Care Home: Four Winds

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What the care home does well Four Winds provides a service that recognises the individuality of people who live there. Staff are able to provide support for people in a way that meets their complex needs. A person living in the home said, "I like it here. I am happy". The personal and healthcare needs of people living in the home are met and relevant healthcare professionals are consulted where appropriate. A healthcare professional who completed a survey said they, "Cope well with caring for the people they support". The home is well managed by a management team who understand their responsibilities and who are committed to ensuring that people who live there experience a good quality lifestyle that meets their needs and wishes. A member of staff who completed a survey said that what the home does well is, "Proper training, support, maintaining equality without discrimination, supervision". Visitors are made welcome and people are encouraged to maintain contact with families and friends. What has improved since the last inspection? The home has a robust Quality Assurance system in place that seeks the views of people using the service and uses the information they receive to develop and improve the service. There have been improvements to the environment as part of the home`s ongoing programme of maintenance, repairs and renewals, including redecoration and new flooring in the communal lounge and dining areas. CARE HOME ADULTS 18-65 Four Winds 32A Church Road Brightlingsea Essex CO7 0JF Lead Inspector Ray Finney Unannounced Inspection 2nd September 2008 09:00 Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Winds Address 32A Church Road Brightlingsea Essex CO7 0JF 01206 308176 01206 308961 fourwinds@consensussupport.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Care Mission 2000 Limited Miss Elizabeth Ikeolumwa El-Schaeddhaei Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 6 persons) 20th September 2007 Date of last inspection Brief Description of the Service: Four Winds is a residential care home providing long stay care for six adults with learning disabilities. The bungalow is situated in a residential area of Brightlingsea, close to shops, post office, G.P. surgery and the seafront. Accommodation is in single rooms, with en-suite wash hand basins and toilets. Shower and bathing facilities are found in the bathroom, a separate shower room and there is an additional separate toilet. There is a communal lounge and dining room where people can relax with a television and music centre. Both the kitchen and separate laundry/utility room are domestic in character. There are gardens to the rear of the bungalow mainly laid to lawn with fruit trees, flowers and bushes. There is also an enclosed patio area with garden seating that people can use when the weather is fine. The bungalow has off road parking at the front. The home charges between £1,717.75 and £3,082.45 a week for the service they provide. This information was given to us in September 2008. Additional items not covered by the fees include toiletries and personal items. Information about the home, including the Statement of Purpose and Service User Guide, can be obtained by contacting the manager. Inspection reports are available from the home and from the CSCI website www.csci.org.uk Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as food records, staff rotas, care plans and personnel files. An Annual Quality Assurance Assessment with information about the home was completed by the manager and sent to us before the inspection. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 2nd September 2008 and included a tour of the premises, discussions with some of the people living in the home, the manager and members of staff. Some of the people living there have complex needs and are unable to communicate verbally, although the inspector was able to have some communication based around facial expressions and gestures. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day of the inspection the atmosphere in the home was lively and people were seen to be busy. We were given every assistance from the manager, the deputy manager and the staff team. What the service does well: Four Winds provides a service that recognises the individuality of people who live there. Staff are able to provide support for people in a way that meets their complex needs. A person living in the home said, “I like it here. I am happy”. The personal and healthcare needs of people living in the home are met and relevant healthcare professionals are consulted where appropriate. A healthcare professional who completed a survey said they, “Cope well with caring for the people they support”. The home is well managed by a management team who understand their responsibilities and who are committed to ensuring that people who live there experience a good quality lifestyle that meets their needs and wishes. A member of staff who completed a survey said that what the home does well is, “Proper training, support, maintaining equality without discrimination, supervision”. Visitors are made welcome and people are encouraged to maintain contact with families and friends. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Through the comprehensive admission process, people choosing to live at Four Winds can be confident that their needs will be met. EVIDENCE: The home’s Statement of Purpose and Service User Guide were examined on the day of the inspection. The Service user Guide is written in clear language, using large print and has illustrations to assist people to understand what the service has to offer. The manager said that the Service User Guide is produced in two formats, “word and multimedia”, and is reviewed yearly to keep it up to date with any changes to the service. A person living there said, “I was informed by my mother and spoke to the social worker before they moved me in and I’m quite happy and enjoy it with the other clients”. The manager states in the AQAA, “All service users admitted to Four Winds, are admitted after a comprehensive referral process involving the service users, care managers, relatives (where possible), advocates, community nurses, transitional key workers”. A sample of records examined on the day on the inspection confirm that there is a comprehensive pre-admission assessment process in place. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 9 The assessment starts with a ‘pen picture’ giving background information, which is written from the individual’s point of view. Areas covered include health needs and medication, beliefs, health medication, safety and risk, communication, behaviour, communication, daily living skills, self care, relationships, sexual needs, community presence and participation, recreation and relaxation. The assessment is centred on the person’s individuality and includes information relating to what psychological support is required to address mental health needs and how the person manages their emotions. There are management strategies in place to help with this. One person’s assessment said, “I go to my room when I feel angry or upset” and another “When I am kept busy I feel like a valuable person”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Four Winds receive good quality care, which is based on their assessed and identified needs. EVIDENCE: The manager states in the AQAA, “All service users have extensive, comprehensive care plans in place. These contain support plans and risk assessments to ensure individuality and respect for choices and preferences”. On the day of the inspection a sample of three care plans was examined and they were seen to be written in a person centred way from the individual’s perspective. There is a range of individual care plans covering areas such as General Health and Wellbeing, Personal Care needs, Eyesight, Community Access and Daily Engagement, Finance, Use of Keys and Respecting Privacy, supporting people to maintain relationships, Faith, Dietary needs and Behaviour Management. Care plans identify what they are aiming for, what steps are necessary to achieve the aim and what is the expected outcome. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 11 Individual records are well organised and daily reports are completed. There are detailed strategies in place to guide staff and ensure people receive appropriate support, in particular in areas relating to behaviours that may be challenging. Care plans also contain sufficient detail to guide staff and enable them to provide care in the way people want and need. There is positive language used in the care plans and staff are guided to encourage people to self care where possible to maintain or improve independence. Care plans contain records of people’s likes and dislikes. We observed throughout the course of the inspection that people living in Four Winds were confidently making their needs and wishes known to management and staff. People living in the home have a wide range of communication skills, some have good verbal communication skills, others using facial expressions, gestures and taking staff by the hand to lead them to what they want. During the course of the inspection we observed good communication between members of staff and people living in the home. The manager and staff spoken with all demonstrated a good awareness of the range of support individuals living in the home need to make decisions and choices. Care plans contain evidence that advocacy services are involved for people who may need impartial support in making decisions. The manager states in the AQAA, “The service users have participated in the launch of the company and its policies and procedures. This was done in the form of an accessible day of presentations, activities and music etc. It also provided service users with the opportunity to express their ideas and aspirations”. The manager also said that they involve people in the process for recruiting new staff. “Our service users have been offered the opportunity to express their view on prospective applicants and have enjoyed the process of having their say in this matter”. She also said, “Consensus Support Services took over Four Winds approximately a year ago. They have since shown themselves to be committed to involving service users in all aspects of the company and have demonstrated this in several ways, i.e. specialist training for staff team, person-centred philosophy to empower service users etc”. Individual records examined contain evidence that risks are identified throughout the care plans and there are management strategies in place to minimise any identified risk. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Four Winds can expect to enjoy a lifestyle that meets their wishes and interests. EVIDENCE: The manager states in the AQAA, “The home is committed to respecting cultural and religious differences”. Records examined contain evidence that people’s cultural and spiritual needs are taken into account. One person’s file stated, “I do attend church with staff in Brightlingsea”. Each person living in the home has an individual activity planner illustrated with symbols to help people understand it more easily. These planners are in people’s personal files, displayed in the office for staff to refer to and also in people’s individual rooms. People spoken with were happy to talk about what they do including going to college for gardening, cooking and Arts and Crafts. Records examined for one person showed that they are applying to do some Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 13 voluntary work at a charity that provides furniture for people in need. One person spoken with said they like doing jigsaws and showed us the large jigsaw they were in the process of completing. The manager states in the AQAA, “Four Winds is committed to promoting and developing a high quality of life for all its service users. We are currently committed to facilitating our service users to take up opportunities in further education, vocational, literacy and numeracy training” and “Care and support plans demonstrate that service users have access and