Care Home: Grange (The) & Walton Cottage

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What the care home does well A comprehensive range of clear, accurate and accessible information has been produced about the home. This informs prospective people using services about what they can expect if they are considering moving into the home. The information is available in a range of accessible formats to meet the communication needs of people for whom the home is intended, including a pictorial complaint procedure, all of which has been explained to each individual, enabling an informed choice of home. The home has a easy to navigate, informative website in which the home`s monthly newsletter is published with the agreement of people using services. This demonstrates the imaginative and varied opportunities available to people living at the home for community participation. Staff support people to lead full and stimulating lifestyles in which they engage in age, peer and culturally appropriate social and leisure activities. People who wish to move into the home can be confident their needs can be met. This is due to an inclusive comprehensive assessment process carried out by the manager before admission, to establish their needs and aspirations. Assessed and changing needs are reflected in person-centred support plans which they are involved in producing. Significant time and effort is spent planning admissions and a high value placed on responding to individuals` need for information, reassurance and support at this time. Recognition of equality and diversity is embedded in the culture of the organisation, underpinning its policies and procedure, staff recruitment and training and care planning. This ensures the diverse needs of people using services are identified and met in a non-discriminatory way. Daily life at the home promotes independence and informed risk-taking within individual levels of capacity.The home`s atmosphere is warm and welcoming. Discussions with management and staff and practice observations confirmed a high level of commitment to provision of quality services in the best interest of people living at the home. Staff support and empower people using services to have control over their lives, to make decisions and to have active involvement in the day- to- day running of their home. We were told by a person using services, " I like it here. I have so many things in my room. A play-station, TV, DVD player, videos and posters". Survey feedback from people using services confirmed most always make decisions about what they do each day and in the evening and at weekends. Comments included, "I get to go out where I want at weekends". " I have my own room and I like it here, I like going on holiday with The Grange ". Health care needs are met ensuring access to routine health checks and specialist services. Staff work in partnership with health and other professionals. The management of medication is safe and principles of respect, dignity and privacy are put into practice. The approach to ageing, illness and death is handled with sensitivity and respect.Observations confirmed staff and management have a good understanding of the individual needs of people living at the home. A flexible and individualised approach to their care and support was evident, ensuring continuity of structures and routines. Staff support people in maintaining personal and family relationships. They also encourage healthy and varied diets. Pictorial menus are displayed in each of the dining rooms. People using services were observed moving freely around kitchens during the visit, making their own breakfast and lunch and helping themselves todrinks. The induction and staff training programme ensures staff have the necessary skills and competencies. The location of the home is well situated within walking distance of St John`s village, providing convenient access to local shops and a pub. The physical environment is well maintained, clean and hygienic. It is tastefully decorated and furnished, reflecting the individuality and interests of people using services. What has improved since the last inspection? Staff recruitment and vetting procedures now ensure full compliance with statutory requirements. The manager told us she had recently completed her studies for a National Vocational Qualification in management (NVQ Level 4) and for the Registered Managers Award. The home`s statement of purpose has been updated, incorporating more views about the home from people using services. The service users guide has also been updated to reflect new developments and is available on the website. Work was stated to be in progress to produce an information DVD about the home aimed to inform people considering living there about what they can expect. People using services were stated to be involved in this project and the DVD will include a virtual tour of the home and chats with current users and staff. An information pack has been produced about the activities on offer in the home`s day services centre. New developments include daily checks of care plans and fortnightly in- house staff training sessions. Work has taken place on risk assessments to predict behaviour or events that can harm or impair wellbeing. Also on ways for promoting independence and supporting individuals in making informed choices in their daily lives. The involvement of people using services in the running of their home is promoted by ensuring their monthly meetings take place. The complaint procedure has been reviewed and produced in a more accessible format, suited to the communication needs of people using services. Observations confirmed a significant amount of hard work and effort by the manager to customise the Skills to Care common induction work books, to ensure new staff obtain the knowledge and skills they need. The induction package also covers equality and diversity to promote non discriminatory practice. Changes to the staff induction programme ensure new staff have a good knowledge of the home`s policies and procedures before their induction is signed off. They are closely supervised to ensure high quality practice. Boilers have been replaced with modern high efficiency energy saving type. What the care home could do better: This is an excellent service and no requirements or recommendations have been made