Care Home: Fieldview

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What the care home does well Information was available in a statement of purpose and service user guide so that people could make an informed decision about where they lived. The service user guide was written in simple language and had pictures. People`s individual needs and aspirations were fully assessed so that their needs could be met. People`s assessed needs were reflected in care and support plans and reviewed and changed as necessary so that their diverse needs would be met. People were assisted to make decisions about their lives and any restrictions were in their best interests. People were supported to take risks to promote their independence. People had opportunities to be part of the community and to take part in appropriate day time and leisure activities. People maintained relationships with their family and friends. People`s rights were respected and their responsibilities were recognised in their every day lives. People were offered a healthy diet and enjoyed their food. People received personal support in ways that they preferred and needed. Their physical and emotional health needs were being met. The arrangements for managing and recording medication ensured people were protected. There was a complaints procedure and people`s views were listened to and acted upon. There were policies and procedures about safeguarding adults and staff received appropriate training. This helped to protect people from abuse, neglect and self harm. The lounge was large and there was a separate dining area. Each person had a large single room and an en-suite toilet and shower. The laundry facilities were separate from food preparation areas. People lived in a homely, comfortable, clean and hygienic environment. People were supported by an effective staff team, who were appropriately trained, qualified and competent to meet people`s needs. There were usually enough staff to meet people`s needs. People were protected by the home`s recruitment practices. The manager had been approved as a fit person to manage the home and people were benefiting from a well run home. There was a quality assurance system and people`s views were collected using questionnaires. People`s views underpinned all selfmonitoring, review and development by the home. There were health and safety systems and measures so that people`s health, safety and welfare were promoted and protected. What has improved since the last inspection? We made several requirements and recommendations at the last inspection and most of these had been addressed. The statement of purpose had been updated with the name of the organisation that provides the service so that people had the right information about the service. One person`s risk assessment for public transport now specified the amount of staff support needed to make sure they were kept safe. Each person had a missing person`s information sheet with a photograph so that this information was readily to hand to pass on to the police should anyone go missing. The practice of putting medication out for a person to take later had stopped. People were having their medication directly from the original container to make sure that they received the correct dose. People had been provided with bath mats for their en-suite showers so that they did not slip on wet floors and were kept safe. Soap and paper towels had been provided in the laundry to reduce the risk of infection. A full employment history with a written explanation of any gaps was being obtained for new staff to help to make sure that people were not supported by unsuitable staff. The managers and staff were receiving training about the Mental Capacity Act and Deprivation of Liberty Safeguards so that they were aware of what these would mean for people. Records were being kept of unannounced visits to the service by senior managers to help to monitor the quality of the service. Action had been taken to reduce the temperature of the fridge so that people were not put at risk of infection. Action had also been taken to reduce the temperature of the hot water to hand basins and baths to reduce the risk of people being scalded. What the care home could do better: Each person must be given a statement about the fees they have to pay and the method of payment so that they know what they have to pay for. The risk assessments should be reviewed regularly to make sure that they continue to reflect people`s needs. A cupboard should be installed which meets the current storage regulations, (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007), so that any controlled drugs prescribed can be stored safely. Any handwritten additions to the medication record sheets should be signed by two members of staff, one to make the addition and one to witness that the entry is correct. This will help to make sure that the correct information is transferred to the record and people get the right medication. The staffing levels should be reviewed to make sure that there are sufficient staff to meet people`s needs at all times. Key inspection report Care homes for adults (18-65 years) Name: Address: Fieldview Pearcroft Road Stonehouse Gloucestershire GL10 2JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elaine Barber     Date: 1 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 31 Information about the care home Name of care home: Address: Fieldview Pearcroft Road Stonehouse Gloucestershire GL10 2JY 01453824591 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): stroudcarehomes@hotmail.com Stroud Care Services Limited Name of registered manager (if applicable) Mr David Donald Harley Ms Leigh Jones Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: Learning Disability (LD)7 Mental Disorder, excluding learning disability or dementia (MD) 7 Physical Disability (PD) 1 Date of last inspection Brief description of the care home Fieldview is a purpose built home for 7 adults with learning disabilities and/or associated mental illness. The home can also accommodate one person with a learning and physical disability. It is one of three homes owned and managed by Stroud Care Homes. The home is near to the village of Stonehouse and it is close to local amenities Care Homes for Adults (18-65 years) Page 4 of 31 7 7 1 Over 65 0 0 0 Brief description of the care home and transport systems. There is comfortable communal accommodation and large gardens around the home. All bedrooms have en suites and there is an additional