Care Home: Forest Way

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What the care home does well Mrs Skinner, the manager, was able to demonstrate a good understanding of the requirements of the registered manager post and staff told us that they found her supportive and flexible. Mrs Skinner has high visibility in the home and has a sound understanding of the diverse, individualised and complex needs of the people who live at Forest Way and provides good leadership and direction. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individual`s needs and the service is tailored accordingly. The home have excellent communication tools in place which have been developed in order to ensure that people who live at the home are consulted and are involved with the services that are provided. Staff at the home are well-motivated and work well to ensure that people who live at Forest Way are treated with dignity and respect and that their rights to be treated as an individual with opinions and to promote their choices are upheld. Health Action Plans are very well written, detailed and provided good evidence that individuals who live at the home had been involved with their development. People are well supported with their medication and this is provided safely. People access a wide range of both primary and healthcare services as required, this is done in a timely manner. People are supported to access the community and to participate in leisure and social activities as outlined within their care plan, essential lifestyle documents and as part of a person centred planning process. What has improved since the last inspection? The registered person ensures that people who live at the home have access to the appropriate care and treatment as identified in their care plan. This ensures that when needs have been identified they are met effectively and promptly. The registered person and staff employed at the home ensure that medication is administered and handled safely. This is in particular relation to labeling of liquids with the date of opening and signing handwritten entries. This ensures that people are safeguarded from harm or possible error when administering medication. The registered person has ensured that all the people who live at Forest Way, as well as those who request it, have access to a copy of the complaints procedure. This is so that people or their representatives can express concerns or complaints. We further note that for individuals who live at the home this document has been produced in a format which best meets their communication need, an audio version has also been produced for those who have difficulty in reading. The registered person ensures that suitable adaptations, equipment and facilities are provided for people who are physically disabled. This ensures that when people are transferred this is done safely and without fear of injury. The registered person has ensured that at Forest Way there are safe systems are in place for moving and handling people, staff have been trained in specific areas pertaining to individual need. The home let us know about things that have happened since our last key inspection and they have shown that they have managed issues well. They work well with us and others and have shown us that their service continues to provide good outcomes for the people who use it. What the care home could do better: No requirements were made as part of this visit, some recommendations were made in order to improve and build upon the good practices which are already established within the home, these are; The home should ensure that the statement of purpose and the service user`s guide contain the correct contact details of the Care Quality Commission, this is in order that people have been provided with accurate, up to date information. The manager told us of the plans for each resident to have their medication stored in their own rooms, we advise that the home seek advice to ensure that medication is held securely. It is recommended that the home review and update their own internal audit record of staff training that has been completed in order that it fully reflects what has been achieved. An area to incorporate the date of completion should be added to quality assurance surveys in order to validate the date that these have been responded to. The Organisation should review its admission policy in order to ensure that the information contained within it is up to date and in line with current good practice. Key inspection report Care homes for adults (18-65 years) Name: Address: Forest Way Main Road Minsterworth Gloucestershire GL2 8JQ     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: Odette Coveney     Date: 2 5 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Forest Way Main Road Minsterworth Gloucestershire GL2 8JQ 01452750686 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ree.jefferies@brandontrust.org www.brandontrust.org The Brandon Trust Name of registered manager (if applicable) Mrs Kathryn Skinner Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Date of last inspection Brief description of the care home Forest Way provides care and support for up to five adults with profound learning and physical disabilities. The home is a detached property with large gardens. The home is owned by a Housing Association. All service users have single rooms and access to a comfortable lounge with dining area. Four of the bedrooms are on the ground floor. The home has a sensory room and the grounds outside are well maintained. The home is situated close to local amenities in the village of Minsterworth and on the main road to Gloucester and the Forest of Dean. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 5 0 7 0 1 2 0 0 9 Brief description of the care home The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. Prospective service users and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service Users Guide. Copies are kept in peoples rooms. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over six hours and was completed in one day, by two representatives of the Care Quality Commission.The manager was present during the inspection and she and the staff team fully participated in the process. Evidence was gained from a whole range of different sources, including:- Information provided by the manager in the Annual Quality Assurance Assessment questionnaire, completed prior to our visiting the service, directly speaking with people who live and work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at Forest Way. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? The registered person ensures that people who live at the home have access to the appropriate care and treatment as identified in their care plan. This ensures that when needs have been identified they are met effectively and promptly. The registered person and staff employed at the home ensure that medication is administered and handled safely. This is in particular relation to labeling of liquids with the date of opening and signing handwritten entries. This ensures that people are safeguarded from harm or possible error when administering medication. The registered person has ensured that all the people who live at Forest Way, as well as those who request it, have access to a copy of the complaints procedure. This is so that people or their representatives can express concerns or complaints. We further note that for individuals who live at the home this document has been produced in a format which best meets their communication need, an audio version has also been produced for those who have difficulty in reading. The registered person ensures that suitable adaptations, equipment and facilities are Care Homes for Adults (18-65 years) Page 7 of 32 provided for people who are physically disabled. This ensures that when people are transferred this is done safely and without fear of injury. The registered person has ensured that at Forest Way there are safe systems are in place for moving and handling people, staff have been trained in specific areas pertaining to individual need. The home let us know about things that have happened since our last key inspection and they have shown that they have managed issues well. They work well with us and others and have shown us that their service continues to provide good outcomes for the people who use it. 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 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Due to a well written statement of purpose and a service users guide, those who live at Forest Way, prospective residents or their families have all relevant information to make a decision about the nature of the home and whether their needs can be met there. People who live at the home have a contract which clearly outlines the written terms and conditions for the home, these have been produced in a format that has been tailored to the individual with careful consideration given to their communication needs. Evidence: Forest Way has a statement of purpose that is specific to the service and facilities that it provides to the four people who live at the home. It clearly sets out the objectives and philosophy of the service and is supported by a well written service users guide. The guide details what people who wish to move into the home can expect. The guide also gives information to people about the specialist services which they can access. Information is recorded within both the statement of purpose and the service users Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: guide in respect of the quality of the accommodation, qualifications and experience of staff, how to make a complaint and also a copy of the most recent Care Quality Commission inspection report. We saw within individuals care files that all people had been given copies of both of these documents, these had been produced in both multi media format and also with photographs and symbols that have taken into account the complex communication differences and differing mental capacity of the individuals who live at Forest Way. We did note that the statement of purpose and the service users guide give incorect contact details for the Care Quality Commission and these should be amended where required in order that people have accurate information. From examination of documents in place at the home we could see that admissions are not made to the home until a full needs assessment has been undertaken. For people who are self-funding and without a care management assessment, a skilled and experienced member of staff from the home always undertakes an assessment. There have been no admissions into the home since our last visit to the service, there are no immediate plans to fill the one vacancy at the home. The manager was able to tell us of the importance of ensuring that the home only admit people whom they are able to support fully with all aspects of their care, such as ensuring that peoples emotional and social needs can be met. The manager also spoke of the importance of ensuring that any new person coming into the home is compatible with those who already live there, considering a balance of individual needs and relationship compatibility with others who already live at the home. On a practical level, the manager also confirmed to us that as the only vacant room at the home is on the first floor (there is no passenger lift at Forest way) any-one considering to move into the home would have to be fairly mobile and be able to manage stairs safely. Within individuals care files we saw that each person had been given a contract, this is a statement of the terms and conditions of the placement. We saw that these documents had again been tailored to the communication needs of each person and had set out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. These terms and conditions were clear, jargon free, easy to understand and gave a very clear understanding of what people who live at the home can expect. The manager and staff team at the home actively promote opportunity for clarification. We saw that these terms and conditions are reviewed regularly. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Forest Way are well supported with their needs by staff at the home and also from other external agencies as required. Detailed, person centred care planning documentation is in place. These reflect the current and changing personal, social, emotional and health needs of individuals. Evidence: During this visit we reviewed the care and associated records for two of the people who live at the home, we also sampled the records for one other person. Care records were reviewed at this visit and it was found that the plans in place had been generated from a care management assessment. Within individuals files we saw that the home maintains well-written and detailed care plans and the associated strategies in order to support people. We saw that information recorded within the care plans covered areas such as the support required with personal care and healthcare, communication, accessing the community, and also the support required Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: for individuals