participate in further education as well as leisure activities available in our area”. Records examined also contain evidence that people are involved in using facilities in the local community and go shopping, swimming, and out for trips in the minibus. One person’s care plan contained an Occupational Therapy assessment report where the Occupational Therapist observed the individual going out independently in the local community, crossing the road and accessing the library. One person who completed a survey said, “Staff support me about what I would like to do” and another, “I like going out”. Staff spoken with said that they support people to keep in touch with their families and care plans examined contained evidence of input from relatives. On the day of the inspection one person was out buying new clothes for an approaching weekend visit to the family home for a celebration. Another person spoken with also said they visit their family. Records of the home’s own Quality Assurance surveys show that relatives feel they are made welcome. Relatives who completed surveys for us at the Commission also confirmed that one of the things the home does well is help people living there keep in touch with their relatives. One person said they were, “Very well kept in touch” and another “Especially Christmas times and birthdays”. One person who lives in the home who completed a survey said, “Sometimes if I want to talk to my [relative] I ask the staff to phone [them]”. People living in Four Winds are encouraged to take part in daily routines such as shopping and cooking to the best of their abilities and this is documented in their care plans. One person who completed a survey said, “I myself help to do some domestic tasks every morning such as hoovering”. The manager explained that the providers, Consensus, hold a forum every other month called ‘Your Voice’ where people using the services can make their opinions known. Two people living in Four Winds attend this forum with their keyworkers as representatives of the home. Records examined show that the home also has monthly Service User meetings. The manager states in the AQAA, “The home is constantly striving to improve diversity of choice”. Records examined confirm that there is a wide range of food available. On a tour of the premises, food stocks were seen to be plentiful and included fresh Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 14 fruit and vegetables. The manager said that food is very important to the people living in Four Winds. People spoken with said they like the food and they were observed to be enjoying their lunch on the day of the inspection. The manager states in the AQAA, “Menus at the home provide a range of meals that reflect choice and a dietary need. We keep records of all meals eaten at Four Winds and demonstrate the choices offered”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect their personal and healthcare needs to be identified and provided with the support to ensure these needs are met as they would wish. EVIDENCE: Care plans examined contained sufficient detail to ensure people receive the support they need in ways that they wish and there are clear guidelines for staff about how people want their personal care carried out. Through discussions with the management team it is apparent that they have a good awareness of people’s individual needs. Throughout the day of the inspection staff were observed to treat people with respect. The manager states in the AQAA, “All Support plans ensure that personal care is delivered in a sensitive way, designed to meet the individual needs of the service user” and “Both the management and staff are resolutely committed to delivering this care in a sensitive way which maximises service users privacy, dignity and self respect”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 16 A healthcare professional who completed a survey said, “As far as I am aware privacy and dignity is respected”. Information about people’s individual medical and healthcare needs were well documented in the sample of records examined. The manager and senior staff spoken with were able to demonstrate an in depth knowledge and understanding of people’s needs in relation to health. There was ample evidence in people’s personal records of input from a range of healthcare professionals, including occupational therapist, optician, ophthalmologist, clinical nurse specialist and G.P. There is also evidence of input from the consultant psychiatrist around behaviour. Records examined also contain evidence of a range of charts for recording health related areas including weight. The manager states in the AQAA, “To promote health, we ensure are service users have dental screening, appointments, psychiatry, behavioural and medication reviews, blood tests, and other health specific reviews related to individual service users. All service users have their Health Action Plans recorded on file”. A healthcare professional who completed a survey said, “I only have involvement with one service user at Four Winds. As far as I can ascertain [their] needs are met by the service in liaison with other health professionals/services as needed”. On the day of the inspection medication records and storage were examined. Medicine Administration Record (MAR) sheets were completed appropriately. The cupboard used for storing medication was secure and large enough to accommodate all the prescribed medication. The management team were able to demonstrate an awareness of their responsibilities around appropriate storage and recording of controlled drugs. There were no controlled drugs in use at the time of the inspection. Consideration should be given to how medication storage could be improved, in particular the provision of an appropriate facility for the storage of controlled drugs so that they meet the requirements of recent changes to legislation. This would ensure that there is appropriate storage available should anyone be prescribed medication that requires this level of secure storage. A healthcare professional who completed a survey said, “The individual I