bath and shower room. The home has under floor central heating. Fee levels range from 1133 pounds and 72 pence to 2029 pounds and 23 pence. Each person is given a copy of the Statement of Purpose and Service User Guide as they move into the home. Further copies are available in the office. The last inspection report is displayed in the hall and copies are available on our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home and by the staff. We had surveys back from five people who lived in the home and six staff members. We also received a survey from a health care professional. We looked at all the information that we had received about the home since the last inspection. This helped us to decide what we should focus on during our inspection. We visited the home on the 14th July 2009. We talked to the registered manager and the training officer. We looked at some of the agencys records and talked to two members of staff. We met with three people who lived in the home and asked them about their experience of living in the home. Care Homes for Adults (18-65 years) Page 6 of 31 The judgments contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 22nd July 2007. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? We made several requirements and recommendations at the last inspection and most of these had been addressed. The statement of purpose had been updated with the name of the organisation that provides the service so that people had the right information about the service. One persons risk assessment for public transport now specified the amount of staff support needed to make sure they were kept safe. Each person had a missing persons Care Homes for Adults (18-65 years) Page 8 of 31 information sheet with a photograph so that this information was readily to hand to pass on to the police should anyone go missing. The practice of putting medication out for a person to take later had stopped. People were having their medication directly from the original container to make sure that they received the correct dose. People had been provided with bath mats for their en-suite showers so that they did not slip on wet floors and were kept safe. Soap and paper towels had been provided in the laundry to reduce the risk of infection. A full employment history with a written explanation of any gaps was being obtained for new staff to help to make sure that people were not supported by unsuitable staff. The managers and staff were receiving training about the Mental Capacity Act and Deprivation of Liberty Safeguards so that they were aware of what these would mean for people. Records were being kept of unannounced visits to the service by senior managers to help to monitor the quality of the service. Action had been taken to reduce the temperature of the fridge so that people were not put at risk of infection. Action had also been taken to reduce the temperature of the hot water to hand basins and baths to reduce the risk of people being scalded. 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their representatives had the information that they needed to make an informed decision about whether the home was the right place for them. Peoples needs were assessed when they moved into the home so that their needs would be met. People did not have information about the fees so that they would not what had to pay for their care. Evidence: We looked at the statement of purpose and service user guide. We saw that these were detailed and contained all the required information. The service user guide was written in simple language and had pictures. There was information about the complaints procedure. The address for contacting the Care Quality Commission needs to be updated. We made a requirement at the last inspection that people wishing to use the service need access to current information in the Statement of Purpose and Service User Guide that includes the correct name of the organisation providing the service they receive. This had been updated and the name of Stroud Care Services had been included. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We looked at the files of three people. Their needs had been assessed when they moved in. Each person had a community care assessment and an assessment of needs by the home. One person had a psychology assessment. We made a requirment at the last inspection that people must be provided with a statement in respect of accommodation and personal care and the total cost to them. When we looked at the files we saw that each person ahd a copy of the service user guide and the terms and conditions but this did not include the amount that they had to pay. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons assessed needs were reflected in care and support plans and these were reviewed and changed as necessary so that their needs would be met. People were assisted to make decisions about their lives and any restrictions were in their best interests. People were supported to take risks to promote their independence. Evidence: The manager told us in the AQAA that one of the things they did well was specific care planning involving the people who used the service, health care professionals and families whose input may be required. We looked at three personal files. We saw that each person had a daily routine which included information about the support needed at different times of the day. Each person also had an essential lifestyle plan and separate care plans for particular needs, for example, working towards independence, preparing an evening meal and managing finances. These were reviewed and progress was recorded. During our visit we saw people making decisions about what to do during the day for Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: example where to spend their time. We saw people helping themselves to drinks. The manager told us in the AQAA that the home supported people to make informed and safe choices. We read in the files about how people made decisions and were working towards independence. Three people told us in the surveys that they always made decisions about what they did each day, one person said that they usually made decisions and one said that they sometimes did. Two people said that they could do what they wanted during the day, the evening and the weekend, two said that they could not do what they wanted at these times and one did not answer that question. We made a requirement at the last inspection that any restrictions to peoples freedom of movement