Care Home: Elcot Close (5)

What the care home does well The Statement of Purpose and Service User Guide are available in alternative formats and provide sufficient information. The documents enable prospective new people to the service to decide if the home is the right place for them. Each person has a care plan in place, which is regularly reviewed to take account of any changes, which may have occurred. People living at the home have a `Life Book`, which is easily accessible for each individual. The people who use this service have the opportunity to receive incentive payments for small household tasks, such as vacuum cleaning and tidying the home. People are supported to attend day services and leisure activities of their choice. Staff are properly recruited, inducted and trained. What has improved since the last inspection? The Service User Guide has been updated and contains all of the required information. The home is developing working within a Person Centred approach. Communication passports are in place and people using the service have the opportunity to write their individual plan in their own words, if appropriate. The acting deputy manager now provides additional supervision support to staff members, which has alleviated some of the pressure on Mrs Messenger and ensures that staff have the opportunity to regularly meet with their line manager. New carpet has been fitted to certain areas of the home. A call system has been installed to the bedroom on the ground floor as recommended at our last visit to the service. What the care home could do better: When a person using the service has diabetes, greater clarity is required as to the support required and details of who is responsible for areas such as toe nail care. Care must be taken to ensure that anygaps on the Medication Administration Record (MAR) are explained. When medication stock is received by the service, it must be witnessed and dated by two members of staff. The home need to ensure that they have storage available for controlled medication, which meets the legal requirement. The cupboard which stores toxic materials must be locked at all times. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elcot Close (5) Elcot Close (5) Marlborough Wiltshire SN8 2BB The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Lintern Date: 2 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 35 Information about the care home Name of care home: Address: Elcot Close (5) Elcot Close (5) Marlborough Wiltshire SN8 2BB 01672516320 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : White Horse Care Trust care home 5 Number of places (if applicable): Under 65 Over 65 5 2 learning disability Additional conditions: The maximum number of service users who may be accommodated in the home at any one time is 5 No more than two service users admitted as younger adults with a learning disability may be accommodated after attaining their 65th birthday. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home 5 Elcot Close is a spacious detached well-maintained property situated on the outskirts of Marlborough town centre. The home is registered to provide residential care for up to five people who have a learning disability. It is managed by the White Horse Care Trust and is one of a number of care homes run by them. The house, which is in a quiet culde-sac, has a pleasant enclosed garden to the rear of the property and an open planned garden at the front. The home provides single bedroom accommodation for all service users. The home has its own transport so service users can access the wider community and attend a range of health care provision. Typically the home provides a minimum 2 staff on duty during the day. At busy times extra staff may be deployed. There is no awake staff at night, support staff take it in turns to sleep in so as to be available to respond to any night time needs as they arise. Additionally there is an on call system in operation so extra help can be summonsed in an emergency. The home encourages and enables service users to maintain their independence. The philosophy of care is in line with the principles of John OBriens five accomplishments. The Registered Manager is Christine Messenger. Care Homes for Adults (18-65 years) Page 5 of 35 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 Care Homes for Adults (18-65 years) Page 6 of 35 How we did our inspection: This is what the inspector did when they were at the care home 5 Elcot Close was last inspected on 28th June 2006. The unannounced key inspection took place on 26/05/2009. The inspection took place between 9.30 am and 5:00 pm. The registered manager of 5 Elcot Close is Mrs Christine Messenger. Mrs Messenger is the manager of two Trust homes and works across both services. The manager was unavailable on the day of our site visit, however we were assisted by staff members on duty. Mrs Messenger was available to receive feedback at the end of our visit. At the time of our visit two of the people using the service were at home. Two people were shopping with staff and one person was at day services. We were able to meet with people living at the home and observe interactions between themselves and staff members throughout the day. We took the opportunity to meet with three members of staff to obtain their views on the service provision. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys; to be distributed by the home to Care Homes for Adults (18-65 years) Page 7 of 35 peoples using the service and staff members, care managers, GPs and other health care professionals. Three members of staff, two people using the service and four healthcare professionals responded. The feedback received, is reported upon within this report. We sent Mrs Messenger an Annual Quality Assurance Assessment (AQAA) to complete. This was their own assessment of how well they are performing and it gave us information about their future plans. