Care Home: Chantry Gardens

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What the care home does well No requirements were set at the last inspection. People using the service had an assessment of their needs prior to being offered a place at the home. This ensured that people could feel confident that their needs would be met. However, there have been no new admissions to the home since the previous inspection. People using the service have been provided with a written copy of the organisation`s service agreement as well as the terms and conditions of the funding authority. There is a Statement of Purpose and Service User Guide, which is available for any interested party. Each person has a care plan, which has been kept under review. Support plans are person centred and focus on individual needs, ensuring that every aspect of the person`s life is documented. People using this service are encouraged and supported to make choices and decisions about how they wish to live their lives. Independence is promoted, by staff encouraging people to participate in the running of the home. Strategies are in place to reduce most risks in daily living. Risk assessments and care plans are very well ordered and cross reference easily to each other. This enables staff members to access information readily. Each person has a person centred health action plan in place. Evidence demonstrates that people have the opportunity to participate in activities, both in the local and wider community. People are encouraged to participate in their hobbies and interests. People are supported to maintain links with family members and friends, if they choose to do so. Opportunities are available for people to keep in touch with their friends. Care plans inform the reader of household tasks, which the person living at the home is happy to undertake. People living at the home can choose the time they prefer to go to bed, and the routines they prefer to follow, with regard to personal care. Great thought and effort has gone into menu planning for the home. It ensures that staff receive appropriate guidance on offering a well balanced diet. There is also an excellent format for choosing meals and purchasing the necessary food. Medication is appropriately managed and records are kept. Medication policies and procedures are in place. The home provides a very clean and hygienic environment for the people who live there. Decoration, furnishings and fittings are of a good standard. Records demonstrate that new staff are properly recruited, inducted and trained.The manager has the motivation and enthusiasm to continue to develop the service and ensure positive outcomes for the people who live at the home. Systems are in place to monitor quality assurance effectively. Health and safety systems are in place to promote peoples` health, safety and welfare. What has improved since the last inspection? The new manager has only been in post for three months; however she has already developed new systems and methods of approach. Staff are now receiving regular supervision and arrangements are in place for staff annual appraisals to take place. The home now has a complaints log in place. Although, records show that there have been no complaints received. A good practice recommendation was made at the last inspection, which related to the home considering employing more permanent staff rather than relying on bank staff. We discussed this with the manager who assured us that the home is now almost fully staffed and that there are adequate staffing levels to enable people to lead the life they choose. The home continues to not have a personal computer. However the manager reported that she has identified this as a benefit for the effective management of the home. It would also provide a useful resource for the people they support. The home currently uses the El Box to access the internet if they wish to do so. What the care home could do better: Contact details for CQC need to be updated on various documents. Where a person may present a risk of choking a risk assessment should be in place and kept under review. It would be good practice to develop evaluation forms to be completed when people participate in activities, trips and outings. This will enable staff members to determine whether an activity has been successful or not. Key inspection report Care homes for adults (18-65 years) Name: Address: Chantry Gardens 69 Chantry Gardens Southwick Trowbridge Wiltshire BA14 9QT     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: Pauline Lintern     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: Chantry Gardens 69 Chantry Gardens Southwick Trowbridge Wiltshire BA14 9QT 01543416106 01225766381 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.voyagecare.com Milbury Care Services Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home 69 Chantry Gardens offers accommodation and personal care to three service users with learning disabilities. The home is one of a number of services run by the organisation called Milbury Care Services. The home is a detached bungalow situated in a residential area in the village of Southwick, which is to the west of the county town of Trowbridge. There are a small number of shops within walking distance of the home. The premises are in keeping with the local community and have a style and ambience that reflect the homes purpose. Service users are provided with their own bedrooms and all other facilities are Care Homes for Adults (18-65 years) Page 4 of 33 3 3 3 Over 65 0 0 0 Brief description of the care home located on the ground floor. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This service was last inspected on 19th December 2006. The inspection took place on 01/12/2009. At the time of our visit the three people who live at the home were at their day services and therefore we were unable to obtain their views on the service. The registered manager, Ms Holly Caswell was available to assist us throughout the day. There were two staff members on duty until the morning, when they finished their sleep in shift. We were therefore unable to spend time with them. Surveys were sent out to people who use the service, health care professionals and staff members to complete if they wished to do so. We received 5 responses from staff, 2 from people receiving a service and 1 from a health care professional. Their comments form part of this report. We sent Ms Caswell an Annual Quality Assurance Assessment (AQAA) to complete. This Care Homes for Adults (18-65 years) Page 6 of 33 is the homes own assessment of how well they are performing and provides us with information about their future plans. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures. The judgments contained in this report have been made from all the evidence gathered during the inspection; including the visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: No requirements were set at the last inspection. People using the service had an assessment of their needs prior to being offered a place at the home. This ensured that people could feel confident that their needs would be met. However, there have been no new admissions to the home since the previous inspection. People using the service have been provided with a written copy of the organisations service agreement as well as the terms and conditions of the funding authority. There is a Statement of Purpose and Service User Guide, which is available for any interested party. Each person has a care plan, which has been kept under review. Support plans are person centred and focus on individual needs, ensuring that every aspect of the persons life is documented. People using this service are encouraged and supported to make choices and decisions about how they wish to live their lives. Independence is promoted, by staff encouraging people to participate in the running of the home. Strategies are in place to reduce most risks in daily living. Risk assessments and care plans are very well ordered and cross reference easily to each other. This enables staff members to access information readily. Each person has a person centred health action plan in place. Evidence demonstrates that people have the opportunity to participate in activities, both in the local and wider community. People are encouraged to participate in their hobbies and interests. People are supported to maintain links with family members and friends, if they choose to do so. Opportunities are available for people to keep in touch with their friends. Care plans inform the reader of household tasks, which the person living at the home is happy to undertake. People living at the home can choose the time they prefer to go to bed, and the routines they prefer to follow, with regard to personal care. Great thought and effort has gone into menu planning for the home. It ensures that staff receive appropriate guidance on offering a well balanced diet. There is also an excellent format for choosing meals and purchasing the necessary food. Medication is appropriately managed and records are kept. Medication policies and procedures are in place. The home provides a very clean and hygienic environment for the people who live there. Decoration, furnishings and fittings are of a good standard. Records demonstrate that new staff are properly recruited, inducted and trained. Care Homes for Adults (18-65 years) Page 8 of 33 The manager has the motivation and enthusiasm to continue to develop the service and ensure positive outcomes for the people who live at the home. Systems are in place to monitor quality assurance effectively. Health and safety systems are in place to promote peoples health, safety and welfare. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. People receive an assessment so that their needs can be met. People are provided with a copy of the funding authorities terms and conditions and a copy of the organisations service agreement. The Statement of Purpose and Service User Guide provides Information on the service to all interested parties. Evidence: The home has a Statement of Purpose and Service User Guide. Both documents inform the reader about the service they would receive. They include how to make a complaint or raise a concern. We noted that the contact details for CQC need to be updated. There have been no admissions to the home since the last inspection. The people living at Chantry Gardens have lived there for a number of years. They therefore have established routines and their individual and varied needs have been assessed over time. At the last key inspection, this outcome was judged as excellent. There has been no Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: information to conflict with this view. Based on this, we have made a judgment, that the assessment process would ensure the service could meet the persons needs. Care Homes for Adults (18-65 years) Page 12 of 33 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. This judgment has been made using available evidence including a visit to the service. Peoples care plans reflect their assessed needs and are kept under review. The home works with a person centred approach, identifying individual goals and aspirations. People are encouraged and supported to make choices. Strategies are in place to minimise any potential risks. Evidence: Peoples assessed needs and personal goals were reflected in the individual plans so that these needs and goals could be met. Plans were found to be person centred and detailed individual needs, wishes, professional support networks, relationships, choices, likes and dislikes and communication needs. Support plans provide the reader with detailed information on how staff can support the person with every aspect of their life. Evidence shows that care plans are regularly reviewed. One file we sampled contained a communication passport for the person, which was dated 18/09/09. This provided information on how the person might express Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: themselves. It reminded staff I can make decisions and choices as long as things are explained to me in a clear way and not using too many words. Within the AQAA under what we do well it states, support plans are written with input from service users, and these along with risk assessment are reviewed every 6 months and updated as necessary, to reflect any