Care Home: Ballards Ash Farm

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What the care home does well A person centred approach to care planning is in place which reflects people`s wishes and aspirations providing a personalised and individual service. People indicated to us activities they really enjoyed including massage, music and holidays. Excellent systems are in place to enable people to understand information and to express choices and make decisions. This includes the use of photographs, symbols, pictures and makaton sign language. Staff have a good understanding of how to support people when anxious or angry. Staff said they have access to excellent training which includes access to courses about autism and learning disability. Robust quality assurance systems are in place which include obtaining feedback from people living in the home and their relatives. Ballards Ash Farm is maintained to a high standard providing a sensory environment for people which is homely and has a lively atmosphere. What has improved since the last inspection? No requirements were issued at the last inspection. All documents are being signed and dated. Staff have access to regular supervision. Staff have refresher training in the administration of medication and six monthly assessments of competency are in place. What the care home could do better: Reference requests for new staff should ask former employers the reason why staff left their employ. Where staff are employed before their Criminal Records Bureau (CRB) check has been returned a risk assessment should be in place to describe their role and responsibilities. Key inspection report Care homes for adults (18-65 years) Name: Address: Ballards Ash Farm Brinkworth Road Wootton Bassett Swindon Wiltshire SN4 8DS     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: Lynne Bennett     Date: 1 9 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Ballards Ash Farm Brinkworth Road Wootton Bassett Swindon Wiltshire SN4 8DS 01793840807 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Choice Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Ballards Ash Farm is one of a number of homes owned and managed by Community Homes of Intensive Care and Education (CHOICE). The home is situated on the outskirts of Wootton Bassett and accommodation comprises of nine single bedrooms with en suite facilities. Ballards Ash provides medium to long-term care to adults with learning disabilities and complex needs. The aims of the service are to promote the rights of residents in a secure, supportive stimulating and homely environment. There are a minimum of four staff on duty throughout the waking day, in addition there are two waking night staff. Fee levels are available upon request. 9 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This inspection took place during January 2010 and included a visit by one inspector on 19th January. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). The registered manager was present throughout our visit. We (the Care Quality Commission - CQC) talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We observed the support being provided to other people living in the home and spent time with them. We had received surveys from 8 people living in the home, 4 relatives, 4 staff and health care professionals. Care Homes for Adults (18-65 years) Page 5 of 29 During our visit we examined a selection of records including staff files, health and safety and quality assurance systems. We had a walk around the environment and were invited to look at some peoples rooms. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 7 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of information enabling them to make a decision about whether they wish to use the service. Completing a care needs assessment that provides a holistic summary of peoples needs ensures that the home is able to meet peoples needs. Evidence: The home has a Statement of Purpose and Service User Guide which were last reviewed in April 2009. The latter document was produced in a format using photographs,pictures and plain English. This also included a statement of terms and conditions which had been personalised with photographs relevant to the individual. Some people had signed these documents. Copies of the Statement of Purpose were available in the home and each person had a copy of the Service User Guide in their file. The AQAA stated that future plans included developing information in more appropriate formats if needed. The admission information for the last person admitted to the home was inspected. They had a transition programme which had been discussed with their relatives, care Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: manager and previous placement. A number of visits including overnight stays were planned before the person moved into the home. Records were being kept of these visits and indicated that further visits were planned to ensure a smooth transition. Copies of an assessment of need and care plan from the placing authority had been received prior to admission. The referrals manager for CHOICE had also completed a comprehensive assessment. Supporting information from the parents had also been provided. The AQAA stated that prior to admission people were provided with pictures of the home and staff to familiarise them with their new environment and staff who would be supporting them. During their transition people were involved in the choice of colour scheme for their rooms. Care Homes for Adults (18-65 years) Page 10 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect peoples assessed needs and there is evidence that people are being supported to make choices about their lifestyles. Imaginative use of resources enables people to express their wishes and needs. Risks are being managed safeguarding them from possible harm. Evidence: We case tracked the care of three people including the last admission to the home. Each person had two files containing historical