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures, staff files and training records. At the last inspection two requirements and four good practice recommendations were made. All requirements and recommendations have been met in full. The judgements contained in this report have been made from all the evidence gathered during the inspection; including the visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 8 of 35 What the care home does well The Statement of Purpose and Service User Guide are available in alternative formats and provide sufficient information. The documents enable prospective new people to the service to decide if the home is the right place for them. Each person has a care plan in place, which is regularly reviewed to take account of any changes, which may have occurred. People living at the home have a Life Book, which is easily accessible for each individual. The people who use this service have the opportunity to receive incentive payments for small household tasks, such as vacuum cleaning and tidying the home. People are supported to attend day services and leisure activities of their choice. Staff are properly recruited, inducted and trained. Care Homes for Adults (18-65 years) Page 9 of 35 What has got better from the last inspection What the care home could do better When a person using the service has diabetes, greater clarity is required as to the support required and details of who is responsible for areas such as toe nail care. Care must be taken to ensure that any Care Homes for Adults (18-65 years) Page 10 of 35 gaps on the Medication Administration Record (MAR) are explained. When medication stock is received by the service, it must be witnessed and dated by two members of staff. The home need to ensure that they have storage available for controlled medication, which meets the legal requirement. The cupboard which stores toxic materials must be locked at all times. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Pauline Lintern Colston 33 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 Care Homes for Adults (18-65 years) Page 11 of 35 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 set out 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 12 of 35 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 13 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a Statement of Purpose and Service User Guide, which provides the reader with information about the service. While there have been no new external people to the service, the organisations admission policies would be adhered to, to ensure appropriate placements. This judgement has been made using available evidence including a visit to the service. Evidence: Information about the service is available in alternative formats, such as pictorial and widget. The home sent CQC a copy of the updated service user guide. There have been no recent external admissions to the home. Two people have transferred to 5 Elcot Road from another Trust home. This was due to the home being closed. Staff members told us that both people had the opportunity to visit the home Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: for tea and meals. Several overnight stays also took place. When the people moved into the home permanently they were supported by staff from their previous home, who worked along side the staff at Elcot road. Both people were observed during our visit and appeared settled and comfortable in their new home. Due to there being no new external admissions the key standard which relates to the assessment process could not be fully addressed. Care Homes for Adults (18-65 years) Page 15 of 35 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 . Peoples assessed needs and personal goals were reflected in the individual plans so that these needs and goals could be met. People make choices and decisions about their lives with assistance as needed. People are supported to take risks as part of an independent lifestyle. Unnecessary risks are minimised. This judgement has been made using available evidence including a visit to the service. Evidence: Each person has a detailed care plan. Each person has a review calendar in the front of the file, which indicates when reviews are due. Plans are separated into sections, which cover all aspects of the persons life. This includes mobility, health care needs, privacy, dignity, choice, culture, communication, social needs, occupation, consent and Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: goals. However, it was noted that one persons file did not fully clarify how their needs should be met relating to the management of their diabetes. We asked that this be more detailed to reflect safe parameters and responsibilities. There was a diabetes management plan in place, however it was dated 2006. We asked Mrs Messenger to review the plan to ensure that it was current. Two people living at the home showed us their individual Life Books. They were easily accessible to the people using the service. Both people told us that they enjoy looking through the books at pictures, leaflets, programmes of shows and concerts and photographs of family members and past events, which they attended. Staff members told us that they had attended person centred planning training called making it real. The home have already started to work with a person centred approach. Mrs Messenger told us that some people using the service have written their own individual plans (IP), using their own words and they keep a copy in their rooms. Mrs Messenger asked one person if we could see their plan, however the person was unable to locate it for us. IP meetings record the goals and aspirations that the person using the service may have. Records show the progress that has been made to achieve these goals. One person identified their goal as being able to do more gardening. This resulted in the person being given an allocated piece of garden to look after. Records show that this person used this area to grow herbs and regularly weeds and tends to its up keep. The person told us that they enjoyed having the garden and that the herbs are used for cooking by the home. Each person has a communication passport, which provides information on the persons communication and emotional needs. It details how the person communicates and how staff can assist them. It also details how the person may express when they are feeling both happy and unhappy. One file states when I am happy I will get very excited, laugh and giggle. When I am unhappy I become pale and go very quiet, I may seek reassurance from staff. There are examples of choice and decision making in the care plans and ways in which people are supported to make choices. One persons file reminds staff to give X time and use various methods to support her choice making such as by using pictures as well as verbal prompts. Another persons plan records I communicate by touching, poking and pointing. I use signalong on occasions and so staff need to attend training. I will refuse to get in/out of the vehicle if I do not wish to go somewhere. When I dont like something I will shout out and rock my head from side to side. Within our surveys one person commented I usually make decisions about what I do each day, the staff help me sometimes. It depends what the other clients are doing. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: Each person had risk assessments for all aspects of daily living. The assessments also include the action to be taken to reduce risks. Assessments are regularly reviewed to take into account any changes. Mrs Messenger reported that an assessment had been completed with regard to restricting one persons access of the front door. We discussed whether a referral was needed in line with the Mental Capacity Act deprivation of liberties safeguards. It was felt that at this time this restriction was in the persons best interests and was in place to ensure their safety. Mrs Messenger confirmed that the situation would be regularly monitored and risk assessed to ensure that if circumstances change, the correct action would be taken. Care Homes for Adults (18-65 years) Page 18 of 35 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 . People are provided with a range of activities and opportunities, offering them full engagement with their local community. People are able to maintain and develop appropriate relationships with friends and families. Peoples individual lives have an appropriate balance between necessary routines, and individual choice. People are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. This judgement has been made using available evidence including a visit to the service. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Daily diaries and reports indicate that the people living at the home have the opportunity to take part in a range of activities. People access adult education classes at the Wyvern College in Marlborough. Marlborough Resource Centre, Harlequins day services and the Gateway club are also accessed. One persons activity plan records that they attend the New Road group, which is a drop-in centre, and visit the Jubilee gardens. One person had recently attended a ball, which was organised by Mencap. Mrs Messenger supported the person to attend. The person told us the evening had been great and they really enjoyed themselves. Staff arranged for the person to have a professional photograph taken of them, which is now displayed in the lounge. The person told us that they had chosen their outfit themselves and also decided how they wished to have their hair styled for the event. Mrs Messenger confirmed that a staff member brought in pictures of various hairstyles for the person to choose from. Mrs Messenger reported that the whole event had been a great success. Some people using the service continue to receive incentive payments for some tasks completed around the home. This includes vacuum cleaning, tidying bedrooms and washing up. Staff members told us that it enables people to use the money to buy personal items or to save if they choose to do so. People are supported to access local facilities such as swimming, horse riding and trips to the pub for lunch. Within the Life Books sampled we saw many photographs of when people have been out for meals for their birthday and Christmas meals. There were photographs of themed events attended such as Halloween parties and garden parties at other Trust homes. Staff ensure that the people using the service have the opportunity to attend pantomimes, shows at the theatre and visit places of interest. One person told us how they had enjoyed their day out at the London Eye and the river boat cruise. They appeared to take pleasure in showing us photographs of the day trip. During our visit to the home, one person was completing wooden puzzles and another person was using their lap top computer later in the day. There is an exercise bike available to people living at the home. One person told us that they had just bought a Wii fit and as a result had lost 2lbs in weight. All people living at the home have the opportunity to attend a church of their choice, if they wish to do so. Care plans outline people specific spiritual needs. At the time of our visit staff confirmed that only one person chose to attend church on a regular basis. Mrs Messenger explained that when the polling cards had arrived at the home for each individual, she took time to explain what this meant to each person and asked them if they wished to vote. She confirmed that no one chose to do so. One file we sampled recorded that the person has a long standing friendship with a Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: person they have known for a number of years. Evidence shows that staff support the person to maintain links with this friend. The person showed us photographs of themselves with their friend. One person showed us a photograph of their boyfriend and themselves on their birthday when they went out, with staff support for a meal. The home has a telephone available for people to use if they wish. It has a large number dial pad for people with limited vision. One person told us that they regularly talk to their mum on the telephone. Daily notes show that people can have visitors to the home when they choose and often go home on visits to see family. Staff members told us that the people they support can choose when they wish to go to bed and when to get up. They explained that one person has fewer day services than the others so they often choose to have a lie in. One care plan reminds staff to encourage one person to get up at a certain time to enable them to have plenty of time to consume their food following their regular injection. Staff members showed us the menu file, which is used on a weekly basis for people to choose the menu for the following week. All meals take into account individual specific dietary needs. One person we spoke to told us that they enjoy the food at Elcot close. The home has a large fridge and two upright freezers situated in the kitchen. It was noted that all were well stocked with food. Care Homes for Adults (18-65 years) Page 21 of 35 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 receive support in ways that they prefer and need. People have access to health care professionals as required. However care plans need to record who is responsible for all aspects of a persons health care needs, such as foot care. Medication is generally well managed, however some records need to be witnessed by another member of staff and dated. The home must ensure that they have available storage facilities for controlled medication, which meets the current legislation. This judgement has been made using available evidence including a visit to the service. Evidence: Peoples preferred routines are identified within their care plans. The ways in which Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: people like to be supported are recorded in detail. Details about health care needs are also recorded in the care plan. However it was noted that one person who is diabetic did not have a support plan or risk assessment relating to the care and maintenance of their toe nails. Daily diaries and discussion with staff members