Care Home: Burgess Care Limited

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What the care home does well The service provides a spacious and relaxed home for a number of people with learning disabilities and related difficulties. Although there are a relatively large number of people, the service is divided into four separate `houses` so each area has a homely domestic feel. During the visit, there was sufficient area for people so they have plenty of individual space. This was helped by the fact that a lot of people were out doing activities for much of the time. Although the service is not easily accesible to any local community, the service ensures that people get out and about to a variety of activities that they enjoy. There was no sense during the visit that anyone was bored or at a loose end. On the contrary, everyone appeared to be either enjoying an activity, returning from one, or anticipating one. Two relatives spoken with were very appreciative of the service and of the improvements they had seen in those using it. One person was particularly appreciative of the care and support given throughout some acute health difficulties, and of the general support and care offered, which was compared favourably with previous services. "200% better since moving here" and "they bend over backwards to help" were two comments. What has improved since the last inspection? The service has improved training and recruitment, and has ensured that staff have training in physical intervention and communication. Clear care plans and support guidelines are in place. There are contracts in place to help protect those using the service. Medication is clearly recorded and checked, minimising the chances of errors not being noted. Staff were complimentary about the leadership of the manager, feeling that consistent guidelines were helping the staff to work more as a team. There was a positive mood noted amongst staff, and a willingness to work as a team, rather than as individuals, to help provide more consistent care and support for people. What the care home could do better: The service needs to do more to minimise the risk of service users being vulnerable to attack by other service users. The close proximity of the three self-contained flats means that they should only be used by people who get on reasonably well with each other. More could be done to evidence that people using the service have a greater say in their own care and support. Key inspection report Care homes for adults (18-65 years) Name: Address: Sharmer Fields House Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Martin Brown     Date: 0 4 0 5 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Sharmer Fields House Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH 01926614048 01926613048 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Burgess Care Name of registered manager (if applicable) Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is: 19. The registered person may provide the following category of service only: Care Home Only - Code PC; To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: - Learning Disability - Code LD maximum number of places 19. Date of last inspection Brief description of the care home Sharmer Fields registered premise consists of 3 five-bedded self-contained facilities and a block of 3 new bed-sits for more independent people. Each unit is individually identified as the Meadows, Sharmer Fields House, the Paddocks and Tree Tops. Each unit is home for small groups of people with learning disabilities. Burgess Care provides 24 hours support to the people living in the home. The home is set in a rural area, 300 yards off the Fosse Way at the end of a shared drive. There are extensive Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 19 Brief description of the care home grounds to the property. Shared facilities in all units consist of a lounge, quiet room, kitchen and laundry. Shared facilities are on the ground floor of each unit; there are also office facilities in each unit. Available also is a converted stable, which offers daycare facilities for the service users. There are well-maintained lawns as well as an allotment area maintained with the assistance of the service users. Two of the units are not suitable for access by wheelchair users. However the provision of another fivebedded self-contained unit on the premises has full facilities to enable wheelchair access. The fees at the time of writing this report range between £1,784 and £3,087 per week depending on the level of staffing support people require to meet their needs. For up to date information about fees the reader should contact the home directly. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report has been done using information we have gathered about Sharmer Fields. We visited on Tuesday morning, May 4th 2010, and stayed until late afternoon. We visited without letting anyone know we were coming, so we could see the home without people making any special preparations. We met with people living there, as well as the manager and the staff who were working at the time. We also looked at paperwork to see that things which were being written down were being done so properly. We looked closely at how three people in the home were doing, as well as meeting other people living there who were happy to meet us. After the inspection we also spoke to three professionals with a stake in the service, and two relatives of people who use the service. The staff, manager and people staying at the home were very helpful and welcoming. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 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. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has in place the framework to ensure it can properly assess the needs of prospective users of the service, accompanied by the determination of the manager that this process will be followed, so that only people whose needs can be successfully be met by the service will be admitted. Evidence: The service has had no new admissions since the last inspection, which noted shortcomings in some assessments, and a lack of contracts for individual users of the service. Outside professionals expressed concern that the service had admitted people previously whose needs it could not fully meet, and whose interactions affected the well-being of others using the service. The needs of one person admitted some years ago has resulted in a number of safeguarding incidents, two of which in recent months has affected the well-being of another user of the service. We looked at a sample of three current files; all contained contracts; the manager Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: advised that this was now the case for all current users of the service, and that contracts would be in place for all new admissions. A clear admissions and assessment process is in place, ready to ensure that any prospective new admissions are fully assessed to ensure the service is fully aware of their needs and is confident that it can successfully meet them. The manager advised that any future admission would follow these processes. Outside professionals had expressed concern that these had not been followed in the past. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of the service can be confident that individual care plans guide and reflect the support given to them, and that individual risks are recognised in a way that allows them to take risks in a supported way as part of achieving greater independence. The well-being of particular residents is put at risk if the service cannot ensure that they are not protected from the actions of other residents. Evidence: A sample of three care plans from different houses within Sharmer Fields were looked at. These detailed individual support needs and gave clear guidance on managing, where relevant, challenging behaviour. The emphasis throughout was on minimising the occurrence of such behaviours, avoiding triggers with strategies for diffusing, rather than escalating, concerning behaviours. Staff spoken with showed a good awareness of individual behaviours, moods, preferences, and of training and agreed procedures. We witnessed throughout the inspection staff working with people living there in a positive friendly and open manner, with an emphasis on giving choice and providing activities where appropriate, and following guidelines, where, for example, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: autistic tendencies for particular people demanded clear communication. One element absent from those care plans looked at was clear evidence of the involvement of the person concerned, or a representative. Staff and management advised that most of the people living at Sharmer Fields may be unable or unwilling to put a mark or signature to show agreement with a care or support plan, but agreed that care plans should more clearly demonstrate their involvement. Brief conversations with some residents showed that their interests tended to lie with more concrete things than care plans, such as where the next cigarette was coming from, or what or when the next activity was, or how enjoyable the previous activity had been. Staff agreed that a statement from the person completing the plan might help, in a similar way that staff supporting the completion of service user surveys indicated the extent of involvement, understanding and agreement. Two incidents involving one person assaulting another have resulted in short term measures put in place, with more long term measures being proposed. This is currently being monitored by outside agencies, who expressed concerns at the incidents, the effect on the well-being of the person who had been assaulted, and the need for an effective long-term solution, to ensure such an incident does not recur. Professionals spoken with expressed concern at the great progress made by this person at Sharmer Fields being undone by these incidents. A relative noted the 200 progress made by this person at Sharmer Fields since their move there. Staff showed a good understanding of individuals where communication was an issue, individual charts were in evidence. Nevertheless, it was apparent that the individual nature of much non verbal communication placed much reliance on staffs familiarity with that person. It was good to see that even relatively newly recruited staff showed a good rapport with and understanding of individuals. In one instance, staff advised that one persons verbal skills had improved greatly since living amongst people who used speech more regularly. Individual preferences were recorded, and in one house were seen displayed on the wall. Discussion with one person and observation showed that these reflected and guided their activities. Risk assessments showed a good awareness of particular risks, and allowed potentially high risk activities to take place. One person, in spite of having an activity fully risk assessed, returned that afternoon from an activity, having had an accident during it. This appeared not to have diminished their enjoyment of the activity; on the contrary, having taken part in a provably risky activity appeared to have added to their Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: enjoyment of it. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Sharmer Fields enjoy a wide variety of activities, according to their individual needs and wishes, which help socialisation and independence skills. Evidence: Many of the people living at Sharmer Fields were out for a good portion, or all, of the inspection, taking part in a wide variety of activities. A reflexologist visited during the inspection, for a regular session with particular residents. This was eagerly awaited and enjoyed by those taking part. One person was full of smiles and anticipation as soon as they saw the reflexologist arrive. One person has a regular day service; some others attend different college courses on various days to learn, for example, cookery, or gardening skills. The home is in a rural setting, but near a busy road, so people rely on cars to get to activities, even those involving walking and public transport. There are sufficient cars Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: and staff to ensure everyone gets an opportunity to get out at least every day. Everyone living at the home had the opportunity to go out for at least some of the time during the inspection. There is flexibility in activities, but there are activity planners, linked to individual preferences, and those looked at were being adhered to, with one person going horse riding, and another going swimming. People are supported to maintain contacts with family and friends, with visitors welcomed, or individuals supported to make family visits. Surveys returned by relatives showed a high level of satisfaction with with staff support. People are supported in socialising with other people in ordinary activities, through day courses, and in one example, a regular night club event in Leamington. Plentiful stocks of healthy food were in evidence, and discussion with staff showed that they balanced the need to encourage healthy diets with individual preferences for such as burgers and chips. Choices were facilitated in one instance by photos of food assisting one person to make informed choices in advance. The manager advised that people living at Sharmer Fields were now taking a more active part in choosing food and going shopping for items. One person later returned from shopping with a staff member with items of food. Care Homes for Adults (18-65 years) Page 17 of 31 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. People living at Sharmer Fields can be confident that they will be given proper support to ensure their personal and health care needs will be met, and that this will be done without undermining their dignity. The service needs to ensure that the well-being of one service user is not undermined by the behaviour of another. Evidence: A sampling of records showed regular health checks taking place, with regular appointments to doctors, dentists, chiropodists as appropriate. Where there have been, or are particular on-going health care problems, these are well-managed with suitable outside professional guidance and help being sought. Staff spoken with recognised when health problems could influence individual behaviours. All staff now receive training in specific methods of physical intervention, giving them the knowledge and confidence to intervene effectively where a persons behaviour may put themselves or others at risk. There had been two incidents recently in which one person living at Sharmer Fields had attacked another; immediate short term strategies have been put in place to prevent a re-occurrence of this, whilst plans are formulated for a longer term solution to be put into place. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: One relative spoken with felt there been a 200 improvement in the life of their family member since they moved to Sharmer Fields. Another relative spoken with was extremely appreciative of the support given by staff throughout one persons very serious illness and hospital stay. They felt the home was the best possible place for them, and that the service had bent over backwards to ensure a good quality of life for this person, and spoke of how the staff had showed examplary care and support throughout. One person attended a hospital appointment that day; staff ensured they had the necessary encouragement and support to help make the outcome successful. All health and personal support took place in a positive manner, in which peoples dignity and privacy were maintained. A sample of medication was looked at in three of the houses. In all, records were seen to be accurate, and fully checked and audited by staff and management, and amounts dispensed tallied with records. The manager had been keen to ensure the system worked effectively, as there had been a number of errors noted previously. Notes for each medication showed its purpose, as well as details of possible side effects, ensuring staff were able to be familiar with each medication and its use. One shortcoming was noted, where an allergy to orange was noted for one person. This did not record what form the allergy might be expected to take, whether the allergy was still current, or when it had last been noted. The manager advised that she would have this checked. Care Homes for Adults (18-65 years) Page 19 of 31 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. People living at Sharmer Fields can generally be confident that they are protected from abuse, neglect and self-harm, and that appropriate action is taken in response to any concerns. Long term solutions are needed to prevent recurrence of specific incidents of violence from one service user to another. Evidence: We have received one complaint regarding this service. This concerned a staff member who had been dismissed, and demonstrated that the service had made much-needed improvements to its recruitment process, which is discussed in the staffing section of this report. The manager advised that there has been one external complaint recently, which she had previously advised us about, and which is being addressed with the involvement of appropriate agencies. There have been two allegations raised by a user of the service; these were responded to, and the relevant safeguarding agency was informed. These allegations were judged to be unfounded, and policies and strategies have been put in place to effectively manage any similar allegation in this specific area, without diluting responses to any future allegations. There have been two incidents involving a service user attacking another service user. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: These have been discussed elsewhere in this report. Staff are now all trained in specific physical intervention techniques, and those spoken with were able to explain how they now managed incidents of challenging behaviour, and could give examples of triggers and how to diffuse and de-escalate situations. Throughout, staff spoken with echoed the managers belief that they were working more effectively as a team, each following consistent guidance with the people using the service. An example of this was where one person was occasionally refusing medication. A protocol was agreed with the consultant so that this was dealt with consistently by all staff. This enabled refusals to be dealt with proportionately and effectively, with minimum fuss. The manager gave examples of how staff had previously not been following agreed guidelines, and where disciplinary action had been taken. Discussion with staff and observation demonstrated that the views of people living at Sharmer Fields were listened to and acted upon. Preferred activities and other preferences were seen to be catered for. In examples where likes conflicted with wellbeing, such as one persons wish to smoke continuously, a consistent program was in place to try and limit this, both as an activity,and as an all consuming passion. Where there were restrictions on access to fridges for example, this is done on a strict basis of preventing individual self harm, with the emphasis on allowing open access unless there are clear reasons for not doing so. We looked at a sample of records of personal monies for people living at Sharmer Fields. These were regularly checked to ensure accuracy, with all transactions being signed for. Care Homes for Adults (18-65 years) Page 21 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Sharmer Fields benefit from a spacious, clean, well-maintained environment. Some communal areas could benefit from walls being less bare. Living arrangement for one unit, where the communal stairway crosses the path from one persons flat to their kitchen, remains a potential area of conflict. Evidence: Sharmer Fields consists of four separate houses and an administrative building which has an upstairs which is being considered for possible future use as a self-contained flat. The approach road, shared with a neighbouring farm, is now tarmacked, as is the parking area. A gate from the approach road now gives an added element of safety. The remoteness of the site, along with its proximity to a main road, means that people living there can only access other areas via motor transport. There is now a maintenance man employed by the service, to enable prompt repairs of items, as the needs of the people living at Sharmer Fields results in some wear and tear on the fabric. One bedroom door frame had been damaged by persistent banging and was in the process of being repaired. Paintwork around one stairway had worn away/been damaged. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: In spite of such wear and tear maintenance and refurbishment is sufficient to maintain a clean, homely and pleasant environment throughout. The exceptions to this were some corridors, bathrooms and communal spaces which were rather bare. Staff advised that pictures were removed by people living there, but agreed that there may be other solutions, such as more decorative walls, that might help brighten them up. A small number of bedrooms and individual flats were seen; these were personalised to reflect the interests and personalities of those living in them. Kitchen areas were bright and spacious, a number of cupboards and fridges and freezers had locks on, where individuals who used them were at risk of harming themselves or misusing or abusing the contents. One house, of self contained flats, is not proving suitable for all current occupants, as its layout requires two people to walk past the door or someone who assaulted one of them twice. Temporary solutions, involving deploying staff, have been put in place, but management agreed that a more permanent environmental solution is needed. Corridors were uncluttered, and laundry facilities continue to run effectively. The houses were all clean and airy with no unpleasant odours noted. Care Homes for Adults (18-65 years) Page 23 of 31 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. People living at Sharmer Fields can be confident that they are now supported by staff who are properly recruited, suitably trained, and work as a committed and consistent team to help better their lives. Evidence: There has been a high staff turnover at this service in previous months; the manager expressed confidence that the staff team was now gelling and saw new and existing staff working together as a consistent team. Outside professionals had expressed concern about the numbers and motivation of staff previously. The manager acknowledged shortcomings in some staffs approach previously, and there had been a number of departures in recent months. There were sufficient staff on duty during the inspection, with teamwork and a positive approach by staff enabling individual activities to take place. Staff surveys returned as part of this inspection were broadly positive, but a number raised concern about greater need for additional cover so that staff holidays and, in particular, sickness did not leave staff struggling to provide for activities. The manager acknowledged that this had been an issue, but saw the taking on of new staff, and a more positive work ethos by staff, as reducing the scale of this problem. All staff spoken with were positive about the service, the staff as a team, and the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: leadership. Typical comments were Were working as a team now, Everyone is working in the same direction, I feel I can rely on other staff. We saw staff working together, and covering for each other in a positive manner and all working together for the benefit of people