Care Home: Hawthorns

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What the care home does well The house is clean and there is plenty of space in people`s rooms and shared rooms in the house so that people can have quiet times or share in what is going on in the house. People can go on outings most days with support workers, to visit interesting places and have their lunch out if they want to.The home helps people keep in touch with their families and friends. It makes sure that people are helped to stay healthy and visit the doctor or nurse if they are ill. What has improved since the last inspection? The last time we visited we found that the people who run Hawthorns did not always know enough about the new staff who were going to come and work here. There are rules about how to make sure that people living here are safe. Now anyone who wants to come and work at Hawthorns is properly checked to make sure that they are allowed to work here so that service users are always safe and well supported. The people who run Hawthorns come and visit more often and write about what they find when they come. This shows that they want tomake sure that people living here are happy and well supported. They make sure that the staff know about the rules and what they have to do to follow them so that everyone is safe. The people who run Hawthorns have done a lot of the things that we said they had to do when we last visited, to make the home cleaner and a nicer place to live. Some of the rooms have been decorated and everyone helps to keep their rooms and the house clean. The people who run the home know that they need to do some things better and have told us how they are going to do this. They are making sure that support staff always know how best to support the people who live here by going on courses to learn about the sorts of things that will help each person. There is now another person - an area manager - who helps themanager and staff at Hawthorns and another home, Holt Farm, to run things well. This means that people living at Hawthorns have managers and support staff who know them well and can help them do new things. What the care home could do better: The kitchen cupboards and some of the tiles are broken and need to be changed, so that it is easier to keep clean and the kitchen is better to make meals in. Some of the carpets and furniture is old and worn out new carpets and furniture should be bought to make sure that the home is always nice and comfortable for everyone. Outside, the grass is long and there are lots of weeds. Some of the path stones are broken or missing. There are holes in the drive that make it bumpy and muddy for people using it. The people who run Hawthornssaid they are going to make the garden a lot better and use some of it to grow vegetables in. This should be done, so that people living here can have a nice place to sit, grow things, or do activities when the weather is good. We know that the home is already working on some of the things that could be better and we look forward to hearing about them and seeing these new changes when we next visit. Key inspection report Care homes for adults (18-65 years) Name: Address: Hawthorns 2 Bushey Ground, Brize Norton Road Minster Lovell Witney Oxfordshire OX29 0SW two star good service The quality rating for this care home is: 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: Delia Styles Date: 0 8 0 7 2 0 0 9 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. They reflect the things that people have said are important to them: 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 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 Information about the care home Name of care home: Address: Hawthorns 2 Bushey Ground, Brize Norton Road Minster Lovell Witney Oxfordshire OX29 0SW 01993776336 01993709056 princecres@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Meriden Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection 0 5 0 7 2 0 0 9 A bit about the care home The home is registered to provide care for up to six adults under 65 with a learning disability. The needs of residents have been described as mild to moderate learning disabilities and autistic spectrum disorder. The home is not registered to admit those requiring care mainly because of their physical disablement, dementia or mental disorder but strives to continue to care for those who become so, as long as it can continue to meet their needs. Residents mental health needs are secondary to their learning disability and these are met by the community mental health services. The fees for this service range from 1,500 pounds to 2,100 pounds weekly. Extras include toiletries, hairdressing, magazines and newspapers, spending money for holidays and some activities. No fee is charged for transport. 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 How we did our inspection: This is what the inspector did when they were at the care home Before the inspection, we sent out some surveys (questionnaires) to people to ask them what they think about Hawthorns. We got 4 surveys back from the people living here, 4 from staff and 3 from doctors, nurses or social workers who visit the home or know the residents. The inspector met all 4 people who live at the home and was shown around so that she could see some of their rooms (if they said it was alright to do this). The inspector looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. The inspector talked to the manager, Spiwe Shana, and some of the support workers about how they help people to go on trips out and activities so that they have interesting things to do. The area manager and the person who owns Hawthorns were there too, so we could talk to them about how the home is run and what they are going to do next. We would like to say thank you for helping us to find out what you think about living at Hawthorns. What the care home does well The house is clean and there is plenty of space in peoples rooms and shared rooms in the house so that people can have quiet times or share in what is going on in the house. People can go on outings most days with support workers, to visit interesting places and have their lunch out if they want to. The home helps people keep in touch with their families and friends. It makes sure that people are helped