confirmed that the person regularly attends the chiropodist; however this was not clear within the persons care plan. We asked Mrs Messenger to ensure that this was added to the persons plan to ensure that all staff would be aware of who took responsibility for this task. The daily records showed that people had appointments with health care professionals. Dates of appointments and outcomes are recorded. People have access to the GP, district nurse, chiropodist, optician, urinary clinic, dentist and consultant psychiatrist. One person using the service told us that if they are unwell, staff will either take them to the doctors or call for a home visit. We looked at the arrangements for managing medication. Generally record keeping was good; however we found three unexplained gaps for topical creams and sprays. Mrs Messenger reported that she will remind staff of the importance of correctly completing the medicines administration record (MAR). It was noted that when medication is received into the home it is counted, recorded and signed by one member of staff. This information is later transferred onto the MAR sheet by a staff member. We asked Mrs Messenger to ensure that the medication is also counted, witnessed, signed and dated by another member of staff to ensure no mistakes are made. The home currently does not hold any controlled medication. We discussed the need to have the facility for safe storage available in case some one is prescribed such medication in the future. At the time of our visit no one using the service was self-medicating. One person administers their own injection once a member of staff has drawn it up in the syringe. The persons MAR advises which injection site should be used and is supported by a body map. Daily blood tests and insulin administered is recorded separately. The person regularly attends the diabetic clinic. People using the service sign a consent form to confirm that they are happy for staff to administer their medication. All staff receives training prior to being able to administer medication. There are clear protocols in place for the use of as required medication. As required medication is recorded on a separate yellow sheet to avoid confusion. Care Homes for Adults (18-65 years) Page 23 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home are safeguarded by the homes policies and procedures for complaints and protection. People are protected from abuse, neglect and self harm. This judgement has been made using available evidence including a visit to the service. Evidence: The home has an appropriate complaints procedure. There have been no complaints since the last inspection. Within our surveys people told us that they were aware of the homes complaints procedure. One person using the service commented I would speak to Christine if I had any worries or concerns. One person we spoke to told us that they would either speak to the manager or CQC, if they were unhappy. One member of staff commented If someone had concerns I would inform them to use the complaints procedure and support them to access it. Also complete a Regulation 37 notification form and contact the Commission if necessary. There is a policy about abuse prevention. There was information about the No Secrets guidance for Swindon and Wiltshire. Staff members confirmed that they had attended safeguarding training and were aware of the procedure to follow if they suspected any form of abuse had taken place. There have been no allegations of abuse. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: The home continue to ensure that the ethos/culture of the home and the relationship between some people living at the home and long serving staff members is documented within care plans. The manager explained that she ensures that staff are aware that often the use of nicknames could be perceived as over familiar and she monitors this frequently. However, the home has recognised the diversity of some of the people they support and safeguarded them by putting clear protocols in place. As part of the inspection process we looked at the arrangements for holding money on behalf of people living at the home. We sampled the transaction records and cash held of two people. Both records and cash held balanced and was correct. Receipts are kept for all transactions and signed by two staff members. Care Homes for Adults (18-65 years) Page 25 of 35 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 . People live in a comfortable and clean environment, suitable to their needs. This judgement has been made using available evidence including a visit to the service. Evidence: Since our last visit to the service the building work has been completed and a new bedroom is now situated on the ground floor. We made a recommendation at the last inspection relating to the need for a call system to be considered for this room. This has now been actioned and there is a bell call system in place, which also displays the word help on a screen in the hall way. This ensures that the member of staff on sleeping in duty on the first floor will be informed that assistance is needed. The home itself is in keeping with other houses in the vicinity. It is in the corner of a cul de sac and has a private enclosed garden. The house has two lounge areas with comfortable seating, televisions, DVD players and music systems. There is a personal computer in one of the lounge areas. There is a separate dining room, and a good sized kitchen. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: The home was found to be in a good state of decoration and repair. It was noted that new carpet had been purchased in some areas. The home appeared clean and hygienic in all areas at this visit. There was a washing machine and drier located in the utility room. Care Homes for Adults (18-65 years) Page 27 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported by an effective staff team, who are appropriately trained, competent and qualified to meet their needs. People are protected by the homes recruitment practices. This judgement has been made using available evidence including a visit to the service. Evidence: Staff members confirmed that generally there are three staff on duty in the morning and two from 3.30pm. One member of staff undertakes sleeping in duties. Staff members confirmed that there are sufficient staff on duty to meet the needs of the people they support. Within our surveys one member of staff commented usually there is enough staff to meet individual needs. We have two new gentlemen living at the home so we are in the process of assessing the current staffing ratio in relation to the needs of the clients, so in the future our staff levels may change depending on the outcome of the assessment. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Before staff commence their National Vocational Qualification in Social Care (NVQ) they complete the Learning Disability Qualification (LDQ), which provides a good underpinning knowledge and can be used as evidence towards their NVQ. One member of staff told us that they did not intend to complete their NVQ, due to personal pressures. Within the Trust members of staff are often seconded from other services. For example when one Trust home was recently closed all of the staff were redeployed to other Trust homes in the area. The manager confirmed that Elcot Road is currently fully staffed. We sampled the recruitment records of two members of staff and found them to be in order. Satisfactory references and clearance with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) list are sought prior to a person commencing their employment. Within our surveys one member of staff commented my induction mostly covered everything I needed to know. Another member of staff we spoke to told us I had an induction booklet, which was signed off when the manager and I felt I was competent in each area. Staff members told us that the Trust provide very good training for their staff. One person added we have training which is relevant to our service, such as diabetes, physical intervention, dementia or epilepsy. They confirmed that they attend mandatory training in subjects such as health and safety, first aid, basic food hygiene, manual handling, safeguarding, medication and fire awareness. Staff confirmed that the Trust notify them when they are due to attend refresher training. The home has a training matrix and a training programme for 2009/10. Staff members can apply to attend any courses they wish. Staff members told us that they are receiving formal supervision from their line manager. Mrs Messenger confirmed that this is an area which has been difficult to maintain, however now that she has a deputy who is trained to provide staff supervisions, this has alleviated some of the pressure. Staff members confirmed that they receive annual appraisals and attend regular team meetings. Care Homes for Adults (18-65 years) Page 29 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are benefiting from a well run home. Peoples views underpinned all self-monitoring, review and development by the home, although these views need to be documented. Peoples health, safety and welfare is promoted and protected by the health and safety measures. However failure to securely store toxic materials could seriously jeopardise this. This judgement has been made using available evidence including a visit to the service. Evidence: As stated in the summary of this report Mrs Messenger is currently managing two services for the Trust. She explained that she divides her week across both services according to the needs of each. Mrs Messenger is a qualified and competent manager and runs the home in the best interests of the people who live there. When she arrived Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: at Elcot Close on the day of our visit, it was evident that she has a good relationship with the people living at the home and the staff team. People using the service came to welcome her and were clearly happy to see her and have a joke with her. Staff members told us that they are well supported by Mrs Messenger and that she is very approachable. The Trust continues to send out annual satisfaction surveys to all interested stakeholders. Mrs Messenger explained that the most recent surveys are currently at the head office. We were able to see last years surveys and the homes development plan. We sampled reports from the regular management audits completed by senior managers with the Trust. Secret Squirrel unannounced visits take place on a regular basis, as do Trustee visits. We discussed resident meetings with some staff members. They confirmed that although they have not held one recently they do still take place. However they added that sometimes the people they support say that they have nothing that they wish to discuss. We talked about the importance of capturing peoples views and how this may be an area for further development. There is a health and safety policy to comply with the relevant regulations. A number of general environmental risk assessments have been completed and are kept under review. There were also individual risk assessments relating to safe working practices such as manual handling. A monthly health and safety audit takes place by the designated responsible staff member. Hot water temperature regulators are fitted to the taps and radiators are guarded to protect people. There is a fire risk assessment in place, although it was unclear if it had been reviewed recently or not. One member of staff is responsible for Infection Control. Records show that they attended refresher training in this subject on 5/12/07. The home was been awarded three stars by Kennet District Council for Food Safety on 12/06/08. All toxic materials are stored in the utility room. At the time of our visit we found the key left in the cupboard door and the door was unlocked. We discussed this with the manager during feedback. She agreed that this was a potential risk to the people receiving a service. All COSHH data assessments were in place. Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes  No  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 32 of 35 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 Description 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 Description Timescale for action 1 6 12 You must ensure that diabetic management plans are kept under review. 09/07/2009 To ensure that peoples needs are being met. 2 19 13 You must ensure that care 09/07/2009 plans provide clarity on who is responsible for the toenail care of people with diabetes. To ensure that peoples needs are met. 3 19 13 You must ensure that the all 09/07/2009 entries of medication onto the MAR sheet are witnessed, dated and signed. To avoid mistakes being made. 4 20 13 You must ensure that safe storage for controlled 09/08/2009 Care Homes for Adults (18-65 years) Page 33 of 35 medication, which meets legislation requirements, is available, if needed. To comply with current legislation. 5 42 13 You must ensure that all toxic materials are securely locked away at all times. 09/07/2009 To ensure the health and safety of people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 37 To provide further opportunities for people to express their views. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). 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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