at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Grange (The) & Walton Cottage The Grange And Walton Cottage 26-28 St John`s Road Woking Surrey GU21 7SA     The quality rating for this care home is:   three star excellent 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: Patricia Collins     Date: 0 9 0 2 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 34 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 34 Information about the care home Name of care home: Address: Grange (The) & Walton Cottage 26-28 St John`s Road The Grange And Walton Cottage Woking Surrey GU21 7SA 01483730670 01483730670 grangeandwaltoncottage@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grange & Walton Cottage Limited (The) The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Miss Parveen Akram Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either within the following categories: Learning disability (LD) Mental Disorder- excluding learning disability or dementia (MD) Date of last inspection 18 18 Over 65 0 0 care home 18 Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home The Grange and Walton Cottage is a small family owned Ltd company that has operated a care home for adults with learning disabilities since 1986. The home provides personal care and support for up to eighteen adults of either gender whose primary need on admission is a learning disability. The home is also registered to accommodate adults with a mental disorder, excluding dementia. Accommodation comprises of two detached properties in adjoining grounds. The home is situated in a residential area within walking distance of shops and other local in the village of St Johns and is on a bus route. The Grange has 10 single bedrooms, 6 on the ground floor and 4 on the first floor and Walton Cottage has 8 single bedrooms, three downstairs and 5 upstairs. Neither property has a passenger or chair lift. A large spacious building has been erected in the rear garden of Walton Cottage providing onsite day services for people who live at the home. Communal areas in both properties include sitting and dining rooms, bathing and toilet facilities, kitchens and utility rooms. Off street parking is provided and the large, secluded rear gardens are attractive and accessible to people using services. Each property is furnished to a high standard, affording a comfortable, clean and homely environment. Care Homes for Adults (18-65 years) Page 5 of 34 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: The inspection process incorporated discussions with nine people using the homes services. Also with the responsible individual on behalf of the provider organisation, the registered manager, deputy manager and a support worker. Some time was spent on indirect practice observations, specifically assessing the quality of interactions between staff and people using services. All available information has been taken into account to inform judgements about how well the home is meeting the National Minimum Standards for Adults. This includes the cumulative assessment, knowledge and experience of the home since its last key inspection. The inspection process involved sampling records and tour of the premises including the day centre and viewing the garden. We also considered information in Care Homes for Adults (18-65 years) Page 6 of 34 surveys completed by six people using services with support from the manager and staff. Each year providers registered with the Commission for Social Care Inspection (CSCI) must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CSCI. It provides quantitative information about their service, requiring assessment of the service against the National Minimum Standards (NMS) outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and its content was clear, of good quality and validated by evidence. This information was also used to inform judgements about the home. We wish to thank all of the people using the homes services, its management and staff for their time, hospitality and assistance throughout the inspection visit. What the care home does well: A comprehensive range of clear, accurate and accessible information has been produced about the home. This informs prospective people using services about what they can expect if they are considering moving into the home. The information is available in a range of accessible formats to meet the communication needs of people for whom the home is intended, including a pictorial complaint procedure, all of which has been explained to each individual, enabling an informed choice of home. The home has a easy to navigate, informative website in which the homes monthly newsletter is published with the agreement of people using services. This demonstrates the imaginative and varied opportunities available to people living at the home for community participation. Staff support people to lead full and stimulating lifestyles in which they engage in age, peer and culturally appropriate social and leisure activities. People who wish to move into the home can be confident their needs can be met. This is due to an inclusive comprehensive assessment process carried out by the manager before admission, to establish their needs and aspirations. Assessed and changing needs are reflected in person-centred support plans which they are involved in producing. Significant time and effort is spent planning admissions and a high value placed on responding to individuals need for information, reassurance and support at this time. Recognition of equality and diversity is embedded in the culture of the organisation, underpinning its policies and procedure, staff recruitment and training and care planning. This ensures the diverse needs of people using services are identified and met in a non-discriminatory way. Daily life at the home promotes independence and informed risk-taking within individual levels of capacity.The homes atmosphere is warm and welcoming. Discussions with management and staff and practice observations confirmed a high level of commitment to provision of quality services in the best interest of people living at the home. Staff support and empower people using services to have control over their lives, to make decisions and to have active involvement in the day- to- day running of their home. We were told by a person using services, I like it here. I have so many things in