living there, particularly in respect of enabling activities to take place as planned in a timely manner. Staff were positive about training. A staff member who had worked at the service for a number of year felt that the training was now much more accessible, so that everyone now had no excuse for not having done all the mandatory training, as well as other training that assisted with providing better care and support for the people living at Sharmer Fields. A training matrix, along with individual records, showed training taking place in a timely manner. The number of staff who have National Vocational Qualification level 2 is currently below expectations, but the manager advised that numbers currently undertaking this qualification, along with those registered to do it, exceeds half of the total of staff at the service. Many of the staff are relatively new. We spoke with two newly recruited staff during the inspection. They had both been working in the sphere of learning difficulty previously, so much of their induction involved familiarising themselves with the processes at Sharmer Fields, and the individual needs of people living there. We examined a sample of three staff files. All had appropriate checks, including references and Criminal Records Bureau checks. The manager advised that she had ensured that all staff had all the proper checks before starting work, as there had been some shortfalls noted in this area prior to her arrival. Records of regular supervision were in evidence; staff spoken with confirmed they have regular, bi-monthly, supervision, and value the support and supervision given, as part of working consistently as a team. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are benefiting from a better more consistently led service since the arrival of the new manager. Evidence: The new manager, Jill Davis, has many years of experience in related areas of care. She has been in post since January and advised that she is in the process of registering as manager. All staff spoken with were positive about the progress the service has made in the few months the new manager has been in post. Typical comments by the staff included: there is much more support now, we are working as a team now and we can rely on each other and management. The impression we gained from staff was that there had been many management changes and that staff felt they had not been properly guided or supported for a long time, but that they now felt they were making rapid progress, with clear procedures being laid out, training being available, and a positive ethos evident throughout. The service is now far more transparent, ensuring that incidents affecting the well being of users of the service, including any medication errors or serious refusals, are Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: reported to us. Two outside professionals with close involvement with the service were spoken with after the inspection. They acknowledged that there had been improvements since the arrival of the new manager, but added that one of their concerns with the service over recent years has been the lack of consistency with a number of different managers only remaining in post for short periods, leading to much-needed improvements in the service either not taking place or being short-lived. They had concerns about whether measures put in place for preventing a recurrence of the incidents where one resident had assaulted another would be sufficient. They were appreciative of the improvements made under the new manager, but expressed concerns that the service was heavily reliant on the continuing presence of the manager for these improvements to be maintained and built upon. The manager advised that she was aware that the service had seen a number of different managers over recent years, and had suffered from inconsistency and a lack of coherent leadership, but that she saw her position there as a long term one. Surveys returned by relatives to the service were looked at. These were very positive, with only a few concerns raised regarding maintenance of the decor. Two relatives spoken with at length after the inspection were extremely positive about the quality of care and support offered by Sharmer Fields, feeling that their loved ones had made great progress there, which they had not seen elsewhere. There were no health and safety concerns noted in the running and maintenance of the building. Records continue to be kept, and hazardous substances are stored safely. Staff showed a good awareness of what was safe and unsafe for general access, without unduly restricting individual users of the service, particularly, for example, as regards access to kitchen items. Health and safety of service users in regard of their interactions with each other is discussed in other sections of this report. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 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 9 13 The service must ensure a 07/08/2010 satisfactory long term solution is found to minimise the risk of a service user attacking other vulnerable service users. This is so that vulnerable users of the service are not put at risk. 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 6 The service should better evidence the involvement of service users or their representatives in their own care and support plans. Where allergies are noted, it should be clarified what any likely effects are, and it should be clarified medically if the allergy is still current. Action should be taken where some communal walls are rather bare, and where there is damage to paintwork. Physical living arrangements should reflect and meet the needs of users of the service, and not put people in Page 29 of 31 2 20 3 4 24 24 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 potentially confrontational situations. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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