to stay healthy and visit the doctor or nurse if they are ill. What has got better from the last inspection The last time we visited we found that the people who run Hawthorns did not always know enough about the new staff who were going to come and work here. There are rules about how to make sure that people living here are safe. Now anyone who wants to come and work at Hawthorns is properly checked to make sure that they are allowed to work here so that service users are always safe and well supported. The people who run Hawthorns come and visit more often and write about what they find when they come. This shows that they want to make sure that people living here are happy and well supported. They make sure that the staff know about the rules and what they have to do to follow them so that everyone is safe. The people who run Hawthorns have done a lot of the things that we said they had to do when we last visited, to make the home cleaner and a nicer place to live. Some of the rooms have been decorated and everyone helps to keep their rooms and the house clean. The people who run the home know that they need to do some things better and have told us how they are going to do this. They are making sure that support staff always know how best to support the people who live here by going on courses to learn about the sorts of things that will help each person. There is now another person - an area manager - who helps the manager and staff at Hawthorns and another home, Holt Farm, to run things well. This means that people living at Hawthorns have managers and support staff who know them well and can help them do new things. What the care home could do better The kitchen cupboards and some of the tiles are broken and need to be changed, so that it is easier to keep clean and the kitchen is better to make meals in. Some of the carpets and furniture is old and worn out new carpets and furniture should be bought to make sure that the home is always nice and comfortable for everyone. Outside, the grass is long and there are lots of weeds. Some of the path stones are broken or missing. There are holes in the drive that make it bumpy and muddy for people using it. The people who run Hawthorns said they are going to make the garden a lot better and use some of it to grow vegetables in. This should be done, so that people living here can have a nice place to sit, grow things, or do activities when the weather is good. We know that the home is already working on some of the things that could be better and we look forward to hearing about them and seeing these new changes when we next visit. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Delia Styles Care Quality Commission South East region Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. A full assessment of the needs of a person who wants to move to the home is completed, that takes into account the needs and wishes of prospective residents, so that the home and the prospective service user can be assured that the home will meet their support needs and preferences. Evidence: The homes Annual Quality Assurance Assessment tells us they have have had two people come to live here since our last inspection in 2007. The registered manager described the careful process of assessment and matching of potential new residents that she follows to make sure that the home and facilities can meet the needs and preferences of people who want to come and live here. Whenever possible, potential residents are invited to spend time at the home with other residents - for example, for meals, joining some activities and staying overnight - so that everyone in the house has a chance to get to know each other. If the person themselves cannot visit the home in person, their families or advocates are closely involved in looking at the home, talking to staff and providing information that will help the prospective resident to settle into their new room and environment. One person who came to live here in the past 12 months has recently moved out. The manager said that not all the details of this individuals behavioural difficulties had been available to the home when they moved in and it became apparent that group living did not suit the person. The multidisciplinary and safeguarding team worked with the person to find them more a more appropriate placement to suit their needs. We looked at the new Statement of Purpose that is pinned up in the lounge area - the home has recently changed its name from Maytrees to Hawthorns. The information does Evidence: is not in easy-read format or use picture bank symbols and so may not be accessible to some potential residents. The manager said that the current residents are able to access printed information, but that they are looking at developing information about the home in different formats to meet the range of needs for prospective new residents and perhaps a DVD, involving current service users. The 4 residents who completed our survey said that they did have enough information about the home before they came to live here. Not everyone could remember being asked if they wanted to move into the home - 1 person said that the social worker put me here, one could not remember and 2 said that they had been asked. 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. Since the last inspection improvements have been made to peoples personal plans and the records about their day to day support and health and social care needs. People living here are supported to make decisions about their lives and risk assessments are in place for activities that promote their independence and freedom of choice. Evidence: We looked at a sample of the personal care plans (PCPs) for the people living here. These give a very clear picture of each persons care needs and very clear guidance about how staff should respond to certain behaviours that might cause disagreements or conflict with other members of the household. The AQAA tells us that they have worked hard to develop the care plans so that they have detailed information about the support and welfare needs of people living here. The documentation includes Health Action Plans (HAP), Person Centred Plans (PCP), notes of Care Programme Approach meetings (CPA), Behaviour Support Plans and activity plans. Risk assessments are included where an individuals chosen activities or lifestyle may involve potential risk or harm. The risk assessments are aimed at reducing risk whilst promoting peoples safety and independence. It was clear during the inspection that people living here are actively encouraged to make decisions about their lives. For example, one person had decided they did not want to go away on the weeks holiday booked for the other residents but would rather go on a trip to London and go to a musical and sight-seeing. One resident said they were looking forward to the holiday and was anxious to know when they and the others would start packing. People living here are consulted about the changes made in the house - for example the Evidence: colour of the decor, menu choices and and the decoration and furnishing for their own rooms. 