Care Home: Haven House (Haslemere)

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What the care home does well The home provides a range of information to assist people who are considering using this service and their representatives in making an informed choice of home. Preadmission assessment procedures ensure people admitted to the home can be confident their needs can be met. The physical environment is well-maintained, safe, clean and homely. It is furnished and decorated to an overall high standard and bedrooms are personalised, reflecting the individual tastes and interests of their occupants. People using this service are supported and encouraged to participate in domestic routines within individual levels of capability, and to have a say in decisions affecting their lives. One individual was stated to enjoy gardening and grows vegetables and flowers in the greenhouse. When people using services were asked in our survey what they liked about the home, comments included, "Staff helpful, good people, fun to be with, nice food and outings and look after me", also " Cleaning, dinner" and " Happy cooking". A person-centred approach was evident in the way staff identify and meet the diverse needs of people using this service. This means planning starts with the individual and not services, taking account so far as possible,individual wishes and aspirations. Consistent programmes of care and support promote independence and empower people to have control of their daily lives. Staff assist and support the progression of communication skills, enabling and encouraging people using services to express themselves and make choices. Opportunities for social inclusion, for developing socialisation skills and for using community resources are available to ensure people using this service lead fulfilling lives. Staff work collaboratively with multi-agency professionals involved in the care and support of each person. Robust risk assessments and working protocols provide people with the level and quality of support they need to promote their safety, health and wellbeing. We received positive feedback about the home and staff from the home`s general practitioner and other professionals who responded to our survey. Comments received from relatives included, " My sister is very happy and well looked after. They recently organised a lovely surprise 50th birthday party and made it a very special day. Lots of activities are organised for evenings and weekends and holidays from the day centre. Staff are very caring and have endless patience. A member of staff who has now left set up a work placement for my sister which she loves". " Staff are very good at making life as interesting as possible, with visits, holidays and outings. All my daughter`s wishes are considered carefully. She has no speech, uses Makaton. I am very happy with the home, my daughter is happy to go back when she has been home to us, she has a very good quality of life." What has improved since the last inspection? There is an ongoing programme of redecoration and refurbishment of the premises. Since the last inspection carpets had been replaced in the lounge and a bedroom, the dining room has new floor covering and new blinds have been fitted in the kitchen. A new wheelchair adapted vehicle has also been purchased. The care plans are now held electronically, enabling these to be easily updated. The organisation now has its own website. The medication policy and procedure has been reviewed and is more robust. People using this service were stated to be more involved in domestic routines, for example shopping for food and keeping their home clean and tidy. A person using services has assumed responsibility for updating the home`s see-read menu each evening. What the care home could do better: The home has not had a registered manager since 2006 and a requirement has been made for registration of the new manager who is imminently due to take up post. Shortfalls in the home`s management identified during this inspection, were known to the organisation through its self-monitoring systems and receiving an appropriate response. Other areas identified for improvements related to an element of staff recruitment practice, induction record keeping, staff training and supervision. Discussions were stated to be taking place with the landlord regarding proposals for upgrading the ground floor bathroom and replacing missing wall tiles. Key inspection report Care homes for adults (18-65 years) Name: Address: Haven House (Haslemere) Haven House 44 Kings Road Haslemere Surrey GU27 2QG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 1 9 0 6 2 0 0 9 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 30 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) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Haven House (Haslemere) Haven House 44 Kings Road Haslemere Surrey GU27 2QG 01428661440 01428661450 hhman@whitmorevale.co.uk www.whitmorevale.co.uk Whitmore Vale Housing Association Limited care home 9 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home Haven House is a care home providing personal care and support for up to nine adults of both genders whose primary needs on admission are learning disabilities. The registered provider is Whitmore Vale Housing Association Limited and the home is part of a group of care homes and other services for people with learning disabilities, operating in Surrey. The building was purpose built in 1999 and is owned by a social landlord. The home is located in a residential area within walking distance of Haslemere town centre. It is a detached property on two levels, comprising of a ground and lower ground floor. The building is wheelchair accessible and a passenger lift Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 0 0 9 9 9 9 Brief description of the care home provides access to both floors. Bedroom accommodation is for single occupancy and arranged on both floors near to toilet and bathing facilities. Communal lounge and separate dining and kitchen facilities are on the ground floor and a quiet lounge on the lower ground floor. The home has limited parking facilities, a balcony terrace and enclosed garden with a furnished patio. It provides a homely and secure environment in which independence and social inclusion is promoted. Weekly fee charges are from 863.55 pounds to 1342 pounds. A percentage of fee payments include a holiday and clothing allowance. Additional charges apply for one to one support not included in the core fee and for hairdressing. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Date of last Key Inspection: 3rd July 2007. This unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector over a period of five hours and facilitated by a manager employed by the organisation who is currently overseeing the homes management. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgments about how well the home is meeting the National Minimum Standards (NMS) for Adults. This includes accumulated evidence and our knowledge and experience of the home since its last key inspection. Also feedback in survey questionnaires received from seven people using this service, completed with staff support; also from six relatives, a therapist, a general practitioner, care manager and two staff members. Care Homes for Adults (18-65 years) Page 6 of 30 Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. It provides quantitative information about their service, requiring assessment of the same against NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and its content used to inform judgments about this service. The inspection process incorporated discussions with three people using the service. We toured the premises looking at most bedrooms, all communal areas and the garden. In addition to discussions with the manager facilitating the visit, we spoke with two support workers, sampled records amd carried out direct and indirect practice observations. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? There is an ongoing programme of redecoration and refurbishment of the premises. Since the last inspection carpets had been replaced in the lounge and a bedroom, the dining room has new floor covering and new blinds have been fitted in the kitchen. A new wheelchair adapted vehicle has also been purchased. The care plans are now held electronically, enabling these to be easily updated. The organisation now has its own website. The medication policy and procedure has been reviewed and is more robust. People using this service were stated to be more involved in domestic routines, for example shopping for food and keeping their home clean and tidy. A person using Care Homes for Adults (18-65 years) Page 8 of 30 services has assumed responsibility for updating the homes see-read menu each evening. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 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. People who use this service and their representatives have clear information to help them choose a service that meets their needs. Copies of care management needs assessments are obtained before admission to ensure the home can meet individual needs and aspirations. Evidence: The home has a comprehensive statement of purpose and service users guide specific to the group of people who use this service. The service users guide was noted to be a comprehensive, informative document. It details the service provision and what prospective people considering using this service and their representatives can expect. It incorporates information about the complaint and admission procedures and has been produced in a pictorial, easy read format, using language and symbols aimed to make this information accessible to the people who use this services. Though noted both documents had been reviewed since the last inspection, they needed updating again to reflect more recent management changes. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: Three admissions had taken place since the last inspection, two of which had been at short notice owing to circumstances outside the homes control. The records viewed verified all three admissions had been agreed after receiving needs assessments carried out by care managers, integrated where appropriate with the care programme approach for individuals with dual conditions of learning disabilities and mental health disorders. Though not the practice for independent pre-admission needs assessments to be carried out by the organisation, it was noted that this is planned and an assessment tool for this purpose is being developed. Care plans had been generated from the needs assessment information, using a person centred approach. This means the planning started with the individual and so far as possible, meets individual wishes and aspirations. A person using services who moved into the home last year told us about her experience of the admission process. She stated there was opportunity to visit the home with her family and to see her room, before deciding if she wanted to live at the home. The outcome of our survey confirmed most people had been consulted and asked whether they would like to live at the home. One individual said they were not asked but had received information about the home in advance of moving in. Care Homes for Adults (18-65 years) Page 12 of 30 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. Assessed and changing needs and personal goals are mostly reflected in individual care plans. There is opportunity for people using services to make informed decisions and to take risks, as part of an independent lifestyle. Evidence: A key worker system is in operation for monitoring outcomes for each individual and updating care plan. We looked at two files of people using services to assess how well the home meets the key standards. These contained care plans covering all aspects of daily living including support needs for personal and health