or choice must be discussed with them and their placing authority, with reviews as changes occur to the reasons for these restrictions. Consideration must be given to the impact of the Mental Capacity Act on such restrictions. We had commented on the practice of locking the kitchen at night and said that this should be reviewed. The manager told us that this had been discussed in managers meetings and it was decided that it would not be safe for some people to have access to the kitchen unsupervised. They said that the people who could access the kitchen safely were looking to move to a setting where they could be more independent. We saw that there was information about the Mental Capacity Act and Deprivation of Liberty Safeguards and how they related to the support people needed. We saw that there was also information in the care plans about the reason for restrictions for some people. We also recommended that people should be able to have access to drink making facilities in their rooms if they so wish as long as there is not a risk to their safety. The manager told us that everyone had been offered a kettle in their room and only one person wanted one. This person had just bought a new kettle. We saw that each person had a series of risk assessments with action to be taken to reduce risks. These focused on promoting independence and keeping safe. They included for example, accessing the community independently, access to public transport and use of a kettle in the bedroom. There was no record that these had been reviewed but there was space to record progress. One person had a risk management plan agreed with social services. We made a recommendation at the last inspection that a risk assessment for a person using public transport should clearly state the level of staff support needed for this activity. We saw that this risk assessment clearly stated that the person could use public transport independently but if staff support was needed this would be offered. We also recommended that a missing persons information sheet with a photograph should be created for the two new people who moved to the home. We saw that each person had a missing persons Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: information sheet with a photograph. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had opportunities to be part of the community and to take part in appropriate day time and leisure activities. People maintained relationships with their family and friends. Peoples rights were respected and their responsibilities were recognised in their every day lives. People were offered a healthy diet and enjoyed their food. Evidence: The manager told us in AQAA that the home provided structured and chosen activities and enabled the people they supported to access a wide range of community activity. When we looked at the files we saw that each person had an activities programme. These showed that people had structured activities during the week including attending a day service and college. They also went shopping and participated in household chores. One person groomed horses on a farm. One person went to church on Sundays and they all had group activities at the weekend. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: We looked at the daily records of three people for the last month. One person wrote in their own records. We saw that people had opportunities to go out into the community. These included going to Stroud on the bus, going to church, going to Gloucester, out for lunch, dancing, bowling, shopping and swimming. There were also records of day trips, for example to Longleat. The records showed that people had a range of leisure activities. These included playing with a games console, watching TV and DVDs, playing board games, bowling, going to a car boot sale, going to the pub, arts and crafts, listening to music, golf and relaxing in the garden. We saw information in the records about how people kept in contact with their family and friends. People visited people in the other houses run by the organisation. It was clear from the care plans that people ere expected to contribute to the household chores and keep their rooms tidy. The activities programmes included the chores that people were involved in. Staff told us that people do their own laundry. The daily records showed that people participated in the routines of the home. When we looked at the daily records we saw that these included a record of the food that people had eaten at breakfast, lunch and tea. They showed that people were having a varied diet and were involved in preparing some of their own meals and shopping for food. During our visit we saw people preparing their own drinks on their return from their daytime activities. We asked people in their surveys what the home does well they said The food is nice, staff help me to eat a healthy diet, Food, and The food is very good. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received support in ways that they preferred. Peoples health care needs were being met. People were protected by the medication practices. Evidence: When we looked at the care records we saw that these contained information about how people liked to be supported and their preferred routines. Each person also had a health assessment. In their survey a health care professional said that the service always supports people to live the life they choose wherever possible The manager told us in the AQAA that each person had a health action plan. When we looked at the records of three people we found that each person had information about how their health care needs were to be met. The records showed that each person was registered with a GP. We saw that appointments with health care professionals were recorded with information about the outcome. People saw the GP, community nurse, psychologist, speech therapist, community psychiatric nurse, consultant psychiatrist, chiropodist, dentist and optician. Each person also had an annual health check. A healthcare professional who completed a survey told us that peoples social and healthcare needs were always properly monitored, reviewed and Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: met by the care service. There was a medication policy. Each person had a record in their personal file of all the medication that they took. Medication was stored in a locked cupboard. The manager said that no-one was taking controlled drugs. There were agreements with the GP about homely remedies that could