changing needs choices or aspirations. The plans reflect the information input shared from families/friends, care manager and health care professionals, as agreed by the service users. Staff members sign to confirm that they have read and agreed each support plan. Monthly summary sheets are in place along with daily notes. The summary sheets provide a quick overview of events that have taken place during the month. The manager explained that this acts as a memory jogger for staff to follow up issues and evaluate what has happened over the month. Cultural and spiritual needs are included within the support plans. One person asks I would like staff to remind me of important dates and support me to buy gifts and cards for important people. Issues of choice and autonomy are also addressed. There is a focus on promoting independence. The manager reported that since coming into post she has developed systems to encourage people to participate in choice making. This was very evident by the new menu planning file, which will be reported upon in more detail under standard 17. As part of the inspection process we sampled individual risk assessments. All documentation is well ordered and clearly links to specific support plans. This ensures that information is easily accessible for staff members. We saw that risk assessments are regularly reviewed and monitored. We noted that one person may have a potential risk of choking. A risk assessment was not in place to minimise any risks. We asked that a risk assessment be completed and a copy sent to day services, as the individual takes a packed lunch daily. Ms Caswell confirmed that she would action this straight away. Care Homes for Adults (18-65 years) Page 14 of 33 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. This judgment has been made using available evidence including a visit to the service. People have access to a variety of activities within the local and wider community. Links with families and friends are maintained. Peoples rights and responsibilities are respected by staff members. Menu planning has been further developed to enable people to be fully involved in the process. Evidence: People living at the home continue to have valued daytime activities. People attend the Ashton Street centre throughout the week. We saw that whilst at their day services people can participate in many activities such as dance, cooking, arts and crafts, sports and photography. One persons support plan reports that they enjoy painting, tapestry, listening to classical music, going to the theatre and eating out. Examples of the persons work Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: are displayed tastefully around the home. Ms Caswell told us that this person enjoys spending time in the smaller lounge listening to music or undertaking art projects. There is a desk available for them to work on and an easy chair to relax in. Another persons interests include collecting models of commercial vehicles such as lorries, diggers and farm equipment. Evidence of this is displayed in their bedroom. Ms Caswell showed us the new activities folder, which is located in the lounge area so that people can easily access it at any time. In the front of the folder is guidance for staff on how the folder could be used. The folder is sectioned into various coloured plastic pockets. Each pocket contains different leaflets on various places of interest, resources and facilities available to the people in the home. For example it was evident that most people living at the home enjoy seeing animals, therefore one file contains information about safari parks, zoos and farms. Another file provides information on Salisbury Art centre, fashion exhibitions and theatre programmes. Ms Caswell reported that she was planning to take one person to the opera and a Christmas concert and has plans to attend the ballet in the future. One person has regular keyboard lessons at the home. An external tutor carries out the sessions. A keyboard is available in the smaller lounge area. Within the AQAA they have identified one area where improvements have been made: one service user commenced a college course in September to carry out her passion of arts and crafts and now has the opportunity to broaden her skills set The manager told us that she is planning to develop an achievements folder. This will enable the people living at the home to display their achievements over the year. We saw that there were photographs of runner beans and drawings that had been entered into the local flower show. Included in the photograph was the certificate of merit. Ms Caswell confirmed that the runner beans had been grown at the home. People living at the home know that their bedrooms are their private areas and are respected as such by the staff team. Peoples preferred form of address is detailed within their care plan. People can choose to go to bed and get up when they wish, however attendance at day services can restrict this choice during the week days. The manager explained that on occasion people will not attend day services. This enables them to have quality one to one time at home with a member of staff. This is usually once a month. One person can become tired after attending day services for a full week so they now remain at the home on Fridays. Records demonstrate that the people using the service are supported and encouraged Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: to maintain contact with their families and friends. One persons files records that they go out every other Sunday with their father. Staff are supporting another person to maintain a long term friendship with someone in Bristol. As mentioned previously in this report we found excellent systems have been developed by Ms Caswell to support people with menu planning. A well ordered and informative file has been developed, which provides staff with guidelines on how to use the file properly and information on a well balanced diet. The file enables people using the service to choose pictures of various ingredients, they may wish included in their meal, such as vegetables or meat choices. The laminated picture is then placed on the menu sheet for the