care, communication, mobility, orientation and community inclusion. Risk assessments, strategies and guidelines were in place for meeting needs, promoting independence and the management of behaviour. Guidance and indicators were also available to aid staff in early identification of mental health relapse, to ensure prompt referral to health professionals. A person centred approach to care planning was evidenced by all available information, including discussions with some people using services and staff. These and care notes were generally of a good standard. Care plans had been Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: produced in easy read language, using symbols, pictures and photographs to meet individual communication needs. They contained clear action plans and a likes and dislikes section. They were specific about any restrictions on choice, for the wellbeing of the individual, for example about how many items are to be offered to make that choice appropriate and realistic. Various professionals have had and continue to provide input to individuals, ensuring needs are fully assessed and met. These include the community learning disability team for specialist services, day services and adult education. Some staff had received equality and diversity training. The care plans sampled how the home meets the diverse needs of each individual. People using services are encouraged and supported to express their cultural and religious identities and engage in age appropriate social and leisure activities. There was evidence of the social model of disability being well understood in the homes day-to-day operation. Independence is promoted within individual capabilities and there is a strong commitment from staff to overcoming environmental and communication barriers, enabling people using service to live fulfilling lives. Survey feedback from four people using this service confirmed they usually have a choice in what they do each day. Two others told us they always decide. All respondents told us staff always listen to them and and act on what they say. One person commented, I enjoy that I am given the opportunity to make my own choices and I am helped to promote my independence. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported to participate in age-appropriate social, educational and leisure activities and to be part of their local community. They are offered a healthy diet and flexible meal times and links with families and friends are encouraged. Evidence: Services are tailored to meet the assessed needs and preferences of the people who live at Haven House and in accordance with funding agencys contracts.Routines are person centred and overall flexible within a structure of various day services and adult education commitments. Staff were respectful towards people using this service during the visit. They are encouraged and supported to lead a stimulating and purposeful life through varied lifestyle opportunities which change in response to changing needs. Two individuals present during the visit had just returned the evening Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: before from a four day holiday at Euro-Disney in Paris, with staff. Others were attending various day services in the community. We were told by another person using this service that she was going on holiday with a member of staff in a couple of weeks, which she had helped plan, staying in a caravan by the sea. She was also looking forward to her birthday party the day before going on holiday. She commented that she liked living at the home and liked the staff. The home has two vehicles to access community resources, one with a tailgate lift suitable for wheelchair users. Designated drivers have been shown how to clamp wheelchairs in the larger vehicle, to ensure their safety. A comment in our survey from a person using services that the individual would like to go out more in the evening and weekends was discussed. Assurances were received that since the survey social and leisure community activities opportunities had increased. Recent trips out included a visit to Wisley Gardens to see a tribute concert and trips to other community shows and events were planned. Positive comments were received from relatives confirming people using services engage in a wide range of appropriate leisure and social activities, in the home and in the community. People using this service are supported and encouraged to participate in the running of their home. They are stated to have increased involvement in food shopping and domestic routines since the last inspection. One person was said to enjoy gardening. Menu planning involves the whole group during their monthly meetings which are facilitated by staff. A written menu is then produced and one person using services is responsible for updating the pictorial, see-read menu displayed in the kitchen, each day. Weights are monitored and staff encourage people using services to choose healthy eating options, though their advice is not always followed. A colour coded menu planner is used with picture references, to meet the communication needs of individuals and ensure all have an informed choice of food. Staff encourage people who use the service to have active lifestyles and sometimes walk with them to the local shops. A referral had been made for dietician input to the home. The families of people using this service are actively involved with Haven House through a charity called Haslemere Haven Trust. They raise funds to provide additional facilities, adding quality to service provision. They take an active interest in what their relatives who live at the home do and visit as often as they can. The organisation has been responsive to dissatisfaction raised recently by individual relatives about aspects of the homes operation and about communication. Senior management is being proactive in this matter, to achieve improvement. A staff member said they usually collate holiday photos into a slide