information, person centred plans, risk management strategies and health action plans. They also had a daily file which contained monitoring records and daily notes. There was evidence that people were having annual reviews to which their placing authorities were invited.Copies of the homes review and the placing authorities assessment of need and revised care plan were on their file. The registered manager showed us a schedule of planned reviews for 2010. Comprehensive records were in place based on these reviews. Each person had an Essential Lifestyle Plan based on their physical, cultural, spiritual, psychological and social needs and preferences. From these individual goals were developed which Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: promoted their individual needs and independence. Regular monitoring of these goals was in place with comments from key workers indicating whether progress was being made. For instance one person was being supported to clean their teeth and records indicated that staff were continuing to use verbal prompts with some success. Monthly reports were being collated by key workers providing evidence of general behaviour, day and night reports, activities and family contact. Staff commented that although a key worker system was in place all staff had a good understanding of peoples needs. This was verified through our discussions with staff. All staff were being asked to read peoples care plans and other documents and to confirm this on a signature list for each record. This is good practice. Any restrictions within the home were documented in peoples care plans or risk assessments to describe the rationale for these and to confirm that they were in place to safeguard people from harm. Restrictions included access to the kitchen during food preparation, use of bed-sides and the use of a key pad on the front door. A Deprivation of Liberty screening tool had been completed for all people which indicated that no one needed an assessment under this legislation. Excellent systems were in place to enable people to make choices and decisions about their daily lives and to express themselves. There was evidence of daily use of photographs and symbols to demonstrate peoples daily activities. Each morning people were supported to display the pictures illustrating their activities for that day in the lounge/diner. Staff rotas were displayed in the hall using photographs. Toilets had signs using text and symbol and kitchen cupboards also used this signage. People had access to a touch screen computer and one person had access to their life book on a slide show on their laptop. Staff were observed using makaton sign language with people during our visit. They also discussed how they enabled people to make choices by using objects of reference. Good use was made of photographs around the home to remind people of activities, holidays and parties. Each person also had a communication profile in their care plan indicating how to understand non verbal behaviour and how to interpret verbal behaviour. One person had a large poster in their room and smaller copies in their care plan as an aide memoir for staff to interpret their verbal communication. The home had access to a Psychology team who work with people and staff to develop Risk Management Strategies. These were being regularly reviewed. They provided clear information for staff about how to manage risks and reduce any hazards in order to enable people to achieve independence and live a full and active life. Additional risk assessments were in place in relation to community access, epilepsy and the Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: environment. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. People are supported to maintain contacts with families and friends. They are offered a varied and balanced diet appropriate to their needs, promoting their health and wellbeing. Evidence: Each person had an individual activity schedule which had been put together to reflect their individual interests, wishes and lifestyle choices. An activity co-ordinator had been appointed and kept robust records about peoples interests, what they had tried out and whether it had been successful. Staff said that they offered people informed choice about a range of activities building up their confidence by observing an activity before actually trying it out. Great thought had been given to providing people with sensory environments either in their own rooms or in the communal areas. They had Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: access to a swing, trampoline and sensory room in the garden. Lounges provided music either through DVDs, television channels or a variety of musical instruments. People were observed choosing where to spend their time enjoying listening to music channels on the television or playing a drum. During our visit some people went to college either for day or evening courses. One person told us they liked having a massage. People were able to take part in an Art therapy session in the afternoon. other people had been out for music therapy sessions. Surveys confirmed that activities are well thought out and arranged for the individual service user, and never in my wildest dreams did I think that we would find such a wonderful home, providing as many activities as possible within the bounds of availability and ability. Some people indicated they would like more activities at weekends. Staff said that they make sure that each person has the opportunity to go out at weekends which are more flexible enabling people to go for walks, shopping and to the pub. Activity records sampled for January 2010 indicated that people had also been bowling, shopping, to have a haircut, college, music therapy and had a massage. Other records indicated that people had access to the cinema, theatre, holidays of their choice, swimming, hydrotherapy and social clubs. There was an activities room in the home where people could access the