Care Home: Ashleigh [Minchinhampton]

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What the care home does well Prior to being offered a place at the home, a full assessment of needs is completed to ensure that the home is the right place for the potential new person. The home has a Statement of Purpose and Service User Guide, which is available to provide information about the home. Each person has a care plan, which is kept under review. Plans are based on agreed achievable and measurable goals. Actions and outcomes are monitored and recorded. People using this service are encouraged and supported to make choices and decisions about how they wish to live their lives. Independence is promoted, by staff encouraging people to participate in the running of the home. Strategies are in place to reduce most risks in daily living. Risk assessments link to care plans and minimise any potential risks whilst promoting independence. Evidence demonstrates that people have the opportunity to participate in activities, both in the local and wider community. People are encouraged to participate in their hobbies and interests. People take an active part in choosing meals for the week, writing shopping lists and preparing food. People are supported to maintain links with family members and friends, if they choose to do so. Opportunities are available for people to keep in touch with their friends. Evidence shows that people have the opportunity to enjoy a `lie in` if they choose to do so. Some people choose to undertake small household tasks. Medication is appropriately managed and records are kept. Medication policies and procedures are in place. The home provides a very clean and hygienic environment for the people who live there. People using this service benefit from having a committed and experienced staff team to support them. Health and safety systems are in place to promote peoples` health, safety and welfare. What has improved since the last inspection? Since the last inspection all staff members have completed safeguarding vulnerable adults training. Good progress has been made with regard to developing an effective quality assurance system. Within the AQAA it states other areas where improvement has taken place, such as `new care plan system has been developed to allow for a more personalised and concise approach and a capabilities training framework has been established`. What the care home could do better: When a person using the service is prescribed specific `as required` medication, this should be reflected within their care plan. A training matrix informing when refresher courses are due and when courses have been completed may enable the manager to easily identify training needs. New staff should sign a declaration to confirm that they are mentally and physically fit to work at the home. Some staff members should attend infection control training, which could then be disseminated to the remaining staff. Radiators should be risk assessed regularly to ensure that each person living at the home is safeguarded, in the event of their needs changing. Key inspection report Care homes for adults (18-65 years) Name: Address: Ashleigh [Minchinhampton] 3 Box Crescent Minchinhampton Glos GL6 9DJ     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: Pauline Lintern     Date: 0 8 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 30 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 30 Information about the care home Name of care home: Address: Ashleigh [Minchinhampton] 3 Box Crescent Minchinhampton Glos GL6 9DJ 01453886636 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jo@ggh.org.uk Gloucestershire Group Homes care home 3 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 accomodated is 3 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Ashleigh is a semi-detached house with accommodation for three adults with Aspergers Syndrome/Autism. This home differs from other homes within the organisation as the service users display more autistic needs. The organisation offers a very specialised, individual service for its service users, and staff receive training to support them appropriately. The home is situated in Minchinhampton, near Nailsworth and enables service users to access local community facilities such as shops, take aways, chemists and a Post Office. Service users also have access to transport that is provided by the home and this enables them to access facilities in several other local towns. Family and friends are welcome to visit the home at any time and service users can meet them in private if they wish to. The service users attend various activities, which include Day services provided by Gloucester Group Homes and college courses. The Care Homes for Adults (18-65 years) Page 4 of 30 1 2 0 1 2 0 0 9 3 Over 65 0 Brief description of the care home inspector has visited the day service that is provided by the organisation. It has been developed specifically for people who have Aspergers syndrome/Autism and offers service users very individual programmes to meet their needs. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on 08/12/2009. At the time of our visit two of the people who live at the home were at their day services and one person was waiting to go swimming with staff support. We were able to meet all of the people who live at the home at sometime during the day. The registered manager, Ms Joanne Wheeler was available to assist us throughout the day. We also had the opportunity to meet with the members of staff on duty at the time of our visit. Surveys were sent out to people who use the service or their representatives, health care professionals and staff members to complete if they wished to do so. We received 2 responses from staff, 2 from relatives of people receiving a service and 1 from a health care professional. Their comments are included within this report. We sent Ms Wheeler an Annual Quality Assurance Assessment (AQAA) to complete. Care Homes for Adults (18-65 years) Page 6 of 30 This was the homes own assessment of how well they are performing and provided us with information about their future plans. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures, training and quality assurance. We also looked at the arrangements for managing medication. 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. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Since the last inspection all staff members have completed safeguarding vulnerable adults training. Good progress has been made with regard to developing an effective quality assurance system. Within the AQAA it states other areas where improvement has taken place, such as new care plan system has been developed to allow for a more personalised and Care Homes for Adults (18-65 years) Page 8 of 30 concise approach and a capabilities training framework has been established. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 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. This judgement has been made using available evidence including a visit to the service. The home has a Statement of Purpose and Service User Guide, which provides people with information about the service. Due to there being no new admissions the key standard which relates to the assessment process could not be fully addressed. Evidence: Information about the service is provided within the Statement of Purpose and Service User Guide. The manager explained that she would be updating the Statement of Purpose to reflect one persons changing needs. All people who use the service have lived at Ashleigh for a number of years. It was therefore not possible to look at the admission process in practice. People therefore have established routines and their individual and varied needs have Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: been assessed over time. 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. Care Homes for Adults (18-65 years) Page 12 of 30 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. This judgement has been made using available evidence including a visit to the service. Service users needs and goals are reflected in their individual care plans. People are able to make choices about how they live their lives. People are supported to take informed risks. Evidence: As part of the inspection process we examined the care of two people living at the home. We saw that plans are sectioned into individual goals. Goals are set with the person receiving the care and their families or representatives during review meetings. Documentation is in place to ensure that records are maintained of who is taking responsibility for actioning the goals and when and how it has been achieved. This provides an achievable and measurable system, enabling people to achieve what is important to them. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We saw that one person was being supported to take more exercise to maintain a healthy weight. The manager explained that the person was not particularly fond of just going for a walk; however they found that if the person had a reason to be walking it was acceptable to them. Ms Wheeler confirmed that the person now walked to their day services, which they were happy to do. We saw that a record of their weekly exercise was completed and dated by staff members. We saw that the plans work well for the individuals living at the home, were well ordered and were supported by an assessment of risk. Each person using the service had signed and dated their care plan to show that they had full involvement in its development. We noted that people living at the home have the opportunity to feedback on their annual review if they wish to do so. Within the AQAA it states that the home plan to review the new care plan system to ensure its effectiveness for service users and the provision as a whole over the next twelve months. One persons overall goal was to manage their weekly allowance and promote their independence. The person now has their own money tin with a key. Their key worker has sectioned off the tin into different days of the week. This enables the person to take responsibility for ensuring that they have sufficient money for their expenditure for the week. Another persons care plan reminds the reader it is important to recognise that goals are not set in stone and should be recognised as flexible and open to change. This person had their annual review on 24/7/09. We saw evidence that people make choices about how they live their life at Ashleigh. One person has decided that they prefer to get up at about 11.00am. The manager told us that the person likes to get up at their own leisure and this choice is respected. One persons health action plan dated 07/07/09 records X is able to make an informed decision. If it was felt that X was not able to make an informed decision, a best interest meeting would be proposed to support X. Individual risk assessments are in place and link well to the persons care plan. We saw that assessments are kept under review to ensure that any changes in the individuals life are considered. Care Homes for Adults (18-65 years) Page 14 of 30 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. This judgement has been made using available evidence including a visit to the service. People using the service are able to participate in a variety of activities. People are able to follow their preferred routines and receive visitors as they wish. People are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. Evidence: As