Care Home: Dovedale Court

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What the care home does well People receive the support they need in ways that are right for them. One person says, `I do things with staff and am about here and do things. I do games with (the special needs tutor) and go out. I like my flat and helping out. I`m good here`. People have the opportunity to undertake an extensive range of occupational and social activities. One support worker says, `we like to try to be out and about. We have enough transport and staff to enable this to be done. We do all sorts like shopping, cafes and other things like bowling. They need to have a full life and they certainly do here`. People say that they are provided with good quality meals. One person says, `I do my meals with staff. I have all sorts and do good things. I have what I want and help cooking things. I go in kitchen to cook and help out with plates and stuff`. People are helped to stay in good physical health. This includes being supported to obtain medical assistance as and when it is needed. There are reliable arrangements for handling and dispensing medication. There is a modern automated fire detection system. This gives a high level of fire safety protection. There are reliable arrangements for keeping people safe. These include assisting people to manage their spending money. Support workers have the skills they need and they receive suitable training. There are suitable health and safety systems. These help prevent accidents and other untoward events. What has improved since the last inspection? A number of improvements have been made since our last Annual Service Review. These include the following things: Work has started on making the individual plans of support more user friendly. This includes the use of a new multi media tool that makes it easier for some people to say what they think. This greater accessibility is important because it will enable people to become increasingly involved in making and reviewing decisions that affect them. People have been supported to undertake a wider range of occupational and social activities. Special arrangements have been made to safeguard the interests of two people who needed to receive particular forms of support. Various parts of the accommodation have been redecorated and some new bedroom furniture has been provided. New health and safety audits are regularly completed. These are done to help make sure that people do not have avoidable accidents. More support workers have been recruited. This has resulted in fewer occasions when external agency support workers have to be used. All of these things enable the Service to better meet the needs of the people who live there. What the care home could do better: One part of the Registered Provider`s medication administration procedure is not always being implemented. This might result in misunderstandings about what medicines have been dispensed. Parts of the accommodation are not presented to a normal domestic standard. One of the security checks that need to be completed in relation to one support worker has not been done. Fire drills are not being held as frequently as is considered necessary by the Registered Provider. The fire training provided for support workers needs to be strengthened. This is necessary so that more frequent checks are made to ensure that they can reliably operate the fire safety procedure. Key inspection report Care homes for adults (18-65 years) Name: Address: Dovedale Court Dovedale Court Quantock Drive Ashford Kent TN24 8QN     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: Mark Hemmings     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Dovedale Court Dovedale Court Quantock Drive Ashford Kent TN24 8QN 01233611536 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dovedale.court@unitedresponse.org.uk www.unitedresponse.org.uk United Response Name of registered manager (if applicable) Ms Liesl Cooper Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. 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 10 people who have a learning disability can make their home in Dovedale Court (the Service). The premises are a courtyard of modern houses. Some of the houses are in one terrace and one is a detached property. Some of them are whole houses while others are divided into self contained flats. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 10 Brief description of the care home All of the bedrooms are single occupancy. They are laid out as bed sitting areas. There is a bed, bedside table, wardrobe and comfortable chair. Each of the houses and flats has their own lounge, kitchen and bathroom. People can use the Services telephone free of charge. There is an activity centre in the grounds. This is a single storey building that is divided into three areas. There is a sensory room that has got large floor cushions, a projector and things such as a water bubble feature. The main room is used for craft work and music sessions. There is also a small side room. This is used by a special needs tutor. It has a computer and various learning materials. There is an enclosed garden at the centre and at the side of the courtyard. This has some flower beds and several areas of lawn. The Service has the use of three vehicles. The Registered Provider is a charitable organization. The Service is set in a residential street. There is a corner store nearby. There is a bus stop within easy walking distance. There is both on road and off road parking. Ashford town centre is about half a mile away. There is a mainline train station in the town. The weekly charge for living in the Service runs from £1426.00 to £1547.00. Please contact the Manager if you want to find out more details about the charges. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 3 Star. This means that the people who use this Service experience excellent quality outcomes. We arrived unannounced at the Service at nine oclock in the morning and we there for about six 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 our last Annual Service Review. This Review was an office based activity when we examined all of the information we had at that point about how things were going in the Service. We completed this on 27 January 2009. During the inspection, we spoke with three of the 10 people who live in the Service. Care Homes for Adults (18-65 years) Page 6 of 29 More generally we spent time with another three of them while they were in and around the activity centre. We spoke with the Manager, the two deputy managers 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 support, medication records, the activities plan, the menu, the staff roster, staff training records, financial records, policies and procedures and various health and safety certificates. Before we visited the Service, we asked various people to fill out a questionnaire for us. We wanted them to tell us what they think of Dovedale Court. One person who lives there, one relative, five support workers and two health and social care professionals kindly completed them for us. Later in our Report we will tell you some of the main things they say in their replies. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? A number of improvements have been made since our last Annual Service Review. These include the following things: Work has started on making the individual plans of support more user friendly. This includes the use of a new multi media tool that makes it easier for some people to say what they think. This greater accessibility is important because it will enable people to become increasingly involved in making and reviewing decisions that affect them. People have been supported to undertake a wider range of occupational and social activities. Special arrangements have been made to safeguard the interests of two people who needed to receive particular forms of support. Various parts of the accommodation have been redecorated and some new bedroom furniture has been provided. Care Homes for Adults (18-65 years) Page 8 of 29 New health and safety audits are regularly completed. These are done to help make sure that people do not have avoidable accidents. More support workers have been recruited. This has resulted in fewer occasions when external agency support workers have to be used. All of these things enable the Service to better meet the needs of the people who live there. 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 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is accessible written information about the facilities and support provided in the Service. People who are thinking of moving in 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: When someone is thinking of moving into the Service, the Manager meets with them. This is so that she can find out what support they need and want. She also talks with health and social professionals such as doctors and care managers (social workers). All of this is done to help her to build up a really good picture of how the person can best be supported. The person is invited to visit the Service, usually on several occasions. This is so that everyone can be confident that moving into Dovedale Court is the right thing to do. There is quite a lot of written information about the Service. There is a Service Users Guide. This is written in a user friendly way. It briefly describes the main facilities and Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: services someone can expect to have. There is also a contract of residence. This sets out some of the rights and responsibilities people have if they decide to make Dovedale Court their home. In their questionnaire replies everyone says that they had enough information about the Service before they moved in. The Manager says that before someone moves in, she shares the information she has learnt with the support workers. One support worker says, we always discuss what support someone needs long before they move in. We are told about what help they need and who they are as a person. People arent just a collection of needs, they are whole people and each one needs to settle in, in their own way. We let people have space and we dont overload them. Its great to see someone gradually gaining in confidence as they establish their own routine and test out the things that will make this their home. All of the people who live in the Service at the moment are quite settled in their home. The Manager says that if someone wants to move on they will be supported to do this. This may include liaising with family members and with care managers to make sure that the person has the help they need when they leave. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience 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. People are supported to manage their financial affairs. There is a sensible approach to risk taking. Evidence: Each person has an individual plan of support. These plans help support workers provide the right assistance for people. The plans are kept up to date by the support workers making daily notes. Most of the plans are not presented in a user friendly way. This might make it more difficult for people to be actively involved in decisions that affect them. The Manager has already started to address this issue. As part of this a new multimedia tool is starting to be used. This should help people join in more when there is a review of their plan of support. There is a key worker system. This means that each person has a support worker who takes a special interest in their wellbeing. Each person meets with their key worker on a one to one basis. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Support workers know how to respond to each person in ways that are helpful for them. One person says, good, good when asked about the support they receive. Another person smiles when asked the same thing. A third person says, I do things with staff and am about here and do things. I do games with (the special needs tutor) and go out. I like my flat and helping out. Im good here. One support worker says, we know all of the (people who live here) really well over the years. Its a very settled staff team and so we know them like family, indeed they are a sort of family to us. We know how they are each day and we know how to help them in the best way. Each day is different, whats right on one day may not be the best thing on the next. Im absolutely certain that the residents come first here and that everyone gets the support they need and want and that it is done with kindness not just because its a job. 