computer and do arts and crafts. Plans were in place for further development of this room. People were observed making choices about how to spend their time and with whom. The registered manager said that each morning people were encouraged to choose and help prepare their breakfast. We observed one person having breakfast with the member of staff who had supported them. They would also do the same for their tea. People were encouraged to help clean their rooms and help with the laundry. People had house meetings regularly and had the opportunity to be involved in the weekly choice of menus. The registered manager said that advocacy was not available locally although they had tried to access this for people. The AQAA said staff support people with their post reading through any letters with them. We observed people bringing the post to the manager and being involved in the process of sorting through letters. Monthly records indicated how people had been supported to keep in touch with family and relatives. One person was taken out for lunch by their parent during our visit and another parent telephoned. Key workers were keeping regular contact with relatives via telephone or email. One relative said, there is an effort to celebrate special occasions such as Valentine Day, Halloween or birthdays and friends and relatives are always invited to these occasions. The AQAA confirmed that, staff support is provided for visits to family and relevant others and support to contact family and relevant others frequently. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The home employs a cook during the week and she said she provides a menu which reflects peoples likes and dislikes. She confirmed that there are no special dietary needs although they encourage healthy eating and a nutritional diet. People were joined for lunch and appeared to enjoy a Roast dinner with fresh vegetables followed by Trifle. Robust individual menu records were being kept for people both in the kitchen and on their personal files. Monitoring records also included fluid charts for people for who there may be concerns. Their care plans also reflected the need to monitor fluid intake. The kitchen was inspected in 2007 by Environmental Health and obtained 5 stars. This is excellent. Records were seen to be in place for monitoring temperatures of fridges, freezers and hot food temperatures. The cook confirmed that she kept records in line with the Better food safer business guide. Comments in surveys included, Its quite remarkable how the cook manages to provide the quality of meals on so small an amount of money. The AQAA indicated that the home had investigated how to support a person from an Afro-Caribbean background and they had discussed the choice of menu to reflect their cultural background and tastes. Their mother said she would be happy with the menu provided by the home. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are being met helping them to stay well. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication and training of staff in specialised techniques. Evidence: Peoples likes and dislikes were clearly recorded in their care plans as well as their preferences for support to maintain their routines. This latter information was particularly important for those people with autistic spectrum disorder. Staff spoke about the importance of consistency of approach and understanding the need for peoples preferred routines to be followed. Each person also had a document providing guidance about how staff should show respect and courtesy. This included indicating their preferences for the gender of staff providing their personal care, using their preferred name and including them in conversations by using their preferred method of communication. This is excellent practice. Staff were observed knocking on peoples doors prior to entering their rooms and announcing themselves. The AQAA stated, service users are supported to uphold a positive style and image individual to them and of their choosing. Clothes shopping, jewelry, perfume, aftershave, grooming, Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: communication, activities are all very important aspects of life and are strongly supported by staff. Care plans confirmed that the skin and hair care of an Afro Caribbean person was respected and promoted. Their relative said, my daughters hair care needs are met appropriately to her ethnicity. Each person had a Health Action Plan in place and there was evidence they were accessing annual Health checks. One person had a hand held file should they need admittance to hospital. Robust health records were in place evidencing regular contact with a range of health care professionals in their local community including their General Practitioner, Dentist, Optician and specialists. Some people had access to the local Community Team for People with Learning Disabilities (CTPLD). They also had access to other health care professionals through CHOICE including a Psychology team. Records of health care appointments also included an outcome of the visit. A summary sheet was in place for easy monitoring of health care appointments. Medication was supplied to the home in a monitored dosage system. The registered manager said the pharmacy had inspected them and had found no problems. Staff confirmed they had completed medication training at a local college and there was evidence that six monthly competency audits were completed for staff. They had also completed training in the use of emergency medication. Good systems were in place for the administration of medication including robust stock control, protocols for the use of as necessary medication and protocols clearly explained the maximum dosage and when emergency services should be called. There was authorisation from the GP for the use of homely remedies. There were occasional lapses in the countersignatures for handwritten entries on the monitored dosage record but the majority of entries had been countersigned. A signature list was in place indicating which staff had been trained to administer medication. We observed medication being dispensed and this was done satisfactorily. Medication was taken to the person and then the administration record was completed once they had taken their drugs. The administration and storage of controlled drugs was satisfactory. Staff spoke about how peoples medication had been reviewed and reduced significantly since they had moved into the home. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place that enable complaints and concerns to be raised by people using the service or on their behalf. Systems are in place which should safeguard people from possible abuse. Evidence: The home had a complaints policy and procedure in place. Each person had a laminated copy of this in their room which had been produced using symbol and pictures. There was a complaints and suggestion box in the hall for people and their visitors. A complaints book was kept and evidenced that the home had not received any complaints. Copies of compliments from relatives were read. This was confirmed in the DataSet accompanying the AQAA, which also stated that the complaints procedure was explained to people. Surveys from people indicated that they were all aware of the complaints procedure. A staff survey indicated if any concerns are raised these were dealt with quickly. Staff confirmed they had completed training in the safeguarding of adults. Training records verified this. A copy of the local procedures was accessible in the office. Staff spoken with had a good understanding of the organisations whistle blowing procedure and were confident that poor practice would not be tolerated and dealt with quickly by management. Staff had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Staff discussed with us how they supported people when anxious or angry.They said they had completed training in SCIP (Strategies for Crisis Intervention and Prevention) including refresher training when needed. Comprehensive Reactive Management Strategies were in place providing staff with clear and succinct information about triggers, signs of anxiety, preventative action and responsive intervention. Robust records were kept describing any incidents and how they had been managed. These were being monitored by both the Psychology team and CHOICE. Records for the last month indicated that physical intervention using a two person removal had not been used. Staff confirmed that this was very rarely used and that distraction and diversion techniques were usually used effectively. They also stated that as necessary medication was rarely used in response to peoples emotional wellbeing. Staff described how peoples behaviour had changed since moving into the home and that people were calmer and more settled. Care plans emphasize the need for a consistent approach by the staff team and this is clearly benefiting people living in the home. We examined peoples individual finances. People have bank accounts for which the management team are counter signatories. No cash cards were being used. Records were examined for the people being case tracked and found to be satisfactory. Receipts were kept for all purchases and were being cross referenced with the financial record. Checks on balances were in place. Financial records were audited at Regulation 26 visits and by CHOICE. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating a lively and sensory environment that matches their personal requirements. Evidence: Ballards Ash Farm provides spacious and comfortable accommodation for people. A relative commented, the atmosphere at Ballards Ash is warm and friendly and they keep the home clean and tidy. Communal areas were pleasantly decorated providing a homely atmosphere which people appeared to enjoy using. They had access to a lounge with sofas which had recently been recovered, a lounge/diner and a separate dining room. There was also an activities room on the second floor which was due to be refurbished. In the garden they had access to sensory equipment and a sensory room. A patio and secure barbeque area led to an area of lawn. Each person had a room which they had chosen the colour scheme for with either a bath or shower en suite. Several rooms had been redecorated and people were being supported to choose new curtains and bedding. Some carpets were being replaced. On the first floor there was an additional bathroom. Some peoples rooms had been developed into sensory environments. Good use was made of photographs around the home reminding people of activities and social events or holidays. The home had access to a maintenance firm to deal with day to day issues. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Good infection control measures were seen to be in place both in the kitchen and laundry. Personal protective equipment was provided for staff. Colour coded mops and buckets were in place and individual baskets provided for laundry. A contract was in place to dispose of clinical waste. Staff were completing training in infection control. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. Evidence: Relatives commented, staff are professional in their attitude to residents and visitors and staff are friendly and caring. Staff spoken with expressed how happy they were working at Ballards Ash Farm and surveys stated, fabulous place to work and an upbeat environment. We observed staff supporting people during our visit and they treated them with dignity and respect, they were accessible and approachable providing person centred care. There had been considerable consistency within the staff team. New staff were completing an induction which is equivalent to the Skills for Care Common Induction Standards. Copies of completed inductions and new inductions were examined on staff files. Staff confirmed that once they had completed this they then had access to the Learning Disability Qualification (LDQ) and National Vocational Qualification (NVQ) in Health and Social Care. Bank staff confirmed they also had access to these qualifications. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Staff confirmed that staffing levels were appropriate to meet peoples needs and that sickness or absences were covered by the team or bank staff. A cook was employed during the week. Staff said they had responsibility for keeping the home clean. Surveys indicated, staff are always willing to help. The AQAA stated that regular staff meetings were being held and this was verified by staff during our visit. They said that excellent communication systems were in place to ensure a consistent approach and continuity of care. We looked at recruitment and selection records for 4 new staff appointed between 2008 and 2009. The home uses an front summary sheet to evidence when information was requested and when it was returned. Application forms evidenced that where there were gaps in employment history this was being investigated and a full employment history provided. Two references were being obtained for each person prior to appointment. These did not evidence that the home had requested former employers in health and social care the reason why staff had left their employ. This information must be obtained for new staff. Emails confirmed that povafirst (now replaced with ISA Adult First) checks were taking place before appointment. One person had been appointed before their Criminal Records Bureau (CRB) check had been obtained. The registered manager described their roles and responsibilities until the CRB was returned in line with our requirements. These should be recorded as part of a risk assessment. Copies of training certificates evidencing training completed prior to appointment were being obtained. Evidence of identity had been provided with a current photograph. Copies of birth certificates should not be kept in line with Data Protection Act recommendations. CHOICE has a robust training programme in place. They monitor staff training needs corporately and had produced a training matrix identifying what had been completed and when refresher training was due. Comprehensive training records were also maintained in the home confirming access to a wide range of training, courses and open learning. Staff had completed mandatory training, safeguarding, medication, learning disability and autism awareness, dementia and epilepsy. Staff confirmed that if they identified training pertinent to the needs of the people living in the home this would be sourced. One member of staff had been supported to access an English as a Foreign Language course. He was able to do this at the home. Training planned for January included values and attitudes, positive behaviour and intensive interaction. Staff surveys commented on the excellent training programme and personal development for staff. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. There are effective quality assurance systems involving people who live at the home. Systems are in place to maintain and monitor the health, safety and welfare of people, which should safeguard them from possible harm. Evidence: The registered manager has considerable experience supporting people with a learning disability and associated autistic spectrum disorder. She has a Diploma in Management and has an NVQ Level 4 in Health and Social Care. She is also an assessor of National Vocational Qualifications. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. This had been returned to us within our timescales.Surveys indicated, the home is running very well, and a caring well managed team on the whole. One relative said,It is no wonder the residents continue to flourish. Staff and management had received training in the Mental Capacity Act and Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Deprivation of Liberty Safeguards. As mentioned there was evidence that the screening tool had been used for each person to assess whether they were subject to Deprivation of Liberty Safeguards. This was not applicable to anyone living in the home at the time of the inspection CHOICE has a robust quality assurance system in place which includes monthly visits to the home in line with Regulation 26. Copies of reports for these visits confirmed that people living in the home are part of this process. Surveys had been sent out to people, their relatives and care managers in September 2009 and from this the registered manager had produced a development plan for the home. Actions highlighted here were being put into place. An audit had also been completed by a manager from another area based on our KLORA (Key Lines of Regulatory Assessment). The registered manager said that a positive outcome had been confirmed. Health and safety systems were in place providing evidence that fire, water, infection control and utilities were regularly monitored and serviced. This verified information supplied in the DataSet. We accompanied the deputy manager on their monthly health and safety audit of the home. Any issues identified at previous audits had been dealt with. The home had a fire inspection in 2009 and informed us of the outcome providing us with copies of fire risk assessments. Records confirmed staff had access to fire training and regular fire drills took place including night evacuations. The AQAA confirmed that incident and accident records were being kept, monitored and responded to appropriately. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 The registered person must obtain verification of the reason why staff left former employment in health and social care. This is to safeguard people from possible abuse. 26/02/2010 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 34 Where staff are appointed before their CRB is received, a risk assessment should be in place to detail their role and responsibilities. Copies of birth certificates should not be kept. 2 34 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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