mentioned in the summary of the report, on our arrival at Ashleigh one person was just about to leave for their swimming lesson. They confirmed that they were a good swimmer and enjoy the activity. Within our surveys one relative told us X is content and happy at Ashleigh and this is Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: obvious when I see him on our regular visits from him. This contentment is sustained by the fantastic opportunities and level of care which X benefits from every day. He has constant opportunities to try new things as well as the riding lessons, swimming, music, TV etc every week. Another person told us Ashleigh is a warm, safe environment for people who live there and there are plenty of opportunities for people to be actively involved in activities of their choice. Ms Wheeler reported that one person enjoys their IT lessons at a local college. Another persons timetable shows that they attend art lessons and music and drama at the college. The organisation also run their own day services called Spring Mill where they offer an outreach service to people in the community. The manager explained that the service also opens regularly in the evenings, offering a social evening for people to meet their friends. People using the service have the opportunity to pick a holiday of their choice. Ms Wheeler confirmed that the process will start after Christmas, with initial discussion with the people they support. Each person using the service has a weekly training day where they are supported by staff to undertake tasks such as laundry, cleaning, bed changing or shopping. During our visit we observed people carrying out small household tasks. One person likes to Hoover and wash the floors and another person chooses to empty the dish washer. People appear to have established routines, which are important to each individual. Within the AQAA the home has identified their plans for the next twelve months, to continue to improve personal diets and fitness levels, supporting lifestyle choices. To ensure that we are meeting the needs of an ageing population. Each Sunday the menu is chosen for the following week. One persons individual goal is to maintain their cooking skills and to encourage X to use his imagination for the weekly menu. We noted that the main meal of the day is taken in the evenings as people generally take a packed lunch to their day services. One member of staff told us that one person likes particular items of food for lunch and that the home always ensure these food items are available. Care Homes for Adults (18-65 years) Page 16 of 30 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. This judgement has been made using available evidence including a visit to the service. People are supported to address their personal and health care needs effectively. The medication arrangements in place should protect people. Evidence: People living at the home are able to complete their own personal care needs with staff members offering prompts, where necessary. The manager has now developed health action plans for each person living at the home. She told us that she feels they will further evolve as time goes on. Every month a health check is completed for each person to ensure that their healthcare needs are being met and any concerns identified so that advice can be sought from the appropriate professional. Within the AQAA we asked how the home has improved in the last twelve months, all Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: staff has received medication training through Stroud College. The new personal health profile will coordinate all relevant information specific to the individual and make it more accessible for both service user and staff. Within daily and weekly records we saw that people have access to various healthcare professionals when they are required. This includes psychiatrists, opticians and chiropodists. Records demonstrate that the people living at the home have the opportunity to attend well man clinics for regular health checks. We discussed how one persons needs may change in the near future and how the home will manage this. Ms Wheeler reported that a review of their needs is planned for March. Ms Wheeler will amend the Statement of Purpose accordingly and ensure that staff are provided with any necessary training to enable them to meet the persons needs. All staff members receive accredited training in the administration of medication. We found that medication administration records were in order, with no unexplained gaps. No one using the service currently self medicates. Regular stock checks are completed on medicines held at the home. Ms Wheeler told us that every one receiving a service signs their own medication record; in addition to the staff signing the medication administration record (MAR). The records are kept in a separate file by the front door. We saw that there are guidelines on the use of as required medication within the medication file. We asked Ms Wheeler to also include any individual protocols within peoples care plan. This should provide information on when the medication should be administered. Care Homes for Adults (18-65 years) Page 18 of 30 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. This judgement has been made using available evidence including a visit to the service. Policies and procedures are in place to enable people to raise concerns or make a complaint. The home has policies and procedures in place for the Protection of Vulnerable Adults. Evidence: A complaints policy and procedure are in place. Within the AQAA we asked what the home does well, the home has an updated written complaints procedure that is easy to understand and is given to each person living in the home. Key