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 living here are able to participate in a range of activities that meet their varied interests, abilities and lifestyle. People are encouraged to take up opportunities to be part of local community life. Where personal and family relationships exist, people are encouraged to maintain and develop these. Evidence: Each person has a key staff worker who helps them to helps them to talk about what activities and hobbies they like and to draw up an activity plan, so that chosen activities and outings feature regularly. Residents told the inspector about the kinds of things they enjoy doing - swimming, shopping, going on holiday and using the computer at the library. When at home, people like to read, write, watch DVDs and cook. The surveys received showed that people felt that they can do what they want, including at weekends and in the evening. The homes AQAA states that the home is constantly looking out for opportunities for new activities and hobbies that residents will enjoy taking part in. Examples given were a recent train trip, art sessions held in the home by an outside artist. It is evident that a great deal of planning and care has been taken by staff to get ready for a weeks holiday in the Isle of Wight for 3 of the four residents, accompanied by staff, in July. Residents go out twice a day and enjoy walks, swimming, drives, visits to the local cafes, garden centres and the gym. One health and social care professional wrote in our survey that the home could improve by having more structure to daytime activities and Evidence: timetables. The registered manager said that the the flexible approach by the homes staff means that all the residents are able to exercise more choice and spontaneity about how they spend their day and are more accepting of the choices and preferences of other people in the house. Residents personal and social relationships are identified in their Person Centred Plans (PCPs). Staff recognise the importance of family relationships and where appropriate residents are supported to make home visits. As at our last inspection, one person again said that they did not like living at the home and wanted to move out after their holiday. The manager explained that this persons wishes are regularly discussed with their representative and advocate. The person always decides that the home does suit them and that they have improved since moving here. The same individual was being supported and encouraged by staff to write some of the things they wanted to discuss at a forthcoming review meeting. Each person takes a part in the housekeeping rota and are prompted and assisted to practise their domestic skills, such as doing their laundry, tidying their rooms and helping lay the tables and clear away after meals. The menus pinned up in the kitchen included residents meal choices. One person said they did not like lasagne planned for the evening meal but staff said this person will have an alternative. On the day of the visit, residents were having a very late snack lunch of hot dogs, because they had been out to do the weekly grocery shopping and to take out some money ready for their holiday. On Sundays, residents choose a pub or restaurant to go out to for a roast dinner. The AQAA tells us that people are offered a healthy diet with the advice of a dietician. Also, that fruits are put out on the table where service users have free access. At the inspection visit it was noted this was not the case - residents had to ask staff to open a secure storage box in the kitchen to choose what fruit they wanted. The manager explained that before, when there had been unrestricted access to the fruit some people had over- indulged and had consequently had stomach upsets. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Hawthorns are supported to meet their personal care needs. Access to additional support from health care professionals is consistent and meets individuals health needs. Medication is stored securely and administration is accurate, ensuring the safety of the people who live at the home. Evidence: The care plans seen include guidance about how people wish their personal and health care needs to be supported. Personal care is provided in private in either peoples bedrooms or the bathrooms. People are prompted with their personal care as needed and they choose their own clothes and hairstyle. Times for getting up, going to bed, and mealtimes remain flexible. Support plans refer to preferred routines and peoples likes and dislikes. People are supported to see their local GP and other community health care workers, such as learning disability community nurses, psychiatric nurses, and psychiatrists when needed. Staff also support people to access specialist health care support at outpatient clinics. Surveys completed by 3 health and social care workers show indicate that they feel people living here are supported by staff who always seek advice and act on it to meet residents social and health care needs and improve their well-being. Some of their additional comments showed that they feel the service does well in supporting people with complex needs and in providing a residential service for adults with learning disabilities, mental illness and challenging behaviours who have been difficult to place. One person added that the service could improve by building on practical skills, Evidence: knowledge and attitudes relating to supporting people with learning disability and