Care Home: Gowlands

Similar services:

• Coopers Mill Ltd
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• Newton Court (1-2)
• Kings Lane (32)
• Pemdale

What the care home does well Gowlands offers a specialised respite service to guests who have a range of complex needs. Currently the home has approximately 90 guests who use the service on a regular basis. The organisation required to offer this service, with such high satisfaction rates, is extensive. The management and staff at Gowlands achieve this, and achieve it in a way that ensures that guests very individual needs are understood and met. Management and staff at the home are always looking for ways to develop and improve the service for the benefit of the guests. Gowlands provides a friendly, comfortable and stimulating environment for guests. A sensory room, activities room, hydrotherapy pool and sensory garden are all available to them during their stays at the home. Care plans are informative and help staff to understand the levels of assistance and support service users want and need. The staff team support guests to take part in activities, both in the home and around the local community. Feedback questionnaires are routinely sent to parents/carers to complete after each stay. Completed forms seen by us showed a continued high level of satisfaction with the service offered at Gowlands. What has improved since the last inspection? A new indoor hydrotherapy pool has been provided for guests to use with staff support, and a new hot water boiler had been installed in the home. The main activities room on the second floor had a new TV, a new drum kit, new WII games console, new settee and carpet and had been redecorated. A new specialised portable hoist had been purchased. The kitchen had been refurbished and the dining room had new curtains and had been redecorated. A new bath that had been ordered at the time of our first visit. This was seen to have been installed when we returned to the home for our second visit. Communal corridors and some bedrooms had been redecorated. Staff had been trained on inclusive communication practice. What the care home could do better: Regular fire drills need to be held at the home. Certain areas of the home would look better maintained if they were redecorated and/or cleaned. These areas are mainly some doors that were scratched/marked, some carpets that looked stained and some dining room furniture with scratch marks. Staff who administer medication to service guests should be regularly assessed as to their competency for this role. All staff at Gowlands should be offered 1 to 1 support meetings at least six times a year. Team meetings should also be held at least six times a year. The results/findings of service user surveys should be collated and made available for people who use the service Key inspection report Care homes for adults (18-65 years) Name: Address: Gowlands Sutton Bridge Farm Sutton Road Rochford Essex SS4 1HJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alan Thompson     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Gowlands Sutton Bridge Farm Sutton Road Rochford Essex SS4 1HJ 01702541761 01702531668 gowlands@hamelintrust.org.uk www.hamelintrust.org.uk Hamelin Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Cheryl Ann Dibley Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Personal care to be offered to no more than 9 younger adult service users with a learning disability (LD). The age of service users for whom personal care shall be provided shall be sixteen or over. The maximum number of individuals to be accommodated shall not exceed nine (9). The number of service users to whom personal care is to be offered shall not exceed 9 (nine) younger adults. Date of last inspection Brief description of the care home Gowlands is a large detached, three-storey house, which has been extended to provide a good standard of accommodation for guests. The home does not provide any long term care, but specialises in providing regular respite care for people with learning Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 9 Brief description of the care home disabilities, and any associated complex needs, who are living with family or carers in the community. Gowlands is run by Hamelin Trust, a registered charity. People using Gowlands prefer to be called guests. Contact details for the home are as shown above, with the exception that the address postcode should read: SS4 1XS, and the Fax number has been changed to: 01702 260129. The home is situated in a semi rural area, and has extensive grounds, all of which are accessible to guests. The grounds include a sensory garden and wheelchair trails, and a new indoor hydrotherapy pool. There are car parking facilities to the rear of the home. Internally Gowlands has spacious communal accommodation. Each guest has a single room. Bedrooms are situated on all floors of the home. Upper floors are accessible to guests via a passenger lift. A sensory room and activities room are located on the second floor. Bathrooms and toilets are suitably adapted to meet the needs of guests. Gowlands has its own transport to enable service users to access all the local community facilities. The previous inspection report is made available to guests and their families. A Statement of Purpose and Service Users Guide are also available, and are provided to people when they first visit the home. The nightly charge as advised by the manager is £247.91 to £538.42 . The range of fee relates to the level of staffing required by individual guests e.g. one to one. There are no additional charges to guests, although there is an expectation that guests will bring in personal spending money for use during their stay. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We did this inspection over two days on 31st March and 14th April 2010. Our first visit was unannounced. This report reflects our findings on these days along with information provided by the manager and feedback by service guests, their relatives and staff. The inspector was not able to stay for the whole day on the 31st March which is why we went back on 14th April to finish our inspection. Our most recent inspection before this was on 10th May 2007. The manager completed and returned their Annual Quality Assurance Assessment (AQAA) to us before the inspection. This is a self assessment required by law which gives homes the opportunity of recording what they think they do well, what they could do better, what has improved as well as their future plans for improving the service. The AQAA had been comprehensively written and some of the information and detail provided within the AQAA has been included in this report. Care Homes for Adults (18-65 years) Page 6 of 31 During our visits we spoke with the homes manager, staff on duty and senior managers from Hamelin Trust. We also met with service guests. However because of peoples disabilities we were unable to engage in conversation with most, but we did ask for CQC surveys to be completed by service users or their representatives. We also asked staff to complete surveys. Overall we received eight completed surveys back and reference to what was said in these has also been made in this report. We also looked at some records, policies and procedures and we were shown around parts of the home and grounds. All matters relating to the outcome of the inspection were discussed with the manager of the home, with full opportunity for discussion given and/or clarification where necessary. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Regular fire drills need to be held at the home. Certain areas of the home would look better maintained if they were redecorated and/or cleaned. These areas are mainly some doors that were scratched/marked, some carpets that looked stained and some dining room furniture with scratch marks. Staff who administer medication to service guests should be regularly assessed as to their competency for this role. Care Homes for Adults (18-65 years) Page 8 of 31 All staff at Gowlands should be offered 1 to 1 support meetings at least six times a year. Team meetings should also be held at least six times a year. The results/findings of service user surveys should be collated and made available for people who use the service If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests considering using Gowlands can be sure that the service will assess and be able to meet their needs. Evidence: The current service guests are generally funded by local authorities. The process to request a place begins with families completing a comprehensive application form to seek a place at Gowlands. This information is supported by the social services service placement team who will confirm the levels of staffing support needed and the funding for the requested period of the guests stay. It was confirmed by the manager that senior staff from the home then visit the potential guest at home or day care activity to assess their needs and the suitability of offering a placement. The format used for this is the homes care and support plan document. One seen had been well completed and covered a wide range of headings and needs including, safety, health, mobility, communication, diet, personal care, sleep, behaviours, leisure, social skills and cultural needs and beliefs. Forms looked had been signed by the guests relative which evidences that they are kept informed of Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the information recorded. According to individual needs, guests always have a phased approach to beginning their stays at Gowlands. Comments in surveys returned to us confirmed that people were included in the decision to stay at Gowlands. People also agreed that they received enough information about the service before they decided to stay there. Discussion with staff, and training documentation looked at showed that staff are offered appropriate training to meet the individual needs of guests. This had included since our last inspection training on Inclusive Communication to assist staff in meeting the needs of guests who have limited verbal communication skills. 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 information in care plans ensures that guests needs could be met in a way they would wish. Evidence: At the time of this inspection there were eight guests staying at Gowlands. Two of their support/care plan files were inspected. These had detailed risk assessments that showed the perceived level of risk and guidelines for staff on methods to minimise risk. Risk assessments had been reviewed. Files seen also included moving and handling assessments, an assessment of risks associated with challenging behaviours and an infringement of rights assessment. Staff had been trained on managing challenging behaviours, and the manager said that further training on this subject was due to be arranged. Daily assessed needs were listed under the headings covered at the pre-service assessment and added to as staff get to know the guest. Overall the support plans seen contained the information needed to meet peoples needs, under headings of, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: safety, medication, physical and medical health, toileting, mobility, communication, bathing, dressing, dislikes, activities, behaviours, night routines, eating and drinking, and education. Each file had a summary of identified goals for the guest, and the actions for staff to take towards achieving these. Staff contact the guests relatives prior to each stay at Gowlands to check for any changes in peoples needs. There also six monthly reviews carried out on all guests care plans, when relatives are again contacted for updates on guests needs. In addition to these reviews staff from the home will attend reviews carried out by the service commissioner such as Social Services. Files seen evidenced that peoples views are included in the review processes. Healthcare issues and medication histories were seen to be recorded on service users files. However the manager told us that staff at Gowlands do not normally get involved in guests healthcare appointments as these are dealt with by relatives whilst guests are at home. Where possible guests are encouraged to make choices, and there were different communication aids, such as symbols and photographs, available to assist this process. The home is pro-active in this area and constantly looking to improve communication strategies. Information boards for guests include photographs and symbols of peoples day care placements and regular activities that they partake in. We also saw individual specialist aids that had been brought in by guests to assist communication during their stay. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests at Gowlands can expect to have opportunities to take part in their preferred activities and will be supported to continue with their usual routines. Evidence: Guests are assisted to maintain their normal routines and attend their regular day care facilities and clubs during their stay. Where this is not possible due to distance guests undertake alternative activities/outings during their stay. On the second day of the site visit all but two guests were attending their day care facility. Both guests at the home had 1 to 1 staff support and where seen to be engaged in activities throughout the day. Families confirmed in surveys that guests using Gowlands enjoyed the lifestyle provided at the home. Comments included, there is a wonderful, friendly, family atmosphere, and our relative really enjoys his stays there, I feel completely relaxed and happy knowing that he is happy and is being well cared for, nothing is too much trouble for the staff, staff treat people as individuals. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Gowlands offers a range of activities for guests both inside and away from the home. There is a new hydrotherapy pool adjoining the home that is available for guests to use. On the second floor of the home there is a well equipped sensory room and a separate large activities room. The ground floor lounge areas also provide plenty of equipment and opportunities for activity. During the site visit some guests enjoyed use of the activities room and the equipment in the lounges. Outside there is a sensory garden which is accessible to all guests and the home has continued to develop paths around the grounds so that wheelchair users can access more outside areas. These include the pond viewing platform and several new static display features opposite the front of the home. The rear garden also offers a pleasant recreational area with a small bird aviary and BBQ facilities. Transport is available to assist guests in making full use of local community facilities, which have included shopping trips, cinema trips and drives out according to guests preferences and known interests. Guests preferences in relation to activities were recorded in care plans. Guests can bring in their choice of belongings and any equipment to pursue individual hobbies or interests during their stay. Gowlands offers a respite service, therefore families are often away during guests stays. Relatives are however encouraged to have whatever input they wish. Comments included in surveys returned to us confirmed that staff always or usually always listened and acted on what they said. Care plans reflect how guests are to be supported in a way that encourages maximum independence whilst being cared for safely. Throughout this inspection staff were observed to interact appropriately with service guests and appeared to always use the individuals preferred form of address. People were included in discussions about routines and choices and the atmosphere in the home was supportive and friendly. Service users appeared relaxed and at ease with the staff. Since our last inspection a cook had been employed at the home. The cook plans the menus ahead and does the provisions shopping on a weekly basis. We looked at the menus for a three week period. These evidenced a varied and balanced diet is offered to people staying at the home. Many guests continue to have individual dietary needs such as diabetes or food allergies and these are well managed by the home through the use of individual dietary information cards. During the site visits guests were offered choices about what they would like to eat and drink. Symbol and picture cards assist guests to make their choices. Care Homes for Adults (18-65 years) Page 16 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. Guests staying at Gowlands can expect to receive personal and healthcare support in an appropriate and dignified way that meets their expectations and needs. Evidence: Gowlands operates