week. Staff can then ensure that the menu contains the chosen ingredients or chosen meal. There is also a pictorial shopping list section. Ms Caswell told us that this has been sectioned to enable people to recognise the area in the supermarket where they may locate certain foods, such as fruit and vegetables, meat, fish and dairy produce. This is a good example of empowering the people who use the service Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. Care plans detail how individuals wish to have their personal support delivered. Evidence demonstrates that people lining at the home have access to health care professionals as required. The arrangements for managing medication are satisfactory. Evidence: Care plans record how the person using the service wishes to have their personal care support provided. For example one file sampled records I like to have a lie in at the weekends until 9.00am, I make my own breakfast, I will then wash my dishes. I will empty the bins, get my bag ready and have a shower and wash my hair. I would like someone to style and dry my hair for me. I appreciate members of staff checking that I have the correct clothes for the weather/climate. Within the AQAA it states, we offer all service users the support they require in their preferred way, meeting their health and physical needs. Ensuring that their capabilities are worked with to give them the opportunity to administer and control their own medication. The polices and procedures of the organisation are implemented in order to insure the service user is protected and that the ageing, illness and death Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: of any service user is handled with respect and as the individual would wish. One health care professional commented in our survey staff are always approachable and friendly. They are professional and work in a manner that is personal centred. Service users are so well presented and appear happy. One member of staff told us The home gives good support to the people that live there. Evidence shows that people living at the home have access to healthcare professionals when required. The manager told us that one person receives input from the Consultant Psychiatrist. They last visited this person in October 2009. One person has an epilepsy profile in place, including a risk assessment dated 26/11/09. The profile includes an epileptic seizure and weight record. Within health folders the section my health in hospital identifies any areas the person may need support with such as medication and personal care. It also identifies if a person needs support with decision making and names any agreed person to help in accordance with the Mental capacity Act 2005. Each person has a person centred health action plan. We saw that one person had a medical review on 23/4/09. We noted that one person had their behaviour guidelines reviewed on 30/11/09. It details distraction techniques and interventions to be used. The manager told us that all staff attends training in non violent physical intervention. Documentation is in place to record any incidents/accidents. The format has been further developed to include pictures and easy to identify coloured recordings. People who are prescribed as required medication have a risk assessment completed and guidelines within the support plan on how and when it should be used. We looked at the arrangements for managing medication and found that overall they were satisfactory. We did note that there were three gaps on the medication administration record. The manager confirmed that this was a very unusual occurrence. Ms Caswell told us that the home are currently piloting a new medication system, which may be adopted across the organisation if found to be successful. She demonstrated how the system would work and how the system could reduce the risks of medication errors taking place. Ms Caswell was confident that the system would be a positive development for the home. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: The home does not currently hold any controlled medication. However consideration should be given to safe storage in the event of a person being prescribed controlled medication in the future. Staff members currently complete their mandatory medication training electronically on the El Box. This covers the skill set and knowledge areas. Staff are then assessed for competency. All staff are re-assessed annually to ensure they maintain the competency skills. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to the service. Overall this is a service where residents are safe and listened to and a service rarely complained about. People are protected from abuse, neglect and self harm. Evidence: Since the last inspection the home now has a complaints log in place. This will enable the manager to identify any emerging trends or patterns. As mentioned previously the contact details for CQC are in need of being updated. Within the AQQA it states that the home has not received any complaints since the last inspection. We discussed how the views of people living at the home are obtained. Ms Caswell explained that she has recently introduced house meetings. A flip chart had been used to record peoples comments and views. Ms Caswell reported that she was hoping to encourage people to participate more in the meetings and we discussed possible communication tools that may be beneficial. The manager told us that the home receives a monthly questionnaire from Selwood Housing, which enables her to identify any area within the property, which may need Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: attention or are raising concern. Within the AQAA it states all service users and their families are provided with an accessible version of letting us know what you think policy and service users are each provided with I am worried cards. They told us about areas where improvements have been made, Provision of accessable version of letting us know what you think with a I am worried card and POVA procedures to each service user, staff, families and other professionals. Staff members receive refresher training in the Protection of Vulnerable People (POVA) every two years. One new member of staff had commenced their employment the previous day to our visit. Ms Caswell confirmed that she had spent time with the member of staff, explaining key policies and the local protocols for reporting any form of abuse No Secrets. The staff member is then required to sign to say they have fully understood the procedure. Safeguarding training is completed on the El Box. Ms Caswell confirmed that the course is very thorough. Safeguarding procedures are also covered within the induction work book. The system for looking after residents money was checked and found to be in good order. We noted that one person using the service, signs their own money transaction sheet in addition to a member of staff. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. The home provides a clean, comfortable and safe environment for people to live in. Evidence: As part of the inspection process we toured the premises, which we found to be clean and tidy throughout. Chantry gardens provide a homely and comfortable environment for the people who live there. Furniture and soft furnishings were of a satisfactory standard. Within our surveys we asked how the home could improve, we received some comments relating to the interior of the home. Comments included, replace and update the furniture that is not suitable for the service users and update decor and furniture so it feels more relaxing here. The manager told us that they are planning to replace the carpet in the two lounges and hallway. Bedrooms will be next to have the carpets replaced. We viewed peoples bedrooms and found them to be clean and tidy. People have personalised their rooms with posters, photographs and ornaments of their choice. People have televisions, DVDs and music centres in their rooms. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: Communal rooms were found to be comfortable with settees and arm chairs. There was a television in each lounge. The bathroom has a walk in shower, with hand rails for people who may need them. We noted that the floors and walls were clean and hygienic. The kitchen is domestic in type. There are two freezers and plenty of food preparation areas. The manager told us that the people living at the home are becoming more involved in the general upkeep and undertaking small household tasks. Toxic materials are securely locked in the kitchen. Ms Caswell told us that one person they support likes to access the cupboard for cleaning materials and will ask staff to unlock the cupboard for her. Ms Caswell confirmed that the person has a good understanding of the materials she might use. There is a small utility area where the washing machine and drier are sited. This area was found to be clean. Staff are provided with protective clothing, when required such as aprons and gloves. These were seen in the bathroom and toilet. Anti bacterial hand wash was available at all hand washing facilities. Staff receive training in infection control. The home continues to employ a gardener to keep the garden well maintained. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. People are supported by an effective staff team who have a sound underpinning knowledge of their needs. The manager told us that they have sufficient staff on duty to meet peoples needs. However within staff surveys some people commented that an increase in staffing levels would be beneficial. Evidence indicates that staff are properly recruited, inducted and trained. Staff receive one to one support from their manager. Evidence: The manager told us that during the night two members of staff carry out sleeping in duties. The staff members generally come on duty at 3.30pm and work until the following day, when people have been supported to their day services and general household tasks have been completed. The home then remains unstaffed until people return to the home at the end of their day at day services. The manager told us that she spends her time between Chantry Gardens and the other local Voyage home that she also manages. She explained that this can work well as she is available to be at the home if someone is unwell and cannot attend day service as usual. Within our surveys one person commented under the heading what could the service do better, sometimes they are hard to contact, when a service user is sick and needs Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: to return home, this is due to staff not at house 24 hours. Ms Caswell confirmed that the home occasionally use bank staff. She added that this is usually permanent staff from other Voyage homes, who wish to undertake bank duties. Ms Caswell reported that the home rarely use agency staff. The file of a newly appointed staff member was sampled. This demonstrated that correct recruitment practices have taken place. At the time of our visit the persons check with the criminal records bureau had not been received. Ms Caswell confirmed that the member of staff had not been in the home unsupervised and was spending the time familiarising themselves with policies and documents. We asked Ms Caswell to ensure that she had evidence to show that the member of staff was supervised at all times until the appropriate documents have been received. We also sampled two other staff recruitment files and found them to be in good order. There was evidence that two references, identification and a health declaration had been sought as part of the recruitment process. A photograph of each staff member was found on their file. New staff are given an induction book to work though during their probationary period. This is then signed off when the manager feels that they are competent in all areas. Each person has an individual training record. As mentioned earlier in this report the majority of the mandatory training is completed via the El Box. This includes health and safety, safeguarding, first aid, basic food hygiene, infection control and medication. The manager told us that once a week she synchronises the El Box, which then updates all relevant information and this is then gathered by the head office, which can then identify, where staff stand with their training requirements. Ms Caswell told us that