support is unable to manage [their] own medication but appears to be supported appropriately”. They also commented that, “Not a lot of PRN medication [medication that is prescribed on an ‘as required’ basis] is administered to help control/manage behaviour and I would generally view this as a positive thing”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.. People who use the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. EVIDENCE: As at the last inspection, Four Winds operates a robust procedure for dealing with complaints and records them appropriately. The manager states in the AQAA, “The home provides its complaints procedure in two formats (words and multimedia)” and “When a complaint is received, Four Winds has historically responded quickly, reporting through the correct channels and in an open and honest manner”. The manager and deputy manager both were able to demonstrate an awareness of the importance of dealing with complaints promptly and appropriately. There have been no formal complaints since the last inspection. A visiting healthcare professional stated, “I haven’t observed or noted any concerns”. Through discussion with the manager she demonstrated that minor concerns are always taken seriously and dealt with through the home’s Quality Assurance process. People who sent completed surveys to us at the Commission were positive about the way concerns and complaints are dealt with. A relative stated, “They are very caring and listen to any concerns (however small) I may have” and someone living in the home, when asked if they knew what they should do if they had any complaints, said, “I complain to the staff, the deputy or the Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 18 manager”. Another person said, “I speak to my keyworker about whatever I wish to do or if I have some problems”. Staff spoken with on the day of the inspection understood their responsibilities around safeguarding people (previously called Protection of Vulnerable Adults or POVA). Personnel records contain evidence that all staff undergo Criminal Record Bureau (CRB) checks before commencing employment in the home and staff have received safeguarding training. In the past an issue that came to the attention of the management team was dealt with promptly and appropriately through the local authority safeguarding procedures. The manager states in the AQAA, “The home continues to have a good working relationship with the local Adult Protection team and has often received support and advice”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is homely, well maintained and clean. EVIDENCE: The manager states in the AQAA, “Four Winds makes every effort to ensure that the environment remains clean, tidy and safe and encourages the residents to play an active part in this. In addition, the management team have highlighted areas for refurbishment in their business plan for the home”. A tour of the premises confirmed that bedrooms are decorated individually to the taste of the person using the room. Four people living in the home were pleased to show us their rooms but one person chose to close the door, as they did not want to be disturbed. One person was pleased to show us their en suite facilities that had been decorated in a vibrant, warm Mediterranean colour of their choice. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 20 The majority of rooms contain ample evidence of people’s individual, personal possessions such as pictures, photos, ornaments, music equipment, CDs and DVDs. A few rooms have less because some people are less tolerant of changes in their environment or dislike having things put on the walls. Since the last inspection there have been some improvements to the environment. The manager states in the AQAA, “The lounge and dining room area have been redecorated with new carpets and laminated flooring. The bathroom and kitchen fittings too have been refurbished. All lounge furniture and bedroom furniture have been delivered as planned”. Throughout the home the standard of cleanliness is good and there are no unpleasant odours. The laundry is small but contains equipment and facilities that are appropriate for the size of the home. There are hand washing facilities in toilets with liquid soap and paper towels to minimise the potential for cross infection. A maintenance person is employed on a part time basis and overall the maintenance of the fixtures and fittings throughout the home is good. However, one of the taps in the toilet area was observed to be taped up, which does not promote good infection control. The manager explains in the AQAA, “Currently the home receives regular maintenance support to rectify minor issues as they arise. However, due to the challenging nature of the client group, this is often difficult to keep up with”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Four Winds are cared for by a competent, well trained staff team who can meet their needs and have been employed following thorough recruitment checks to ensure people living at the home are protected. EVIDENCE: Staff are enthusiastic about completing National Vocational Qualifications (NVQ) and the manager is committed to supporting them to gain the award. Information provided in the AQAA indicates that, out of a staff team of 13 carers, 7 people have completed an NVQ at level 2 or above and a further 5 are working towards the award. The numbers of staff already holding the award meet the minimum of 50 of carers with NVQ as recommended in the National Minimum Standards. The manager holds the NVQ ‘A1’ Assessors qualification, which means she is able to support staff who are working on their NVQ. Personnel records examined confirmed that staff have completed the award. On the day of the inspection staffing levels were seen to be appropriate and people’s needs were being attended to promptly. People living in the home Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 22 were complimentary about the staff team. One person said, “They work very hard” and another, “They are very caring”. A relative who completed a survey commented, “The