Care Home: Banstead Road South (21)

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What the care home does well All the feedback we received from the people who use the service was extremely positive about the home and the staff that worked there. We observed a number of the people who use the service giving positive thumbs up signs when asked about the attitude of staff and the food provided at the home. All the people who live at the home and staff that work there benefit from being involved with a service that continues to be extremely well run by a very experienced, suitably qualified, and highly competent management team. We observed all the staff on duty at the time of this site visit, which included the managers, interacting with all the people who used the servcie in a very caring , respectful and professional manner. We were also very impressed with the non-verbal signing skills all the staff had clearly been trained to use, which enabled them to communicate more effectively with all the people who used the service. In addition to this the service has developed some excellent arrangements to ensure the people who use the service are consulted on, and can participate in, all aspects of life in their home. This includes a widget symbol friendly computer in the lounge which is available to all; easy to read pictorial care plans, menus, activity timetables, fire notices, and staff duty rosters; monthly peer group meetings Chaired by an independent advocate from the RNID; and service user satisfaction surveys. The service also has a very `can do` attitude when it comes to supporting the people who use it to take responsible risks. It was evident from comments made by service users and staff met, and records viewed that the people who use the service are encouraged where possible to maintain and develop their independent living skills. For example, people who have expressed a wish to help staff go food shopping, plan the weekly menus, and prepare their own meals - are actively supported by staff to do so. The social, educational and vocational activities the people who use the service have the chance to participate in each day, both at home and in the wider community, remain extremely meaningful, varied, and `age` appropriate. Finally, the interior design and soft furnishings are of a very high standard ensuring the service users live in a very comfortable and homely environment. The environment has also been suitably adapted to meet the wishes and sensory impairment needs of all the people who live there, which includes indicator lights in the entrance hall and all the bedrooms that flash on and off when the front door bell is used or the fire alarm activated. What has improved since the last inspection? As this service has such a sustained track record of providing high quality care and remains good at recognising what it could improve there were no outstanding requirements or good practise recommendations made at its last inspection for it to address. The manager told us that since the services last inspection the environment has been improved with the purchasing of a new oven for the kitchen and the redecoration of all the service users bedrooms. What the care home could do better: All the positive comments made above notwithstanding we have made a number of good practise recommendations for the manager to consider implementing. We suggest the homes Guide should be up dated to reflect the current age range of the service users for whom it is intended (i.e. 50 and over). How risk assessments are used in the home should be reviewed as it is unclear what choices, if any, the people who use the service have been afforded with regards to taking greater responsibility for handling their own medication and/or financial affairs. All the service users willingness and capable of looking after their own medication and finances should be risk assessed and the results recorded in their care plans. Key inspection report Care homes for adults (18-65 years) Name: Address: Banstead Road South (21) 21 Banstead Road South Sutton Surrey SM2 5LF     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: Lee Willis     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Banstead Road South (21) 21 Banstead Road South Sutton Surrey SM2 5LF 02087700106 02087700106 max.edward@surreyoaklands.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Surrey and Borders Partnership NHS Trust care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: A variation has been granted to allow one specified service user with a physical disability to be accommodated A variation has been granted to allow one specified service user with a physical disability to be accommodated until such time that the home is no longer able to meet their assessed needs. A variation has been granted to allow three specified service users over the age of 65 years to be accommodated A variation has been granted to allow three specified service users over the age of 65 years to be accommodated until such time that the home is no longer able to meet their assessed needs. Date of last inspection Brief description of the care home 21 Banstead Road South is registered with the Care Quality Commission (CQC) to provide personal support and accommodation for up to seven generally older adults (i.e. aged 50 and over) with learning disabilities and hearing impairments. The home is owned, managed, and staffed by the Surrey and Borders NHS Trust, a specialist provider for people with learning disabilities. Five people currently reside at the home. