Care Home: Church House

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What the care home does well There is a relaxed and homely atmosphere. People say that the support workers give them the assistance they need in ways that are right for them. One person says, `I am at home and do lots of things with staff. I get good here, good for me`. There are interesting occupational and social things that people can do. One person says, `I like the horses and working with horses and things. I go each day to the horses`. Another person says, `I like working with gardens. I go to work there in the garden area`. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. People are helped to lead normal lives through responsible risk taking. One support worker says, `we want to help people lead normal home lives. They need to be encouraged to do things for themselves within the limits of what they can safely do`. People are served with good quality meals. One person says, `good, good, I like the food I make. I eat plenty`. There are arrangements to promote health and safety. What has improved since the last inspection? A number of improvements have been made since the Registered Provider took over the Service. These include the following things: Relatives have been invited to the Service for a coffee evening. This was done to introduce them to the new Manager and to the team of support workers. A user friendly complaints procedure has been introduced. This has been done to make it easier for people to raise any concerns they may have. People have been supported to become more involved in deciding what meals to have and in preparing them. Some new garden furniture has been purchased. Arrangements have been made to more actively involve the people who live in the Service in the appointment of new members of staff. Arrangements have been made to strengthen the way training is provided for support workers. This includes more detailed introductory training, the provision of introductory training for agency support workers and plans for the delivery of ongoing training for all of the support workers. All of these things are designed to better enable the Service to support people in ways that are right for them. What the care home could do better: Parts of the individual plans of care and support are not presented in a user friendly style. This might make it more difficult for people to access what is being said in them. The plans of care and support are not always being reviewed regularly. This might make it difficult for people to be fully involved in decisions that affect them. Records relating to the investigation of complaints are not held in the Service. This means that we can not audit what steps have been taken to resolve issues. The fire risk assessment needs to be updated. This is so that there is a current evaluation of how well the fire safety regime meets the national standard. The records relating to the security checks completed for new support workers are not kept in the Service. This means that we can not fully confirm that the necessary checks have been done. The Manager is not registered. This means that we have not had the chance to formally assess his suitability for the position. The system of having monthly house meetings is overdue. This might reduce the opportunity for people who live in the Service to have their say about their home. Key inspection report Care homes for adults (18-65 years) Name: Address: Church House Church House Rectory Lane Harrietsham Maidstone Kent ME171HS     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: Mark Hemmings     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Church House Church House Rectory Lane Harrietsham Maidstone Kent ME171HS 01622285970 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Lifestyles (FL) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Up to eight younger adults who have a learning disability can make their home in Church House. The premises are a large, detached house that was purpose built about three years ago. There is provision for all of the people who live in the Service to have their own bedroom. The bedrooms are on both the ground floor and the first floor. Each bedroom has got its own private bathroom. All of the bedrooms also have a television. Each person has a key to their bedroom door. On the ground floor there is a Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 8 Brief description of the care home large lounge and dining area. There is also a communal bathroom, the kitchen and the laundry. On the first floor, there is the Managers office and a private area for support workers. The Service is in a rural location just outside the village of Harrietsham. The nearest town is Maidstone about eight miles away. There is a general village store within easy walking distance. There is also a bus stop and a train station nearby. The Service has its own vehicle. There is plenty of car parking for visitors. The Registered Provider is a private company. It runs a number of similar services both in the area and further afield. The weekly cost of living in Church House runs from £838.74 to £1594.65. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. The Service has been operating for about three years. The current Registered Provider purchased the business about six months ago. This was our first Key Inspection since the change of ownership. We arrived unannounced at the Service at about a quarter to nine on the morning and we there for about seven and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received this on time. It is adequately detailed. Further, we considered any information that we have received about the Service since it was registered. Care Homes for Adults (18-65 years) Page 6 of 32 During the inspection, we spoke with three of the five people who currently live in the Service. The remaining two people were staying with their parents and so we did not get the chance to meet them. We spoke with the Operations Manager. She is a senior person who oversees a number of the Registered Providers services both in the local area and in London. We also spoke with the Manager and with three support workers. We looked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of care, medication records, the activities plan, the menu, the complaints documents, the staff roster, staff training records, financial records and various health and safety certificates. Before we visited the Service, we asked all of the people who live there and all members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Church House. Two of the people who live there kindly completed them for us. Later in our report we will tell you some of the main things they are saying in their replies. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? A number of improvements have been made since the Registered Provider took over the Service. These include the following things: Relatives have been invited to the Service for a coffee evening. This was done to introduce them to the new Manager and to the team of support workers. A user friendly complaints procedure has been introduced. This has been done to make it easier for people to raise any concerns they may have. People have been supported to become more involved in deciding what meals to have and in preparing them. Some new garden furniture has been purchased. Arrangements have been made to more actively involve the people who live in the Service in the appointment of new members of staff. Arrangements have been made to strengthen the way training is provided for support workers. This includes more detailed introductory training, the provision of introductory training for agency support workers and plans for the delivery of ongoing training for all of the support workers. All of these things are designed to better enable the Service to support people in ways Care Homes for Adults (18-65 years) Page 8 of 32 that are right for them. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information about the facilities and services provided. People who are thinking of moving are asked about what support they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. People are told about the rights they will have when they move in and about their responsibilities. Evidence: Before someone moves in, the Operations Manager and the Manager meet with them so that they can find out what support they need and want. They also talk with family members and with people like care managers (social workers). All of this is done to help them to build up a really good picture of how the person can best be supported. The person and their family is then invited to visit the Service usually on more than one occasion. This is done so that they can be confident that moving in to Church House is the right thing to do. There is a good deal of written information about the facilities and the support that people can expect to have when they move in. Some of this is written in a user-friendly style using pictures and straightforward language that is easier to follow. In addition to this, support workers explain things to people. This is Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: so that they can ask any questions that they want. It also helps to give them a good understanding of the rights they can expect to enjoy if they decide to move in. The Manager says that before someone moves in, he will share the information he has learnt with the support workers. One support worker says we are told about new people so that we can get ourselves organized to meet their needs. People when theyre moving in need to be supported so that they can find their feet. Each person is different and will handle moving in differently. We also need to make sure that people who are already here get used to the new person. In their questionnaire replies both people say that they had enough information about Church House before they decided about living there. Some of the people who live in Church House intend to make it their longer term home. Others may only stay for a shorter period. This may be so that they can practice the skills they will need for living more independently. The Operations Manager says that the Service will increasingly focus upon supporting people who want to move on to more independent living settings. One support worker says, it would be far easier to do things ourselves on most occasions but we dont, because we recognise its important for people to rely upon themselves as far as possible so that they stay engaged with the reality of everyday life. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the support they need in ways that are right for them. Parts of the system used to review the individual plans of care and support are not working as intended. People are helped to manage their financial affairs. There is a sensible approach to risk taking. People are involved in the running of their home. Suitable steps are taken to keep confidential information private. Evidence: Each person has an individual plan of care and support. These plans help support workers provide the right support for people. The plans are kept up to date by the support workers making daily notes. There is a key worker system. This means that each person who lives in the Service has a support worker who takes a special interest in their wellbeing. The Registered Provider wants each person to meet with their key worker every weekend to see how things are going and to plan out the following week. Not all of these reviews are up to date. The Registered Provider also wants to have more detailed annual reviews. Most of these are overdue. The Manager says that he is actively working to address both of these shortfalls. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The support workers have a good understanding of how each person expresses themselves. Parts of the support plans are written in a user friendly way, but other parts are just written in a standard text. More can be done to make these parts of the support plans interesting so that people can be better helped to take an active part in their preparation and review. Support workers know how to respond to each person in ways that are helpful for them. One support worker says, the plans are important thats for sure but things cant be too rigid. People want different things on different days and we have to recognize this and be flexible. We make a point of listening to people and not rushing them into things just because its part of their normal routine. In their answers to our questionnaire, both people say that they always receive the care and support they need. One person says, I am at home and do lots of things with staff. I get good here, good for me. Sensible steps are taken to support people to lead everyday lives of their own choosing. This includes support workers helping people to take reasonable risks and to avoid situations that might be harmful. For example, some people like to help out in the kitchen. Support workers help them to do this. They check out that there are no hot pots and pans on the cooker that might tip over. One support worker says, we want to help people lead normal home lives. They need to be encouraged to do things for themselves within the limits of what they can safely do. For example, some people will want to help in the kitchen while others will find this much more difficult. We know them so well we know what theyll want to do and what the risks are that need to be managed. People are helped to take an active part in the running of their home. This includes having a say in which members of staff are appointed. One person was involved in the recent appointment of the Manager. They say, I interviewed (the Manager) and asked him questions. I liked him best because I could talk to him. The Registered Provider does not get involved in managing peoples financial affairs. The Operations Manager says that this is so that there are no conflicts of interest. Most people receive help from members of their families. The Manager says that people will be provided with an advocate if this is necessary. This is someone who is independent of the Registered Provider and who can support people to say what they want about important decisions in their lives. Support workers know that it is important to keep confidential information about Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: people private. The Registered Provider has as clear policy on confidentiality. Also, the subject is raised with new support workers when they do their introductory training. One support worker says, private information is private to the individual and we must not discuss it with someone else outside the home. If someone external needs to be told, thisll be done by (the Manager). Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are interesting occupational and social things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There is a range of occupational things that people can do if they want to. These include doing college courses, paid jobs, household tasks and helping out with the shopping. There are also social things to do such as doing arts and crafts, going out to the pub, going for drives to places of interest and pursuing particular interests such as computers and the internet. When we were in the Service, one person went out to work, another one was setting up their computer and a third person was listening to music in their bedroom. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The Assessment says that the range of things that people can do is kept under review. It says that new and different opportunities continue to be offered. In their answers to our questionnaire both of the people say that they are happy with what they do each day. One person says, I like the horses and working with horses and things. I go each day to the horses. Another says, I like working with gardens. I go to work there in the garden area. People are helped to keep in touch with members of their families. Support workers help make arrangements for people to stay with their relatives. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. Recently, the Service has hosted a coffee evening for relatives. This was done so that they could meet the new Manager. It also was a chance for them to say how they think things are going in Church House. People are encouraged to make their bedrooms their own private space. They are laid out as bed sitting areas and so people can spend as much time was they want there. One person says, I go and do things in my bedroom and I am busy with stuff. Im okay. There is a telephone that people are supported to use. As necessary, support workers help people to deal with any mail they get. The Service used to operate a conventional catering system where most people had the meals that were on the menu for a particular day. This has recently been changed so that people are supported to plan their own meals and to shop for what foods they need. They are also supported to prepare their chosen dishes. People say that they like their meals. One person says, good, good, I like the food I make. I eat plenty. The records show that people are having a normally varied and balanced diet. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped in ways that are right for them. They are helped to stay well. There are safe systems to manage medicines. Evidence: The support workers are relaxed and informal in how they are. They help people to organise themselves without being bossy. People are helped to wear neat and clean clothes so that they can look how they want. One person says, I get on well with everyone at home and like being here. I know how things are and I use my room a lot for things. We observed one person being supported in their bedroom. They werent rushed at all and the support workers chatted with the person so that they knew what was going on and felt more involved in things. People are helped to keep healthy. Support workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Each person has a health action plan. Parts of these are written in a user friendly way. They are intended to support people to promote their own health. This includes things such as watching their weight and trying to follow a lower fat diet. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Two people are supported to manage their own medication. This involves support workers checking out that they are taking their medicines at the right time and in the right way. Support workers manage medication for other people who are less able to be involved in this. There is a system to check that the correct medicines are received from the chemist. Once in the Service, medicines are stored securely. The Assessment says that all members of staff who give out medication have been trained so that they know what they are doing. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. These are being completed correctly. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a user friendly complaints procedure. There are arrangements to make sure that complaints are dealt with properly. People are kept safe. Evidence: There is a new complaints procedure. It is much more user friendly than the old one. One part of it needs to be updated. This is so that people who live in the Service are fully informed about their rights. The Manager says that this will be done by 1 December 2009. People are relaxed about saying what they want. In their questionnaire answers both people say that they know how to make a complaint and who to speak with if they are not happy about something. The Operations Manager says, we absolutely encourage people to say what they want like you would without thinking about it at home, so that we know how theyre feeling about things. One of the support workers says, theres an open atmosphere here and people can say whats on their minds. No one has complained to me about anything and I think that things are right here for (the people who live in the Service). One person says, I can say things and tell (members of staff) about stuff I want. Im happy and have no complaints about my home here. The Registered Provider has a detailed policy and procedure that explains how it will investigate and resolve complaints. The Operations Manager says that all complaints will be referred to her. She takes the lead in making sure that the matter is then resolved. Since the Registered Provider took over the Service, the Operations Manager Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: has investigated four complaints. These were about various things. One was from a relative and concerned how someone was being supported to promote a particular aspect of their health. The Operations Manager says that she was able to demonstrate from the records that all was well with the person concerned. She says that this reassured the complainant. Another complaint was about a damaged fitment in one of the bedrooms private bathrooms. The Operations Manager says that this was repaired straight away. A third complaint was from someone who wanted to be supported to move from the Service. The Operations Manager says that she promptly contacted the persons care manager and that a move was arranged as quickly as possible. The fourth complaint is still being resolved. This involves the arrangements that need to be made to ensure that one person who lives in the Service can see one of their guests in private. The Operations Manager says that all complaints are investigated in a thorough manner. This includes her speaking with the various people involved so that she can establish the facts. She says that there are full records of the various steps she takes in relation to each complaint. These records are not kept in the Service. Without us having access to them, it is more difficult for the Operations Manager to show us precisely what she has done. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. The support workers are confident that people are being kept safe. Recently, the Registered Provider has Kent County Council to look into a concern about one persons wellbeing. The Operations Manager says that the Service will fully support the investigation. The Operations Manager says that the Registered Provider is committed to promoting diversity in the Service. By this she means respecting each person who lives there as an individual who is inherently valuable in their own right. One of the Registered Providers policies states, (we are) committed to providing a service that maintains the individuals comfort and dignity and promotes the persons with freedom of choice and self worth. The records show that as part of their introductory training support workers receive guidance about the need to guard against any form of prejudice or discrimination. The Manager says that this commitment to promoting diversity is also expressed in practical terms. For example, in the way that each person receives individualised support that recognises their abilities, preferences and wishes. One support worker says, we respect each of the people for who they are as individuals, we dont think of them as service users, they are real whole people like the rest of us. They have good and bad days like us all. They have lots to offer and are not just the recipients of support. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: New obligations have placed on all registered providers for managing situations in which it may be necessary to deprive people of some of their liberties. The Registered Providers responsibility is to make sure that any limitations will only be done in the best interest of the person. The obligations include the need to have a clear system to contact and to work closely with Kent County Council if a limitation to someones liberty is being considered. The Manager is going to double check that the Registered Provider has developed the necessary systems to support this work. Support workers help most of the people who live in the Service to manage their personal spending allowance. They hold small amounts of money for them and then help them to buy things they want. There is a record kept of the various transactions and there are receipts each of the purchases made. The records accurately show how each persons money is being spent. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is comfortable. There is a modern fire safety system. There is a shortfall in how the fire safety system is being assessed. The kitchen is well equipped. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that the Registered Provider has to have to describe the Service. The building is well maintained on the outside. The garden is well kept. Most of it is laid to lawn and there is not much in the way of shrubs and flowers. There is some new garden furniture that includes a swing seat. On the inside, the accommodation is very well decorated and furnished. There is a modern automatic fire detection system. This should be re-assessed on an annual basis to make sure that no further improvements are needed. The review is overdue. The Operations Manager says that this oversight will be corrected by 1 November 2009. The local Department of Environmental Health has not inspected the kitchen for some time. Shortly after our inspection, the Manager contacted it and asked for an Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: inspection to be completed. The kitchen is clean and well equipped. The records show that the refrigerator and the freezers keep foods cold enough. There is also a system to make sure that foods are used promptly once they are opened. The support workers know about good food hygiene practices. For example, they know about the need to make sure that hot foods are well cooked through. People say that the accommodation is kept comfortably warm. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water system is temperature controlled. This has been done so that the water does not get hot enough to scald someone. There are an adequate number of bathrooms and toilets. There is also an adequate amount of communal space. This means that everyone can enjoy each others company without the place feeling crowded. Each of the bedrooms is laid out as a bed sitting area. One of the people who live in the Service invited us to look at their bedroom. It is a very personalised space that reflects their individual choices in furnishing and decoration. The laundry has a washing machine and a dryer. The laundry is well organised and clean. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough support workers on duty. Support workers have the necessary skills to support people in ways that are right for them. Security checks are completed on new support workers. Evidence: The records show that there are usually three support workers on duty from early in the morning until later in the evening when the night time staffing arrangements start. There is always a member of staff on duty whenever any of the people who live in the Service are at home. There are no house-keeping staff and there is no cook. These tasks are done by the support workers and by the people who live there. One support worker says, I think we do alright in that we organize our time to make sure that people are out and about and doing what they want. We have just enough staff. If the number of people living here goes up we will certainly need more staff on duty. At the moment, there are some vacant posts. The Operations Manager says that efforts are being made to appoint to these. She hopes to have all of the vacancies filled in the near future. This will reduce the need to use agency members of staff. These are people who are not directly employed by the Registered Provider and who are not based in the Service. When we were in the Service, we kept a look out for Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: things that might give us a clue about how well the place is being staffed in practice. We noticed that one person was supported to go out to work. Another person was supported to manage their continence. A third person was helped to sort out their computer. The Assessment says that the Registered Provider completes a number of security checks on new support workers. These include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. One support worker says, when I started I had to give a lot of detail about my past jobs and why I had left. I attended for a thorough interview they asked me all sorts of questions about how I think about disability and the values to use when supporting people. They did not let me start until I had a police check and I know that they took up my references. The records of the checks are not kept in the Service. This means that we are not able to confirm that all of the checks have been completed. The Operations Manager says that in future all of the necessary records will be available for us to inspect. New support workers receive introductory training. Recently, this training has been made more detailed. Agency members of staff also receive introductory training. One support worker says, I did get quite a good induction given that all of the staffing arrangements are new with new people having to find out things as they go along. I didnt work on my own until I was confident that I knew what I was doing. (The local management) are very supportive and easy to talk to. Theres good team work. The residents certainly do come first here. The Registered Provider wants all support workers to receive ongoing training. The Operations Manager says that all of the support workers will be attending core training courses over the next six months. The records confirm this plan. Most members of the small staff team have completed a relevant National Vocational Qualification (NVQ). This Award is designed to further develop support workers ability to provide people with the assistance they need. The Operations Manager says that all support workers will be expected to obtain the Award. There is a system whereby each support worker meets regularly with someone senior to discuss their work. This means that they can talk through any work problems they may have. Our observations show that support workers are adequately supported by the training and guidance they receive to support the people who live in the Service. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service is well managed. The Manager is not registered. There is a quality assurance system. There are suitable health and safety arrangements. Evidence: The Manager has been in post since early September 2009. He has worked in and managed similar services to Church House for a number of years. He has one of the two formal qualifications that are recommended by the National Minimum Standards. He says that he intends to obtain the second Award as soon as possible. The Manager already has a good knowledge of how things are going in the Service. The Operations Manager says that the Registered Provider will comply with our requirement that newly appointed managers apply to us for registration as soon as their three month probationary period has been completed. Support workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. One support worker says, (the Manager) is good actually, he treats staff with respect and cares about people. Hes Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: easy to talk to and not full of himself. He has the residents interests at heart. He listens to ideas and has got lots of his own about how to really develop the Service. The Manager says that there will be monthly team meetings. These will be held so that people can contribute ideas to the running of the Service. He says, its really important that members of staff feel and are genuinely valued for the skills and commitment they can bring to their work. Theyre not just a pair of hands, I want them to be professionals in their own right. People who live in the Service are regularly asked what they think about their home as part of everyday life. Also, there is a system of monthly house meetings. These are where people who live in the Service can review how things are going and can suggest improvements. To date these meetings have not been held very regularly. The Manager says that they will be from now on. The Operations Manager has just prepared some questionnaires. She says that these will be sent out each year to the people who live in the Service and to their relatives. The questionnaires ask about various subjects including the quality of the support provided in the Service and the adequacy of the activities that can be done. The Operations Manager calls regularly to the Service to see how things are going. Once a month she completes a formal audit of things such as the support plans and health and safety arrangements. The records of these audits show them to be thorough and organized. There is evidence that any problems the audits identify are corrected. The records show that there are regular checks of the fire safety equipment including a weekly test of the alarm bells. There are regular fire drills. Recently, the records of these have been made more detailed. This is so that they give a clearer account of how each drill went and of what improvements may need to be made. The Assessment says that all items of equipment used in the Service remain in good working order. The records confirm this account. The records show that there have not been many accidents or other adverse events in the Service since it was registered. Most of them have been minor things. The Manager says that he monitors each event. This is done so that he can see if they can be prevented from happening again. The Registered Provider has a full portfolio of policies and procedures. These are designed to help support workers comply with the principles of good professional practice. They cover subjects such as infection control and the safe storage of things such as bleach. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: Records that contain confidential information are stored securely when they are not in use. The Registered Provider has a system of completing detailed health and safety audits. These are done to help make sure that there are no hazards that might result in someone having an accident. The first of these audits for Church House has yet to be done. The Operations Manager says that it will be done in the near future. The Manager says that there are no particular hazards that need to be dealt with. We did not notice any either. The Operations Manager says that there is a business plan to support the continued operation of the Service. She says that Church House remains financially viable as part of the Registered Providers wider business. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!