clients care needs is carried out prior to admission to ensure the home is able to meet them. Evidence: We looked at the statement of purpose and the service user guide to see if the home provided enough information to prospective clients to help them to decide if their needs could be met there. Full and detailed information was provided, illustrated with colour photographs and symbols and written in user friendly language. Comprehensive information about how the home helps people with learning disabilities to live the life they want was included, and a description of how the contract with the organisation and the landlord works, setting out clearly the rights and responsibilities of the people living at the home. Digital photographs of the interior of the home showing the communal areas, the specialist bath and the wheelchair accessible garden; of the management and the support staff with full details of their mandatory and specialist training; and of what is available in the local area to interest the people Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: living at the home, such as the shopping centre, the swimming pool, the library, various churches, the Farnborough Air Show, places to eat, local pubs, the train station and easy access buses. Since the last site visit, one new person had been introduced to the home, but the placement had broken down, the manager stated. The people, who had been caring for this person, prior to moving to the home, had not given full details of their needs when their assessment was carried out. It was not possible to look at the assessment documentation of this person because their files had been sent to their new placement. All the other people, living at the home, had lived there for many years. The homes assessment procedure consisted of completing a full assessment of the prospective clients need, including a social profile, professional support, personal relationships, financial support, full medical information, details of their personal preferences with respect to food and drink, things they like to do and the risks involved, their level of mobility and communication needs. A profile of personal care skills, areas of risk and the support needs associated, and a full social, domestic and academic profile were completed as part of the process. Visits to the home and overnight stays, so that the new client could familiarise themselves with their prospective new home, and to include and involve the people currently living at the home, were included in the admissions process. Care Homes for Adults (18-65 years) Page 11 of 29 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 people, who use the service, have up to date care plans, which they have been involved in compiling, to ensure they are supported safely and in a way they prefer. Evidence: The AQAA recorded that the people who use the service were, involved in all aspects of the review of their support with their key workers on a monthly basis or as a result of their changing need. Care plans sampled were easy to read and person-centred. Support plans included the personal preferences of the people living at the home and included clear guidance to the staff on how to provide assistance. Communication passports informed the staff of how the people, who use the service, made themselves understood and what they needed to know to successfully support them in decision making. One person, who uses the service, had a plan in place to support their behavioural needs, which made the staff aware of what might upset them and of the measures needed to prevent an escalation of challenging behaviour. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: Risk assessments had been completed with guidelines to the staff on the level of risk involved in the activities undertaken. Clear instructions were recorded on how to minimise risk, whilst supporting the people who use the service, to carry out self-care as independently as they were able, to be involved in the activities of daily living and to access the community. The staff were required to sign to confirm they had read and understood the care plans and risk assessments to enable them to support the people, using the service, safely. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home lead lifestyles which suit them, they are supported to maintain relationships of their choice, their dignity and rights are respected, and they receive a varied and balanced diet. Evidence: On the day of the site visit, the people who live at the home were involved in a number of activities in the community. Two people were taken by the support staff in the homes vehicle, which was specially adapted for wheel-chair users, to the Alice Holt outdoor activity centre to take part in a cycling activity. Another person, who uses the service, attended Parkside Day Centre for a music session and the remaining person went out for a coffee and a walk with a support worker. Photographs arranged for display by a support worker demonstrated that the people who live at the home benefited from leading interesting and varied lifestyles, and Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: participated in many activities both at the home and in the community. Photographs showed the people, who live at the home, visiting Birdworld, cycling at Bushy Park and attending the sensory suite at Parkside Day Centre and relaxing on the waterbed, enjoying the sensory equipment including bubble tubes, colourful lights, and mobiles. People who live at the home had been photographed using the public transport network, including taking a train and a ferry to the Isle of Wight and accessing a local transit bus, specially adapted for wheelchair users. Images showed smiling people on holiday in France, Cornwall, Wales, visiting Butlins Holiday Camp, eating a fish and chip meal by the sea and sailing. Two of the three people, who completed surveys, confirmed they can do what they want to do during the day, in the evening and at the weekend. One person who lives at the home regularly attends their chosen church services in Aldershot, the manager stated, and everyone enjoys social clubs and a weekly disco, where