an established key worker system. The manager confirmed that whenever possible, the home continues to endeavour to provide the same key worker to each guest throughout their varied periods of stay. Care records looked at had peoples known preferences around daily routines and rest times, and of their needs on the levels of personal care support they require. Service guests were unable, because of their disabilities, to tell us about the support provided them by staff. However comments in surveys return to us indicated that relatives are satisfied with the service provided to people when they stay at Gowlands. Care plans contained assessment of healthcare needs. Files seen included a detailed medication history and an information sheet completed by the guests own GP showing their medication regimes. Staff at Gowlands do not normally get involved in guests healthcare appointments as these are dealt with by relatives whilst guests are at Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: home. The manager confirmed that during their stay at Gowlands guests have access to local GP services as a temporary patient, and any district nursing support that the guest receives at home is continued during their stays. The homes written medication procedure/policy clarified policies on administering medication, recording practice, as and when required medications and self administering procedures. There was also guidance on specialised techniques such as administering Stesolid and PEG feeds. All service guests at the time of our inspection were receiving full staff support with their medication needs. Guests files included consent to staff providing this support. Staff at the home do not order medication for guests, this comes in with them from home. Records where seen to show that staff check in guests medication at the time of admission, and check out the unused stocks when the guest returns home. A random sample of medication administration records and stocks of medication held were looked at. No errors were noted. Staff who administer medication in the home had been trained for this role using the providers own inhouse training programme and an additional programme based on the Essex Social Services medication training workbook. We saw evidence of this training, however this did not include records to show that staff undergo regular assessments of practice to confirm that they display on-going competency for this role. Care Homes for Adults (18-65 years) Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices in the home ensure that guests are protected and that their views on the service are listened to. Evidence: The provider had a complaints procedure in place which had been updated in March 2010. This clarified the complaints process for service users and provided clear guidance for managers and staff on how they should respond to complaints. We also saw a pictorial style complaints procedure for service guests who would not have the ability to follow any written procedure. The document seen clearly indicates to service users that they have a right to feel sad or feel unhappy and that they should tell somebody. Comments in completed surveys returned to us confirmed that people knew who to speak too if they were not happy. The home also has information on display about local advocacy services and local authorities are usually involved with guest stays at the home. These organisations offer alternative routes for raising issues or concerns. There was a set template form for recording complaints and a compliments complaints record book. Information in the AQAA shows no recorded complaints in the 12 months leading up to 3rd March 2010, the date the AQAA was sent to us. The manager also confirmed at the inspection that no complaints had been received but assured us that if any complaints are received records would be kept of the issues raised and of the Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: investigation and outcome. The homes policies on adult protection were inspected. There was comprehensive written guidance for staff on recognising and reporting abuse, and the actions to be taken by staff if abuse is suspected. The guidance included types of abuse and a detailed whistle blowing policy reminding staff of their responsibilities to report suspected poor practice. We are aware that a safeguarding issue was raised by the home in 2008. This was properly dealt with by management in liaison with local safeguarding authorities and was closed. Records seen showed that staff are trained on safeguarding vulnerable adults from abuse. Staff spoken with understood what was meant by safeguarding adults from harm and said that if they suspected an issue then they would contact the manager or other senior person. The homes induction training also covered adult protection and safeguarding vulnerable people. There was a policy on responding to and managing challenging behaviours. Staff had received training on this subject and the manager confirmed that update refresher training is scheduled to be provided to staff on responding to peoples behaviours. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gowlands offers a comfortable, homely and well equipped environment for guests who stay there. Evidence: Gowlands provides a comfortable and homely environment. The site visit included a tour of the premises with the manager, when it was noted that the home was clean and there was no evidence of any unpleasant odours. The bedrooms, lounges and dining room were well decorated, however a table in the dining room would benefit from attention to marked surfaces. The manager was aware of this and showed us evidence to confirm that three new tables had been ordered for the dining areas. We also noted that some carpets in communal and corridor areas looked a little stained and some doors around the home were scratched and marked. We have recommended that these areas receive some attention to make then look cleaner and better maintained. The kitchen looked well maintained and had been refurbished since our last inspection. There are two bathrooms and a shower room in Gowlands. Two of these rooms provide hoists and adaptations to meet the needs of the people using the service. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Bathrooms had wcs and there were also two separate wcs around the home. At the time of our first visit we saw that the bath on the first floor had some slight damage. The manager confirmed that this was going to be renewed, with a new bath already ordered. When we returned for our second visit this work had been completed. The new bath had a shower hose attached. Bedrooms seen looked clean, comfortable and the manager confirmed that guests are encouraged to bring in personal items to enable them to individualise the bedroom they occupy. Whenever possible, guests occupy the same bedroom that they have used on previous stays. Many have a favourite room. Each bedroom has a wash hand basin, with toilet and bathing facilities close by. One bedroom also had an ensuite shower. Comments in surveys returned to us all confirmed that the home is always or usually always fresh and clean. Communal space in the home included two lounges, a dining room, a sensory room and an activities room. The activities room had several items of new equipment since out last inspection, some lounge furniture had also been renewed and there were new curtains in the dining room. The laundry room was accessed off the ground floor corridor. The equipment provided looked suitable for the size of the service and the room was acceptabley maintained. The home has extensive grounds which the manager advised amounts to around five acres. Much of this is accessible to service guests, with staff support. Amenites in the grounds include a paved sensory garden, a lawned area with patio and bird aviary, a fenced pond, with overlooking decking and seating and an indoor hydrotherapy pool. The grounds also has ample car parking space for visitors and staff, and there is a mini bus based at the home to allow guests easy community access, with staff support. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported by staff who have been properly recruited and are trained for their roles. Evidence: A staff rota was shown to us on our first visit. Eight guests were staying at the home and there were six support staff on duty which included the Deputy Manager. The Registered Managers hours are supermunery. The manager told us that staffing levels are flexible and are geared to the assessed needs and the funding allocated for individual guests whilst they stay at Gowlands. On the day of our first visit staffing levels reduced to three from 1000am when most guests had left for their day care placements. At night there are a minimum of two waking staff on duty with up to two addition staff on some nights for guests who have assessed and funded 1 to 1 support needs. In additional to the care support staff the home has a cook on duty afternoons and alternate weekends, two part time domestic staff, a part time administrator and a maintenance person. The management team at Gowlands includes a deputy manager, three assistant managers and the registered manager. Staff spoken with said that team meetings take place and we saw some records of key worker meetings and senior meetings. However records were not available to confirm that whole team Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: meetings had been held regularly since our last inspection. We have therefore recommended that the frequency of these is increased. Two staff recruitment files were inspected for people employed since our last inspection. Evidence was seen to confirm that staff had been properly recruited with application forms completed, written references obtained, written terms and conditions issued, and criminal records checks undertaken. Copies of proof of ID and photographs were also on files and evidence was seen to show that job descriptions had been issued to staff. Staff are supported in undertaking NVQ training. Information provided in the AQAA states that eleven out of twenty six permanent care staff have achieved their NVQ 2 awards, however this number does not yet meet the recommended 50 per cent of staff with this award. Staff records seen showed that all new staff undergo initial four day induction training covering health and safety, abuse awareness, medication, infection control, report writing, learning disability awareness, food hygiene, fire safety, moving and handling, personal care and emergency aid. After this staff move on to full induction based on the Sector Skills induction for the service type. Staff said that they received induction training and that this covered what they needed to know when they started their jobs at the home. Staff also told us that the management team are supportive and will respond quickly to any queries or concerns they may have regarding service users well being. Staff at Gowlands are trained for their roles, and all staff have individual training records. The manager also has a central training record which shows training undertaken for the whole team, as