Care Home: Heathlands

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What the care home does well The home supports people to lead busy, social lives and take part in the leisure activities that they enjoy. A survey respondent who was asked what the home does well said....As far as I am concerned, everything. Another respondent records.....It appears to me that the main aim of the home is to make people happy and confident. Service users receive personal support in the way they prefer and they can be confident that their health care needs will be met in full. All care plans are reviewed regularly and kept up to date to ensure that people have their needs met. The service is building a stable and motivated staff team and the manager has an excellent understanding of each persons needs. He spends time working alongside staff to ensure they are competent in carrying out their roles. The provider has an equality and diversity policy. It was clear from observation that people are treated fairly in the home and no one is treated less so because of something different about them. The manager and staff made it clear throughout the inspection that they strive to tailor support around people`s unique needs. The manager records in the home`s AQAA....Activities are open to change, if desired by the residents, as are most aspects of this service. What has improved since the last inspection? All three of the good practice recommendations made in the last inspection report have been addressed. There was a previous concern regarding the lack of availability of female staff at the home. Staffing arrangements have since been reviewed to ensure that staffing rosters accurately reflect the particular gender and personal care needs of all of the people living in the home. Service users care reviews are now carried out in a more private environment, that better maintains their privacy and dignity. The homes complaints procedure is clear and easy to understand. At the last inspection however some relatives commented that they were unaware of the procedure. The home continues to remind all stakeholders of the published complaints procedure and have in addition produced this in a pictorial format to better meet service user`s needs. They have plans to further develop the content all of the home`s information documents and in addition, to make them available in audio versions. There have been some environmental improvements in relation to internal decor and the garden area, which has been cleared of accumulated debris. This has improved the quality of the lives of people living at Heathlands. What the care home could do better: Prompt consideration should be given to providing training for all staff in the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure that any restriction of movement or liberty in place for service users is legal and ethical and they can clearly evidence this. Service users live in a largely comfortable and homely environment that meets their needs but would benefit from some further areas of the home and elements of the outbuilding being refurbished and updated. Improvements to the communal bathrooms would ensure infection control measures in the home are fully met and the potential to place people at risk is eliminated. The service must keep records appropriately and notify the Commission only when it is necessary to do so, and in line with the specific demands of legislation Key inspection report Care homes for adults (18-65 years) Name: Address: Heathlands Chequers Lane Walton-On-The-Hill Surrey KT20 7ST     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: Marion Weller     Date: 2 1 0 7 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: Heathlands Chequers Lane Walton-On-The-Hill Surrey KT20 7ST 01737817882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): heathlands@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services Name of registered manager (if applicable) Mr Robert Whitlam Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 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 Brief description of the care home Heathlands is a care home providing personal care for up to six adults of mixed gender with profound or severe learning disabilities. The home admits service users with complex needs, including challenging behaviours and autistic traits. The premises is a detached, two storey building which is domestic in size and character. Its location is central to the semi-rural village of Walton on the Hill. Local shops are within walking distance. Larger shopping facilities and a range of leisure Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home amenities, countryside and parkland are all within easy travelling distance. All bedrooms are for single occupancy and are situated on the ground and first floor, accessible by stairs. Toilet and bathing facilities are on both floors. Communal areas comprise of a fitted kitchen with separate utility room, dining room, lounge and sun lounge. The home has dedicated transport facilities available to service users and there is a small car park at the front of the premises and a large secure and secluded garden at the rear. The organisation operating the home is a registered charity and a major provider of support services for adults with learning disabilities in the South East of England. The fees at the home range from £1506.57 to £1544.32 per week. 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: Heathlands last had a key inspection on 2nd August 2007 no requirements were made and the home was subsequently assessed as a two star, good service. An annual service review was completed on 7th August 2008 and no changes were made to this rating or the inspection programme. This key inspection was undertaken on the 21st July 2009 and the inspector, who was unaccompanied during the site visit, was in the home from 10:45 am until 3:45 pm. During the site visit the inspector spoke with two members of the support staff and the registered manager and held a brief conversation with the provider organisations service manager over the telephone. The inspector was shown around the communal areas of the home and was invited to view individual bedroom accommodation. In addition, some records and documents were inspected. The inspection report takes into account all the information obtained about the service since the previous site visit. This includes any formal notifications, phone calls and letters received and any information concerning complaints or allegations. The Care Homes for Adults (18-65 years) Page 6 of 30 manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The AQAA document was received by us within the timescale given. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document gave us information which provided a reasonably clear picture of what was happening in the service and their plans for further development. Due to the communication difficulties experienced by service users, direct views about their care could not be obtained on the day of the inspection. Observation indicated that people living in the home were closely paid attention to and were clearly understood by the staff supporting them. Prior to the site visit we sent surveys to two relatives of people currently receiving services at Heathlands, four members of the staff group and also contacted health and social care professionals involved with the service, to gather their views. A total of 7 completed surveys were returned to us. Comments taken from surveys have been used throughout the report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Prompt consideration should be given to providing training for all staff in the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure that any restriction of movement or liberty in place for service users is legal and ethical and they can clearly evidence this. Service users live in a largely comfortable and homely environment that meets their needs but would benefit from some further areas of the home and elements of the outbuilding being refurbished and updated. Improvements to the communal bathrooms Care Homes for Adults (18-65 years) Page 8 of 30 would ensure infection control measures in the home are fully met and the potential to place people at risk is eliminated. The service must keep records appropriately and notify the Commission only when it is necessary to do so, and in line with the specific demands of legislation 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. Service users and their representatives are provided with the information they need to make an informed choice about moving in. They may benefit further if alternative formats were explored to ensure the information provided by the home is understandable to them. The manager understands the importance of undertaking comprehensive pre admission assessments for prospective service users so that the people who move in can be confident that the home can support them. Evidence: The home has a statement of purpose and service user guide. The manager stated that the template for the statement of purpose is currently being updated by the provider organisation and he was therefore unable to produce an up to date copy. The homes AQAA records that information documents have been kept under review to ensure they remain current. The service users guide was available to peole living in the home and their representatives in a pictorial and easy read format. The manager states that there are plans to further develop and improve the content and to introduce service information documents in audio versions. The manager was aware of Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: the individual abilities and support needs of the people who use the service, and recognised that exploring more suitable formats for the homes information documents may benefit service users. The manager said that prospective service users would only be admitted to the home following a comprehensive assessment of their needs. This would be carried out by him or a member of staff qualified to do so and would involve gathering information from the individual and people who are important to them and professionals involved in their care. The provider organisation has a dedicated development manager who works with managers to support them when people are moving into and on from services. There have been no new admissions to the home since the last inspection. The current service user group has been living at the home since it opened in 2001. Service user files viewed provided no evidence of pre admission care needs assessments undertaken at that time. There was however care needs assessments available which have been developed since 2001. These were seen to be comprehensive and included assessments of the persons daily living and social care activities, as well as their health care needs and related to the individuals preferred mode of communication, their personal care needs in respect of bathing or showering and their likes and dislikes. The homes AQAA records that the provider organisation has a comprehensive admissions policy, committed to supporting service users with their choice of home. The admissions policy is recorded as being last reviewed in February 2005. The manager stated that a number of polices and procedures are being reviewed by the provider organisation to ensure they are current. 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. Person centred care plans are in place which clearly identify service users needs and choices. Service users are encouraged to make decisions and to take responsible risks. Consideration should be given to providing training in the Mental Capacity Act and Deprivation of Liberty Safeguards to all key staff at Heathlands to ensure that any restriction of movement or liberty in place for service users is legal and ethical. Evidence: Most of the staff team have received Person Centred Active Support (PCAS) training. The manager explains in the homes AQAA that a PCAS approach to supporting people enables individuals to voice their choices, become more independent and be included in planning for every aspect of their life. People living at Heathlands do not have verbal communication skills; however, they are able to inform staff of their wishes and choices through body language, gesticulation and leading staff by the hand. This was observed throughout the site visit. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Staff were seen to provide just enough support and help to allow people to experience success in undertaking tasks and to enable them to participate in meaningful activities inside and outside the home and in maintaining relationships that are important to them. The manager discussed that active support and service user involvement has now become an integral part in the day to day lives of the service users. People living in the home were observed making drinks for themselves and helping prepare the teatime meal with discreet staff support. Any restrictions to service users choices are managed through their personal support plans and risk assessments which are reviewed every six months and updated regularly. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS), assessments of capacity and decision making for residents is being undertaken in a way that complies with published codes of practice. There is no one living in the home who is the subject of a deprivation of liberty authorisation. This information is not made clear in the homes AQAA and was checked with Social Services after the inspection was completed. Because service users are particularly vulnerable at Heathlands, consideration should be given to providing training for key staff in the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure that any restriction of movement or liberty in place for service users can be clearly evidenced as legal and ethical. Service users personal support plans are made available in a pictorial format, with the aim that they or their representatives become more involved with and are kept informed of their plan of care. The staff spoken with said they encourage relatives and other people who matter to the person to be involved in care planning meetings and reviews. Staff were knowledgeable about service users choices, needs and views and skilled in ensuring they were being met. Each service user has a named key worker who works closely with them. The provider organisation has a finance policy that supports people to manage their own finances where possible. For those who need help and support, there are clear guidelines for staff to follow. People living in the home have individual bank accounts, and the home securely holds small amounts of money for people living there. No survey respondents raised any concerns about the homes management of service users finances. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Heathlands are supported to lead busy and interesting lives that meet their social and cultural needs. They are supported to identify and undertake their responsibilities in the home and their rights to privacy and personal space are respected. A varied and nutritious menu is available and people are supported to choose the meals they enjoy. Evidence: Due to their complex needs, no one living in the home is in any form of paid employment. Individual support plans evidenced that service users regularly take part in daily living activities in the home such as making their bed, laying and clearing the table, washing up, cleaning their rooms and helping with the weekly shopping and food preparation. The manager stated that service users are also involved in maintaining and feeding the homes pet rabbit and some enjoy working in the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: vegetable patch at the bottom of the garden. Fresh produce grown there is regularly used in the home. On the day of the inspection a service user was seen preparing meat for the teatime meal, with discreet staff support. Observation confirmed that routines of daily living are flexible and service users clearly choose when to be alone or in company. Records of all activities undertaken are being maintained. The home has its own transport to enable service users access to community based facilities and activities. Service users attend the Croft Day Centre and engage in activities at the local social club. On the day of the site visit, some service users were observed to be out enjoying their chosen activities. The home is a member of the local residents association. Heathlands won the Best Dressed House award in the Walton-on-the Hill May Pageant, which raises and enhances the profile of the service and its residents within the community, presenting people living in the home in a positive and inclusive light. All of the service users have the opportunity to attend the local church and their religious and cultural preferences are recorded in their personal care and activity plans. The manager states.....The residents regularly take holidays to places of their choosing and staff support them on these trips. The manager has also been promoting the Stay up Late campaign and some late evening activities for service users are now taking place. Staffing rosters are adjusted to enable this to happen. A survey respondent asked what the home does well, recorded.....Providing out sourced activities. Risk assessments are in place in to ensure the welfare of individuals and to allow then to take responsible risks in their chosen lifestyle. The manager records that the home promotes contact with service users families and friends, and that some visit regularly, others contact by phone because of distance considerations. The home enables one of the residents to go and spend time at their relatives home. The manager stated that this year they have re-established contact with the relatives of one of the service users who they have not been in touch with for nearly sixty years. Food and meal times are an important part of the day at the home. The manager records in the AQAA......We have been developing pictorial menus which not only inform the people we support about the meal which is to be prepared, but also enables them to easily choose an alternative and communicate that wish to staff. There is free access to the homes kitchen and drinks and snacks are available throughout the day. Two service users were observed making themselves hot drinks during the afternoon. 