Care Home: 92 Wilcot Road

What the care home does well The home continues to provide a home, which is safe comfortable, clean and tidy. There has been good progress in the development of person centred planning. Staff members have supported people to attend appropriate activities and holidays of their choice. A great deal of time and support has been given to the people using the service to develop personalised, individual `Life Books`. What has improved since the last inspection? At our last visit to 92 Wilcot Road we made one good practice recommendation relating to the development of a training matrix. There is now a new system in place for monitoring training needs. The staff team are adopting working with a person centred approach. What the care home could do better: Some documents did not provide current contact information for CQC. These included the Statement of Purpose and the complaints policy. The Statement of Purpose should be available in alternative formats. Consideration should be given to the introduction of communication tools for some people. This may include some basic sign language. Risk assessments must be reviewed to ensure they are current. There must be clear procedures and guidance within care plans for people who are diabetic. Staff should be provided with training on diabetes. Clear protocols for foot care must be included within the care plan for people with diabetes. These need to be endorsed by a medical practitioner. Recruitment files should contain a photograph of the member of staff. When people participate in activities, it would be good practice to evaluate how successful the activity was for the person living at the home. Some consideration should be given to developing regular residents meetings within the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 92 Wilcot Road 92 Wilcot Road Pewsey Wiltshire SN9 5NL two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Lintern Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: 92 Wilcot Road 92 Wilcot Road Pewsey Wiltshire SN9 5NL 01672563914 01672563914 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : White Horse Care Trust care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD The maximum number of service users who can be accommodated is 3. A bit about the care home 92 Wilcot Road is a care home for three people with a learning disability some of whom were previously cared for in a nearby long stay hospital for people with a learning disability. The home is located in the small town of Pewsey. The service replicates principles of ordinary living and the house, which is semi detached, is indistinguishable from other houses in the street. All the bedroom accommodation is in single rooms and there is a range of communal space including an attractive patio and garden. The service is managed by the White Horse Care Trust, which has a number of similar care homes throughout Wiltshire and beyond. The aim of the service is to provide ordinary living that maximises independence. The home provides transport for accessing the local area and further a field. Service users can attend Marlborough day centre for day activities subject to the availability of places. Typically 2 people staff the home through the waking day. At night time one staff member sleeps in and is expected to respond to any night time and emergency needs as they arise. 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 & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home This service was last inspected 25th June 2007. The unannounced inspection took place on Tuesday 12th May 2009 between the hours of 9:30 and 3:45 pm. The manager Mrs Shaw, was on duty on the morning of our visit. The deputy manager assisted us during the afternoon. On our arrival to the home all of the people who live there were at their day services. One person returned to the home at lunch time and we were able to meet with them. Due to communication difficulties we were unable to fully obtain their views on the service provision, however we were able to observe body language and staff interactions. We sent Mrs Shaw an Annual Quality Assurance Assessment (AQAA) to complete. This was her own assessment of how well they are performing and it gave us information about their future plans. Information from the AQAA is detailed within this report. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to do so. We also sent surveys; to be distributed by the home to people using the service and staff members, care managers, GPs and other health care professionals. Three staff members and two people using the service responded. Staff completed the service user surveys on their behalf, if they were unable to do so independently. The feedback received, is reported upon within this report. We reviewed the information that we had received about the home since the last inspection. We looked around the home and saw a number of records, including care plans, risk assessments, health and safety procedures, staff files and training records. The judgements contained in this report have been made from all the evidence gathered during the inspection; including the visit to the service and takes into account the views and experiences of people using the service. What the care home does well The home continues to provide a home, which is safe comfortable, clean and tidy. There has been good progress in the development of person centred planning. Staff members have supported people to attend appropriate activities and holidays of their choice. A great deal of time and support has been given to the people using the service to develop personalised, individual Life Books. What has got better from the last inspection What the care home could do better Some documents did not provide current contact information for CQC. These included the Statement of Purpose and the complaints policy. The Statement of Purpose should be available in alternative formats. Consideration should be given to the introduction of communication tools for some people. This may include some basic sign language. Risk assessments must be reviewed to ensure they are current. There must be clear procedures and guidance within care plans for people who are diabetic. Staff should be provided with training on diabetes. Clear protocols for foot care must be included within the care plan for people with diabetes. These need to be endorsed by a medical practitioner. Recruitment