be taken and protocols about how as required medicines should be given. A monitored dosage system was used. There were printed medication administration (MAR) sheets provided by the pharmacist. These were used to record medicines received into the home and administered to people. These were well maintained. We also saw that some handwritten additions had been made to the MAR sheets which were signed by two members of staff and dated. This meant that it was possible to cross reference them with instructions in the care plan. There were three handwritten additions which were dated but not double signed. Records were kept of the temperature of the cupboard to make sure medicines were stored at the correct temperature. One person managed their own medication and staff were checking that they had taken it. The healthcare professional who completed a survey said that staff always supported people to take their own medication or managed it correctly where this was not possible. We made a requirement at the last inspection that medication must be given directly to the person for whom it is prescribed from the original container. This is to ensure that people receive the correct dosage of medication. The manager told us that staff were no longer leaving medication out to be given later and this had been addressed. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints were taken seriously and their views were listened to and acted upon. People were protected from abuse, neglect and self harm. Evidence: We saw that there was a complaints procedure available in a folder in the lounge. This was available in large print. There was also a copy upstairs outside the bedrooms. The procedure showed how to make a complaint and who to speak to including how to contact the Commission for Social Care Inspection. This needs to be updated to include how to contact the Care Quality Commission. The manager told us that they were going to change this. There was a record of complaints, the investigation and the outcome. The manager told us in the AQAA that there had been two complaints in the last twelve months. Four people out of five who completed surveys said that they knew how to make a complaint and they knew who to speak to if they were not happy. The other did not answer these questions. Three people who completed surveys said that staff always listened and acted upon what they said and two said that they usually did. There was information about Gloucestershire Safeguarding Adults Procedure. This was in simple language and pictures. The training records showed that staff had received training about prevention of abuse. The manager told us in the AQAA that there had been no safeguarding issues in the last twelve months. Six staff who completed surveys said that they knew what to do if people had concerns about the home and Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: one did not answer that question. We have noted at previous inspections that staff are trained in Positive Behavioural Management by two managers qualified to do this training. This is accredited with BILD. When we looked at the training records we saw that staff were up to date with this training. Some people manage their finances independently. For those who need support risk assessments are in place. Financial records were examined and found to be satisfactory. Receipts were cross-referenced with debits and credits and balance checks conducted regularly. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a homely, comfortable, clean and hygienic environment suited to their needs. Evidence: Fieldview offers accommodation to a high standard, and it was purpose built a few years ago. Each person has a large single room with en suite facilities that include a shower. A bathroom is also provided on the first floor. Communal areas were clean at the time of the visits. The gardens around the home are well maintained. A maintenance person is employed for day-to-day repairs of the home. At the last inspection several people complained of problems with water from their shower leaking onto the floor of their en suite. An incident record indicated that one person had slipped as a result of this. We made a requirement that people must be able to have a shower safely and without the risk of harm. When we looked at the ensuites we saw no evidence of wet floors and people had been provided with bath mats. People who lived in the home shared responsibility with staff for keeping the home clean. Hazardous products were stored safely in the laundry and this was kept locked. Paper towels and liquid soap were available near communal hand washbasins. We Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: made a requirement at the last inspection that people using the laundry must have access to soap and paper hand towels to prevent the risk of infection. We saw that these had been provided. Four people who completed surveys said that the home is always fresh and clean, one said it was usually fresh and clean. One person said The home is always clean. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by an effective staff team, who were appropriately trained, qualified and competent to meet peoples needs. There were usually enough staff to meet peoples needs. People were protected by the homes recruitment practices. Evidence: We looked at the staff rota. There were three staff on duty during the day. There was one sleeping and one waking member of night staff. Four people said in their surveys that staff always treated them well and one said they sometimes did but made no comments to explain. One said one of the things that the home does well was Going out with staff 1:1. Two staff said in their surveys that there were always enough staff to meet individual needs of all the people who use the service, two said usually, one said sometimes, they said staffing issues are a big problem with not enough staff on occasions. and one did not answer that question but they commented I sometimes feel we are very pushed as staffing is sometimes an issue. We looked at the training records, talked to the training manager and looked at the training plan for the next few months. We saw that staff were offered training in food hygiene, first aid, health and safety, manual handling, medication, positive behaviour management, fire safety, safeguarding adults and equality and diversity. There was also training about mental health, report writing, care planning, learning disability and Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: communication, the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager told us in the AQAA that new staff had induction training using the Skills for Care Induction. Five staff said in their surveys that their induction covered everything they needed to know to do their job very well and one said it mostly covered everything they needed to know. Four staff said that they had training that was relevant to their role, helped them to understand individual needs, kept them up to date with new ways of working and gave them knowledge about health care and medication. Two did not answer that question. We made a recommendation at the last inspection that staff and managers need to be aware of the implications of the Mental Capacity Act. We saw that there was information for staff in the home about the Mental Capacity Act and Deprivation of Liberty Standards. The manager and a staff member told us that there had also been some training for staff about the Mental Capacity Act the previous week. Training about the Deprivation of Liberty Standards was planned for the following week. The manager told us in the AQAA that there were nine members of staff and seven of them had a National Vocational Qualification (NVQ) at Level 2 or above. When we looked at the training records we saw that two staff had NVQ level 3 and one was working towards NVQ level 3. The standard about recruitment was met at previous inspections. There was a recruitment procedure. There had been one new member of staff recruited since the last inspection. We saw their recruitment records which showed that the recruitment procedure was followed and all the required checks were made before they started work. We made a requirement at the last inspection that before staff are appointed a full employment history, with a written explanation of any gaps, must be in place to ensure that people are safeguarded from possible abuse. This had been addressed. The member of staff had completed an application form, which included an employment history and a written explanation of a gap in employment. There was a medical questionnaire. Two written references, a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults (POVA) check were obtained before they started work. Six staff confirmed in their surveys that they had received all the necessary checks before they started work. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were benefiting from a well run home. Peoples views underpinned all selfmonitoring, review and development by the home. Peoples health, safety and welfare were promoted and protected by the health and safety measures. Evidence: The manager told us that they had worked in the organisation for six years. They had NVQ level 3 and NVQ level 4 and the NVQ Assessors award. They were working towards the Leadership in the Management of Care Award. The manager also said that she had applied to become the registered manager for the service. Since the inspection the manager has been approved as a fit person to manage the service. There was a process for assessing the quality of the service. Questionnaires had been sent to the people who lived in the house every month to six weeks. An annual development plan had been produced based on the findings from the survey. We saw the development plan for 2008 and the manager told us that the plan for 2009 was at head office. The manager provided information about the quality of the service in the AQAA. It was clear and provided the information that we needed. It told us what the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: service does well, what has improved since the last inspection and what improvements they planned in the next twelve months. We made a requirement at the last inspection that in order to assess the quality of service being provided records must be kept of any unannounced visits by representatives of the provider to the home. We saw that records were being kept of these visits. Arrangements were in place for the training of staff in health and safety, moving and handling, fire safety, first aid and food hygiene. There was a gas safety certificate and a certificate to show that the electrical wiring had been checked. There was portable appliance testing and vehicle checks. The Environmental Health Officer visited in 2008 and awarded the home 4 stars. There were fire safety checks and fire instruction for staff to ensure that they knew how to keep people safe in the event of a fire. We made two requirements in relation to health and safety at the last inspection. The first, where the temperature of the fridge is outside safe parameters action must be taken to ensure that people are not put at risk of infection, had been addressed. We looked at the fridge temperatures and saw that these were occasionally too high. The manager said that staff adjusted the fridge when this happened and the records showed that the temperature taken after a high reading was reduced. The second requirement, action must be taken to adjust water outlets registering outside safe parameters (over 43 degrees C) to prevent people from being scalded, had also been addressed. The records of the water temperatures showed that they were mostly under 43 degrees centigrade. There had been a slight rises in the water temperature in the spare room one week but this had been adjusted and was at a normal temperature subsequent weeks. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 Each person must be given a 28/08/2009 statement about the fees they have to pay and the method of payment. So that they know what they have to pay for. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 20 The risk assessments should be reviewed regularly to make sure that they continue to reflect peoples needs. A cupboard should be installed which meets the current storage regulations, (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007), so that any controlled drugs prescribed can be stored safely. Any handwritten additions to the medication record sheets should be signed by two members of staff, one to make the addition and one to witness that the entry is correct. This is to make sure that the correct information is transferred to the record and people get the right medication. The staffing levels should be reviewed to make sure that there are sufficient staff to meet peoples needs at all times. Page 29 of 31 3 20 4 33 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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