they have the opportunity to meet people and make friends. Other places of local interest, visited regularly by the people who use the service, include parks, garden centres, restaurants and zoos. Care plans sampled recorded regular contact with families and advocacy had been sought for a person with no family links. Throughout the day of the site visit we saw support staff assisting the people who live at the home to make choices and be involved in the daily routines of the home. The wheelchair friendly environment with its wide corridor and abundance of support aids, was accessible to all, and included an enclosed garden with raised beds where vegetables had been grown by the people who live at the home, for all to enjoy. One person who uses the service, confirmed in the survey they completed, that they always make decisions about what they do each day and two recorded that they usually do. The home had a pictorial menu to help the people who live there to choose the meals they wanted, and the manager said they did this on a weekly basis. Personal preferences with respect to food were recorded and the people who live at the home accompanied the support staff on the weekly food shopping trips. The AQAA recorded that everyone currently living at the home required assistance at mealtimes, which were staggered to ensure the right support was provided. The support staff were observed offering discreet and appropriate support to individuals at lunch time on the day of the site visit. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service receive personal support from the support staff in the way they prefer. Their physical and emotional healthcare needs are met and procedures are in place to ensure their medication is handled safely. Evidence: Support plans and observations made on the day of the site visit, confirmed that the people who live at the home received support in ways they prefer. The three people who completed surveys thought that the support staff always treat them well. One recorded that the support staff always listen and act on what they say and two that they usually did. The manager stated that two key workers were allocated to each person to ensure consistency and continuity of support. The AQAA recorded that Health Action Plans had been developed over the previous twelve months and that these would be improved over the next twelve months. Information about individuals health and attending medical appointments in the future would be provided in pictorial or audio formats to make them more accessible to the people using the service. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Visits from healthcare professionals were recorded and records sampled included General Practitioner (GP) appointments and hearing, dental and vision check-ups. The AQAA recorded good relationships with local GP practices and with community nurses. One person had an epilepsy risk assessment and a protocol for the staff to follow for the use of invasive treatment, should this be required. Maintaining a healthy lifestyle was recorded as involvement in cycling and sailing activities and a record was kept of individuals weight. The Grab and Go information specifically for admission to hospital was clearly identifiable and readily available to ensure that essential healthcare information would accompany any individual to hospital should the need arise. The home was well-equipped with mobility aids to enable the people who use the service to move around according to their needs and wishes. No controlled drugs were currently stored at the home, but the storage facility was suitable should the need arise and a controlled drugs register was available for the recording of this medication. We looked at the medication records of two people who live at the home and checked the balance of their medication, which was correctly recorded. The home had a medication policy and procedure and clear guidance for the staff to follow to ensure that medication would be handled safely. A list of signatures of support staff trained to administer medication, was kept, and full information about any side effects of medications was available to the support staff. Risk assessments with respect to the management of individuals medication had been carried out to ensure this task was carried out safely. Since the previous site visit, when a requirement had been made to ensure that medication was fully recorded and accounted for because two loose tablets had been found in the medical cabinet, regular audits by the manager and the senior staff had been implemented. The staff training matrix recorded up to date medication training for the staff responsible for administering medication for the protection of the people who use the service. The AQAA confirmed that the support staff receive regular sixmonthly refresher updates from an external agency. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service know how to complain and the support staff are aware if they are not happy. The care home safeguards the people who live there from abuse, neglect or self-harm and takes action to follow up any allegations. Evidence: The complaints procedure was available in pictorial format to enable the people who use the service to access it. The three people who live at the home who completed surveys, recorded that they knew who to speak to if they were not happy, and two confirmed they knew how to make a complaint. The people who use the service were supported by a stable staff team, who understood their communication needs very well. Throughout the day we saw the support staff responding sensitively to the needs of the people living at the home. The AQAA recorded that, the staff have good knowledge of individuals communication and body language and can detect if something is wrong. The home had received no complaints over the previous twelve months, the manager stated. A copy of the local authority Safeguarding Adults Policy and Procedure was available at the home to inform the staff of how to make a referral and the AQAA confirmed that all the support staff had received safeguarding adults training since the previous site visit. The AQAA recorded that