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 7 7 Brief description of the care home Max Edwards remains in operational day-to-day control of the service, which he has managed for 12 years. Located on a residential street relatively close to the centre of Sutton the service is a short car or bus ride away from the centre of town with its wide variety of local shops, cafes, banks, and leisure facilities. The home has its own transportation, is within easy walking distance of several bus stops, and is relatively near a couple of main line train stations with good links to central London and the surrounding areas. This large detached home is built over two floors comprising of seven single occupancy rooms, a separate dining room, main lounge, quite room, kitchen, laundry, office, and staff sleep-in room. There is also a large well maintained and equipped garden at the rear of the property, and ample space for parking vehicles on the front driveway. All the people who use the service and/or their representatives have been supplied with up to date information about what services and facilities they will be offered by the home, and how much they can expect to be charged for them. Fees charged for services and facilities provided currently stands at between 49K and 84K per annum per placement. Care Homes for Adults (18-65 years) Page 5 of 32 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 quality rating for this service remains 3 stars. This means the people who use the service continue to experience excellent quality outcomes. From all the available evidence gathered during the inspection process it was evident this service not only has a sustained track record of delivering excellent standards of care and support for the people who live at Banstead Road South, but also continues to have a substantial number of strengths, which includes the way it is managed. We spent four hours at the home and spoke at length to three people who use the service, the homes manager, the deputy manager, and two support workers. We also looked at various records and documents, including three care plans and the risk assessments they each contained. Finally, we read the homes Annual Quality Assurance Assessment (AQAA), which was Care Homes for Adults (18-65 years) Page 6 of 32 completed and returned to us by the services managers, as we had requested. This self-assessment document helps us determine the homes rating by telling us what the manager thinks the home does well, what has improved since our last inspection, and what they could do better. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? As this service has such a sustained track record of providing high quality care and remains good at recognising what it could improve there were no outstanding requirements or good practise recommendations made at its last inspection for it to address. The manager told us that since the services last inspection the environment has been improved with the purchasing of a new oven for the kitchen and the redecoration of all the service users bedrooms. Care Homes for Adults (18-65 years) Page 8 of 32 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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. The home ensures the people who use the service and their representatives have access to all the up date information they need to determine whether or not the place is right for them. The homes admissions procedures are suitably robust to ensure only the right people are accepted whose needs and wishes staff can meet. Evidence: As stated in the services AQAA the manager showed us an easy to read version of homes Statement of Purpose and Guide, which was written in plain language and illustrated with all manner of easy to understand pictures, symbols and photographs. The Guide also refers to how the services ensures best practise regarding equality and diversity is always promoted and taken into consideration in everything it does. However, we do recommend the manager considers revising the Guide to make it much clearer to prospective new service users and their representatives that the home is intended to accommodate generally older adults. The manager confirmed that as stated in the services AQAA no new admissions have Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: been accepted, either temporary or permanent, or placements broken down in the past 12 months. The manager demonstrated a good understanding of what constituted best practise regarding new admissions, despite not having received any new referrals for sometime. The manager was also very clear he would not accept anyone unless he believed they were compatible with the people who already resided at the home. Care Homes for Adults (18-65 years) Page 12 of 32 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 are very person centred and can be easily understood by the people who use the service and staff, thus ensuring all the relevant parties have access to all the up to date information they need. The service has developed excellent arrangements to enable the people who use it to be consulted on, and participate in, all aspects of life in their home. The service has a can do attitude when it comes to supporting the people who use it to take responsible risks as part of a structured programme to promote their independent living skills. Evidence: All the care plans we looked at were very person centred, clearly developed with the people for whom the plan was intended, and concise. The plans we saw set out in detail what each individuals current personal, social, and health care needs were; how they should be met through positive interventions; and what peoples unique Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: strengths, goals, and preferences were. The plans were also easy to read and contained lots of personalised photographs of the services users and various social events they had participated in. Equality and diversity issues were also extremely well covered in care plans. Staff met told us all the information included in care plans is kept up to date because they are reviewed at least once every six months. We also commend the service for establishing one to one meetings between service users and their designated keyworkers before care plan reviews take place. This enables the pople who use the service to have their say and be fully involved in the review process. People who use