mental illness. Regular review meetings are held with the homes staff and external health and social workers and there is good documentary evidence of these. A senior social work practitioner contacted in a follow-up telephone conversation about the service, said that his clients needs were well met and that the staff always took advice and acted on suggestions in relation to that person, so that he feels that it has been the best placement possible for them. No residents were considered able to take full responsibility for administering their own medication at this time. The systems for receipt, storage, administration of medicines was discussed with the registered manager. The homes policies, procedures and the training and assessment of staff in safe administration of medicines ensure that residents receive their prescribed medication correctly. The registered manager assesses staff competency in giving out medications. The pharmacist visits the home regularly to review the medication systems and is available to offer advice to staff. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an effective system in place for responding to, investigating and recording complaints. Systems and procedures are in place to ensure the protection of the people who live in the home. Since the last inspection staff training has been improved to ensure people living here are appropriately protected. Evidence: The homes AQAA states that the home has had 4 complaints in the 12 months before this inspection, all of which have been looked into and satisfactorily resolved in line with the homes own complaints procedure. We discussed the entries made in the homes complaints record with the registered provider, Mr Tim Wood. The Commission has received information about one adult safeguarding investigation since the last inspection. Information provided by the registered manager indicates that the home has co-operated fully and followed local social services safeguarding adults procedures. There was also evidence that the home managers had acted appropriately and promptly when made aware an allegation of staff misconduct reported through the whistle-blower procedures in place. The answers to our survey questions we got back from residents and staff showed that people know who to raise any concerns or complaints with. One person was seen to be actively supported by staff to write about and photocopy things they wanted to discuss at their next review meeting with social care workers and advocates. The induction and training records for recently appointed staff showed that they were shortly to attend training sessions about safeguarding and in safe Physical Intervention Techniques (PIT). 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements have been made to the environment since the last inspection and generally the home presents a comfortable and domestic environment that meets the individual needs of the people living here. The home needs to carry out overdue work in the kitchen and to improve the access and outdoor facilities and grounds so that these are consistently safe and serviceable for residents use. Evidence: The home is a large extended bungalow with shared areas, residents bedrooms, WC and bath and shower rooms all accessed from a narrow hallway. The home is situated in extensive grounds , including an orchard and fenced area of ground with one sheep grazing. A laundry room and office are in a separate building, with workshop area, garages and car parking spaces at the rear of the home. Access to the home is via a narrow lane and along a deeply pot-holed driveway. The outside of the home is poorly maintained, with weeds, broken paving and un-mown grass giving an unkempt and run-down appearance. Inside the furniture and fittings are modern and domestic in style. As we noted in our last report, the kitchen units are old and worn and need replacing. Broken tiles and stained grouting behind the kitchen sink taps, worn sink and old tiled kitchen work top that cannot be effectively cleaned, are potential infection hazards in a food preparation and washing-up area. It is evident that this work is overdue. We discussed this with the proprietor, Mr Tim Wood, who said that when the new maintenance person starts work (subject to satisfactory references) the programme of repairs and refurbishment will include re-fitting the kitchen. Mr Wood said that he was confident this could be done by October 2009. One fridge was not working and is used only for vegetable storage the homes area manager said. A fridge freezer is in good working order and staff check the temperatures to ensure that food is stored safely. Evidence: The homes AQAA tells us that improvements have been made by repainting the lounge and redecorating the dining area. They acknowledge that further improvements are still needed, for example, replacing the carpets, sofas and the kitchen units. All areas of the home were clean. Notices, symbols and soap dispensers are readily available to help residents and staff maintain good hand hygiene. Two residents surveys answered always to the question, Is the home fresh and clean? one person stated sometimes and another Its cleaned every day. 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. Since our last inspection the home has improved its recruitment and screening process which safeguard the people who live at the home from unsuitable staff. The scope and frequency of staff training has also improved so that the needs of people who live at The Hawthorns can be met by appropriately trained staff. Since the last inspection some progress has been made in improving the continuity in care and support for residents through supply of bank staff and successful recruitment of more permanent staff. Evidence: During this visit the inspector discussed the staffing structure and the roles and responsibilities of people with the registered manager, area manager and registered person (proprietor). The home has improved the continuity of staffing and the way that less experienced staff are supervised and have access to training and information that tells them about the different support needs and disabilities of the people living here. We looked at the training and recruitment files for 2 staff members who have started working here since our last inspection 