three safeguarding referrals had been made over the previous twelve months and three investigations had been carried out. The individual around whom the investigations centred had since moved to another Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: placement. A system was in place to safeguard the finances of the people living at the home. Records sampled confirmed that balances were correct. Receipts were retained and money safely stored. All transactions had been signed off by the staff member responsible. Care Homes for Adults (18-65 years) Page 19 of 29 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 people who use the service benefit from living in a homely, safe, clean and comfortable environment, which is adapted to suit their needs. Evidence: The home was a purpose-built bungalow, located in a residential area of Farnborough and within easy reach of shops, restaurants, local pubs, churches, library, train station and easy-access buses. Parking was provided in bays close to the home and was also permitted on the roadside. The home was designed to meet the needs of wheelchair users and had wide corridors to facilitate mobility. The spacious, welcoming hallway provided a versatile space to use for activities, and communal areas leading off from the hall way included the sitting room, kitchen/dining room, bathroom and utility room. The bedrooms and shower room were located off a wide corridor. The sitting room was homely and comfortable and contained a large television, music centre and books for the entertainment of the people living there. There were framed photographs of the people who live at the home on the walls, and the manager stated that the curtains had been dyed as an art project with some of the people living there. French windows opened out into the garden, much of which was laid to lawn and provided with furniture for outdoor entertainment in the summer months. There were raised beds for growing vegetables Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: and a bird table, which the manager stated one particular individual liked to take responsibility for. The kitchen and dining room were contained in one area, which was divided by a broad worktop. This enabled the people living at the home to observe cooking activities safely, and promoted communication whilst meals were being prepared and eaten. We looked at the bedrooms of the people who live at the home and found that they were well equipped to support their needs. Specialist equipment such as adjustable beds, hoists, and grab rails were provided. Sensory items such as bubble tubes and sensory boards with a variety of textures to stimulate sensory awareness were available to the people who live at the home, in addition to televisions, DVDs, music centres and books. Bedrooms had been personalised to reflect the interests of the people living there and one persons room contained art work, which they had created, displayed on their walls to enhance their self-esteem. They had a comfortable easy chair to relax in and a communication board informing them of their weekly schedule and of other events of interest. In the bathroom was an adjustable bath, to facilitate the bathing experience for individuals and to promote the health and safety of the support workers. The water was thermostatically controlled for the safety of the people living there, and when we tested the temperature of the water we found that it was set at a temperature to protect the people from the risk of scalding. Much had been done to enhance the environment since the last site visit. The AQAA recorded that new furniture and carpets had been provided in the lounge, and the people who live at the home had had their bedrooms decorated to reflect their individual taste. A requirement made at the previous site visit with respect to maintenance issues had been complied with. There were no malodours throughout the home, the mould issue in the shower room had been rectified and a cleaning schedule was in place. Missing tiles had also been replaced, promoting the health and safety of the people who live at the home. The laundry room had hand washing facilities to reduce the risk of infection and the industrial washing machine had a sluicing facility. The Control of Substances Hazardous to Health (COSHH) cupboard was secure and the equipment was colour coded to aid infection control. Two of the people who completed surveys confirmed that the home was always fresh and clean and one recorded that it usually was. Care Homes for Adults (18-65 years) Page 21 of 29 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 people who live a the home are supported by well trained staff, who have been safely recruited to protect them. Evidence: The AQQA recorded that the home employed seven full time support staff and that no staff had left the employment of the home in the previous twelve months. The manager stated that the support staff work in teams of three with a team leader and that regular bank staff, who had many years of experience working with the people who live at the home, make up the teams, but do not work alone. She also stated that there were plans to recruit more permanent staff in the forthcoming year. Some of the people who live at the home received specific one to one time provided by an art and craft teacher and the work they had produced had been tastefully displayed. Another person we support loves having stories read to them in their one to one time, the manager stated, and we saw this person enjoying their books with a member of staff in the sitting room. Throughout the day of the site visit, support staff were observed working sensitively with the people who live at the home. They appeared confident and showed a good understanding of individuals needs. All of the people, who completed surveys, confirmed that the staff and managers treated them well, two of the three recorded that the staff always listen and act on what they say, Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: and one that they usually did. No staff had left the employment of the home over the previous twelve months, and at the previous visit, carried out a year ago, three