workers and staff are an integral part of supporting individuals to resolve complaints or disputes. If the complaint is of a more formal nature there is a clear procedure to follow that identifies contact numbers for Gloucester Social Services and the CQC. They also told us Annual reviews are held at which individuals are encouraged to raise any concerns if not already done so throughout the year. The manager confirmed that they have not received any complaints in the last twelve months. At the last inspection a requirement was made relating to staff members attending Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: training in safeguarding vulnerable people. Ms Wheeler confirmed that all staff have now completed the training. One member of staff we met with confirmed that they attended the course in the summer. Each person using the service has been given a copy of the Alerters guidance. We noted that copies of the guidance were displayed on the notice board. Systems regarding the safekeeping of peoples personal monies are well managed. A member of staff and the person using the service both sign any financial transactions that take place. There have been no allegations of abuse since our last visit to the service. Care Homes for Adults (18-65 years) Page 20 of 30 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. This judgement has been made using available evidence including a visit to the service. The home provides a clean, comfortable and safe environment for people to live in. Evidence: Ashleigh is a semi-detached house, in a residential area on the edge of Minchinhampton. The home is domestic in scale and in keeping with other houses in the street. There is a pleasant lounge and conservatory for people to relax in, if they choose to do so. There is comfortable seating and pleasant soft furnishings. There are photographs around the home, a television in the lounge and a stereo system. The conservatory is used as a dining room and overlooks the rear garden. Some people choose to listen to music or do their ironing in the conservatory. Some areas of the home are in need of some attention, such as the bathroom, toilet and ceiling in the lounge. Some areas are just general wear and tear, others requiring new flooring and redecoration due to a damp problem. Ms Wheeler told us that they Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: are in discussion with the landlord and work has begun in the bathroom. At the time of this visit we did not view individuals bedrooms. There is a small but well maintained garden to the rear of the home. At the front of the property is a lawned area, which is maintained by a gardener. One person living at the home takes responsibility for feeding the birds. The kitchen facilities are domestic in style. The washing machine is sited in the kitchen. We noted that there were supplies of gloves available for staff members. Anti bacterial hand wash was situated at hand washing facilities. We recommend that some staff members attend training in Infection control. This could then be disseminated through the team in staff meetings. Ms Wheeler agreed to action this. At the time of our visit we found the home to be clean, hygienic and fresh. Care Homes for Adults (18-65 years) Page 22 of 30 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. This judgement has been made using available evidence including a visit to the service. People are supported by an effective and experienced staff team who has a sound underpinning knowledge of their needs. There has been no new staff since the previous inspection when the standard about recruitment was met. Some progress has been made with regard to the training provision for staff. Evidence: Within our surveys we received the following comments in relation to the staff and service provision at Ashleigh; we, father and mother, feel very confident that Ashleigh does very well in all areas. We feel that our son and ourselves we are very lucky, we feel that staff at Ashleigh and Gloucester Group Homes do all they can to care for our son and others. Annual reviews are very detailed and discussed with us and our son, written and verbal communication, which is essentially important to the smooth running and continuity of everyday living within the home is very good. Staff have a lot of experience and knowledge of the support needs of individual service users and I think Ive said it all already, but can I just take the opportunity to say that in my opinion X is in very good hands. The staff are all professional caring people Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: who know X and very importantly have Xs welfare always at the forefront of any decisions made regarding him. I am very grateful! During the day one member of staff is on duty to support people to their day services. Some people living at the home have been risk assessed as able to stay at the home independently. One member of staff confirmed that the staffing ratio of 1-3 works well. The home does not use agency staff, however they have their own bank staff available to cover annual leave and sickness. Ms Wheeler told us that the bank staff work across all of the homes in the organisation and also at the day services. This means that the people using the service are supported by a consistent group of staff, who understand their needs. The home has not recruited any new staff since the last inspection; we therefore did not assess national minimum standard 34 in full. We noted that the home did not ask potential new staff for a declaration of their mental and physical health. We asked that this be implemented in the future and any risk assessments necessary to be put in place. We discussed the training programme for staff members. Ms Wheeler