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. Service users receive personal support in the way they prefer and they can be confident that their health care needs will be met in full. Evidence: Details of peoples preferences in respect of their personal care and support needs are recorded on their individual person centred care plans. The service also maintains health action plans for each service user and all individuals have access to a GP, dentist, dietician, optician and chiropodist when necessary, to maintain good health. The manager records in his AQAA that all service users have up to date eye and hearing tests and attend annual Well Man / Woman checks and medication reviews with their GP. End of life and serious illness plans are in place for some individuals living at the home. The manager stated that some end of life plans require further development and in addition need the involvement of people who are important to the service user. This work is planned, but the manager understands peoples sensitivities around this aspect of care. Staff are able to access end of life training, which includes offering support to the bereaved. It was observed that people who live in the home are cared for and supported in the Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: way they prefer. The manager said that new staff do not support service users with personal care until both parties are confident with each other. The staffing roster provides for the availability of mixed genders and skills to be available on each shift. The recommendation issued in the last inspection report to review staffing arrangements at the home to ensure that service users needs, in respect of the organisations gender policy are met, has now been addressed and will be removed from this report. Staff was observed to promote service users privacy and dignity. For instance, staff was seen to knock on doors before entering bedrooms, offered personal care in private behind closed doors and people were spoken to respectfully. A survey respondent when asked what the home did well recorded......As far as I am concerned, everything. The home has a robust policy for the safe storage and administration of medication. Staff receive comprehensive training and until they have satisfactorily completed the course they are not permitted to handle medication to protect service users. Regular competency testing of staff in relation to medication administration is undertaken. Medication administration recording sheets were sampled, they were all dated and signed by staff, there were no unexplained gaps in records found. Protocols are in place for service suers when required medication, which is being well managed. Protocols are also in place for any refusal of medication prescribed by the GP. The home keeps a record of medications returned to the pharmacy, which was signed and dated by care staff and the pharmacist. Medications are stored securely. Observation showed that topical and oral medicines are currently being stored together. Best practice suggests these should be separated. A senior support worker stated that the shortfall to good practice has been identified and plans are in place to resolve this matter. During monthly quality assurance visits, the provider organisation includes a check on medication used in the home to regularly monitor service users welfare and safety. The providers last report in relation to medication administration records states.....All looks good. Well organized - good records. The last inspection report records that a care manager commented that at times care reviews were held in the communal dining room and that privacy was an issue. This matter has been given due consideration since the last inspection. The manager reports that care reviews now take place in the homes office space. A care manager surveyed before this inspection felt that when information from the home was requested, timescales for receipt of the information could be improved upon. The care manager records.....Sometimes the service needs a reminder. Care Homes for Adults (18-65 years) Page 18 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 protected by the policies and procedures in place for dealing with concerns, complaints and their protection. Evidence: The complaints procedure is included the service user guide and a copy is also available to view in the homes administration office. This is available in a pictorial format to better meet the needs of the people who live in the home. Where possible each service user is given a copy of the pictorial version of the complaints procedure. The manager was aware that due to service users communication difficulties, they were somewhat disempowered from using the procedures. The manager records in the homes AQAA that.....More accessibility is needed with service guides; these will be in audio version, in addition to the pictorial format. As mentioned above, some service users are non verbal, but staff are able to tell if they are unhappy by their body language, and each individual has their own unique way of communicating their mood to staff. Observation indicated that people living in the home were closely paid attention to and were clearly understood by the staff supporting them. Some staff had known and supported individual service users for a number of years. There have been no formal complaints received by the home in the last 12 months. Our records indicate that complaints would be responded to within the providers Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: guidelines and the manager evidenced a clear awareness of the procedure. A survey respondent raised concerns about a lack of timely and effective communication by the service in a matter of serious concern involving their relative. The manager explained this was in relation to a safeguarding matter and at the time he was not 100 sure of the exact protocols, but had assumed that confidentiality was to be maintained and that all interested parties would be contacted by the chair of the safeguarding team. Evidence was seen that the manager has since made efforts to apologise and explain the reasons behind his perceived lack of action. There has been one referral made under the Local Authority Safeguarding Adults procedures since the last inspection. This matter was fully investigated and is now closed. An action plan was put in place which predominantly dealt with the service being asked to address environmental issue with the potential to harm people living at Heathlands. This has since been done. Recruitment procedures for new staff are robust. Prior to employment all staff receive a full POVA and enhanced CRB checks to fully protect service users from any potential for harm. Records indicated that training is provided for all staff in safeguarding adults issues and the procedures to follow if they suspect abuse. Staff members are also made aware of safeguarding procedures during their induction period. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a largely comfortable and homely environment that meets their needs but would clearly benefit from some further areas of the home and elements of the outbuilding being refurbished and updated. Improvements to the communal bathrooms would ensure infection control measures in the home are fully met and the potential to place residents at risk of harm is eliminated. Evidence: The home provides a physical environment that meets the needs of the people who live at Heathlands and was found to be overall comfortable, clean and tidy. Service users bedrooms generally offered a good standard of accommodation and had been decorated to reflect the individual tastes and choices of the occupants. It was observed however that an occupied bedroom on the first floor had a radiator cover that did not fully extend to the floor, leaving exposed hot water pipes and bare brickwork where the skirting board had been removed and exposed flooring where the carpet finished. This situation does not protect the service user from excessive temperatures when the radiator is in use, neither does it provide a homely and comfortable finish to the room. Seals around the bath, sink and flooring in the communal bathroom on the first floor Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: was seen to be aged and made cleaning difficult. Some ceramic wall tiles were also coming away from the wall. This situation has the potential to compromise the homes infection control procedures and therefore the safety and welfare of service users. The manager said the other communal bathroom on this floor is no longer in use. The room was however freely accessible. The manager provided information to show that the Fire Officer had visited the home during March 2009. The home were found to be fully complaint but a recommendation was made for the provider to develop a contingency plan for the provision of alternate premises, should it be required, following a full evacuation of Heathlands. The manager stated this matter is receiving consideration by the provider. The homes fire procedures are in pictorial format to meet the needs of service users. The written fire evacuation procedure gives the main area for evacuation, in the case of a fire and the meeting point for people living and working in the home, to be at the rear of the back garden, and the outbuilding in the case of bad weather. As the provider has these specific plans for evacuation in place, consideration should be given to the procedure in practice. The entrance door to the outbuilding was observed to be aged and in a very poor state of repair and not fit for purpose. The manager records in his AQAA.....We plan to replace the ageing wooden doors on the brick outhouse. This should now be a priority. Some areas of the home have been redecorated since the last inspection. The manager records.....We have decorated a number of areas within the house; the lounge, stairwell and kitchen plus installed new handrails on the stairs. Bedrooms have been redecorated to individuals tastes. We have cleared much debris from the back garden, with the remainder not in clear view. It was observed that the dado rails in the downstairs communal rooms have had their hard edges removed at the corners where they have the potential to cause injury to some service users. This is a commendable but not all of them have been redecorated and evidence bare wood. Evidence suggests that attention to maintenance needs at Heathlands tends to be reactive rather than proactive and there is often slippage in timescales for work needed to be fully addressed. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a competent and motivated staff team who understand their roles and responsibilities. They are further protected by the homes robust recruitment practices. Improvements in the availability of the appropriate gender mix on staffing rosters, ensure that service users needs are now being appropriately met. Evidence: Staff spoken with evidenced a good understanding of service users needs and preferences. Throughout the site visit they were observed to be respectful and caring towards the service users. The Avenues Trust has a rolling staff training programme. Mandatory training is planned and undertaken by all staff, with regular updates provided. The manager also records in his AQAA.....All new staff appointed are subject to a 6 month probation that may be extended if required. During this time staff receives structured induction and foundation training that is supervised by a Senior or Manager. There was sufficient staff on duty to meet the needs of the service users on the day of the site visit. The home has eight full time and seven part time support staff. The duty roster evidenced a minimum of three members of staff on duty each shift. With the Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: availability of one waking night staff and another staff member on call in the home. The provider organisation ensures that service users needs are met in respect of providing the appropriate staff gender mix on all roster shifts. There are clear lines of accountability in the home and staff are aware of the demands of their role and the providers expectations of them. The Avenues Trust maintains recruitment files at their head office; this was in agreement with the previous regulator, The CSCI. Evidence kept in the home indicates robust recrutiment procedures for the protection of service users exist. All staff found to be appointable are required to have at least two