staff personnel files had been sampled and found to contain evidence of appropriate recruitment procedures to protect the people who live at the home. At this visit, the key to the filing cabinet containing the staff personnel files was not available, so we requested the information to be sent to us the following day. The information we received confirmed that Criminal Record Bureau (CRB) checks and references of the two support staff sampled, had been received prior to the commencement of employment at the home, for the protection of the people living there. The three support workers, who completed surveys, also confirmed that their employer had carried out checks such as CRB and references before they started work. The AQAA recorded that all the staff had completed an induction as recommended by Skills to Care. We sampled the training and development logs of two support workers and the organisations certificate of completion entitled Our Approach, which covered such topics as, understanding the organisation, communicating effectively, recognising and responding to abuse, and making a difference, was included. The manager stated that the induction was carried out over six months. The three support workers, who completed surveys recorded that their induction mostly covered everything they needed to know to do the job when they started. They had, however, been recruited before the Skills for Care Common Induction Standards had been made available. With respect to National Vocational Qualifications (NVQ), the AQAA recorded that three of the seven support workers had completed a NVQ at level 2 or above in Care or Health and Social Care. The manager added that one support worker had completed half of the work towards this qualification, another had just completed level 3, and another support worker had just registered to commence the course. The three support workers, who completed surveys, all confirmed that they were being given training that is relevant to their role, helps them understand and meet the individual needs of the people who use the service, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication. The manager stated that she was a trainer in autism awareness and behaviour support for people whose behaviour challenges, and was able to cascade this training to the support staff. The AQAA recorded that safeguarding adults training had been updated over the previous twelve months, and that the support staff had also received training on the Mental Capacity Act and the Deprivation of Liberty Standards to aid them in the identification of the need to refer people, who are not able to make Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: decisions for themselves, for assessment. The staff training matrix confirmed that mandatory training, which included food hygiene, first aid, health and safety, medication administration, moving and handling, invasive training and fire training had been kept up to date and future updates were included. Other specialist training with respect to the specific needs of the people who live at the home was available to the support staff and included Person Centred Planning and Tools and restraint training (SCIP). Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people, who live at the home, can have confidence in the management to protect their best interests, listen to them and take into consideration their views in the running of the home. The environment is safe for the people and the staff because health and safety practices are carried out. Evidence: The homes registered manager had been on a period of extended leave, and a temporary manager, who was also the registered manager of another Dimensions home, was managing the home when we visited. She confirmed she had many years of experience working with people with learning disabilities and of management, and that she had completed the Registered Managers Award and a National Vocational Award at level 3 in Health and Social Care. She stated that her time, which was supernumerary, was divided equally between the homes. She also confirmed she was in the process of applying to be the registered manager of this home, and was very enthusiastic about her role, about team working, and had a firm belief in empowering the staff to take on responsibilities when they were ready to do so. Shift leaders had been trained by the manager, who stated that there was always a manager on call to Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: provide support. The AQAA recorded a number of ways in which the views of the people who live at the home had been incorporated into the running of the home. These included; each individuals person centred plan, which helps in the development of the service plan for the coming year, so that the team focus can be on achieving the right outcomes for the people we support to enable them to live the life they want, regular monthly meetings take place within the service giving the people we support an opportunity to tell us what is working and not working regarding their support, and individuals participate in the completion of regular quality assurance surveys. Some of the changes made as a result of listening to the people who use the service included, increasing community based activities to include sailing and cycling, increasing the one to one support individuals receive on a daily basis to participate in meaningful activities, and the development of active support programmes to encourage each individual to participate in a range of both daily living skills and interest based activities with as much or as little support as they require. The AQAA recorded that equipment had been tested or serviced as recommended by the manufacturer or other regulatory body, and certificates sampled, confirmed that servicing had been carried out in a timely manner, for the protection of the people using the service and the staff supporting them. The staff training matrix confirmed that mandatory training had been updated on a regular basis and future updates were included, confirming safe practise. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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