the service have an array of opportunities to express their views about their home find out whats going. For instance all the people who use the service regularly attend peer group meetings Chaired by a independent advocate from the Royal National Institute for the Deaf (RNID) each month. There are also lots of communal notice boards conspicuously displayed throughout the home that contain a wide variety of information about community based social events and educational and leisure opportunities. Easy to read and understand pictorial/widget symbol menus, activity timetables, minutes of meetings, care plans, and staff duty rosters are also on display in various communal areas. Theres a computer terminal in the dinning room that has a specialist program that people who use the service have access too and can use to convert the written word into widget symbols. Finally, the people who use the service are encouraged and supported by staff to complete then providers own satisfaction surveys on an annual basis. It was also positively noted that staff actively support all those service users who are willing and capable of filing in their own diaries regarding what they have done each day. It was evident from all the written and verbal feedback we received from the people who use the service and staff that the service continues to excel at enabling all its stakeholders to have their say and be fully involved in making decisions that affect the homes day to day running. Two staff we informally interviewed together both demonstrated a good understanding of the importance of prompting service user choice and independent living skills. Furthermore, care plans viewed contained lots of detailed risk assessments and management strategies that enabled the people who use the service to take reasonable risks as means of prompting self esteem and independence. For example, some of the people who use the service are appropriately supported to go horse riding, travel abroad, cook their own meals and do their own laundry. We commend the service for having such a can do attitude toward the people who use the service taking positive risks. Care plans are very person centred and can be easily understood Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: by the people who use the service and staff, thus ensuring all the relevant parties have access to all the up to date information they need. Care Homes for Adults (18-65 years) Page 15 of 32 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. The social, educational and vocational activities the people who use the service have the chance to participate in each day, both at home and in the wider community, remain extremely meaningful, varied, and age appropriate. The service continues to offer the people whop use the service a real choice of nutritionally well-balanced and varied meals, which meets individuals specific dietary requirements and tastes. Evidence: The manager told us a local church organises monthly sermons specifically for people with impaired hearing, which according to records we viewed is proving popular with a number of the people who live at the home. All the care plans looked at contained detailed information about individuals spiritual needs and wishes. Two people we met during this inspection used a combination of non-verbal sign Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: language and computerised widget symbols to tell us they could do what they wanted and were happy with the choice of social activities that they were offered. It was evident from the feedback we received that opportunities to choose to engage in social activities are very individualised and matched the unique social interests of each service user. For example, one individual we met was clearly looking forward to going out for lunch that day and travelling to London on public transport the tomorrow, while another individual was evidently very happy relaxing in their room watching sport on their television. Records sampled at random showed us that the servcie also encourages and supports people who to attend educational courses at the local college and/or undertake paid (therapeutic earnings) employment. It was also evident from the minutes of one residents meetings and entries made in individuals daily diary notes that everyone had been given the opportunity to choose where they went on holiday this year and who they went with. We also found evidence to support comments made by the manager in the services AQAA that activities have been made more flexible to accommodate the changing needs and social interests of this generally older group of people. Feedback from the people who use the service and records revealed alternative activities are always considered if individuals change their mind at the last minute about doing a particular prearranged activity. We commend the servcie for its person centred and flexible approach to planning what the pople who use the service participate in each day. It was evident from feedback we received that the people who use the servcie are actively encouraged and supported by staff to use public transport as a means of promoting individuals independent living skills. For example, we are aware a number of the people who use the service went on holiday using public transport this summer and often go on day trips on the train. An individual who uses the service communicated to us that they ca invite people who visit their home whenever they like. The manager told us the servcie has built up some excellent relationships with their neighbours and the relatives and friends of the people who use the service. It was evident from the minutes of one meeting that the barbeques the home had arranged this summer had been well attend by the relatives, friends and neighbours of the people who live at 21 Banstead Road South. It was positively noted that everyone who uses the service is offered a key to the front door and their bedroom, and are actively encouraged by staff to use them. We agree with the comments made by the manager in the services AAA - this gives the people who live here a sense of ownership of their home. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: All the people who use the service and staff we met confirmed that as stated in the AAA the servcie has a very flexible approach to meal choices, times, and locations. Records kept of the meals eaten by the the people who use the service showed us people can choose to have breakfast when they like; can decide what they want for their main meals on the day because there are no set menus; and can eat their lunch and snacks either in their bedrooms or the dinning area. It was positively noted that based on individual choices three different styles of cooked breakfast had been prepared and eaten that morning by the people who use the service. Easy read pictorial menus are conspicuously displayed on a notice board in the dinning room for all to see. We received a thumbs up from a person who uses the service when asked if they liked the food at the home and whether or not they were looking forward to having quiche and salad for their supper, as advertised on that days menu. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive all the personal and health care support they require and in the way they prefer it provided. Policies and procedures for the handling medication looked after by staff on behalf of the people who use the service are sufficiently robust to keep people safe, although the way risk assessments are used should be reviewed as it is unclear what choices people have been given regarding taking control for administering their own medication. Evidence: Duty rosters sampled showed us that as stated in the AQAA female staff are always available to offer same sex personal care to all those people who have specifically requested it. All the people we met who use the service were dressed in well maintained and laundered clothes that were age appropriate and suitably for the time of year. We looked at health care action plans for three people who use the service. The plans Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: were available in an easy to read format which could be understood by the people who use the service and showed us they are in regular contact with all the relevant health care professionals. All the people who use the service and staff told us that as stated in the AQAA everyone who lives at the home has a health care check up at least once a year in line with recommended best practise. Staff maintain detailed records of the outcome of all the appointments the people who use the service have with various health care professionals. The manager confirmed that no major accidents involving the people who use the service have occurred in the past. The manager was aware that we should be notified immediately about the occurrence of any significant incident or event which adversely affects the health or well being of the people who use the service. The manager confirmed that as stated in the AQAA the home does not currently stock any Controlled Drugs on behalf of the people who live there, and that there have been no serious incidents involving the handling of medication within the past 12 months. No recording errors were noted on medication administration sheets sampled at random. We noted that all the medication held by the home on behalf of the service users is securely stored away in a locked cabinet. The manager told us that in addition to staff undertaking daily audits of medication dispensed each day, he carries out medication spot checks at regular intervals, and recently invited a qualified pharmacist to inspect his staff teams medication handling practises. The manager told us that none of the people who currently reside at the home were willing and/or capable of taking greater responsibility for administering their own medication. However, no records in relation to the assessments of risk upon which this decision should have been based could be produced on request. We recommend the manager reviews the homes current medication arrangements with all the people who use the service and their representatives, and keeps a record of these decisions, especially with regards peoples views and the identified risks associated with self medicating. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has good arrangements in place for dealing with complaints, which ensures the people who use the service and other major stakeholders feel any concerns they may have will be listened to and acted upon. People who use the service are kept safe because staff understand what constitutes abuse and know what to do if they witness or suspect it. Evidence: The manager stated in the AQAA that the service had not received any formal complaints about its operation in the past year. Pictorial copies of the services complaints policy were conspicuously displayed throughout the home which two people who live there told us they understood. All the staff met demonstrated a good understanding of what constituted abuse and who they should notify without delay if they suspected or witnessed any of the people who use the servcie being abused, harmed or neglected. The deputy manager told us all the staff had received training on abuse and safeguarding matters. As stated in the AQAA the manager confirmed that no safeguarding incidents or staff referrals for possible inclusion on the Protection Of Vulnerable Adults register have occurred in the past twelve months. We observed staff giving a service user their own money to spend whilst they were out. The manager told us the service actively supports people to look after their own Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: money are far as they are willing and capable of doing so. Not all the care plans viewed contained assessments of risk which clearly identified peoples wishes and capacity to look after their own finances. These assessments need to be developed