my room. A play-station, TV, DVD player, videos and posters. Survey feedback from people using services confirmed most always make decisions about what they do each day and in the evening and at weekends. Comments included, I get to go out where I want at weekends. I have my own room and I like it here, I like going on holiday with The Grange . Health care needs are met ensuring access to routine health checks and specialist services. Staff work in partnership with health and other professionals. The management of medication is safe and principles of respect, dignity and privacy are put into practice. The approach to ageing, illness and death is handled with sensitivity and respect.Observations confirmed staff and management have a good understanding of the individual needs of people living at the home. A flexible and individualised approach to their care and support was evident, ensuring continuity of structures and routines. Staff support people in maintaining personal and family relationships. They also encourage healthy and varied diets. Pictorial menus are displayed in each of the dining rooms. People using services were observed moving freely around kitchens during the visit, making their own breakfast and lunch and helping themselves to Care Homes for Adults (18-65 years) Page 8 of 34 drinks. The induction and staff training programme ensures staff have the necessary skills and competencies. The location of the home is well situated within walking distance of St Johns village, providing convenient access to local shops and a pub. The physical environment is well maintained, clean and hygienic. It is tastefully decorated and furnished, reflecting the individuality and interests of people using services. What has improved since the last inspection? 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. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 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 11 of 34 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. Information has been produced to enable an informed choice of home and decisions whether it can meet the expectations and aspirations of prospective people who wish to use its services. Needs are assessed before being offered a place at the home to be assured these can be met. Good practice introductory admission procedures are demonstrated. Evidence: The homes management understands the importance of having sufficient information to enable an informed choice of home. Feedback in surveys received from people using the homes services confirmed they had sufficient information on which to base an informed decision about the homes suitability. Comments included, My mum and dad asked me if I want to live here and we saw nice pictures. My mum and dad helped me decide it was the right place for me. An up to date statement of purpose is available specific to the homes services and facilities, setting out its aims and objectives and philosophy of care. A service users guide has been produced detailing what prospective users of this service can expect. It provides a clear account of Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: services provision, the accommodation, qualifications and experience of management and staff and how to make a complaint. It is written in plain English with photographs of the home. A record on the care files sampled evidenced copies of the service users guide and complaint procedure had been given to people using services and explained, on admission. Their consent was recorded on their files relating to the management of their personal finances and medication. Work was in progress involving people using services in making a video and DVD of the home, to help prospective people who wish to move in make an informed choice. The home has an informative website clearly setting out who the home is for. It states that its service are for people with the a learning disability as their primary condition on admission though some may have secondary mental health conditions. The home accepts people who have Autism, Cerebral Palsey, Epilepsy and Schizophrenia. A monthly newsletter is published on the homes website. This includes photographs and news of about people using services, describing their social and leisure activities and interests and about staff. Admission procedures ensure the manager carries out her own needs assessments in addition to obtaining copies of community care assessments from care managers, prior to admission. There had been no admissions since the last inspection. At that time three files were sampled and pre-admission assessments found to be comprehensive, ensuring the home could meet the needs and choice of lifestyles of individuals. Significant time and effort is spent planning admissions to ensure these are personal and well managed. A discussion with two people using services during the inspection visit confirmed their experience of best practice admission procedures. Both had received information about the home before they visited to view it. They had opportunity to spend time at the home before admission, joining staff and people living at the home for lunch and finding out from them about routines. They had a choice of bedrooms and of bedroom colour schemes. Their experience of the assessment process confirmed this had been inclusive and they had been actively involved in producing their care plans. They had opportunity to stay overnight and experience life at the home before making an informed decision about whether it was right for them. Care Homes for Adults (18-65 years) Page 13 of 34 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 excellent 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 benefit from person centred care involving them in decisions about their lives and in planning the care and support they receive. Evidence: Developments since the last inspection include a daily check of care plans to ensure continuity. Also fortnightly in- house training for staff, to ensure they have adequate knowledge and involve users in everything the home does. Work is in progress to further enhance communication with people using services through developing records and other documents using signs and symbols. The home has explored ways to further promote independence and for supporting individuals in making informed choices in their lives. Also enabling engagement in decisions affecting the day to day operation of their home by ensuring monthly meetings for people using services take place. People using services have one to one sessions with staff on a daily basis in which they can bring up an issues they may have. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: The statement of purpose includes the organisations policy statement on equality and diversity. This sets out a commitment to achieving a living and working environment providing equality of opportunity and is free from discrimination on the grounds of race, religion, gender, class, sexual orientation, age, disability and special needs.The care plans and associated care records for two people randomly examined clearly demonstrated how the service meets individual diverse needs within this framework. Care records also detail how individuals are supported and enabled to have control over their lives, within their levels of capacity. They each have a key worker to coordinate their care and document personal history in a way as to enable a new member of staff or other key workers provide continuity of support.The approach to developing care plans is person centred, recognising the individuality, diversity and rights of people using services; also ensuring their involvement and control in developing personal goal plans.Care plans reflect current needs, risks have been assessed and and risk management strategies and behavioural management programmes are in place. Care documents were up to date, well recorded and ensured the health and wellbeing of people using services. The home produces a comprehensive report for care managers annual reviews. The home also convenes six monthly review meetings in between for each individual. Monthly house meetings take place and suggestions from people using services are acted upon. They have a say in the range of social activities they enjoy, trips and where to go on holidays. Their request for pets was listened to and they have rabbits, guinea pigs and a fish tank. They are encouraged to be actively involved in looking after their pets, with staff support. The home has introduced various IT software programmes to enable improvement in literacy skills. Some people using services have their own e-mail accounts and receive support in using IT equipment including a webcam to chat with family and friends. Their wishes for changes to the menu are listened to. Photographs of Halloween and birthday parties were seen also the annual Christmas party. This year it was held in a community hall to accommodate the numbers of people who wish to attend, including families and friends. People using services are actively involved in the planning and preparation for these occasions, with staff support, sending out invitations, purchasing, and making decorations and fancy dress costumes. Their request had been met for a plasma large screen television in one of the lounges with free-view music channels. Care Homes for Adults (18-65 years) Page 15 of 34 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. People who use this service are offered a healthy diet and enjoy their meals. They participate in age, peer and culturally appropriate activities and are part of their local community. They are able to make choices about their lifestyle and are supported in developing life skills. Evidence: Survey feedback from people using services confirmed most always make decisions about what they do each day and in the evening and at weekends. One person said sometimes, clarifying they did not like his day services. Two people said they liked to visit their family at weekends. Comments included, I get to go out where I want at weekends. I have my own room and I like it here, I like going on holiday with The Grange . Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Information obtained from records and discussions with people using services during the visit confirmed they engage in a wide range of social and leisure activities. Photographic evidence was seen of this years Christmas party held in a community hall due to the year on year growth of the popularity of this event which is well attended by families and friends. Birthdays are celebrated with parties, meals out and meeting up with friends at the local pub. The homes newsletter includes photographs of shopping trips, information about an individual changing the colour scheme of her bedroom then shopping for new bedding and nice things to put in her room. Another newsletter included a photograph of a person using services riding his new bike in the park last summer. It was evident from all available information that people using services have a a high community presence. They attend various day services in the community, use gyms and go swimming, attend college courses, horse riding and have opportunity to go to church. Small group holidays were arranged last year including a holiday in Europe enjoyed by four people. The homes on-site activity centre has various projects include first aid and gardening. An individual said she had eaten vegetables she had grown, last year. Some individuals had been issued with certificates after successfully completing About Us projects in money matters and the access cafes projects. Discussions with management confirmed a lack of suitable employment opportunities for people using services. At the time of this inspection one person was in part time employment and six others registered with the Employability scheme. The manager said the benefit system penalises users if they work beyond a specified amount of hours or earn over a certain amount. People using services have a choice of whether or not they attend their day services.The home is aware of the potential closure of some day services and the home manager has not been able to obtain information to allay the anxieties of those affected. Both kitchens were clean and hygienic and well equipped. People using services are supported in shopping for food and in cooking meals as well as making group menu planning decisions. A four weekly menu is displayed in dining rooms, using picture symbols and affording choice of meals. The menus indicated a varied diet and accommodated special dietary needs and preferences.People who were at home during the visit were observed making their breakfast, drinks and snacks, with staff support. The home has