during the night. The constant link throughout individuals care plans was the appropriate use of language, care plans had been structured in a professional way, yet do not lose the essential elements of care such as ensuring that individuals rights and choices are upheld and that people are treated with dignity, respect and the support they need, when they need it. The care plan is developed with, and owned by the person using the service. The records for each person at the home, including their health action plan, care plan, risk assessments, intimate care policies are based on a full and up to date holistic assessment.These are all in individuals rooms. Care plans seen by us were person centred and focused on individuals strengths and personal preferences. The plan incorporated essential lifestyle planning information with a personal support plan and had been written with the individual and, where possible, their representative, and included information that is important to them. These documents included information such as who and what is important to them, how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. We saw that care plans are all different and highly individualised and they include evidence that the service values improving outcomes for people using the service. Care plans are kept under daily review as part of the handover between staff for each shift and is also recorded within daily records completed by staff. At this visit we found that the manager and staff know individuals who live at the home well and they have recorded the preferred communication style of the individual, and use innovative methods that enable the person to fully participate. This includes communication toolkits, relationship circles, intensive interaction, objects of reference, photographs, visual timetables, drawing and symbols. During our last key visit to the service which was completed by us in January 2009 a requirement was set by us that the registered person must make sure that people have access to the appropriate care and treatment as identified in their care plans. This is to make sure that where needs are identified in care plans staff enable people to have these needs met. A review of peoples needs during this visit found no concerns, people are well supported, their needs are known and are met. This requirement has been met. The manager told us about community initiatives that people at the home are involved with, for example one of the residents is an active participant in advising the local community group about rights of disabled people and accessibility issues in order that these can be improved and acted upon. One of the people who lives at the home has been supported to attend the local Community Police Safety at home and in your Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Community awareness day. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their life style, and supported to engage with social and recreational activities which meet individuals expectations. Evidence: Within the AQAA completed by the home and sent to us prior to our visit, they had recorded; Clients are supported to participate in activities they enjoy whether they are social or educational. The home also told us that people are supported to maintain contact with family and friends. On the day of our visit people were supported by staff to attend local community groups and planned activities. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The staff at the home support people who live at the home to enjoy individual holidays and days out, in order to do this the home have allocated 1:1 time for residents, this is incorporated within the staff duty role for each person, we saw that staff work flexibly in order to facilitate this. Incorporated within individuals care plans we saw that the home had consulted with people and had recorded both planned and ad hoc activities that people are involved with, such as hydrotherapy, reflexology, aromatherapy, massage and music therapy. One of the residents at the home enjoys supporting the local rugby team and has a season ticket in order to attend the matches on a regular basis. The manager also told us of a community trampolining activity that some people at the home attended, however, due to the service not being provided as specified the outcomes achieved for people who attend are under review. The home has its own mini-bus in order to assist in transporting people to their activities, all of the people who live at the home also have membership of the community dial a ride transport. We did not review menu planning during this visit, it was not appropriate. All of the people who live at the home are fed by a tube. We saw that each person had clear instruction in place for this method of feeding. Protocols were well written and incorporated advice which had been obtained from the dietician. Staff have also completed training to ensure that they have the skills to support people with their food in a safe manner. During our visit we saw that people were treated respectfully and sensitively during their meal time. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Forest Way is registered with the Care Quality Commission to provide accommodation and personal care for up to five adults, male or female, who have a diagnosis of learning difficulties. At the time of our visit there were four people who live at the home and there are no planned admissions into the home, there have been no new admissions since our last visit to the service. All of those living at the home are registered with a general practitioner. There was a record of visits to the doctor and these were up to date and sufficiently detailed. We also saw evidence to confirm that individuals are well supported with their primary healthcare needs such as the dentist, chiropodist and optician. We saw that care plans have clear information about how people wish to be supported with their personal care and their health; The home also has in place additional Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: information that links into peoples care plans. These are called a health action plans. The plans seen by us informed the reader about the individual, their life experiences and set out in detail how all their current requirements and aspirations are to be met through positive individualised support. We saw that for one person the home had effectively used photographs to demonstrate physiotherapy exercises and the use of equipment that had been supplied for them in order to maintain their independence, this is evidence of good