files should contain a photograph of the member of staff. When people participate in activities, it would be good practice to evaluate how successful the activity was for the person living at the home. Some consideration should be given to developing regular residents meetings within the home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Pauline Lintern Colston 33 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 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 . Prospective new people to the home are provided with information about the service. However, the home must ensure that information is current and available in alternative formats. There have been no new admissions to the service since our last visit to the home. At the last key inspection, this outcome was judged as good. There has been no information to conflict with this view. Based on this, we have made a judgement, that the assessment process would ensure the service could meet the persons needs. This judgement has been made using available evidence including a visit to the service. Evidence: The Statement of Purpose is available to anyone wishing for information about the service. The manager confirmed that it is not yet available in alternative formats. However, she reports that this is an area that she intends to develop. There is a Service User guide, which contains a copy of the last inspection report, pictures and photographs about the home. We noted that contact details for CQC are not current. All people who use the service have lived at 92 Wilcot Road for a number of years. It was therefore not possible to look at the admission process in practice. However previous inspections have found that the home has ensured that peoples needs and aspirations have been assessed prior to being offered a service. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Each person living at the home has a care plan in place, which is kept under review. However, care plans must contain sufficient information on the management of diabetes. This service enables people to make decisions about the way they choose to live their lives. This is an area, which might be further developed by the introduction of communication tools. Strategies are in place to support people to take responsible risks, however assessments do need to be regularly reviewed to ensure they are current. This judgement has been made using available evidence including a visit to the service. Evidence: Each person being supported at the home has an individual care plan, which informs the reader on how to ensure the persons needs are met. They generally cover all aspects of the persons life such as health, communication, spiritual needs, consent, personal care, social needs, relationships, mobility, sexuality and choice making. However, it was noted that one persons file did not fully clarify how their needs should be met relating to the management of their diabetes. We asked that this should be more detailed to reflect safe parameters and responsibilities. Evidence: Within our surveys one staff member commented care plans are regularly reviewed. Information is always verbally given at change over of staff and through the communication book. Within the care plans consideration has been given to individuals spiritual needs. For example one plan states that X likes to attend church weekly in Pewsey and that they have their own Bible. Another persons file identifies that they prefer not to attend church, however they do enjoy Christmas carol services. We noted that the home have started to work with a person centred approach. For example each file had a one page profile, which informs the reader on how best to support the person, what is important to them and things they do not like. They also contain a photograph of the person. Files sampled showed that peoples goals and aspirations have been recorded and provide a pathway to how this may be achieved. One file sampled identifies the persons circle of support, which includes names of people I love, people I like and people I know. Other headings included my achievements, my gifts and qualities and things that matter to me. Not all of the record had been completed but it was evident that good progress has already been made. One person living at the home showed us their life book. This was obviously something that they were proud of and took pleasure in sharing with others. The life books sampled had been developed with the person being supported and with staff members. They were bright and colourful with lots of photographs, pictures, die cuts and easy to read text. It was evident that a great deal of thought and time had gone into the development of the books, which has resulted in an excellent reminder of events and holidays, which may have taken place in the persons life. Staff members confirmed that the people they support really enjoyed developing the life books and contributing to the contents. One file had a section developed solely on the persons communication needs. This has also been written in a person centred format and includes entries such as I dont like to wear my hearing aids and when I like something I smile, giggle and rub my hands together. We discussed how the home may be able to further develop communication tools for some people living at the home. Staff members told us that one person may benefit from the introduction of some sign language to support verbal speech. Within our surveys we asked people living at the home if they are able to make decisions. One person told us I usually make decisions about what I do each day. One persons care plan records that they are able to make a choice, if clear information is given to them. The plan suggests that pictures and objects may be used to enhance understanding. It states X may need support with colour co-ordination. Evidence: Mrs Shaw reported that the deputy manager and herself have currently been very busy reviewing risk assessment within the home. We noted that a number of assessments still need to be reviewed as many indicated that they had not been reviewed since 2005. During feedback Mrs Shaw confirmed that since our visit they have already addressed some issues raised during our visit. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to participate in appropriate activities, both in the local and wider community. Links with families and friends are encouraged and maintained, if appropriate. People living at the home are respected as individuals. Meals appear varied and well balanced and take into consideration peoples likes and dislikes. This judgement has been made using available evidence including a visit to the service. Evidence: On the morning of our visit to the service each person living at the home was attending day services. One person returned to the home at lunch time and we were able to meet with them. The daily notes sampled demonstrated that the people living at the home are provided with opportunities to attend local events, such as fetes in addition to massage sessions at another local Trust home. Evidence: People living at the home attend Marlborough leisure centre and Marlborough resource centre, where they can participate in literacy, reading, disco-cise, gentle exercise and arts and crafts. One person attends Crammer Court, which is a social club for the over 60s. People using the service have the opportunity to have a stay back day in the week. This is a day when they do not attend day services, but may wish to visit the hairdresser, walk around Pewsey, go swimming, carry out household tasks or maybe relax and do their knitting. Staff members told us that one person they support has a friend in a local store and they will often walk to the town to see them. People are encouraged where possible to remain independent within the community. Staff explained that one persons mobility has decreased and therefore staff now ensures that they have access to a wheelchair for long journeys. Staff members told us that the people living at the home are well known in Pewsey. One staff member told us how one person living at the home had asked to go on a ship for their holiday. The member of staff explained how they had brought brochures into the home to enable the person to make a choice on where they wanted to go. Consideration was given to the fact that the person did not like hot weather and that there was mobility difficulties. They agreed with the person that a cruise to the Fjords would be ideal and this was then arranged. The cruise was for a week and enabled the person to spend their 60th birthday on board. Following this experience staff supported X to record the activity within a book. This included photographs of people they had met on the trip and dried flowers and cards, which had been given for their birthday. Again, this was a good example of good practice that had been well thought out and planned. The member of staff who had made the arrangements for the trip had a written account of how and why they had made the decisions around the trip. This summer arrangements have been made for all of the people living at the home to go to Butlins in Minehead. The deputy manager told us that each person will have their own member of staff to support them and they will each go their own way during the day. This will enable people to participate in activities that they individually prefer, during the day and they can all meet and socialise in the evening, if they wish to do so. We discussed how activities might be better recorded to ensure that the manager has the opportunity to evaluate how successful they may or may not have been. Staff members told us that each person living at the home has a key to their bedroom; however they do not tend to be used. In one persons care plan it states that they like to regularly telephone friends and staff are asked to ensure X is supported to use the phone in the office for privacy. Evidence: The main meal of the day is taken in the evening, when people can sit and relax together. During the day people take packed lunches to their day services. People with specific dietary needs have guidelines in place to ensure that staff are aware of their eating plan. The home has a file, which contains pictures of various meals to aid choice making. It was noted that most of the pictures were poor quality and it was difficult to identify what the meal was. We suggested that new pictures/ photographs be obtained to make the pictures easier to recognise for people. Menus sampled showed that meals are varied and well balanced. Records indicate that fridge/freezer temperatures are recorded daily to ensure they are at a safe temperature. We noted that most opened food in the fridge had been dated, when it had been opened except for a jug of stock/gravy, which did not have a date on it. The fridge contained lots of fruit and vegetables. 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 . Guidelines are in place to ensure that people have their personal care delivered in a way that they prefer. People have access to healthcare professionals when required. However, greater clarity within support plans would ensure peoples needs are fully reflected. The arrangements for managing medication are satisfactory. This judgement has been made using available evidence including a visit to the service. Evidence: Individual care plans provide guidance on how staff should deliver personal support in a way, which is preferred by the person living at the home. Within one support plan it informs staff members that in the event of a thunder storm X may seek re-assurance at night. Within the personal hygiene section of the care plan it states X needs very little help with bathing, however staff need to check the water temperature. Staff can leave X in the bathroom but they need to stay on the landing with the door ajar. It was noted that a risk assessment was in place to support this activity. Where identified as a need within the assessment, people have their weight monitored and recorded. It was recorded in one persons care plan that X needs their toe nails cut and filed at least once a week. We asked Mrs Shaw to ensure that this activity ceased until clear guidance and advice was sought from the diabetic nurse or the podiatrist. When a Evidence: person has diabetes we would expect to see clear detailed procedures and protocols in place. The care plan did not fully advise staff of peoples roles and responsibilities regarding the management of the persons diabetes. Although there was a blood monitoring record in place, which stated parameters should be 4-7, we felt that there should be clearer guidance on what to do if the person showed adverse signs. A risk assessment needs to be in place and kept under review with regard to toe nail care and diabetes. Staff members explained that due to one persons