staff at Four Winds are excellent”. As at last inspection the home operates an appropriate recruitment process. A sample of three personnel files examined contained all the documentation required by regulations, including two written references, relevant proofs of identity and completed application forms with no unexplained gaps in employment. Criminal Record Bureau (CRB) enhanced disclosures and Protection of Vulnerable Adults checks are carried out to help safeguard people living in the home by ensuring that anyone who is prohibited from working with vulnerable people is not employed. There is evidence in personnel records examined of a range of staff training relevant to the roles they are carrying out. This includes Foundation Health and Safety, Conflict Management, Introduction to Epilepsy, Medication, Moving and Handling, Infection Control, Food Safety and First Aid. There is also evidence that staff have received training around safeguarding (previously referred to as Protection of Vulnerable Adults or POVA). Staff have received appropriate training to enable them to recognise signs of abuse and ensure they are aware of their responsibilities to report and act on evidence of abuse. The manager states in the AQAA, “Staff training and supervision and development has been thorough and consistent in the last year”. Staff spoken with were complimentary about the training and a completed survey received from a member of staff stated that what the home does well is, “Proper training, support [and] supervision”. Records examined confirmed that the home has a supervision process in place that meets National Minimum Standards and staff have regular supervisions and appraisals. Monthly staff meetings are held and the minutes of these were examined. The manager states in the AQAA, “The management team intend to continue to maintain the current rate of staff supervision to ensure that retention of quality staff remains high”. Staff spoken with said that they feel well supported by the management team. A survey received from a member of staff stated, “We meet monthly for our supervision session”. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of people living there. EVIDENCE: As previously reported the registered manager runs both Four Winds and another home owned by the providers, Consensus Support Services Limited. The manager is experienced and competent to manage both services effectively and professionally. The Registered Manager is qualified to NVQ Level 4 in Care and has completed the Registered Managers Award (RMA). As documented previously in this report, she also holds the NVQ A1 Assessors qualification. Four Winds also has a deputy manager who deals with the day to day running of the home in the absence of the registered manager. Through discussions the manager and the deputy manager were both able to demonstrate a good Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 24 awareness of their responsibilities and it was evident that they work well together as a team and their skills complement one another. Record keeping is maintained to a high standard. Staff surveys document that staff feel well supported. The manager completed the Annual Quality Assurance Assessment (AQAA) document promptly when we asked for it. The AQAA contained comprehensive and detailed information about the service that has been confirmed to be accurate at this the unannounced Key Inspection of the service. On the day of the inspection we discussed the home’s Quality Assurance system with the manager, who was able to demonstrate a good awareness of how they seek the views of people living in the home and their representatives. Four Winds has a robust process in place for seeking the views of people using the service and the evidence is recorded in the home’s Quality Assurance file. Quality Assurance records contain completed surveys from relatives, staff and health and social care professionals. Comments from members of staff include, “The manager is always very professional and helpful” and “I like the management because they are very supportive”. Relatives said they are, “made to feel welcome” and “the staff do a good job”. Surveys for people living in the home are in a format that uses graphics and are written using clear language. A internal auditor from Consensus visited the home to undertake a Quality Monitoring audit and the local authority also carried out a quality monitoring visit to the home. The management team has collated the information received from the range of sources used to seek opinions and identified the service’s strengths as well as areas for development. An action plan has been produced and areas for development are reflected in the home’s five year plan. Records examined contain evidence of other ways in which people are consulted including minutes of meetings and reviews. Similarly staff are able to give their opinions through regular staff meetings. Ample evidence was presented to confirm that the management team actively seek the views of people living in the home and their representatives and act on the information that they receive. As at the last inspection, up to date policies relating to health and safety are in place. The manager states in the AQAA, “The management of the home conducts health and safery checks in and outside the home, responds to concerns, hazards, accidents, incidents coming from the home”. A sample of records relating to health and safety and maintenance of the home were examined and all were found to be in order. Staff training and development files contain evidence of health and safety training in safe working practices. Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (4) (a) (c) Requirement An appropriate facility for the storage of controlled drugs must be available in the event someone in the home may be prescribed medication that requires this type of secure storage. Timescale for action 31/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Four Winds DS0000017821.V371045.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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