Care Home: Gorse Hill

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What the care home does well Current and prospective residents were provided with appropriate written information, which ensured the residents were aware of the services and facilities available in the home. Before moving into the home the residents` needs were thoroughly assessed and discussed with the person. This enabled the registered manager and prospective residents to determine whether or not their needs could be met within the home. Following the assessment, detailed transitions plans were drawn up to make sure the new resident felt comfortable and assured about their move into the home. All residents had a support plan based on their assessment of needs. The residents were supported to participate in the review and development of their plans. This meant the staff were aware of the resident`s needs and preferences. The plans were supported by thorough risk assessments and where necessary crisis management strategies, which meant that the staff had good information about how to manage and respond to any areas of identified risk. The daily routines were flexible and designed to meet the needs and wishes of the residents. This meant the residents were able to choose their preferred lifestyle and their individual preferences were recognised. The residents spoken to felt they were well cared for and the staff treated them with respect. The expert by experience noted that, all the residents liked living in the home and "They thought it was a friendly place to live and most of the time got on with the other people they lived with". The residents were provided with spacious comfortable bedrooms with their own ensuite bathroom. The residents could personalise their rooms according to their own tastes and preferences. This meant that the residents felt comfortable in their personal space. The residents had access to a clear complaints procedure and there were established ways of consulting the people living in the home. This made sure the registered manager and staff were aware and could respond to any concerns. A good percentage of staff had achieved NVQ (National Vocational Qualifications) level 2 or above. This meant the staff had the necessary qualifications to carry out their role effectively. The registered manager had developed ways of monitoring the quality of the service, which included ongoing consultation with the residents and staff. This meant that the service was run in the best interests of people living in the home. The expert by experience wrote the following about his impression of the home, "My overall view of the house was that the people who lived there were happy". What has improved since the last inspection? Since the last inspection, the registered manager had arranged "Getting to Know You" meetings. These meetings were held before a new resident moved into the home, toensure that staff had the opportunity to learn more about the person`s needs and preferences. This meant when the resident moved into the home the staff were familiar with the resident`s individual requirements. Residents` meetings had been held on a more frequent basis. This meant that the residents were given more opportunities to discuss life in the home and highlight any concerns. The medication records had improved and procedures had been drawn up to provide staff with specific guidance about how to administer medication prescribed "as necessary". This meant the potential for error when handling medication had been minimised. A number of improvements had been made to the premises, to aid the comfort and independence of the residents. As such, several areas had been redecorated, one bedroom had been refurbished and a new cooker had been purchased for the kitchen. Training courses for staff were offered on a designated computer, which meant that the training was much more accessible to staff and they could complete their training at a convenient time. What the care home could do better: There were no legal requirements made during the inspection. This meant the home was providing a safe service with good outcomes for the residents. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gorse Hill 2 Stephenson Drive Burnley Lancashire BB12 8AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Gorse Hill 2 Stephenson Drive Burnley Lancashire BB12 8AJ 01282438916 01282831457 gorsehill-voyage@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Voyage Ltd Name of registered manager (if applicable) Mrs Catherine Veronica Plaskowski Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 Date of last inspection Brief description of the care home Gorse Hill is registered with the Commission for Social Care Inspection as a care home for adults (aged 18 -65) with learning disabilities. The home provides accommodation for up to 10 people of both sexes. The rooms are all single occupancy and there are small flats available which provide the opportunity for more independent living. These flats contain a sleeping area, sitting area, bath/shower room and kitchen. The communal areas of the home include a large sitting dining area, a smaller lounge, a quiet lounge, a kitchen, and a crafts room. The home is surrounded by gardens and has a patio/ barbeque area with a large water feature. Gorse Hill is situated on the Burnley to Padiham Road with nearby bus stops to both towns. There are a variety of Care Homes for Adults (18-65 years) Page 4 of 31 10 Over 65 0 care home 10 Brief description of the care home shops and other amenities nearby. A local park is within easy walking distance. There is a minibus available for trips to shops and supermarkets and other less easily accessible amenities. At the time of the inspection the scale of fees ranged from £984.20 to £2281.00 per week. The home has a statement of purpose and service users guide, which informs the current and prospective residents about the services and facilities available at the home. Previous inspection reports can be viewed in the home or obtained from the Commissions website at www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home, was conducted at Gorse Hill on 28th January 2009. The inspection was carried out by an inspector and an expert by experience. An expert by experience is a person who has a personal understanding or experience of services and has received training in taking part and contributing to the inspection process. The expert wrote an account of his visit to the home and his observations are included throughout the inspection report. Whilst the inspector wrote the report, it refers to We as it was written on behalf of the Commission. We last inspected this service on 23rd January 2007 and an annual service review, which did not include a visit to the home was carried out on 31st December 2007. Care Homes for Adults (18-65 years) Page 6 of 31 At the time of the visit there were 9 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the registered manager. We also consulted our