if she feels that the team need training in specific areas she sends in a training request form to the organisation. She added that she has recently requested further training in Epilepsy, nutrition and diet and aspects of aging. Staff members have the opportunity to complete the National Vocational Qualification NVQ level 2. Ms Caswell told us that over 50 of staff have achieved this award or are working towards it. The home was without a manager in post for a few months prior to Ms Caswells appointment. Due to this some staff had not received one to one supervision during Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: this period. Ms Caswell has now developed a supervision programme for all of the staff members and has started the programme. Ms Caswell explained that she is also in the process of setting up annual staff appraisals where she will look at individual personal development plans and work practices. We received comments in our surveys relating to the staff members at Chantry Gardens. These included I feel the home and staff work well and I cant think of anything that could be changed, all the staff are very nice, I am happy living here, Chantry gardens is a lovely place to work. Service users and staff are all very nice. I have worked at Chantry gardens for 4 months and I like it very much, I love working here as it feels like everyone is part of a family and since working at Chantry Gardens the staff and the manager have given me the support to do the job and enjoy the work with the clients. I have worked in care work for about 14 years and it is hard work but very rewarding when clients reach goals. Care Homes for Adults (18-65 years) Page 27 of 33 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. This judgment has been made using available evidence including a visit to the service. The manager is suitably qualified and trained to ensure that the home is run in the best interests of the people who live there. Systems are in place to ensure that quality assurance is monitored. Policies and procedures are in place to promote the health and safety of the people living at the home and staff members. Evidence: Ms Caswell has been in post for three months. She currently manages Chantry Gardens and another local Voyage home. She holds the Registered Managers Award (RMA) and the A1 Assessors award. Ms Caswell told us that she is planning to undertake the NVQ level 4 in care, once her probationary period is completed. We saw that Ms Caswell has her own personal development plan in place and is eager to develop within her role. Ms Caswell is in the process of submitting her application to become the registered manager of Chantry Gardens to CQC. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: Following discussion and observing the new systems Ms Caswell has already made at the home, it is evident that she is motivated and forward thinking. Ms Caswell told us that she is excited and looking forward to further improving the service for the people she supports. During the last house meeting the manager discussed health and safety with the people living at the home. She told us that there was discussion about various aspects of health and safety. As a result of this discussion people using the service have asked to become involved in the health and safety checks. One person will be supported by staff to check the oil and water levels etc. in the homes vehicle, while other people take responsibility for other areas of health and safety within the home. We felt that this was very good practice. The home has established systems in place for monitoring quality assurance. The organisation completes an Annual Service review and development plan. This was completed 3/9/09. Managers are provided with a monthly service review document and best practice guidelines. The operational manager completes a monthly management audit and the findings are kept at the home. Ms Caswell is keen to further empower the people using the service to share their views and participate in the running of the home. We discussed different ways by which this may be achieved. Within the summary of the AQAA the manager told us what the home does well, 69 Chantry Gardens provides a high standard of support and care within a warm, homely environment. The team have established and maintained good relationships with families and other professionals. They told us about what they feel they could do better recruit a full staff team so that individuals have greater opportunities to take part in the activities they wish to. Improve the environment by replacing carpets and curtains. Policies and procedures are in place relating to the health, safety and welfare of both the people using the service and staff members. We saw that the manager completes monthly health and safety audits to ensure that tasks have been completed by the designated staff member. Environmental risk assessments are in place and kept under review. The home has a Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: current gas safety certificate (9/1/09) and a current portable appliance testing certificate (PAT) dated 28/9/09. All radiators in the home are guarded and hot water outlets are thermostatically controlled. We saw that regular fire drills take place. Staff receive fire instruction along with a questionnaire every six months. There was a fire risk assessment in place dated 27/11/09. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 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 You must ensure that a risk assessment is completed with regard to the person at risk of choking. This will ensure that any potential risks are minimised. 09/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 20 35 The Statement of Purpose and service user guide should contain current contact details for CQC. Staff members should be reminded to ensure that the MAR sheet is recorded correctly. If a new member of staff is working in a supervised capacity, the manager should be able to evidence that they have not worked alone. Care Homes for Adults (18-65 years) Page 32 of 33 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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