decline in mobility, arrangements had been made for an occupational and physiotherapist assessment to take place. It was noted that the persons care plan contained exercises for staff to support the person with. There was also guidance regarding the person accessing the stairs safely. Mrs Shaw advised us that the OK health checks, which used to be available to the people they support are no longer carried out. She explained that the health checks are now called road to health checks and they are now waiting for the community nurse to visit the home so that appointments can be made for the assessments to be completed. Records and daily notes demonstrate that people living at the home are supported to attend healthcare appointments as and when required. This includes well woman checks, visits to dentists and ophthalmic tests. As part of the inspection process we looked at the arrangements for managing medication. Mrs Shaw confirmed that new bolts have been fitted to the medication cabinet, which now complies with legislation. Medication administration records were sampled and found to be in order with no unexplained gaps. All as required medication is recorded on a separate yellow sheet. Photographs of people living at the home are on the front of their medication record to ensure that they are correctly identified. All staff members have to attend medication training prior to being allowed to administer medication. Regular competency refresher training takes place. Medication stock is checked every week and records are maintained. No one at the home currently self-medicates. 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 home has an established complaints policy and procedure in place. People using the service are protected where possible from any potential abuse. This judgement has been made using available evidence including a visit to the service. Evidence: In line with the Trusts procedures each person living at the home has a complaints postcard in their file that is already addressed for them to send to head office if they wish to raise a concern or make a complaint. Within our surveys people told us that they knew who to talk to if they are not happy. The home has a complaints log, which details actions, timescales and outcomes. It was noted that the home had received one complaint since the last inspection. The complaint was made by a member of the public. This issue had been dealt with appropriately and within the agreed timescales. A risk assessment had been completed following the incident to minimise any further potential risks. Staff members receive training in how to recognise any signs of abuse and the protocols they need to follow. The home is signed up to the local No Secrets in Swindon and Wiltshire protocols. The home has a whistle blowing policy in place to protect staff members. As part of the inspection process we looked at the arrangements for holding money of the behalf of people using the service. We checked the recording system and the cash held in the home for two people. We found both to be in order, with corresponding receipts for all transactions. 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 home provides a homely, safe and comfortable environment for the people who live there. We found the home to be clean and hygienic throughout. This judgement has been made using available evidence including a visit to the service. Evidence: On our arrival at the home we toured the premises, including bedrooms, the bathroom and toilet. Communal areas were comfortable and well furnished. The overall decoration of the home was in good order. Bedrooms were found to be clean and tidy. People living at the home had personalised their rooms with various trinkets, pictures and soft toys. One person told us that they are happy with my room. Bedrooms have televisions and music systems if the person chooses. The Trust employ a gardener to ensure it is well maintained. Although the garden is small, staff members confirmed that the people using the service enjoy spending time outside when the weather allows. There is a separate laundry, which houses the washing machine and drier. This area was found to be clean and hygienic. All toxic materials are securely locked away in this area. Supporting safety data is available. Anti bacterial hand wash, protective gloves and aprons were available throughout the home. Evidence: The Environmental health officer carried out an inspection of the home during 2008. They made one recommendation regarding the replacement of the chopping boards. It was noted that this had been actioned and new chopping boards had been purchased. 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 . Recruitment records demonstrate that staff members are properly recruited to ensure that they are able to safely work with vulnerable people. Staff members are trained to ensure that they are competent and qualified to meet the needs of the people living at the home. Staff members are regularly supervised by their line manager. This judgement has been made using available evidence including a visit to the service. Evidence: Mrs Shaw reported that there are generally two staff on duty during the day and one member of staff has sleeping-in duty during the night hours. The home is currently fully staffed. Within our surveys one staff member told us there are usually enough staff to meet individual needs. There are sometimes staff shortages due to sickness etc. Every effort is made to make sure individuals needs are met. When new staff members have completed their induction, they commence the Learning Disability Qualification (LDQ). This qualification covers four units: The principles of learning, your role as a learning disabilities worker, health and safety in a learning disability service and protecting people with a learning disability from abuse. This qualification can then be carried over as evidence for their National Vocational Qualification (NVQ). One staff member we spoke to confirmed that their induction covered everything they needed to know. Evidence: Within our surveys one person commented the induction did very well at covering everything I needed to know. Everything was covered by head office and the manager. We discussed training with one member of staff who commented the Trust are very good with training, they will put extra training on if it is relevant to the needs of the people we support. Records