show for families to look at when they visit. Plans for a newsletter were noted to enhance existing systems for communication with families. Care Homes for Adults (18-65 years) Page 16 of 30 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. People who use this service are offered personal support in the way they prefer and require and their health needs are met. Medication procedures and practice was satisfactory at the time of the visit. Evidence: People who use this service receive personal and health-care support using a person centred approach, set out in a plan of care. Though informed these are reviewed six monthly, a care plan we looked at was last reviewed nine months ago. The care and support respects rights of privacy, dignity, equality and autonomy. All people using services are registered with the same medical practice and staff told us the general practitioner (gp) provides an excellent service to the home. The gp commented, Very caring staff, good adherence to protocols. Two deaths had taken place since the last inspection. Staff said the medical, district nurses and McMillan service had provided an excellent service and very good support to the team when it was decided that one of these individuals would receive palliative care at the home. People using services have access to health screening services and multi-disciplinary mental health and learning disability specialist services. Mobility guidelines produced by health-care Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: professionals and special aids and equipment were in place to ensure needs are met. Staff who responded to our survey said they usually have up to date information about the needs of the people they support. The majority of relatives who responded to our survey were satisfied with the standard of personal and health care and with communication in such matters. Comments included, They looks after my daughter very well, with lots of love and fun. The standard of care and medical attention is outstanding. She loves it there. I am so glad she lives in a happy home. My daughter has various medical needs and these are very well met. Staff are aware of these and always quick to take action and I am always informed of medical appointments/matters. One relative was less positive about communication, however, stating in their experience this had been very poor this last year; also expressing concerns about the way some staff respond to telephone queries. As previously stated in the report, the organisation is taken these concerns seriously and taking action for improvement. All staff are trained in the administration of medication and the policy is for only grade 4 support workers to administer medication. Staff also complete an in-house competency assessment before being permitted to administer medication. Though the homes Annual Quality Assurance Assessment (AQAA) told us staff have a series of competency assessments only one assessment had been carried out for the staff member whose file we viewed. Medication is stored in approved medication cabinets which includes suitable storage for controlled drugs. Good practice observations were evident in the storage and administration of a schedule 3 controlled drug. The organisations medication policy and procedure had been reviewed and further developed. This followed a number of medication errors and maladministration practice at this home and across the group of homes. These incidents have been looked at under local multi-agency safeguarding procedures.The organisation is transparent in reporting all medication errors and omissions in medication record keeping. Rigorous procedures are followed in all instances to ensure staff responsible for errors/recording omissions do not administer medication until they undertake refresher training. The community learning disability nurse and the organisations chief executive have reviewed all medication records and these were observed to be clear and detailed. They also provide staff with information about what each prescribed medication is for and of possible side effects. Record keeping practices provide an audit trail of medication received, administered and disposed of. Weekly spot checks are carried out of medication practice. A monitored dosage medication system is used, reducing the risk of dispensing errors by staff. The medication practice subject to a requirement made at the time of the last inspection no longer applied. The practice of administering tablets in jam to one person was followed up and discussions confirmed the purpose was not a covert practice but to enable the Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: individual to swallow the tablet. It was noted that the organisation had sought written agreement from the gp and discussions with the gp in this matter were ongoing. Infection control practice and procedures appeared satisfactory at the time of the visit. The AQAA informed us of plans to provide staff with infection control refresher training. Care Homes for Adults (18-65 years) Page 19 of 30 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 through various communication channels and know how to make a complaint. They are protected by whistle blowing, safeguarding and other procedures. Evidence: The complaint procedure is displayed in the entrance hall with details of how to make a complaint. It is written in easy read symbol format and had been updated since the last inspection. The majority of people who use the service told us in our survey they know who to speak to if they are not happy and how to make a complaint. One person was unsure. We have not received any complaints about this home since the last inspection and there were no formal complaints recorded in the homes complaint record. The manager present at the time of the visit confirmed the recent concerns of some relatives were raised in a survey carried out by the organisation as part of its quality assurance system, and no formal