practice. We saw that the home has incorporated detailed information within individuals care plans in respect of their communication requirements, they have ensured that essential information has been recorded in order to best facilitate effective communication for the individual concerned. This included the use of body language, facial expressions and communication that is meaningful. The home had incorporated additional guidance for the speech and language therapist in order to further develop communication styles. To find out if medication practices in the home were safe, the practices and procedures for administration, and storage of medication were checked. Medication supplies are stored in a secure cupboard with limited access. The medication administration charts for those who live at the home were looked at. The administration charts were up to date, legible and in order. The staff had signed for medication administrated, or recorded the reasons for any omissions. All staff administering medication attend training to enable them to do this safely. During our last key visit to the service in January 2009 a requirement was made by us that the registered person must make sure that medication is administered and handled safely. This was in relation to labeling of liquids with the date of opening, signing handwritten entries and reviewing homely remedy records regularly.This requirement was made in order to safeguard people from harm or possible error when administering medication. At this visit we reviewed all areas covered by the previous requirement and no concerns were noted by us, practices are sound and records have been well maintained, this requirement has been met. The manager told us of the plans for each resident to have their medication stored in their own rooms, we advise that the home seek advice to ensure that medication is held securely. Within individuals health action plans we saw a special section entitled end of life book, within this the home had recorded individuals religion, information about their Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: next of kin and information about their last will and testament. The home had also spent time with people who live at the home and their relatives in order to find out and record; the people who are important to me, when I die where I wish my belongings to go. These documents had clear information about what people wanted for their own funeral service. This is a difficult subject, yet it was clear that this process had been done in a sensitive, timely way, providing reassurances to people that their wishes will be respected and carried out at the end of their life. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Forest Way can be assured that complaints will be taken seriously and acted upon. The Home also has sound systems in place, practices and procedures to protect those who live at the home from abuse. Evidence: Those who live at Forest Way are protected from the risk of harm or abuse by staff following Gloucestershire Councils safeguarding of vulnerable adults from abuse policies and the homes own robust adult protection policies. We saw within minutes of staff meetings and also within staff supervision notes that the manger had discussed with her team the importance of staff responsibility when it came to whistle blowing for staff if they had concerns that abusive or poor practices were in place at Forest Way, this had been done in a professional and proportionate manner. There was also evidence in the staff training records that staff attend training on the safeguarding of vulnerable adults from abuse, to help ensure that those who live at the home are protected. The manager has a clear understanding of her role and responsibility in line with the homes internal adult protection protocols. During our last visit to the service in January 2009 a requirement was set by us that the registered person must make sure that all people have access to a copy of the Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: complaints procedure. This was so that people or their representatives can express concerns or complaints. At this visit we saw that each person had been given a copy of the complaints procedure and how people can raise any areas of concern had been discussed, individually with them. The complaints procedure recorded the timescales in which complaints would be responded to and also informed people that they can make a complaint one-to-one with a staff member of their choice and/or can be helped to access local independent advocacy or independent communication support workers. At this visit we reviewed how the home deals with and respond to complaints that are raised, we saw that since our last visit to the service there have been no recorded complaints. We saw that the home had made a complaint on behalf of one of the individuals who live at the home in respect of the poor treatment they had received whilst they were in hospital, demonstrating a commitment from the home to ensure that people are treated equally and with dignity and respect, advocating well on the individuals behalf, this is to be commended. We saw surveys that had been completed by relatives of those who live at the home, visitors and professionals who support people who live at Forest Way. Surveys had been completed in October 2009, all people who responded knew of the homes procedure in which they could raise any issues of concern they may have. None were raised. A record of any issues of concern raised to the home is maintained at the home. The home has in place well written policies and procedures regarding any money being held at the home for the people who live there, records of individuals personal finances are maintained and any money held is done so safely. We sampled some records of money being held for people who live at the home against the cash being held, these corresponded, receipts were kept and all was accurate. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Forest Way provides a safe and comfortable environment for the people who live there. The home receives ongoing maintenance and is decorated and furnished to a satisfactory standard. Residents private rooms are comfortable and have been personalised in order to reflect individuals tastes. Evidence: Forest Way provides care and support for up to five adults with profound learning and physical disabilities. There are currently four people who live at the home.The home is a detached property with large gardens. The home is owned by a Housing Association. All of the people who live in Forest Way have single rooms and access to a comfortable lounge with dining area. Four of the bedrooms are on the ground floor. The home is situated close to local amenities in the village of Minsterworth and on the main road to Gloucester and the Forest of Dean. When you enter the home there is a small entrance hall, within this area we found a Community Map on the wall, this showed all of the local services and amenities that Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: people in the home access such as the doctors surgery, community groups and the local pub. Also within the entrance hall we found information for people about the services being provided at the home and within the local community. Available to people was also a copy of the homes statement of purpose and services users guide as well as a copy of the homes complaints procedure and a copy of the last inspection report completed by us in January 2009. There is a communal lounge/dining area and a quiet area that overlooks the garden, all were comfortable areas for residents use. The garden looked to be well tended. Furnishings within the home were of an acceptable standard. Staff at the home undertake domestic duties as part of their role, the home was seen by us to be clean, tidy and free from unpleasant odours during our visit. Since our last visit the home have invested in creating a white room. For this area the home have invested in new sensory equipment and lighting, making this a comfortable area in which people who live at the home can have their senses heightened, or if they prefer they can use this area in which to relax. During our last visit to the service in January 2009 a requirement was made by us that the registered person must make sure that suitable adaptations, equipment and facilities are provided for people who are physically disabled. This is to make sure that when people are transferred this is done safely and without fear of injury. At this visit we found that aids and equipment are provided to encourage maximum independence for people who live at the home; these are regularly reviewed and replaced to accommodate changing needs. Specialist advice is sought by the home to ensure effective use of equipment. Since our last visit to the service the home has installed ceiling hoists in all of the bedrooms in order that people can be moved safely. Within the home we saw that the home had in place specialist equipment, as needed for the people in its care, this included, access to the garden, ramps, rails, bathing and toileting aids and well as mobility, sensory and excellent communication aids. Information about these, pertaining to individual need, was well written within each individuals plan of care, with associated risk assessments in place where required. With the permission of those who live at Forest Way we were able to view individuals private rooms, all rooms were seen to be well decorated and reflected peoples personalities and interests. We saw that people had made their room homely with the use of posters, photographs of family and friends, sensory lighting and their own personal possessions. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Forest Way are cared for by a sufficient number of competent, trained staff. People are protected by safe recruitment practices. Evidence: At this visit the staff records for four staff members were fully reviewed and two staff members were spoken with as part of the inspection process. We have found that the manager/organisation operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of those who live at Forest Way. Written references, protection of vulnerable adults checks and criminal record bureau checks had been undertaken for staff prior to their commencement at work. Clearly defined job descriptions were seen in staff files, these recognised the importance of staff roles in supporting those who live at the home in order that they may achieve their goals as set out within their care plan. Staff complete a comprehensive induction and receive ongoing training in order to fully undertake their role effectively. Evidence of these were seen in staff records and this was confirmed to us by those staff we spoke to. The organisation, Brandon Trust, provides mandatory training with clear records of attendance and renewal dates to ensure staff knowledge remains current for the wellCare Homes for Adults (18-65 years) Page 24 of 32 Evidence: being of people who live at the home. Staff told us they had received update training and this was verified in the records inspected. We saw that staff have completed training in areas such as; intimate care support, first aid, health and safety, Mental Capacity Act Legislation, fire safety, peg feeding, pressure area care and food hygiene. This ensures that those living at the home are cared for by staff with current best practice knowledge and skills, for their safety and well-being. We reviewed the training audits within staff files and found that when we cross referenced this with training certificates and the organisational break down of what actual training staff had completed these did not tally. It is recommended that the home reviews and update its own internal audit record of staff training that has been completed in order that it fully reflects what has been achieved. When we spoke with staff they confirmed they had received training in all mandatory topics and also within some specialist areas. They demonstrated a good knowledge and understanding of these topics for the safety and well-being of people living at the home. Staff we spoke with told us of the high priority given to training by the management. All observed interactions between staff and those who live at the home were kind and thoughtful, demonstrating good rapport and understanding between them. We saw that staff meetings take place regularly at the home, appropariate agenda items are discussed such as how to improve the service, equality and diversity, assitive technology and health and safety. Staff told us that these meetings provide a useful forum in which to exchange ideas and make suggestions to improve the service, we were informed that people are encouraged and feel motivated as ideas are discussed and where it benefits those who live at the home they are acted upon. Supervision sessions take place on a monthly basis and staff find them helpful with a focus on improving outcomes for people using the service. Within supervision records we saw that staff personal development and equality and diversity issues are embedded within this process and is taken seriously at the home. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. We saw that staff have an annual appraisal of their performance and that this includes a review of individuals competency, communication skills, teamwork and leadership attributes. Within the AQAA we asked the service what it does in order to promote equality and diversity in all that they do, they told us; All staff have attended the Equality and Diversity Training day, new staff receive this training at induction, this is to ensure that the ethos of the home is positively incorporated into daily support plans. Where needed individuals have specific support plans eg: expressing sexuality/postural Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: drainage management. The home has an Equality and Diversity action plan which the staff team developed and signed up to which encourages and supports the team to work/function more effectively and integrating diversity in the team and workplace All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people living at Forest Way. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides clear leadership and guidance to staff to ensure those who live at Forest Way receive good quality, individualised, consistent care. Health and safety issues in the home are monitored and addressed in a timely way for the protection and safety of residents. Evidence: Throughout the visit Mrs Skinner demonstrated a commitment to the provision of good quality individualised care packages in the home. We observed many occasions when Mrs Skinner spent time with the residents, she was supporting and reassuring. Mrs Skinner has high visibility in the home and gives strong leadership and direction. She encourages openness and discussion and is regarded as someone who listens. During our last visit to the service in January 2009 a requirement was set by us that the registered person must make sure that feedback is obtained from people living in the home and their representatives about the quality of care being provided. This was to ensure that the quality assurance system takes into account the views of people Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: using the service. We saw that the home incorporates this within formal review meetings, regulation 26 monitoring visits that are completed on behalf of the registered provider, and reviews of the plan of care, staff supervision, staff annual appraisal of their performance and the overview of aspects of managing the service to ensure effective and positive outcomes for those who live at Forest Way. We saw that the home had sent out a quality assurance survey to professionals who support people who live at the home and visitors. These were not dated, the manager informed us that this was completed in October 2009. The surveys covered a broad range of relevant areas such as, staff arrangements, skills and qualities, whether people felt the needs of those who live at the home were being met, if people knew how to raise any issues of concern. We saw very positive feedback from those forms which had been returned. People indicated high levels of satisfaction in respect of the staff, manager and all felt that peoples needs within the home were being met. Additional comments from people included: Staff are extremely helpful and friendly, I am very happy with the care that my relative receives. A further requirement was made by us during our last visit to the service, this was that the registered person must notify us of any incidents affecting the wellbeing of people living in the home. This was to ensure that people are safeguarded from possible harm. At this visit we reviewed a number of documents at the home which relate to the care, welfare and safety of people who live at Forest Way, no concerns were found by us. It should also be noted that since our last visit to the service the manager has kept us informed in writing of incidents which have affected those who live at the home, notifications recieved by us have been well written and demonstrated the homes commitment in ensuring the wellbeing of people in its care. At our last visit to the service a requirement was made by us that the registered person must make sure that a safe system for moving and handling people is in place in the home. We reviewed this requirement at this visit, we found that all staff have received manual handling training and when we asked them about this they were clear about their role and the safety and welfare of people in their care, staff were knowledgeable about the equipment that they use to move people and we saw that staff have received specialist training in order that they know how to use ceiling hoists safely. We saw that each person living at the home have well written, sufficiently detailed manual handling risk assessments in place in order to guide staff and direct their practice, ensuring that those living at the home are moved correctly and in a safe manner. The fire logbook records showed fire alarm tests are being carried out. There are also Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: fire drills carried out on a regular basis to help protect the health and safety for those who live and work at the home. During this visit we found that there is strong evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. The AQAA contains excellent information that is fully supported by appropriate evidence, such as staff training, staff understanding and minutes of team meetings and residents care planning review processes. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to the people in the home. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and the service users guide give incorect contact details for the Care Quality Commission and these should be ammended where required in order that people have accurate information. The Organisation should review its admission policy in order to ensure that the information contained within it is up to date and in line with current good practice. The manager told us of the plans for each resident to have their medication stored in their own rooms, we advise that the home seeks advice to ensure that medication is held securely. The home should review and update its own internal audit record of staff training that has been completed in order that it fully reflects what has been achieved. An area to incorporate the date of completion should be added to quality assurance surveys in order to validate the date that these have been responded to. 2 3 3 20 4 32 5 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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