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, people need to be supported so that they are kept safe when they are out and about in the local area. One support worker says, we want to get the (people who live here) doing more and more things for themselves. We want them to be safe but that doesnt mean taking too many precautions so that people end up being cocooned from doing ordinary everyday things for themselves. We dont want to limit people too much The Registered Provider is the appointee for everyone who lives in the Service. As part of this arrangement, the Manager oversees the operation of each persons bank account. At least one person could be more involved in this than they are at the moment. The Manager says that she is going to look into how the person can be supported to do this. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an extensive range of 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 wide range of occupational things that people can do if they want to. The special needs tutor holds individual sessions with people. In these sessions people are supported to develop their recognition, numeracy and written skills. The tutor carefully plans and records her work so that there is an individual learning plan for each person. People are also supported to do everyday household jobs. This includes shopping for food, helping with preparing meals, washing up, tidying up and doing their own laundry. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: There are also social things to do. These include indoor activities such as arts and crafts. People also attend regular outside events such as horse riding and social evenings. Every year people are supported to take a holiday break. There was a lively atmosphere in the Service when we were there. Some people went over to the activity centre. Other people went out into town shopping. Others were at home relaxing having a cup of tea and watching the television. One person says, I like coming here (to the activity centre) and doing things on the (computer) and doing games. I help out here and do good things. Theres lots to do. I do stuff in my flat and I go to (do) shopping. I buy things I like. I like going out in the car. I do things here and do good things. One support worker says, we like to try to be out and about. We have enough transport and staff to enable this to be done. We can go out. People dont need to be cooped up and we do all sorts like shopping, cafes and other things like bowling. They need to have a full life and they certainly do here. The Assessment says that the range of things that people can do has been increased since our last Annual Service Review. It says that there is, a culture of support. As part of this, it says that people are encouraged and supported to try new experiences even if it means taking risks. People are helped to keep in touch with members of their families. Family members and friends are welcome to call to the Service at any reasonable time. People are encouraged to make their bedrooms their own private space. The records show that people are provided with a normal menu of meals in which there is sufficient choice and variety. One person says, I do my meals with staff. I have all sorts and do good things. I have what I want and help cooking things. I go in kitchen to cook and help out with plates and stuff. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 intrusive. People are helped to wear neat and clean clothes so that they can look how they want. One person says, I watch tele in the evenings and do things. I go to bed when I go and after Ive done what I want. One support worker says, we always treat people like we do each other. This is their home and we want it to be a safe and welcoming place. They have the right to that and our job is to make sure we support them so that they get it. Its important to treat people in adult ways. Theyre not children and need to be treated with adult respect. They can be helped to make their own decisions and helped to do what they want. Another support worker says, the staff treat people very well indeed. Theres a relaxed atmosphere and this means that people can lead good and comfortable everyday lives. They always seem to be doing stuff and going out. Theres no sense of this being a closed community at all, quite the opposite. One health and social care Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: professional says, staff always have the person at the centre of what they do. They will always contact others if they feel that they are unsure about what they are doing or require further assessment. People are helped to keep healthy. The records show that support workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. People are supported to attend medical appointments and they are supported to follow any treatment regimes that might then be necessary. At the moment support workers manage everyones medication. At least one person might be able to take a more active role in doing this. The Manager is looking into how this can best be done. There is a system to check that the correct medicines are received from the chemist. There is also a system to return unused medicines. This system is not always working in the correct way. 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 filled out on each occasion that a medicine is given. Most but not all of these are being completed correctly. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure and there are arrangements to make sure that complaints are dealt with properly. People are kept safe. Evidence: There is a user friendly complaints procedure. This uses various things such as pictures to support people in understanding their right to make a complaint. In one of its documents the Registered Provider states that, all complaints will be dealt with thoroughly, speedily, confidentially, objectively and sensitively. No one need fear the consequences of raising a concern or making a complaint. Anyone who makes a complaint or raises a concern will be kept informed of progress and outcomes. One person says, Im happy, no complaints. I can talk to anyone I want. Im happy. Another person smiles when asked if they feel free to raise a concern about something. One support worker says, Ive never heard any one complain about anything major. People of course have every day grumbles but we listen carefully and sort them out. Im sure that if there was something more serious, it would be looked into by management and resolved in a fair way. The Registered Provider has a detailed policy and procedure that explains how it will investigate and resolve complaints. The Manager says that all complaints will be promptly investigated so that they can be resolved as quickly as possible. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Since our last Annual Service Review neither we nor the Registered Provider have received any complaints about the Service. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. One support worker says, all of the people are treated really well here. This is their home and Im clear in my own mind that each person is safe and very well cared for. The place is organised around people not the other way around. Ive never seen anything but kindness and courtesy here. Sure some people need boundaries but this can be and is done in a respectful way. You dont do things to people you explain to them and encourage them to do the right thing for them. Another support worker says, the residents are very well cared for. We are all on their side and we try to make sure that they lead full lives. Ive never worried about that at all since Ive been here. The people who live in the Service are helped to manage their personal spending money. This involves support workers retaining funds on their behalf and then disbursing them when requested. The records show that this is being done in a reliable and transparent manner. The Assessment says that the Registered Provider is committed to promoting diversity in the Service. By this it means respecting each person who lives there as an individual who is inherently valuable in their own right. It also states that the Service is committed to supporting people to develop, an understanding of their own rights to freedom and self determination. The records show that as part of their training support workers receive guidance about the need to guard against any form of prejudice or discrimination. New obligations have been placed on all registered providers for managing situations in which it may be necessary to deprive someone 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 records show that since our last Annual Service Review appropriate steps have been taken on two occasions to safeguard people who have needed special support. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the accommodation is presented to a normal domestic standard. There are suitable fire safety arrangements. There are suitable kitchens and laundries. Evidence: The building provides a suitable range of facilities for the people who live there. These are broadly 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. Copies of the document can be obtained from the Registered Provider. The building is adequately maintained on the outside. Most of the windows are uPVC. The two windows that have wooden frames have badly pealing paintwork and look unsightly. In two places the plaster around doors that lead into the properties is badly cracked and has been only roughly filled. These areas look unsightly as does some of the paintwork which is marked and scuffed. One of the properties has subsidence and it has been unoccupied for several months. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: This has led to the people who used to live there being relocated to other parts of the site. The garden is neat and orderly. There are lots of hanging ornaments to make it an interesting and colourful space. On the inside, the parts of the accommodation where people actually live is decorated and furnished to a comfortable domestic standard. Recently a number of areas have been redecorated to make them more homely. Also, three people have been supported to buy new furniture for their bedrooms. There is a modern automatic fire detection system. This is being checked to make sure that it continues to operate in the right way. The local Department of Environmental Health does not inspect the kitchens. This is because they are considered to be only of a domestic nature. We examined two of the kitchens. They are clean and well organised. 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. Support workers know about the importance of good food hygiene and they follow the correct procedures. The Manager says that the accommodation is kept comfortably warm. It was pleasantly warm when we were there even though it was a very cold weather. 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 is suitable equipment in place to assist people who have reduced mobility. For example, one person uses a special walk in shower. There is also a hoist that can be used if they need to be helped to stand. Special rails are about to be fitted to the walls to help the person walk about safely. Each of the houses and flats has their own domestic washing machine. There is also a separate larger laundry. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough support workers on duty. Support workers have the skills they need 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 at least six support workers on duty from early in the morning until later in the afternoon when the number reduces to five. There is a staff presence at night. In their questionnaire replies support workers say that there are enough members of staff on duty. One support worker says, there are enough staff around to enable people to receive the individual support they need. Dovedale is a bit like a number of supported houses within the one setting. Recently more support workers have been employed. This has been done so that it is easier to fill in vacancies when members of staff are absent due to holidays or ill health. It has reduced the number of times that agency members of staff have to be used. These are people who are not based in the Service. The Manager says that this