with all the people who use the service and their representatives. We saw staff maintain up to date records and receipts of all the financial transactions they take on behalf of the people who use the service and that balance sheets kept match the amounts held. Service users money is individually stored in a secure place and staff confirmed the people who use the service are not expected to produce receipts for purchases they make with their own money, in line with best practise. Care Homes for Adults (18-65 years) Page 22 of 32 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. The people who use the service live in a very comfortable and homely environment which is kept spotlessly clean. The environment has also been extremely well adapted to suit the wishes and sensory impairment needs of all the people who live there. Evidence: During a tour of the premises we noted that as stated in the AQAA and promised at the time of the homes last Annual Service Review all the bedrooms had been redecorated. A person who uses the servicer told us they had chosen the colour their bedroom had been painted. We noted a lot of pictures, photographs and ornaments displayed throughout the home, which made the place look extremely homely. The manager told us the kitchen has been fitted with a new oven since the last inspection and they have established a time specific action plan to replace a number of the homes carpets. We noted the Parker bathroom on the ground floor had been suitably adapted with grab rails and a call bell alarm. All the homes toilets contained adequate supplies on soap, paper, and hand drying facilities. We recommend the dead lock fitted to the toilet nearest the front door is risk assessed. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The home looked spotlessly clean and smelt fresh. As stated in the AQAA staff told us there is a strict cleaning regime in place which they follow and that they have all recently watched a training film made by the Health Protection Agency. Documentary evidence was produced on request that showed us sufficient numbers of staff have received infection control training in line with best practise regarding environmental hygiene standards. The service is commended for all the work that has been done to adapt the home to ensure the sensory needs and wishes of the people who use the service are met. It was positively noted that all the televisions had subtitling and teletext facilities installed and a computer for service users personal use was available in the lounge. Furthermore, to ensure all the people who use the service know when someone is at the front door or the fire alarm has been sounded warning lights flash on and off in the entrance hall and all the service users bedrooms. Care Homes for Adults (18-65 years) Page 24 of 32 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 people who use the service are kept safe and are appropriately supported at all times because there are always more than enough suitably experienced and qualified staff are on duty. The service also has a very flexible approach to planning the duty rosters which is clearly based on the needs and wishes of the pople who use the service and not staffs. Furthermore, the needs and wishes of the people who use the service are also met because all staff get the right training, supervision and support they require to perform their duties effectively. Evidence: AQAA states the service has experienced relatively low rates of staff turnover and sickness in the past year which has ensured the people who use the servcie have experienced continuity of support from an effective staff team who are familiar with their needs and the homes daily routines. The manager told us no temporary agency staff have been used to cover any shifts in the past year and they always use the same four bank workers who are familiar with the service users needs to cover staff sickness and annual leave. Duty rosters sampled at random revealed there are always at least two staff employed across the day with an additional third person often used to cover peak periods of Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: activity. It was evident from comments made by the people whop use the service and staff that the service has a very flexible approach to planning staffs shifts patterns which are clearly based on the needs and preferences of the people who use the service. For instance, as previously mentioned in this report there are always female staff available to meet people same sex personal care wishes and always enough staff on duty to enable people to access the wider community when they choose. The home has not employed any new staff from outside the organisation in the past year. The manager demonstrated a good understanding of all the pre-employment checks that needed to be carried out on a prospective employee to ensure they were suitable to work with vulnerable adults. The two members of staff we informally interviewed together both told us there induction had been very thorough and covered everything they needed to know about their support worker role and meeting the needs of the people who use the service. These staff also told us the training they received from their employer was always relevant and kept up to date. Documentary evidence was produced on request that showed us sufficient numbers of the current staff team had received up to date training in fire safety, moving and handling, first aid, food hygiene, health and safety, medication, infection control, and safeguarding. The manager told us that 75 percent of his staff team had also achieved a National Vocational Qualification in care level 2 or above. We commend the service for all the specialist training it provides to ensure its staff team have all the necessary knowledge and skills to meet the specifc needs of the poeple who use the servcie. It was evident from the way staff interacted with the people who use the service that non-verbal communication