robust risk assessments for activities of daily living including cooking skills and use of kitchen utensils and appliances. People living at the home are encouraged to keep their home and bedrooms clean and tidy. An individual was observed using the washing machine with staff support. Care Homes for Adults (18-65 years) Page 17 of 34 Care Homes for Adults (18-65 years) Page 18 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and medication procedures ensure their safety and welfare. The principles of respect, dignity and privacy are put into practice. Individuals limited capacity have some choice restrictions, for their safety. Evidence: People using services are registered with a general practitioner (GP) and health action plans have been produced. They have access to their GP and NHS services, also dental, podiatry and opthalmic services. The two care plans and associated records sampled demonstrated these individuals are supported in attending health care appointments. Record evidence was seen to demonstrate health needs are closely monitored and met and input from relevant health and social care professionals. There is management commitment to working closely with external professionals and specialists for advice and support. The manager reported there are barriers to working with some social care teams due to lack of consistency created by the system of locum care managers carrying out reviews who dont know the people using services or the home. Care management teams were stated to be sometimes slow in responding to Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: contact from the home for referral for specialist input to meet the needs of individuals.The manager stated that review actions for care management , for the wellbeing of people using services, were not always met. The manager tries to reduce the impact of these barriers to improvement by phoning and writing to care managers in these matters. The homes management is highly efficient in arranging staff training in health care topics relating to the health care needs of people using the homes services. Guidelines and protocols are in place for management of individuals health conditions, including diabetes and epilepsy. Staff have received epilepsy training and the epileptic condition of a person using services is monitored by the district nursing team.A protocol is in place instructing staff to call paramedics in the event of needing to administer emergency medication for this individual. District nurses have trained staff in the administration of insulin using pen injections and assessed their practice, signing off their competence statements. The staff team has undertaken training in diabetes to be able to recognise indicators of a medical emergency relating to fluctuations of blood glucose levels. A clear care plan is in place in this event with instructions of what action to take. The individual with diabetes has no concept of what not to eat and staff discreetly monitor his dietary intake. Staff promote his independence in monitoring his own blood sugar levels twice daily. Observations confirmed staff awareness and commitment to the social model of disability. It was evident that they see beyond individuals disabilities and provide selfdirected support based upon the rights of dignity, equality, fairness, autonomy and respect. Personal support is flexible, consistent and meets individuals changing needs.The homes management and staff are very alert to changes in mood, behaviours and general wellbeing and fully understand how they should respond and take action. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records were fully completed, containing required entries and signed by appropriate staff. The home has a good record of compliance with the receipt, administration, safekeeping and disposal of medication. There is a staff training programme for medication administration though some staff are reticent to assume this responsibility. Regular internal medication audits are carried by the deputy manager and the supplying pharmacist visits on an annual basis to offer support and advice. Improvements include regular staff supervision of medication practice and in-house training, to meet health needs. Discussion took place regarding the practice of secondary dispensing in exceptional circumstances, when a person using services goes on leave with her family, at very short notice. The deputy manager was advised to ensure a robust risk assessment is Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: carried out and a written procedure in place. Details should include which staff are permitted to do this, what container the medicines are to be put in, how the containers are to be labelled and what other information is to be given. A clear record should be kept of all staff involved in each stage of the procedure and the actions taken. Care Homes for Adults (18-65 years) Page 21 of 34 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. People who use the service are able to express their concerns and have access to a complaint procedure. They are protected by the homes policies and procedures. Evidence: The homes culture empowers people using services to express their views and any concerns, in a safe and understanding environment. Daily one to one sessions take place with staff in which they are encouraged to raise any issues. Monthly group meetings also take place, affording another forum in which problems can be discussed and resolved. A new complaint procedure has been produced which is clearly written in a pictorial format, making it easy to understand. The complaint procedure has been supplied to everyone living at the home. All of the people using services who responded to our survey told us they knew who to tell if the had a complaint. Some would speak with the manager, others with the homes staff and day services staff and others with a family member. All stated that staff treat them well and they are happy living at the home. Most told us that staff always listen and act on what they say. We have not received any complaints about the home since its last inspection. No complaints were recorded in the homes complaint records. Discussions with management confirmed the homes systems ensure any concerns receive an early response and are resolved before becoming a complaint. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Policies and procedures for safeguarding adults available in the home give clear and specific guidance to those using them. There is a system for staff to report concerns about colleagues and managers and staff know that whistle-blowing on bad practice is supported by management. Staff have received safeguarding adults training; also training enabling them to respond appropriately in the management of physical and verbal aggression and other behaviours that challenge services. Since the last inspection one referral has been made and looked into under Surreys multi-agency procedures. This was unsubstantiated, however did raise concern regarding behavioural management practice specific to this individual. The outcome has been for recent input from a specialist health team to support the home in managing this persons challenging behaviours and to review the homes behaviour guidelines. The relative of this individual raised the issue, at the safeguarding meeting, that an agreement at the last care management review for a referral to be made for specialist input for anger management for this individual had not been acted on by care management. Observations during the inspection confirmed no change in practice relating to the management of this persons behaviour in the plan viewed. The manager is transparent in recording time restricted access to a game owned by this individual. The limitation of this activity was stated to be necessary to the wellbeing of this person and others living at the home. A positive outcome of this safeguarding referral has been clarity received by management that referral of other people using services to the same specialist health team can be made direct and does not need to go through care management. Discussions with the manager confirmed she positively welcomes the specialist nurses offer to look at the homes behaviour management plans and guidelines. The safeguarding incident raised issues of previous incidents involving this individual not known to either care management or the CSCI. The home manager was clear that notifications had been sent to both agencys. The manager understands the procedure for safeguarding adults and when incidents should be reported. At the time of the inspection a concern of a person using services who felt unsafe because of the behaviour of another person using services was under discussion with the care managers of both individuals. Guidelines had been produced involving people in decision making processes about limitations on their choices based on risk assessments, for example, unsupervised visits to town. People using services are protected by the homes policies and procedures for the management of their finances and staff recruitment and vetting. Care Homes for Adults (18-65 years) Page 23 of 34 Care Homes for Adults (18-65 years) Page 24 of 34 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. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment that supports independence. Evidence: Both buildings are maintained and decorated to a good standard and tasteful furnishings throughout. The home is domestic in style and character.Bedroom colour schemes are the choices of their occupants and personalised to reflect their many interests and hobbies. There is no lift access in either home and currently people using services are all ambulant. They are afforded choice in moving rooms when vacancies arise and can agree to swap rooms with each other. Kitchens are well equipped, clean and hygienic, as is the whole home. There is a robust infection control policy. Bedrooms and communal areas are adequately spacious, comfortable and furnished with sturdy, quality furniture. Dining rooms are arranged with dining tables and chairs that enable opportunity to sit in small groups. A number of bedrooms and lounges have plasma televisions and music systems. Sufficient toilets, showers and bath rooms are available and of good quality.The environment promotes the privacy, dignity and autonomy of people using services. Some individuals have keys to their bedrooms. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Since the last inspection boilers have been replaced with modern high efficiency energy saving type. The home was warm, well lit and ventilated at the time of the visit. Grab rails have been fitted to the outside of Walton Cottage with advice from an occupational therapist, enabling easier access for two people with minor mobility impairments. The large gardens to the rear of both building are well maintained and fully accessible. The Day centre building in the grounds is adequately specious, warm and of a good standard. Off street parking is available at the front of both buildings. The home has a separate office facility. Care Homes for Adults (18-65 years) Page 26 of 34 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. Staff are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions and ensure the smooth running of the service. Evidence: Feedback from people using services was positive about staff. We were told staff treat them well. One person said, They are alright. Whilst there has been some staff turnover since the last inspection, a core group of staff have worked at the home for many years. The home manager has been employed at the home for ten years and the deputy manager for five, providing good continuity for people using services. The home manager confirmed the recruitment and retention of local staff is an ongoing issue. Staff vacancies continue to be advertised locally and incentives are paid to staff to enhance staff retention. The homes management demonstrates good understanding of equality and diversity throughout the processes of staff recruitment, induction and training. There is wide diversity within the team. Regular staff training is provided to ensure equality and diversity is promoted within the services and monitored through systems for staff Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: supervision and appraisal. Clear policies and procedures are in place to ensure best practice and compliance with legislation for staff recruitment. An information checklist is completed by the manager to ensure all statutory information is received about prospective staff before taking up post. This includes two references, including one from their last employer, a check to ensure