development will further improve consistency in the way that people are supported. When we were in the Service, we kept a look out for things that might give us a clue about how well the place is being staffed in practice. We noticed that people were Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: supported to go out into town when they wanted to. We also noted that people were supported to go to the activity centre so that they were on time for their planned sessions. The records show 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. There is a shortfall in the checks that have been completed for one support worker. The Manager says that this oversight will be corrected by 1 March 2010. In their questionnaire replies support workers say that they received sufficient introductory training when they first started working in the Service. One support worker says, I got lots of training when I first came and it was very good indeed. There was no attempt to rush me and I felt much more confident by the time I finished the training. Theres a lot to learn and I was taught about things such as moving people, epilepsy, support planning and handling difficult situations. The Registered Provider expects all support workers to receive ongoing training. The subjects include first aid, food hygiene and how to respond to people who are expressing themselves in difficult ways. The records show that most but not all of this training is being delivered in a reliable way. One support worker says, oh yes Ive done lots and lots of training since Ive been here. Ive done it about communicating with people, understanding their special needs and about the values of (the Registered Provider). That ones very important because its the value of respecting people thats behind everything else. If you respect people for who they are its hard to go wrong. If you dont, then youre not going to get it right no matter how many courses you go on. Elsewhere in this Report we have commented on the way in which support workers use a range of knowledge and skills to help people in ways that are right for them. For example, some people do not rely on the spoken word to say what they want. Instead they use a combination of signs, sounds and objects. Support workers have a very good understanding of what they mean. This enables people to readily express themselves. Most but not all of the support workers have completed a relevant National Vocational Qualification (NVQ). This Award is designed to further develop their ability to provide people with the assistance they need. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience 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. There are shortfalls in parts of the quality assurance system. There are suitable health and safety arrangements. Evidence: The Manager has been in post for several years. She has a good understanding of how to ensure that people reliably receive support that is right for them. She does not have one of the two formal qualifications that are recommended by the National Minimum Standards. She says that she is keen to start studying for the award in question as soon as possible. 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, we all get on quite well as a team and we coordinate ourselves. Because of the individual addresses we can do our own thing so that people lead individual lives. However, when we do need to help each other out we do. Its a very supportive place. You can talk to (the Manager) and the others and they will listen and help if they can. Another support worker says, we have a good staff team in place as well as good managers. I Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: think it shows in the quality of care received by the people we support. Each support worker meets regularly with the Manager or with one of the deputy managers to review their work and to discuss their professional development. In their questionnaire replies support workers say that they receive all the support they need. People who live in the Service are regularly asked what they think about their home as part of everyday life. Some but not all of them also take part in the annual review that is done of their individual plans of support. Also, their relatives or other representatives are invited to contribute their opinions to the annual reviews. Apart from this there is no other organized system to canvas peoples views about the Service. The Manager is going to review what can be done to strengthen these aspects of the quality assurance system. A representative of the Registered Provider calls to the Service once a month to check how things are going. In addition to this there is a quarterly management audit. This is when a manager from another of the Registered Providers local services looks at how things are going in Dovedale Court. The Registered Provider says that monthly fire drills should be completed. The last recorded fire drill took place in late October 2009. The Manager says that this shortfall will be corrected without delay. The Registered Provider also says that support workers need to have regular fire training. This is done to make sure that they are confident to operate the fire safety procedure. The fire training is not always being delivered on a regular basis. The Manager says that a new system will be introduced to address this shortfall. This will be done by 1 March 2010. The records show that all items of equipment used in the Service remain in good working order. There is a record kept of all accidents and other untoward events. These records show that nothing exceptional has happened since our last Annual Service Review. They also show that the Manager monitors what has happened. This is done so that so that steps can be taken to prevent a recurrence. Since our last Annual Service Review a regular health and safety audit of the building has been started. These are done to help make sure that there are no hazards that might result in someone having an accident. The Manager says that there are no particular hazards that need to be addressed at the moment. We did not notice any either. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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