complaints made. The majority of relatives who responded to our survey were aware of the complaint procedure and two could not remember. Five said the home always dealt appropriately with any concerns. The home had a copy of the organisations safeguarding policy and procedure and latest edition of Surreys safeguarding procedure. Safeguarding training is provided for staff and there is a whistle blowing procedure. There has been an ongoing safeguarding matter which has been the subject of a series of safeguarding meetings relating to maladministration of medication at this home and across the organisations Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: group of homes, over a period of time. Rigorous remedial action has been taken by the organisation as described in the last section of this report. All staff also received a letter from their employer emphasising the need to follow correct medication procedures at all times. The deputy chief executive had also monitored medication practice twice weekly at the home, for a period of time, earlier this year. Another safeguarding referral in October 2008 was investigated and the matter is now closed. Policies and procedures are in place to minimise risks to people using the service regarding their money and financial affairs. They are supported in making choices in how they spend their money. Sound financial management practices and record keeping ensure the safety of money held on their behalf. Care Homes for Adults (18-65 years) Page 21 of 30 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 homes physical design and layout enables people using services to live in a safe, well-maintained and comfortable environment, which encourages independence. The home is clean and hygienic. Evidence: Responsibility for building maintenance is that of a social landlord. Four years ago the landlord was required to contract a major work programme in bathrooms on the upper and lower floor to conform with water regulations. The registered organisation raised the issue at the time and since, of the standard of finish of this work, with unmatching tiles and white tiling roughly finished. Since then the welded seams in the original flooring in the ground floor bathroom failed resulting in a much larger area of flooring having to be replaced on health and safety grounds. The manager present at the time of the visit stated there are plans to replace the walk- in shower in this room with a larger one more suitable to the needs of people using services. There was also a number of wall tiles missing in the shower area that it was stated are going to be replaced. For this reason a requirement was not made. The bath has a chair hoist to enable access. It was understood the organisation may replace this bath with one that has walk-in access, to promote independence. The inspection process included a tour of the building and garden, viewing all communal accommodation and most Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: bedrooms. All bedrooms sampled were personalised. The home has suitable equipment and aids to meet the mobility needs of individuals. Occupational therapists and physiotherapists were consulted before purchasing these aids and others, for maximising independence. The environment is maintained internally and externally to an overall good standard. All areas of the home were nicely furnished and comfortable, the environment being domestic in scale and character. The lower ground floor has a secure garden with a shed and small greenhouse.The gardener recently left and the post is being advertised. In the interim the organisations maintenance person will be responsible for maintaining the garden. The need to remove moss growing on the patio was discussed. The balcony terrace off the lounge provides an attractive sitting area. It has lovely colourful hanging flower baskets, provided and tended by a relative. There is an ongoing refurbishment programme. New kitchen blinds have been purchased and the broken integrated double oven in the kitchen is imminently due to be replaced. This does not impact on catering arrangements as there is another oven. Carpets have been replaced in communal areas and one bedroom. All areas of the home were clean and hygienic. Care Homes for Adults (18-65 years) Page 23 of 30 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 adequate 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 a staff team who know them and are in sufficient numbers to meet their needs. The staff recruitment policy and procedure is safe though remedial action needs to be taken in one area of practice. Shortfalls were identified in areas of staff training and supervision. Evidence: Three staff were on duty including the shift leader at the time of the inspection visit. The staff rotas sampled confirmed that staffing levels were consistently maintained at three during the waking day. At night there is one waking worker and one sleeping in, on -call. Staff were professional in their conduct and demonstrated a warm and caring attitude towards the people they support and were aware of individual needs. The organisation has difficulty in the recruitment and retention of staff due to its location in a very high cost-of-living area. Through the use of bank staff and cooperation of agencies that supply staff to the home, effort is made to have the same staff, so far as practicable, for continuity. Information provided by the manager present and records viewed on the two staff files examined confirmed mostly good practice in staff recruitment and vetting. One shortfall in recruitment practice was drawn to the attention of management for follow up. The recruitment policy is underpinned by equal opportunities legislation and this is monitored by head office. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: New staff have a probationary period and were stated to be supernumerary to staffing levels for one month during which time they are inducted.We were informed that a more comprehensive induction programme has been produced, covering the common induction standards, though not yet implemented in this home. The need for new staff to always sign the induction check list on completion and for this to be signed off by management, was discussed. Feedback from staff in our survey highlighted the need for increased management support to new staff, particularly those with limited or no experience. One employee told us of a lack of direction when first employed at the home. Staff also raised in our survey that supervision arrangements were not supportive and training needs not always followed through when identified at supervision and appraisal meetings. The staff records sampled demonstrated that the frequency of supervision for two employees relatively new in post was not in accordance with the organisations own policy or the National Minimum Standards (NMS). Staff who took up post in November 2008 and March 2009 had each only received one supervision session, though the policy is for these to be every 4 to 6 weeks. There was no record of any meetings between these employees and management at the end of their probationary period, before confirming their posts as permanent. At recent staff meetings the matter of staff not receiving regular supervision had been raised by staff and senior management were now aware and planning to remedy this shortfall. The manager present during the visit had been assigned interim responsibility for oversight of the homes management. She stated supervision dates had been agreed with all staff, however other work priorities meant she would not now carry these out. It was stated the organisations deputy chief executive will now carry these out. The training records sampled identified an ongoing programme of statutory training though not all employees had received all statutory training, including first aid training. The manager present said the organisation is aware of training shortfalls in this team and there are plans for these to be addressed. On this basis a requirement was not made. The organisations staff training programme prepares workers for entry onto the appropriate Health and Social Care National Vocational Qualification (NVQ). Two staff were stated to have NVQ Level 2 qualifications or above which does not meet the standard. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management shortfalls have been identified through the organisations self-monitoring systems and are currently being addressed.These systems take into account the views of people using this service and their representatives. Working practices are safe. Evidence: The inspection outcomes identified a shortfall in the homes management and the need for management stability, for improvement. There has not been a registered manager since November 2006, and though a manager was appointed to the post in February 2008 she did not apply for registration and transfered in March this year to manage another home within the group. There has also been two deputy managers since 2007 and the last deputy manager left in December 2008 and this post is currently vacant. Though there was no evidence that these management shortfalls had affected the quality of care or placed people using services at risk, the interim management arrangements had not been effective to provide the staff team with the direction, support and supervision needed. The organisations senior management team has been proactive recently in taking action to strengthen the interim management arrangements pending a new manager taking up post in July. The Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: deputy managers vacancy had also been advertised and recruitment to this vacancy in progress.The new manager, who is working out his notice with his current employer, has met the people using the homes services and their relatives and attended recent staff meetings, in his own time. Quality monitoring, audit and quality assurance systems are in place. Monthly statutory inspection visits are carried out by senior management on behalf of the responsible individual. Feed back is sought from people using services at their monthly meetings as a group and when they meet with key workers, during review meetings and through an annual survey which is also sent to their families and advocates. The last survey conducted by the organisation was in March 2009. The organisation is planning to strengthen its quality systems and was stated to be appointing a service manager within the senior management structure. The post holder will have delegated responsibility for staff induction and training, for reviewing policies and carrying out audits across the group of homes. A number of policies were observed to be in need of updating. The homes Annual Quality Assurance Assessment (AQAA) we received indicated some essential policies were not in place. Examples of these include one for access to files by users and staff, disposal of clinical waste and relating to staff induction and the common foundation standards. Observations confirmed that policies, procedures and safety and maintenance checks ensure the safety of the environment. The programme of staff training includes training to support safe working practices. At the time of this inspection four staff were noted not to have received first aid training. The manager present stated this was planned and for this reason a requirement has not been made. Care Homes for Adults (18-65 years) Page 27 of 30 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 30 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 37 9 For the home to have a registered manager. This will ensure effective day-to-day management in the best interest of people using this service. 26/03/2010 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 Care Homes for Adults (18-65 years) Page 29 of 30 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). 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