confirmed that safeguarding training, first aid refreshers and fire extinguisher training have taken place since the last inspection. We discussed the benefits of developing a training matrix, which would enable the manager to easily identify when people were in need of refresher training and when training had been completed. The current system does not easily allow for this. Ms Wheeler confirmed that the organisation are looking at training overall and are planning to carry out refresher training for all staff in all areas commencing summer 2010. Training planned already for next year is Mental Capacity Act 2005, manual handling, equality and diversity and first aid. Within the AQAA it states that four members of staff have either achieved or are working towards their National Vocational Qualification (NVQ) level 2 or above in Health and Social care. One staff member told us they were in the process of completing their NVQ level 3. Ms Wheeler described the induction period for any new staff members. This includes completing a work book, which is in line with the Common Induction Standards. There is also an organisations induction work book to be completed. The manager confirmed that she spends time with each new member of staff, taking them to the day services and providing training on the specific needs of the individuals living in the home. She Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: also includes information on policies and procedures, confidentiality, the staff manual and safeguarding. Ms Wheeler reported that she aims to provide bank staff with at least two supervisions a year, however this depends on their availability. Bank staff are encouraged to attend staff meetings to ensure that they feel part of the team. The day before our visit to the service a team meeting took place, which was chaired by Ms Wheeler. Care Homes for Adults (18-65 years) Page 25 of 30 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. This judgement has been made using available evidence including a visit to the service. The home is run by a competent and qualified manager in the best interests of the people living there. Good progress has been made towards developing a quality assurance system. Polices and procedures are in place to promote health and safety within the home. Evidence: The registered manager of Ashleigh is Ms Wheeler, who has a vast knowledge of the needs of the people using the service. She has attended numerous training courses over the years and continues to update her skills and knowledge. She provides an open management approach and confirms that she regularly works a shift to keep her in touch with the staff team and people living at the home. During our visit Ms Wheeler and other staff members were observed interacting with people and being patient and considerate to their needs, desires and emotions. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: We noted that monthly management audits have taken place by another manager within the organisation. Any areas of concern are highlighted and the views of the people being supported are sought and recorded. The last visit took place on 18/11/09. At the last inspection a statutory requirement was made regarding the need for the home to develop a quality assurance system. Good progress has been made and the home now has a quality assurance statement. We noted that satisfaction surveys have been completed by the people living at the home. Ms Wheeler reported that this exercise enabled the key worker and herself to recognise where an individual might need additional support if they wished to raise an issue. A development plan for the service will be developed for 2010. One person using the service prefers to use written communication rather than verbal. The person regularly writes letters to Ms Wheeler expressing how they are feeling and highlighting their needs. We observed Ms Wheeler discussing the contents of a recent letter with the individual and explaining the actions she would take. This is good promotion of a persons preferred mode of communication, whilst enabling them to share their views. Within our surveys we asked how the service could improve. One relative told us without wishing to sound over the top with praise, I honestly cant think of anything. No other suggestions for improvement were made. Health and safety checks are undertaken by staff members. There are environmental risk assessments completed. There is a current fire risk assessment in place. Small electrical appliances were last tested in July 2009. Hot water outlets are checked regularly and recorded. We noted that none of the radiators in the home are currently guarded, although they are fitted with thermostatic controls to ensure a safe heat. We suggested that the radiators are regularly risk assessed to ensure that they do not pose a risk in the future if individual needs change. Ms Wheeler agreed to do this. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 1 20 If people receiving a service are prescribed specific as required medication, their plan of care should give detailed guidance on how the medication is to be used. A number of staff members have the opportunity to complete an infection control training course, which could then be disseminated throughout the rest of the team. You should develop a training matrix to ensure that all staff attend mandatory training and refresher courses as needed to maintain their skills. Continue to develop the systems for measuring quality assurance and the development plan. Risk assess radiators to ensure that they do not pose a risk to the people living at the service. 2 30 3 35 4 39 5 42 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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