well as when updates are due. A recent organisational development to the benefit of the home is the appointment of a training manager. This is aimed at improving the range and consistency of training available to staff. Records seen and discussion with staff confirmed that staff had been provided training on, care planning, medication, inclusive communication, diabetes awareness, epilepsy awareness, risk assessment, communication, food hygiene, manual handling, first aid, NVQ, health and safety, infection control, challenging behaviour, fire safety and abuse awareness safeguarding. Staff spoken with confirmed that they were satisfied with the training they received. This was also confirmed by the majority of people in surveys returned to us. However one person indicated that the training provided was not relevant to their role or helped them meet the individual needs of people in the home. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The management team provides 1 to 1 supervision support to staff and records of this were seen. Areas covered included values, communication, responsibilities, service user issues, performance and personal development. Some staff had received supervision four times in the twelve months leading up to our inspection, but others had fewer meetings than this recorded. We have recommended that the frequency of 1 to 1 meetings is increased to six times a year for all. We did ask staff if, on a day to day basis, they felt properly supported by the manager, and all who responded agreed that they were. Actual comments made to us included, there is always someone available to speak to if they have any problems, the manager is very approachable and listens to what I say. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests stay in a well run home that is managed in their best interests Evidence: The manager at Gowlands is experienced and competent. The manager is a trained learning disability nurse and has experience of working in a hospital setting, a day care setting, as a community nurse and for the last ten years as the manager of Gowlands. Overall the managers nursing and social care experience spans twenty six years, and qualifications include the Certificate and the Diploma in Management Studies. The quality assurance (QA) process used at Gowlands involves sending surveys to service guests and relatives after every stay at the home. We saw some of these which recorded high levels of satisfaction with the service provided. The registered provider also carries out regular monthly checks on the service (regulation 26 reports). Those seen were detailed in content and identified areas for action/improvement. We also saw a QA monitoring record which covers the quality of service as assessed by managers at the home. These processes show us that Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Gowlands activity works towards ensuring that people are satisfied with the service provided however we did not see a summary of responses from people or of any actions taken as a result of feedback from service users or their representatives. The manager confirmed that personal spending monies are held for safe keeping for some service guests when they stay at the home. Records had been kept of the balances held and of receipts for expenditure. A random sample of these were checked and found to satisfactory. Random samples of records required to be kept were also looked at. These included, Regulation 26 reports, assessments, care plans, staff rotas, staff recruitment, visitors book, menus, medication, background info and next of kin details and fire procedures. All of these seen were satisfactory except that only one fire drill was recorded as having taken place in the twelve months leading up to our inspection. We do not consider this sufficient to ensure that all staff are aware of the fire evacuation procedures at Gowlands. Discussions with staff, management and inspection of records confirmed that training is provided to staff in moving and handling, food hygiene, first aid and health and safety. There was also a premises risk assessment in place to try to minimise risks in these areas. Certificates and service records were seen to confirm that the homes passenger lift, emergency lighting, fire equipment and alarms, electrical installation supply, gas boilers and portable electrical appliances had all been tested/serviced. Hot water supply is regulated to minimise the risk of scalding and the manager advised that manual temperature checks are going to be taken in future. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 23 Regular fire drills need to be held at the home. This is to ensure that staff are aware of the fire evacuation procedures at Gowlands. 31/05/2010 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 20 Staff who administer medication to service guests should be regularly assessed relating to their competency for this role. Certain areas of the home would look better maintained if they were redecorated and/or cleaned. These areas are mainly some doors that were scratched/marked, some carpets that looked stained and some dining room furniture with scratch marks. Staff team meetings should be held at least six times a year. All staff at Gowlands should be offered 1 to 1 support meetings at least six times a year. The results/findings of service user surveys should be Page 29 of 31 2 24 3 4 5 33 36 39 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations collated and made available for people who use the service. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!