Care Home: Ashwood House

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What the care home does well From observing the interaction between staff and users of the service it appeared that residents were happy living at the home and we observed that staff and residents got on well together. Each service user has an individual plan of care, which gives staff the information they need to provide the level of support that service users need and in the way they prefer. The home had comprehensive risk assessments in place to protect service users. Risk assessments contained details of any identified risk and also had control measures to minimise any risk. Risk assessments were regularly reviewed and amended as required. Residents are provided with a balanced diet in pleasant surroundings at a time convenient to them and the service users are involved in meal planning. Staff are provided with a range of training opportunities and the home is supporting people to obtain recognised qualifications. Staff told us that they are provided with the training they need so that they can support the residents effectively. The home has comprehensive quality assurance systems in place, which takes into account the views of the people who live at the home. What has improved since the last inspection? The homes completed AQAA told us that the home has improved in the following areas; The provider has recruited a Training Consultant to assist in direct training provision and the home has carried out a review and analysis of training needs within the service. The home has improved its liaison with relatives, ensuring clear communication to promote awareness of its requirements to adhere to standards. The home have explored alternative education and day service provision and have supported a service user to view various activity services. The person has chosen a new provider and the home have re-negotiated his needs and wishes with his care manager to enable the person to attend. What the care home could do better: No requirements or recommendations were made as a result of this inspection. However areas identified for improvement are contained in the main body of the report. General observations were; The home needs to ensure that if any controlled drugs are kept at the home they are kept in a suitable cupboard which meets the required standards. This will ensure that the home complies with the law. Although there is a clear audit trail for the management of service users finances. A system for the auditing of service users bank cards needs to be put in place. The homes completed AQAA also highlighted and identified the homes own areas for improvement. Key inspection report Care homes for adults (18-65 years) Name: Address: Ashwood House 217 Winchester Road Southampton Hampshire SO16 6UA     The quality rating for this care home is:   three star excellent 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: Mick Gough     Date: 1 2 0 1 2 0 1 0 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: Ashwood House 217 Winchester Road Southampton Hampshire SO16 6UA 02380777451 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): angela.cherry@wrcl.co.uk Wessex Regional Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: 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 to 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 Ashwood House is located on the outskirts of Southampton on a busy main road. The home provides care and support for up to five people who have a learning disability. Currently all the service users are male. The aim of the home is to support residents to develop social, daily living and independence skills to become integrated into the community. Twenty-four hour staff support is provided. The house is detached and it has a sitting room, dining room, spacious kitchen and shower room on the ground floor. Bedrooms are situated on the first floor and are single rooms, which are spacious Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 5 Brief description of the care home and have been personalised to each service users own preference. Access to the first floor can be gained by one flight of stairs. There are no en-suite facilities, however there is a bathroom on the first floor, which is accessible from all the bedrooms. Car parking is available to the side of the house and there is a large well-maintained garden to the rear, which offers privacy. 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: three star excellent 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 purpose of the visit was to assess the quality of service provided by Ashwood House since the last inspection of the service, which was carried out in March 2007. We looked at the information provided in the Annual Service Reviews (ASRs) that had been carried out in May 2008 and in February 2009. We also took into account the homes Annual Quality Assurance Assessment (AQAA), which was sent to us when we asked for it. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. As part of the inspection process an unannounced visit to the home was carried out on the 12 January 2010. For this visit we involved 4 service users and 3 members of staff. Also the manager of the service, her line manager and 2 senior staff members assisted us during the visit. Care Homes for Adults (18-65 years) Page 6 of 30 Other evidence for this report was obtained from reading and inspecting records including plans of care, risk assessments, staff rotas, medication procedures, recruitment and training records, incident forms and some of the homes policies and procedures. We were also able to observe staff supporting service users in the home and we were able to see the interaction between staff and users of the service. The home is registered to provide support for 5 residents and at the time of the visit there were 5 people living at the home. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: No requirements or recommendations were made as a result of this inspection. However areas identified for improvement are contained in the main body of the report. General observations were; The home needs to ensure that if any controlled drugs are kept at the home they are kept in a suitable cupboard which meets the required standards. This will ensure that the home complies with the law. Although there is a clear audit trail for the management of service users finances. A Care Homes for Adults (18-65 years) Page 8 of 30 system for the auditing of service users bank cards needs to be put in place. The homes completed AQAA also highlighted and identified the homes own areas for improvement. 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. Prospective new service users have a full assessment of their needs before they move into the home. Evidence: Assessments were seen to be on file for the current service users. We were informed that 4 of the existing service users had expressed a wish to move on to more independent living and the home was supporting them, to do this. The home does not intend to admit any new service e users when people move out as the organisation is looking to re model the service, Care Homes for Adults (18-65 years) Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessed needs and personal goals of residents are reflected in an individual plan of care and this enables them to lead fulfilling lives. People who use the service are well supported and are encouraged to make decision about their lives with assistance given by staff. Residents are supported to take responsible risks and this allows them to live an independent lifestyle as much as possible. Evidence: Care and support plans were seen for 2 service users and both care plans were found to be comprehensive documents and were clear and easy to follow. Care plans had a personal profile of the individual and this contained good information about the person and included information on past history, current situation and future goals and aspirations. There was also a physical description of the person. The care support plans were person centred and they gave good clear information on individual, needs, choices and preferences. They gave staff information on the exact type of support that was required and also told staff how the person wanted the Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: support to be given. The care plans included information on; cleaning rooms, laundry, tidying the house, day service, activities, triggers for any potential challenging behaviour, finance, dressing and undressing, mental health, work and education and daily routines. There was also a detailed plan about individual behaviour. This gave staff clear information on how the person displayed behaviours when they were becoming unsettled and went on to explain to staff what measures they should take to calm the situation. Care plans also had detailed support plans, which identified needs, gave information on desired outcomes and provided an action plan to achieve this. The detailed information in the care plans gave staff the information they needed to be able to support the resident and allowed residents to be as independent as possible. Care plans were regularly reviewed and each service user has a weekly one to one meeting with their key worker, this gives them the opportunity to discuss how the care plan is working and also allows them to change and alter the plan as needed. As well as the individual weekly meeting there is a house meeting held once per week and this gives everyone the opportunity to sort out any minor issues that individuals may have, this meeting also gives each person the opportunity to be involved in planning the weekly menu. Each service users has a more formal review every three months. Annual reviews are carried out and social service care manager, relatives and other interested parties are invited to attend. Service users spoken with told us that they are involved in the care planning process and that they liked the opportunity to discuss issues at the weekly meetings. Daily recording takes place at the end of each shift and this was clear and detailed what the person had been doing during the day and also provided good evidence of care delivery. Residents are supported to make decisions about their day to day lives and staff were observed interacting with residents and taking their views into account. Care plans and recording gave good information on how staff involved residents in decision making and staff told us that they would respect residents wishes. We spoke with 4 of the 5 residents and they told us that staff supported them to make decisions but they were able to make their own choices. We observed staff interacting with service users and they were patient and allowed service users to make their own decisions as much as possible and were on hand to offer guidance and support. Care plans looked at contained risk assessments and these gave details of the assumed risk, the level of risk and also details of the risk. We saw risk assessment in place for; swimming, use of the house car, use of bathrooms, aggressive behaviour, Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: access to the community, medication, electrical appliances and there was also a risk assessment for one person when using their bike. The risk assessments detailed control measures to minimise the risk and they gave staff good information on any support that was required. Risk assessments were seen to be regularly reviewed and they were updated as and when required. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in appropriate activities and they have opportunities for personal development and are encouraged and supported to be part of the local community where they engage in appropriate leisure activities. The homes visiting policy supports residents to maintain family links and their rights are respected. Residents are offered support to plan their own menu and are provided with a balanced diet in pleasant surroundings. Evidence: The homes completed AQAA told us that service users are encouraged to learn independent living skills and undertake as much as possible for themselves. Service users have a flexible activity programme for each individual and they are supported to attend various social occasions and are encouraged and supported to invite friends to their home. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: During our visit we found that each service user has a timetable, set up with the individuals needs in mind. This timetable is displayed in each service users bedroom and gives them information on what they are planning to do each day. Staff support service users to undertake everyday tasks and they are encouraged to participate as much as possible. There is an activity room which has 2 computers and there is a range of equipment for service users. One service user goes to day service and is involved in some voluntary gardening work. We were informed that one service user has just completed a college course and the home is supporting the person to look for other suitable courses to improve independent living skills. Another service user had been working in a charity shop on a voluntary basis but decided that this was too much and made the decision to leave. We observed one service user using their own lap top computer and they were down loading music from the internet. We spoke with this person who told us that they were supported by staff to access the internet. Other service users spoken with were happy with the activities provided by the home. The home provides a range of outdoor activities and on the day of our visit 3 service users were out in the local community. None of the service users are able to access the community independently as they all require varying degrees of staff support. When we arrived at the home one service user told us that he would like to go out to the local shops and staff supported this person to go out. All activities and outings are recorded and this provided good evidence that service users are supported to undertake activities and they go out to local pubs and regularly go out shopping. The majority of service users have regular contact with their families and the home supports residents to maintain contacts with family and friends. Residents are supported to exchange greeting cards. Some service users speak to relatives on the phone and some relatives visit the home. Service users are also supported to go and visit relatives. The home has a clear visiting policy and visitors are always welcome. Staff told us that they would respect residents wishes on who they wish or do not wish to see. Daily routines in the home promote residents independence as much as possible and service users are encouraged to participate in day to day routines. During the visit staff were observed interacting with residents and they appeared to get on well together. Staff used residents preferred form of address and they were very patient and understanding of the residents needs. Staff were seen to communicate with residents in a number of different ways to meet individual needs. The manager told us that residents could be involved as much or as little as they want. Service users have access to a key for their rooms, which they are supported to use if appropriate. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: The home has a weekly meeting with all of the residents to discuss and plan the menu for the following week. Each service user is able to put their own choices forward and staff support residents to ensure that they receive a balanced diet. Breakfast at the home is normally cereals and toast and residents are supported to be involved in meal preparation as much as their skills allow. Lunch is a snack type meal such as egg on toast, sandwiches or beans on toast. The evening meal is the main meal of the day with a hot meal being provided. Service users are encouraged to eat their meals in the dining room; however they can eat elsewhere if they want. The menu is flexible to allow for take aways or meals out in the community. Care Homes for Adults (18-65 years) Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of residents are set out in an individual plan of care and residents have access to all relevant health care professionals. The staff at the home supports residents to have regular health checks and ensures that their health care needs are met. Residents are protected by the homes policies and procedures regarding medication. Evidence: The homes completed AAA told us that the home have made appropriate referrals to the specialist health care team and an occupational therapist has assessed bathing support and adaptations for two service users. An art therapist has been involved regarding anxiety and behavioural therapy, and a dietitian has been consulted regarding healthy lifestyle i.e. eating and exercise. Each service user has their profile of medications and there are detailed medication risk assessment. The service has regular medication audits. During the visit we found that all service users have clear information in their plan of care on their personal care needs. Some service users require only verbal prompts while others need more staff involvement. Care plans provided good information on Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: what actual support was required and support is offered flexibly to suit residents needs. One plan seen had good information for staff on the persons morning routine and gave clear information on how the person wanted to be supported to brush their teeth. Support plans enabled service users to be in charge of their personal care but also enabled the correct support to be given when required. Residents are all registered at 2 local GP surgeries; however they may have different GPs. Dental checks are carried out in the community at a local NHS dentist and sight tests are also carried out in the community. Four of the service users have foot care provided by a visiting chiropodist for which there is a charge, however one service user has their care provided by an NHS podiatrist. Community nurses