satisfactory references and all gaps in employment are explored. They must be POVA checked prior to employment and also have a satisfactory enhanced CRB check. All staff have a copy of the code of conduct and agreed practices set by the GSCC available to them. The recruitment of new staff has improved since the last inspection with two new senior support staff recently appointed. The deputy managers post is currently vacant, but the manager states that recruitment is well underway. The manager is intending to develop systems that will ensure that some service users at Heathfields are involved in the staff interview and recruitment process to ensure they have a say about who is employed to care and support them. Care Homes for Adults (18-65 years) Page 24 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. Service users benefit from having a person in charge that provides clear leadership, and whose aim is to consistently improve and develop the service and the outcomes for people living there. The service must keep records appropriately and notify the Commission only when it is necessary to do so, and in line with the specific demands of legislation. Evidence: The Registered Manager in post at the time of the last Key Inspection of Heathlands left the service on 4th August 2007. A new manager was recruited by the provider organisation and took up post on 1st October 2007. Mr Robert Whitlam completed the fit person process and was registered with us on the 27th November 2008. Mr Whitlam has worked with people who have learning disabilities since 1999 and holds the NVQ level 4 Registered Managers Award and is currently undertaking the NVQ level 4 in Care qualification. His CV and training records demonstrate a commitment to continued professional development. The registration inspector recorded.....Mr Whitlam has a good awareness and understanding of the National Minimum Standards for younger adults and the Care Homes Regulations and the application of other Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: relevant legislation in the care home setting. Support staff spoken with said the manager had an open and inclusive approach to the running of the home, was honest and supportive towards them and keen to develop their skills, to the benefit of the service users. It was evident from observation that the manager knew the people living in the home well and they appeared relaxed and confident in his company. The home has annual quality assurance monitoring systems in place, although these are predominantly organised and undertaken by the provider organisation. Monthly regulation 26 visits are conducted; the three most recent reports were viewed and found to be informative and detailed. Service users views are continually being sought on all aspects of the service using opportunities as they arise. Due to the service users communication difficulties and complex needs, formal residents meetings are not possible. Pre inspection survey responses returned to the Commission indicated that the home is being managed in a way that shows it has the best interests of the people living there at heart, and puts them at the centre of what they do. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards(DOLS),assessments of capacity and decision making for residents are being undertaken in a way that complies with the published codes of practice. There is no one living in the home who is the subject of a deprivation of liberty authorisation from the local authority. As mentioned earlier in this report, this information is not made clear in the homes AQAA and was checked with Social Services after the inspection was completed. Because service users are particularly vulnerable at Heathlands, training for key staff in the Mental Capacity Act and Deprivation of Liberty Safeguards must be provided to raise their awareness of new legislation and to ensure that any restriction of movement or liberty in place for service users can be clearly evidenced as legal and ethical. Policies, procedures and systems are in place to ensure safe working practices. The manager stated that polices and procedures are being reviewed by the provider organisation to ensure they are current. Risk assessments were being carried out and significant findings are recorded for all safe working practice topics. Fire risk assessments were in place for the home. The Fire Officers recent recommendation is under consideration by the provider organisation. Monthly checks and annual audits are in place to monitor the health, safety and welfare of the service users living at Heathlands. Evidence of health and safety checks being carried out at the home are recorded in the homes AQAA. Some environmental Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: shortfalls noted during this inspection in relation to health and safety are recorded mainly in the environment outcome area of this report. Service users would clearly benefit from some areas of the home and the external outbuilding being refurbished and updated. Improvements to the communal bathrooms would ensure infection control measures in the home are being fully met and the potential to place residents at risk of harm is eliminated. The home makes contact with the Commission if there are any significant events that affect the well being of residents. Following a recent organisation wide audit the home informed us that we could expect an increase in the number of incident reports submitted. Staff were told to report all incidents or accidents, however insignificant and minor that previously would have only been recorded in the homes records. The law however is specific in its requirement about what should be notified and when, it is therefore inappropriate for us to receive notifications that are not required. The registered persons must be clear about the demands of legislation and not misuse the commissions recording systems. This matter was discussed with the manager on the day of the inspection. He stated his intention to take this matter up with line management. 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 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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