records about the service. As part of the inspection process we used case tracking as a means of gathering information. This is a way of inspecting which allows us to focus on a small group of residents living at the home, to assess the quality of the service provided. Before to the inspection, the registered manager completed an Annual Quality Assurance Assessment known as AQAA. This is a detailed self assessment questionnaire covering all aspects of the operation and management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and the residents. Four questionnaires were returned from the staff and seven questionnaires were received from the residents. The responses from the questionnaires were collated and used throughout the inspection process. What the care home does well: What has improved since the last inspection? Since the last inspection, the registered manager had arranged Getting to Know You meetings. These meetings were held before a new resident moved into the home, to Care Homes for Adults (18-65 years) Page 8 of 31 ensure that staff had the opportunity to learn more about the persons needs and preferences. This meant when the resident moved into the home the staff were familiar with the residents individual requirements. Residents meetings had been held on a more frequent basis. This meant that the residents were given more opportunities to discuss life in the home and highlight any concerns. The medication records had improved and procedures had been drawn up to provide staff with specific guidance about how to administer medication prescribed as necessary. This meant the potential for error when handling medication had been minimised. A number of improvements had been made to the premises, to aid the comfort and independence of the residents. As such, several areas had been redecorated, one bedroom had been refurbished and a new cooker had been purchased for the kitchen. Training courses for staff were offered on a designated computer, which meant that the training was much more accessible to staff and they could complete their training at a convenient time. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents thinking about moving into the home received detailed information to help them make a decision and staff were given wide ranging information to understand the residents needs and personal aspirations. Evidence: Written information was available for the residents in the form of a statement of purpose and service users guide, which were specific to the resident group. Both documents met regulatory requirements and had been updated in June 2008 to reflect the change in Responsible Individual. The residents had been issued with a copy of the service user guide and the statement of purpose was displayed in the hallway. The guide was presented in an easy read format and had been explained to all the residents on admission. One resident spoken to said the guide was useful and interesting. The previous inspection report was available for the residents to look at in the hallway. This meant that the residents were provided with up to date information about the services and facilities available in the home. Resources were available to produce information in different formats to meet the needs of the residents. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Three residents had moved into the home since the last inspection. Two of the residents files were looked at in detail as part of the case tracking process. From this we could see that the residents needs had been thoroughly assessed and information had been gathered from a variety of sources including other relevant professionals and the residents family. The pre admission assessment was carried out at a convenient time and place for the prospective resident, to ensure they had the time and opportunity to participate in the assessment process. The assessment focused on all areas of the residents needs and considered individual requirements in respect of social and cultural needs. This meant that staff had access to detailed information about the residents needs, preferences and aspirations. Following the assessment, transitional plans were drawn up with the prospective resident, to enable them to visit the home to meet the other residents and staff and sample life in the home. This ensured that wherever circumstances allowed, significant time and effort was spent planning the admission to ensure the prospective resident was comfortable and assured about their move into the home. The plans were reviewed at regular intervals to ensure the needs and wishes of the resident were accounted for and the resident felt comfortable in their new surroundings. Since the last inspection, the registered manager had facilitated Getting to Know You meetings with the staff. This ensured that staff were familiar with the residents needs and preferred lifestyle before they moved into the home. The documentation from these meetings was seen on the residents personal files and were available for staff to consult at any time. The registered manager could therefore be confident that the staff had the necessary skills and knowledge to meet the assessed needs of prospective residents. All residents were issued with a detailed contract with the Company. This gave clear information about the fees and any extra charges. The contracts had been explained to each resident to ensure they fully understood their rights and obligations. Following admission the residents were offered a settling in period of three months, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents individual needs were fully addressed and the residents were well supported to enable them make their own decisions and participate in life in the home. Evidence: The case tracking process demonstrated that each resident had an individual support plan, which reflected their health and welfare needs. The plans were very detailed, with each area of need split into short and long term objectives with guidance for staff on how best the resident could be supported to achieve their goals. Each section was supported by risk assessments and where appropriate crisis management strategies. The latter were designed to provide a consistent approach to behaviours which challenged others and the service. The strategies focused on positive outcomes for the residents as well as keeping them and others safe. One resident said, The staff are always there no matter what and they just know when I dont feel myself. The plans were person centred to ensure the residents fully participated in the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: development and review of their plans. The plans were written in plain language and looked at all areas of the residents life. The staff maintained daily records of care and support, which provided information about changing needs and any recurring difficulties. The records were detailed and the residents needs were described in respectful and sensitive terms. A key worker