they are not on the national list of people unsuitable to work with vulnerable adults (Pova List) and a Criminal Records Bureau disclosure (CRB). Commendable good practice was noted of repeating all CRB and Pova checks every three years though there is currently no obligation to do so. All staff have been issued with the Social Care Code of Practice. The manager completed a three- day train the trainer course and provides a range of internal training sessions for the team.She was commended for her hard work in customising the staff induction programme. This includes service specific training in addition to the six Common Induction Standards, promoting development of essential competencies in new staff. The induction package also covers equality and diversity promoting awareness and non - discriminatory practice. Observations confirmed staff receive all statutory training. A workforce development plan is in place to monitor the teams training needs. The home does not meet the standard for 50 of care staff to achieve a Social Care National Vocational Qualification (NVQ) at Level 2 or equivalent.The reticence of some staff to work towards this qualification continues to be barrier to meeting this standard, despite being made aware at interview of the requirement to do so. Whilst the staff induction prepares new staff for entry onto the NVQ programme, they sometimes leave before obtaining this qualification. The manager said that it is also difficult to keep staff motivated to complete this training, as often they find difficulty in understanding the concept of the training programme. Effort is made to overcome this problem through mentoring arrangements. Staff meetings are regular and two weekly staff training sessions take place. Staff appraisals are carried out twice a year and monthly supervisions take place in between. Discussions with a staff member during the visit confirmed her view that staffing levels are adequate to appropriately and safely meet the needs of people using services. A management on-call system ensures staff are supported day and night. The manager and deputy manager live a short distance from the home, enabling them to promptly visit, out of hours if necessary. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management and administration is efficient and the service is led by a qualified, competent manager. The home is run in the best interest of people using services and their welfare,health and safety is promoted. Evidence: The responsible individual, on behalf of the organisation, was present at the home at the time of the inspection visit. Though the registered manager was off duty she arrived shortly after being informed of the inspection, to facilitate the same. The responsible individual stated he visits and works at the home at least four times a week, sometimes more. He has a clearly designated role dealing with business financial management and also purchases food provisions. He has sound knowledge of both strategic and financial planning and of accountancy, enabling effective financial controls. The responsible individual is also the corporate appointee for a small number of people using services who have separate financial accounts from the business. Efficient systems are in place to safeguard and support people using services in the Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: management of their money. A barrier to improvement was stated to be the failure of annual fee increases paid by local authorities to keep pace with inflation, though service costs increase, year upon year. The homes management works hard to overcome this through savings efficiencies and effective management of resources without impacting on quality of services. This has had significant impact on the development of the homes day services. The registered manager has managed the home for the past six years. Since the last inspection she has completed her NVQ Level 4 in management and achieved the Registered Managers Award. The homes deputy manager was also on duty and has attained the NVQ Level 4 qualification in management. The manager and deputy manager have clearly defined areas of responsibility. Observations indicated that the home has a cohesive senior management team supported by effective and efficient management and administration systems. Discussions with management confirmed a clear vision of the homes values and priorities. A staff member said the management team communicated a clear sense of direction and is supportive. Quality assurance and monitoring processes exist. These include audits and monthly statutory inspections by the responsible individual. Also an annual quality survey is conducted, consulting people using services and their relatives or representatives about the home. At the time of the inspection the 2009 surveys had recently been distributed and those received back were being collated. Observation of the outcomes of the 2008 survey demonstrated the overall satisfaction with services of people using services and their representatives. The home works to a clear health and safety policy. All staff are aware of the policy and are trained to put theory into practice. Health and safety and fire safety risk assessments and audits take place. A fire safety audit was recently conducted by a specialist company and compliance with the fire regulations confirmed. Regular fire tests and fire drills are carried out. People using services were stated to respond promptly to the fire alarm and evacuate to the assembly point at the front of the buildings. Four senior staff are fully trained first aiders and all other staff have received first aid appointee training. Accident and maintenance records sampled demonstrated due diligence in maintaining a safe environment. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: We have not always received statutory notifications of incidents which is a legal requirement. This was discussed with management who gave assurances these had been sent. The requirement for the home to notify the CSCI of any safeguarding adults referrals was also discussed and for the new notification procedure to be followed. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 Care Homes for Adults (18-65 years) Page 33 of 34 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. 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