are provided from the GP surgery if required and other health care professionals are provided through GP referral. The local community learning disability team are available for support if required. We saw that the home keeps records of all visits to any health care professionals and staff at the home support residents to keep and attend any appointments. After any visit or appointment staff writes up health care notes which are then kept in the care plan folder. Medication is supplied to the home by a local pharmacist, via a monitored dose system. We were told that the home is currently in the process of changing their supplier of medication. Each service user has a lockable cupboard in their rooms where their individual medication is stored and staff holds the key to this cupboard. There is a Medication Administration Record Sheet (MARS) kept in each service users cupboard together with a risk assessment and protocol for administering any when required medication. MARS were check and found to be up to date with no omissions. The home has a clear policy and procedure and all staff has completed training in medication procedures and administration. One member of staff told us that the home was organising NVQ training in medication. Currently the home does not hold any controlled drugs. However it was pointed out that should there be a need for any controlled drugs to be held at the home, they must be stored in a proper Controlled Drugs Cupboard in order to comply with the law. The Misuse of Drugs (Safe Custody) Regulations 1973 gives full details of the storage requirements for controlled drugs and suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. Care Homes for Adults (18-65 years) Page 19 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. There is a clear and accessible complaints procedure, which includes timescales for the process and service users can be confident that their views would be listened to and acted upon. All complaints are logged and responded to appropriately. The homes policies and procedures help to protect service users from any form of abuse. Evidence: The homes completed AQAA told us that there had been no complaints made to the home in the past 12 months and this was confirmed on the day of the visit. The home had a complaints log where all complaints could be recorded. The home has a clear and accessible complaints procedure and a senior member of staff told us that the complaints procedure is being made into a more suitable format for service users and that a copy will be kept in individual service users rooms. All those staff who we spoke with were aware of the complaints procedure and they told us that they would assist and support any resident who wanted to make a complaint. Residents spoken with told us that they would raise any concerns with a member of staff. The home has a comprehensive policy on the protection of vulnerable adults and they have a copy of the Hampshire Adult Protection procedure and a whistle blowing policy. There had been one adult protection issue that had been raised and the home cooperated fully in the investigation by social services and this was found to be unsubstantiated. Staff training records showed that staff receive training with regard to adult protection and whistle blowing as part of their induction. The manager and Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: staff members spoken to confirmed that they had received training and were aware of their responsibilities in this area. All of the service users at the home have individual bank accounts. Residents benefits are paid directly into their account and any contributions towards their care are paid directly to Wessex Regional Care. The manager informed us that she keeps bank cards for residents so that staff can support them to draw out money if it is required. However at present there is no procedure in place to ensure that bank cards are regularly checked and the manager told us that she would introduce a checking procedure straight away. The home holds some personal spending money for residents (max £50) and this is kept separately for each service user in a lockable tin and there is a clear record of all transactions with receipts kept. This provides a clear audit trail. Care Homes for Adults (18-65 years) Page 21 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. Service users live in a homely and comfortable environment and the home is clean and hygienic and free from offensive odours. Evidence: During our visit we took the opportunity to tour the premises with a member of staff. The home was found to be comfortable, clean and safe. A system is in place to report defects so that any repairs or improvements can be made. Some of the service users showed us their bedrooms and those seen were suitably decorated with adequate furniture and they had been personalised to reflect the preferences and needs of the individual service user. There is adequate communal space and all areas were clean and comfortable. The completed AQAA told us that the service users have been integral in developing their home and we saw photographs of the residents around the home. We were told that service users are involved in the choice of decoration and that they have chosen and have helped to purchase new lounge furniture. There is an activities room which is located in a building to the rear of the home and this enables service users to carry out activities without disturbing other service users who may be relaxing in the home. The laundry is situated on the first floor of the home and this contains a washing Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: machine and tumble drier. Residents carry out their own laundry duties with support provided by staff. Each resident has a set day for doing their laundry; however they can wash clothing at other times if they wish. Staff told us that they have completed infection control training, and were aware of the homes policies and procedures regarding hygiene issues. Suitable protective clothing such as aprons and gloves were readily available. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides support for residents in a flexible way to ensure that there is sufficient staff on duty to meet residents needs. Service users are supported by competent, qualified and appropriately trained staff that have the skills and knowledge required to support residents and meet their needs. There is a thorough recruitment process and the homes recruitment policy and practise helps to protect residents. Evidence: We looked at the homes staff rota and this showed us that there is a minimum of 2 staff members on duty at all times. Additional staff are also provided to allow for planned activities and to give individual residents one to one support as required. We were told that residents like to have their days planned out, so extra staff are provided as and when required to cover residents social activities. At night there are 2 staff members on duty, one is awake throughout the night and the other is able to sleep but is available if required. We were told that if staff plan any activities for residents the management will ensure there is enough staff on duty to enable the activity to take place. The staff rota allowed for flexible shifts to enable staff to support residents out in the community and additional staff are provided to facilitate activities and appointments. The manager told us that she has a stable staff team who are reliable and flexible to meet residents needs. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: The home employs a total of 8 permanent full time staff with 3 part time staff members. There is also a pool of bank staff that provides additional cover as required. In addition the home manager works flexibly throughout the week. All of the permanent and part time staff members at the home have either completed or are working towards National Vocational Qualifications (NVQs). The homes AQAA told us that the home has a robust recruitment procedure. Documents we were able to see confirmation that appropriate checks had been carried out and records seen included; application form, 2 references, enhanced Criminal Records Bureau checks (CRB) and Protection of Vulnerable Adults (POVA) checks. The home had appropriate proof of identity documents including passport and birth certificate and these were kept on file. The organisation has a human resources department who assist in the recruitment of new staff to meet legal requirements. All new staff have to complete a 3 month probationary period and at the end of this period service users are asked to complete a survey about the staff member so that their views are taken into consideration before anyone is offered a permanent contract. The homes completed AQAA told us that training is an agenda item at both team and managers meetings to ensure that there is clear communication regarding available training courses. Records seen showed that staff undertake a comprehensive induction that must be completed within the first 3 months of employment. Induction includes the completion of an induction workbook that staff work through and this involves some video training. Induction includes; risk assessments, communication, medication administration, health and safety, emergency first aid, infection control, whistle blowing, adult protection, role of the carer, fire prevention and moving and handling. Additional training is provided with regard to food hygiene, behaviour management and breakaway training. Senior staff also receive training appropriate to their role and this includes supervision training, mental capacity act, learning disability, managing challenging behaviour and risk assessment. Additional training is provided as required to meet the needs of individual service users. The manager told us that training needs are discussed at supervision and also at staff personal development planning; she told us that the organisation would support any training that would benefit the residents. 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. Residents benefit from a well run home and the views of residents and other interested parties are sought on how the home is meeting service users needs. The health, safety and welfare of residents and staff are promoted and protected. Evidence: The manager has only been in post since December but she has over 6 years experience in managing services. We were informed that the manager is currently in the process of applying for registration with the Care Quality Commision. Staff spoken with were very supportive of the manager and said that she was very approachable. The manager was in the process of completing NVQ4 in care at her previous employment and is in the process of transferring this to her new role. The home has a good quality assurance system in place and there are weekly one to one meetings with service users and also weekly house meetings where service users can express their views and there was evidence to show that the home acts on what service users say. The home holds monthly staff meetings and there was a staff meeting taking place on the day of our visit. Regular regulation 26 visits are carried Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: out by the provider, these are unannounced visits to establish how the home is meeting its aims and objectives. The person carrying out the visit provides a written report on their findings and copies of these reports were on file at the home. Staff received regular supervision and also annual appraisals. The provider organisation also carry our an annual audit of the service. The home has policies and procedures regarding health and safety issues and the manager informed us that weekly health and safety audits are carried out. There were risk assessments in place for the environment and all staff completes health and safety training as part of their induction. 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 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. 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