system allowed staff to work on a one to one basis with the residents and supported the residents to make ongoing contributions to the development of their plans. The support plans were reviewed at six monthly intervals or more frequently in the event of changing needs. The residents fully participated in their reviews, which also involved professional staff where necessary. Two residents spoken to confirmed they had attended review meetings and had found the meetings worthwhile. Each section of the support plan included a risk assessment to help support the residents take responsible risks and lead the life they wanted. The risk assessments were supported by risk management strategies or control measures which provided the staff with guidance on how best to manage and respond to particular risks. This meant risks were managed in a consistent and safe manner. During conversations with the residents, it was evident that they were consulted both formally and informally about life in the home. This was achieved by way of residents meetings, daily conversations and satisfaction questionnaires. Since the last inspection, the residents meetings had been held on a more frequent basis. This meant the residents had increased opportunity to formally express their views about life in the home. At the time of our visit, an agenda had been posted on the wall in the dining room for the residents to contribute topics for the meeting. Policies and procedures were in place to support the residents with their financial affairs. Stringent audit checks were carried out by the senior staff at the start and end of each shift and records were made of all financial transactions. A random check of money deposited in the home for safe keeping corresponded accurately with the records. This meant that the residents finances were fully accounted for and safeguarded. Further to this, the expert by experience noted that the residents could use their money to buy things of their choice. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were able to make informed choices about their lifestyle and were well supported to develop their skills. Evidence: The individual plans and care records demonstrated that the residents had opportunities to maintain and develop practical life skills. As such, residents were supported and encouraged to identify their personal goals and work to achieve them. During the inspection, two residents spoke about the support they received to prepare and cook food and another person talked about the assistance she was given to arrange a volunteer role with local organisation. The residents were involved in a variety of activities, which were arranged in accordance with their individual interests, needs and capabilities. Wherever possible Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: and appropriate the residents participated in community based events and accessed facilities within the local town for example leisure centres, bowling, restaurants, pubs and shops. The residents were fully involved in planning their lifestyle and some people had chosen to devise an activity plan, which gave structure and variety to their daily lives. Support was also given to the residents who wished to pursue occupational and educational activities, such as attending the local college or acting as a volunteer. The staff team helped the residents communication skills, to enable them to fully participate in daily living activities and have valued roles in the community. This meant the residents were able to develop an individual lifestyle which met with their needs, interests and preferences. The expert by experience asked the residents what they did during the day and made the following notes. A man said that he helped the handy man do things around the house. He also went to the local club to play snooker and sometimes went fishing. One lady said she loved doing crafts. She also said that she had been to college but didnt like the course, so she was waiting to start a different course. She told me that she sometimes at night, she went to the local club and pub to the disco and karaoke. All the people said they were able to choose the things they wanted to do and the staff supported them in doing things. The residents were given an amount of money each year to pay or put towards the cost of a holiday. Last year the residents enjoyed a variety of different holidays to various destinations including Devon, Blackpool and Torquay. This meant the residents had the opportunity to have a break from the home environment and spend individual time with staff. The residents had the opportunity to develop and maintain important personal and family relationships. As such friends and family were welcome to visit at anytime convenient to the residents. Some residents also visited their families on a regular basis and were provided personal support and help with transport arrangements. The residents had unrestricted access to the communal areas and grounds. The residents were also able to use their room at anytime should they wish to spend time alone. One resident said she enjoyed spending time in her room watching the television. All the residents had been issued with keys, so they could lock the door to their private accommodation. The residents participated in planning and preparing the meals. The menu was devised a week in advance and provided the residents with a choice of food each mealtime. Meals were provided three times a day with a range of drinks and snacks available at all other times. The residents spoken to said they liked the food and confirmed that Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: there was always plenty to eat. Since the last inspection, the registered manager had ensured the record of meals had been kept up to date. This record demonstrated that the residents were provided with a nutritious and balanced diet, which catered for individual dietary requirements and preferences. The expert by experience joined the residents for lunch and made the following comments, They (the residents) said the food was OK. I had my lunch with them, which was salad and sausage rolls. It was very nice. They said they had salad everyday and sometimes would like a change. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care received by residents was based on their individual needs. There were arrangements in place to manage medication safely and effectively. Evidence: Individual plans clearly set out the personal support required by each resident and provided guidance to staff on how the residents wished to receive this support. The residents spoken to confirmed that the personal care was responsive to their needs and preferences. One person said, The staff always ask me how I am and if I want time to talk to them. Discussion with staff demonstrated their awareness of the residents rights to privacy and dignity and the need to respond sensitively to individual issues and changing needs. This meant that the delivery of personal care was flexible, reliable and person centred. Health care needs were appropriately assessed and were included in the support plans. Information and guidance was available for staff about how to monitor and respond to specific medical conditions. A separate record was made of medical appointments and Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: there was evidence to indicate that the residents had access to specialist NHS services such as Psychologists, Behavioural Therapists and the Learning Disability Consultant. The residents also attended routine health appointments with the chiropodist, dentist and optician. This meant the residents healthcare needs were understood by the staff team and an appropriate response was made to changing needs. Policies and procedures were in place to cover the management of medicines and were available for staff reference in the medication file. Since the last inspection, all handwritten entries on the medication administration records had been countersigned by two staff and protocols had been drawn up to cover the administration of medication prescribed as necessary. This meant that the staff had carefully checked the instructions on the prescription label and they were aware of the circumstances and parameters of administering medication as required. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. Appropriate records were in place for the receipt, administration and disposal of medication. All staff designated to administer medication had received accredited training. This meant that the staff had received the necessary training to ensure that medication was managed in a safe and consistent manner. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were able to express their views and any concerns and had access to a clear complaints procedure. There were established ways of working to respond effectively to any suspicion or allegation of harmful practice. Evidence: The registered manager fostered an open culture in the home to ensure the residents were able to express their views in a safe and understanding environment. As such ways of working were in place such as residents meetings, daily conversations, satisfaction questionnaires and an open door policy, which provided the residents with various opportunities to discuss life in the home. The residents spoken to said they felt comfortable about expressing their views and were aware of whom to speak to in the event of a concern. Staff who completed a questionnaire also indicated that they were aware of what to do if the residents or their families had a concern. This ensured any problems could be sorted out as quickly as possible. The complaints procedure was included in the service users guide and had been explained to the residents. The procedure contained the necessary information and included the relevant telephone numbers and contact details should a resident wish to raise a concern. According to information in the AQAA, the registered manager had received one Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: complaint during the last twelve months. The complaint had been investigated by the registered manager under the homes complaint procedure. Records had been made of the complaint, investigation and outcome. The details of the complaint had also been discussed with the Commission, so we were aware of the circumstances of the complaint and what action was taken by the registered manager. Detailed policies and procedures for safeguarding vulnerable adults were available, which provided guidance for staff should they suspect or witness any harmful practice. These issues were incorporated into the induction and mandatory training and staff received specific tuition as part of their NVQ training. The staff also had access to a whistle blowing procedure. This procedure set out a system for staff to report any concerns about colleagues or managers to the relevant authorities. Policies and procedures were also in place to deal with violence and aggression towards staff. All the staff had received non-violent crisis intervention training, which enabled them to manage and respond to difficult situations in a safe and consistent manner. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout of the home enabled the residents to live in a safe, comfortable and well maintained environment, which encouraged independence. Evidence: Gorse Hill is a large detached house set in its own grounds. It is located in a residential area approximately one and half miles from Burnley. The home is located near to local shops and other amenities and close to main bus routes to nearby towns. The bedrooms are single occupancy, with some rooms taking the form of a small flat, with kitchen and living areas. All bedrooms have an ensuite bathroom. Communal space is provided in a large sitting dining room, a smaller lounge, a quiet lounge, kitchen and a crafts room. All rooms provided facilities in excess of the National Minimum Standards. The bedrooms/flats were decorated and furnished according to personal taste. The residents said they liked their rooms and commented that they liked to spend time on their own in their bedrooms. The furnishings and fittings were domestic in character and a good standard throughout. The expert by experience made the following comments about the home environment. All of the people had their own rooms. One man took us to his room to show us. He Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: had lots of personal possessions in his room, posters on the wall and photos of his family. It was like a flat, with his own bathroom and kitchen. He said that sometimes he cooked his own meals and other times he had his meals with the others downstairs in the dining room. I liked his room, you could tell that he was happy with it and it felt like it really belonged to him. Since the last inspection, a number of improvements had been made to the premises, to aid the comfort and independence of the residents. As such, several areas had been redecorated, one bedroom had been refurbished and a new cooker had been purchased for the kitchen. Appropriate arrangements were in place for general maintenance and repairs. This meant that routine problems with the building were promptly rectified. The residents had free access to the grounds, which were well maintained and provided plenty of space for any outdoor activities. The home had a good standard of cleanliness in all areas seen and was free from offensive odours. Arrangements were in place for the residents to do their own laundry. This meant the residents could maintain and build on their independence skills. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements in place to manage staff recruitment and training ensured that the residents were supported safely. Evidence: Staff had been issued with an appropriate job description during the recruitment process, which clearly set out their roles and responsibilities. During conversations with the staff, it was evident that they were aware of the limitations of their role and had a good understanding of the needs of the residents. Staff referred to the residents in respectful terms and were observed to interact with the residents in a pleasant way. The expert by experience made the following observations about the staff. They (the residents) said that the staff were friendly and helped them. During my time at the home, I found it to be relaxed and friendly and all the staff seemed nice. A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The roster indicated that a sufficient number of care staff were on duty throughout the waking day. One member of staff carried out a waking watch duty during the night with an additional person available on call. The level of staffing was determined by the needs of the residents and contractual Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: arrangements. All staff who provided personal care were aged over 18 and all staff left in charge of the building were aged over 21. Many of the staff had worked at the home for some time, which meant they had a good knowledge of the needs of the residents. The recruitment and selection procedure for new staff was underpinned by an Equal Opportunities Policy. The recruitment process included the completion of an application form and face to face interview. Whilst there was a tracking sheet in place for each new member of staff detailing the receipt of checks and references, regulatory records obtained during the recruitment process were collated at the Companys headquarters. The Commission had agreed to this arrangement, which meant the records were not seen in the home at the time of the inspection. Staff received thorough induction training, which incorporated the LDQ (Learning Disability Qualification). This training included additional tuition on the safe management of challenging behaviour. Each member of staff had a training assessment and profile and there was an training development plan for the overall staff team. This meant that the registered manager was able to readily identify any future training needs for individual staff and for the staff team as a whole. Since the last inspection, training courses were offered on the EL box (Electronic Learning). This was a dedicated computer, which enabled the staff to complete their training at a convenient time for them. This was particularly useful for night staff. At the time of the inspection, 15 out of 26 staff had achieved NVQ level 2 or above, which equated to 58 of the staff team. In addition two members of staff were working towards this qualification or above. This meant the majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively and efficiently. All members of staff who completed a questionnaire confirmed they had received training relevant to their role and all indicated that they were well supported by the management team with any training needs. Consultation with staff was ongoing and handover arrangements had been maintained. Staff had the opportunity to attend meetings on a regular basis and minutes were seen of the last meeting held in the home. The staff were encouraged to add to the agenda and openly discuss issues affecting the operation of the home. Staff spoken to confirmed that they met up regularly with their line manager and had an annual appraisal of their work performance. However, it was noted that not all staff had received six recorded supervisions during the year. Supervision meetings are important to enable the staff to discuss their experience of working in the home with their line manager. Care Homes for Adults (18-65 years) Page 25 of 31 Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration practices were effective in ensuring the home was run in the best interests of the residents. Evidence: The registered manager had overall responsibility for the day to day operation of the home. At the time of the inspection, the manager was working towards the MDP (Management Development Programme). The registered manager explained that this qualification was the equivalent to the Registered Managers Award, which is a recognised qualification for people managing a care home. The manager had also completed various short courses over the last twelve months to refresh her knowledge and skills. The management approach was consultative and there were established ways of working to consult the staff and residents on an ongoing basis. Relationships within the home were positive and staff spoke to and about the residents in respectful terms. Further to this, a member of staff wrote in a questionnaire, The service users are Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: treated well and with respect and another member of staff commented, We promote independence very well and are a service that hopes that the residents we have will eventually move on to supported living. The registered manager had established a quality assurance system to ensure the service was continuously monitored. As part of this, the registered manager prepared a report every month about all aspects of the operation of the home, which was submitted to the Operations Manager. In addition satisfaction questionnaires were distributed to the residents, their relatives and their funding authorities once a year. The questionnaires were last given out in September 2008. The results of the survey had been collated and feedback had been given to the residents about their participation at a residents meeting. The registered manager had produced a detailed annual development plan, which set out the objectives for the forthcoming year based on the results of the quality monitoring processes. This document linked with the AQAA questionnaire submitted to the Commission. All sections of the AQAA were completed and the information provided gave a clear picture of the current situation within the service and the planned areas for development. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances, food safety and infection control. Staff received mandatory health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Documentation seen during the inspection and information supplied in the AQAA indicated that the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and had participated in regular fire drills. Arrangements were in place to record accidents and incidents in the home and the Commission had been notified as appropriate of any significant event in the home. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 36 Staff should receive individual supervision a minimum of six times a year. This is to ensure staff have the opportunity to discuss their experience of working in the home and identify any future training needs. The registered manager should complete the Management Development Programme, to ensure she has the necessary qualifications for her management role. 2 37 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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