training is considered a vital part of all staffs learning. Staff we met told us they receive regular refresher training in the use of Makaton and Bristish Sign Language from a suitably qualified teacher who visits the home every month. Other specialist courses the staff have recently attended included training in equality and diversity, and the Mental Capacity Act. All the staff we met told us they receive a one to one supervision session with a senior member of staff every month and have their overall performance and training achievements appraised at the end of each year. In addition to this support staff are also expected to attend peer group meetings which are held every 4 to 6 weeks. The minutes of the last staff meetings revealed the staff team are very aware of the changing needs and goals of the generally older adults they now support. Care Homes for Adults (18-65 years) Page 26 of 32 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 people who use the service continue to benefit from living in a home that continues to be extremely well run by a very experienced and competent management team. The service has developed some excellent quality assurance system which enables all the people who use the service and their representatives to express their views and influence how the home is run and continues to develop. Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: All the feedback we received from the people who use the service and staff about the way the home was managed was extremely positive. Comments included - Max (the manager) and Lesley (the deputy manager) work well together and are both very approachable, Max has been in charge here for a very long time so we all know whats expected of us, and the managers here give us a lot of support. The manager has achieved his Registered Managers Award and has been in charge of Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Banstead Road South for twelve years. Max told us he feels he gets all the support he needs from his line manager, deputy manager, and the rest of his staff team. It was evident from the way Max interacted with the people who use the service and staff that he has built up extremely good working relationships with them over a number of years. It was positively noted that the service has developed a very comprehensive internal quality assurance systems that uses various satisfaction surveys to ascertain the views of the people who use the service, their relatives, visitors and staff. The AQAA states the feedback they receive from major stakeholders in the past year was very positive. Typical comments the manager told us they had received from visitors included - my loved one is thriving with the support and atmosphere they receive here, and staff are very friendly and approachable. The manager was able to produce the results of the homes last three monthly inspections which had been carried out by home managers of other Surrey and Border services. It was evident from the outcome of these internal quality assurance reports that Surrey and Borders remains satisfied with the standard of care being provided at the home and the way it is being managed. The homes fire records revealed its fire alarm system continues to be tested on a weekly basis and fire drills involving staff continue to be carried out at regular intervals in line with best practise. During a tour of the premises we noted all the homes fire safety notices were conspicuously displayed in pictorial formats to ensure they could be easily understood by the people who use the service. The homes fire risk assessment for the building was produced on request. These assessment had been reviewed in the past twelve months and up dated accordingly to reflect any identified changes. The temperature of hot water emanating from the ground floor Parker bath was found to be a safe 43 degrees Celsius when we tested it at 12.45. The manager told us staff check the temperature of all the homes water outlets on a weekly basis and keep a record of these tests. The call bell alarm in this bathroom was fully operational when we tested it at the same time and staff responded promptly to it being activated. Up to date certificates of worthiness produced on request that revealed the homes gas installations, electrical system, fire alarms, and extinguishers had all been tested by a suitably qualified professionals in line with health and safety regulations. All the items of food we found in the kitchen during our tour of the premises were correctly stored and labelled in line with basic food hygiene and environmental standards. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The homes Guide should be up dated to reflect the current age range of the service users for whom it is intended that accommodation should be provided (i.e. 50 and over). How risk assessments are used in the home should be reviewed as it is unclear what choices, if any, the people who use the service have been afforded with regards to taking greater responsibility for handling their own medication. All the service users willingness and capacity to look after their own medication should be risk assessed and the outcomes recorded. How risk assessments are used in the home should be reviewed as it is unclear what choices, if any, the people who use the service have been afforded with regards to taking greater responsibility for looking after their own financial affairs. The wishes and capacity of all the people who use the service should be risk assessed and the outcomes recorded in their care plans. The deadlock fitted to the toilet nearest the front door should be risk assessed and based on the outcome appropriate action taken to keep the people who use the service safe from avoidable harm. Page 30 of 32 2 20 3 23 4 27 Care Homes for Adults (18-65 years) 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 31 of 32 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). 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