demonstrate that some staff have received training in Diabetes. Mrs Shaw confirmed that she is intending to arrange for all staff to attend the course. As part of the inspection process we examined the recruitment files of three members of staff. Records demonstrated that all necessary safeguarding checks have been carried out, with both the Criminal Records Bureau (CRB) and against the Protection of Vulnerable adults (POVA) list prior to commencing employment. One member of staff told us in their survey all relevant checks were carried out before I commenced my employment. We noted that recruitment files did not contain a photograph of the member of staff. We asked that this be actioned to provide identification of each member of staff. Mrs Shaw showed us the training matrix, which she has developed for the home. It clearly details each area of mandatory training required, when staff have completed it and when they are due to attend refresher courses. It was noted that one staff member had not yet attended the training for infection control, although they were the designated person for tasking responsibility for this area. We discussed this with the manager, who confirmed that they would ensure the staff member was on the next available course. Mandatory training includes, manual handling, health and safety, safeguarding people, fire awareness, first aid, medication and basic food hygiene. Staff members attend training and refresher courses in Non Violent Physical Intervention. The deputy manager explained that three staff have attended person centred training and the Trust are signed up to the Person Centred Charter. Within our surveys we asked what does the home do well. One person commented we work in a person centred way, enabling each client to fulfil their individual potential in life and being able to experience things in life that are available to everyone. Within our surveys we received the following comments relating to training opportunities there is always plenty of different courses to attend and every effort is made for staff to attend. Some courses are statutory i.e. first aid, manual handling and basic food hygiene and I have attended several training courses; sexual relationships sign a long and found them very useful with the clients I work with. Records demonstrate that staff members are regularly supervised by people trained to do so. Evidence: The home has a supervision planner in place, which records when one to one meetings have taken place and when the next meeting is due. Supervision records sampled were found to be very detailed and well structured. Within our surveys one comment included I have found my supervision and IPR very useful and know if I need to speak to my deputy manager they will arrange a time for me to discuss any issues. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is run in the best interests of the people who live there. Although people using the service have the opportunity to share their views on the service being provided, there is room to further develop this area. The home is considered to be safe. This judgement has been made using available evidence including a visit to the service. Evidence: Mrs Shaw is a registered nurse within the learning disability field. She has over 29 years experience and ensures that the home is run in the best interests of the people who live there. One member of staff we spoke to confirmed that they feel well supported by Mrs Shaw and her deputy. Mrs Shaw is the registered manager for two Trust homes and works across the two services. The Trust carries out regular management audits of the service. These include finance and administration, care visits and unannounced management visits. Satisfaction surveys are also sent out to stakeholders to obtain their views on the service provision. Evidence: We were unable to sample the previous completed quality assurance survey as the records were currently at the Trust head office. Records showed that on 29/04/09 the home had undergone a secret squirrel unannounced visit by a Trust manager. We discussed how the home might offer further opportunities for discussion to the people they support, by arranging regular resident meetings within the home. The deputy manager confirmed that this is something they would explore further. Staff members complete regular health and safety checks within the home. The last health and safety and infection control audit took place on 20/04/2009. Hot water temperatures are recorded daily to ensure the safety of the people living at the home. All radiators are guarded to prevent the risks of burns. The home has a cleaning rota in place to ensure large items are regularly deep cleaned. Health and safety policies and procedures are in place for staff guidance. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 6 13 You must ensure that care plans contain clear guidance and protocols relating to people who have diabetes. 12/06/2009 To ensure that their needs are being met. 2 9 13 You must ensure that all risk 12/06/2009 assessments are regularly reviewed, dated and signed. To avoid any potential risks. 3 19 13 You must obtain written confirmation and guidance relating to the cutting of toe nails with regard to people who are diabetic. This activity must be risk assessed. 19/06/2009 To ensure that the persons needs are bing fully met. 4 34 19 You must ensure a recent photograph of each staff member is kept on their personnel file. 16/07/2009 To provide identification. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 1 The Statement of Purpose and complaints policy should contain current contact details for CQC. Information documents should be available in alternative formats. 3 7 Consideration should be given to the introduction of communication tools for some people. This may include some basic sign language. 4 12 Records could be developed, which will record how successful or not an activity has been. 5 17 The pictorial menu file could be improved by replacing the existing photographs with ones which are more easily recognisable. 6 35 The staff member designated to the responsibility for infection control should attend training in this area as soon as possible. 7 39 To further develop opportunities for the people living at the home to participate in the running of the home. Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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