2 years ago. Some of the training sessions specific to staff members work, such as their Role as a Learning Disability Worker and safe handling techniques when managing residents who may be physically aggressive (Physical Intervention Techniques - PIT) have been provided. All staff have training records that show what courses and updates people have attended. New staff undergo a 6 month probationary period during which they are supervised and their aptitude and skills for their work with residents is assessed. The homes AQAA states that there has been minimal use of agency staff within the last 12 months because the home has recruited its own bank and casual staff. This provides greater continuity of care and support for residents by a committed permanent staff team. The staff turnover remains high - according to the AQAA (completed in May 2009), Evidence: 6 staff had left employment in the home in the preceding 12 months. The home has 6 permanent care workers, 4 of whom have National Vocational Qualification (NVQ) in care at Level 2. This means that, despite the staff turnover, the home has achieved the required minimum percentage (50 per cent) of care staff who have NVQ Level 2 or above. Those staff who do not yet have an NVQ level 2 qualification are in the process of being enrolled on a course. Of the 4 staff surveys we received, all felt their induction covered everything very well that they needed to know to do the job when they started. All 4 considered that they are receiving training that is relevant and helps them understand and meet the needs of the people living here. One person indicated that they did not yet have enough knowledge about health care and medication. Three of the 4 staff said that there are always enough staff to meet the individual needs of the people living here, and one that this is usually so. Residents views about the staff were generally positive ranging from the staff always treating them well and listening and acting on what the residents said, to some do and sometimes (in terms of listening to them). Observation of the managers and staff interactions and relationship with residents at the time of the inspection showed that there is a comfortable, informal and relaxed atmosphere. This was supported in comments made by 2 health and social care professionals in the surveys returned to us. At our last inspection we were concerned that the homes systems for recruiting and training staff were not robust. Examination of two staff files for people recently appointed showed us that the organisation has acted on the requirements we made after our last inspection in relation to shortfalls in their recruitment procedures. The files seen included the required references and police checks, and included satisfactory enhanced level of Criminal Record Bureau (CRB) checks. 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. Improvements have been made to staff training and record keeping since our last inspection so that the health and safety of people living at The Hawthorns is better promoted and monitored. The proprietors have developed new strategies to ensure they review and improve aspects of the service and quality of life for the people living here. Evidence: The manager has been in post since October 2006 and has successfully completed the process to register as manager with the Commission. She is a qualified learning disability nurse and has completed the Registered Manager Award - the academic qualification required by us for managers of registered establishments. The manager has sound knowledge and experience in care of people with a learning disability, quality assurance systems, equality and diversity issues, development and implementation of the services policies and procedures, good people skills, leadership of staff, responds to need and provides an good role model. She has a strong ethos of being open and transparent in all areas of running of the home and is aware of current developments both nationally and by CQC and plans the service accordingly. The registered manager was about to leave the home on maternity leave and in her absence, the organisations area manager is planning to continue to provide managerial cover to Hawthorns and to the proprietors other Oxfordshire home, Holt Farm. Comments we received from staff and health and social care professionals who have regular contact with the home were very positive about the registered manager and also about the improvement to the organisation of the service resulting from the appointment of an area manager. The manager has notified us promptly about any untoward events or accidents affecting Evidence: residents and kept us informed about the outcome of significant issues that have arisen. The proprietor, Mr Wood, showed us the outcomes and recommendations made in a recent quality assurance survey (March 2009) carried out by an external quality assurance auditor. This included the views of residents and their family representatives or advocates and all other stakeholders. The AQAA tells us that the independent auditor awarded three quality stars out of a maximum of 4. The proprietors and managers said they have benefited from going through an external audit process and have made improvements in line with the auditors recommendations. The home has sound policies and procedures in line with current thinking and good practice guidance. Efficient systems are in place to make sure staff follow the homes policies and procedures in practice. The home works to a clear health and safety policy and checks take place to ensure the home meets relevant health and safety requirements and legislation. Records seen were well organised and up to date. The AQAA indicates that most of the homes policies and procedures have been reviewed and updated in May 2009 and include reference to the Mental Capacity Act 2005 and deprivation of liberty safeguards. Are there any outstanding requirements from the last inspection? Yes No 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 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 Description 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 Description 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 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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