Care Home: Hermitage Lane (4)

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What the care home does well There is a Statement of Purpose and Service User Guide, which provides people with information about what service they can expect to receive from the home. Care Plans provide detailed and clear information, which reflects the person`s initial assessment. They are regularly reviewed and are clearly indexed, which enables the reader to easily locate the corresponding risk assessment. Documentation throughout the home is well ordered and easily accessible. Adjustments are made to support plans when a person`s needs have changed, these link with records showing interactions from health care professionals. The arrangements for managing medication are good. Evidence indicates that staff are properly recruited, inducted, trained and supervised. The current staff team appears to be a good mix of age, experience and gender and represents the racial mix of the local community. This home provides a clean and homely environment for the people who reside there. What has improved since the last inspection? The appointment of the new manager appears to have had a positive effect on the home. Staff members told us they are motivated and feel supported by Mrs Arnold. One staff member told us that `Sam has introduced lots of new good things and ways of working, such as the learning logs`. Any potential risks are now assessed for each individual living at the home. These are kept under review to take into account any changes. Mrs Arnold has started to look at the communication needs of the people living at the home. Some people have had referrals made to the speech and language therapist. Staff members are undertaking a basic signing course, which will aid their knowledge and could be instrumental in communicating with some of the people they support. At our last visit to the home, some people told us that they did not know how to make a complaint, if they needed to. From our surveys eleven out of thirteen people confirmed that they knew how to make a complaint or raise a concern if necessary. Although there has been a reduction in day services available for people with a learning disability locally, the home are exploring leisure activities for the people they support. What the care home could do better: The Service User Guide could be more individualised to suit the individual needs of each person using the service.The home is aware that they could further develop communication skills for the people living at the home, which would aid decision making. The home needs to continue exploring social opportunities for the people they support. Care needs to be taken to ensure that protective gloves are located in an area where they are not at risk of cross infection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hermitage Lane (4) Hermitage Lane (4) Upper Stratton Swindon Wiltshire SN2 7QS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Lintern     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Hermitage Lane (4) Hermitage Lane (4) Upper Stratton Swindon Wiltshire SN2 7QS 01793727790 F/P01793727790 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Milbury Care Services Ltd care home 6 Number of places (if applicable): Under 65 Over 65 1 learning disability Additional conditions: 5 No more than one service user aged over 65 years named in the application dated October 2006 may be accommodated. Date of last inspection Brief description of the care home 4 Hermitage lane is one of a number of homes owned and managed by Voyage Care Services. The property is a large detached house located in a quiet lane and within easy reach of local amenities. The home provides accomodation for 6 people with a learning disability. Fees charged range from 1,258.09 pounds to 1,638.36 pounds. Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: 4 Hermitage Lane was last inspected on 13th June 2007. The unannounced key inspection took place on 8/8/209. The inspection took place between 9.30 am and 3.30 pm. The manager Mrs Arnold was available throughout the day to assist us. Mrs Arnold has been in post since December 2008 and has submitted her application to the Care Quality Commission to become the registered manager. At the time of our visit most of the people using the service were at home at sometime during the day. This enabled us to meet with people living at the home and observe Care Homes for Adults (18-65 years) Page 5 of 31 interactions between themselves and staff members. We took the opportunity to meet with two members of staff to obtain their views. One was a recently recruited member of staff and the other person had worked at the home for a number of years. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys; to be distributed by the home to peoples using the service and staff members, care managers, GPs and other health care professionals. Three staff member, two relatives, two healthcare professionals and six people using the service responded. The feedback received, is reported upon within this report. We sent Mrs Arnold an Annual Quality Assurance Assessment (AQAA) to complete. This was their own assessment of how well they are performing and it gave us information about their future plans. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures, staff files and training records. At the last inspection two requirements and seven good practice recommendations were made. The requirements have been met in full. The majority of the good practice recommendations have been addressed or are in good progress of being met. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit to the service and takes into account the views and experiences of the people living at the home. What the care home does well: What has improved since the last inspection? What they could do better: The Service User Guide could be more individualised to suit the individual needs of each person using the service. Care Homes for Adults (18-65 years) Page 7 of 31 The home is aware that they could further develop communication skills for the people living at the home, which would aid decision making. The home needs to continue exploring social opportunities for the people they support. Care needs to be taken to ensure that protective gloves are located in an area where they are not at risk of cross infection. 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 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While there have been no new people to the service, the organisations admission policies would be adhered to, to ensure appropriate placements People considering this service are provided with sufficient information to enable them to decide if it is the right place for them. This judgement has been made using available evidence including a visit to the service. Evidence: Information about the service is available in both the Service User Guide and The Statement of Purpose. Mrs Arnold reported that there is a copy available in a video format if needed. We discussed how the Service User Guide might be adapted to suit each persons individual needs, if appropriate. Mrs Arnold confirmed that this is something she would be exploring further. Within our survey one person commented, X was shown the service user guide at the Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: March meeting, we dont know how much she retained. All people who use the service have lived at 4 Hermitage Lane for a number of years. It was therefore not possible to look at the admission process in practice. At the last key inspection, this outcome was judged as good. There has been no information to conflict with this view. Based on this, we have made a judgement, that the assessment process would ensure the service could meet the persons needs. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide clear detailed information, which reflects the persons assessment and links to the relevant risk assessment. The home is developing ways to further improve peoples communication skills. This judgement has been made using available evidence including a visit to the service. Evidence: We sampled two care plans during our visit to the home. It was evident that a substantial amount of time had been given to ensuring the plans provide the reader with all the information they need, to care for the individual. Plans are sectioned off into separate support plans, which cover all aspects of the persons life. They provide clear and concise instruction on how the persons needs Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: should be met. Records demonstrate that care plans are kept under review and record any changes to the persons care needs. One file we sampled showed that some concerns were raised regarding one persons health. This was clearly documented within the care plan and follow up appointments were documented. Records demonstrate that the person being supported attends their review meeting, if they choose to do so. Parents and care managers are also invited to attend. Each person living at the home has a key worker, designated to them. One member of staff told us what her role as a key worker involved. They confirmed that they have a very good relationship with the person they support. They added that they would often spend one to one time with the person and that they had a very good understanding of their mode of communication. They reported that although the person they support is unable to communicate verbally, they make decisions by refusing to move if they do not wish to do something. Within our surveys one member of staff commented, I am a key worker and am always kept informed and up to date about the needs of the people I support. Another person commented, X communicates via body language and can clearly make a choice, this is always respected by staff. Files contain photographs, pictures and mementoes, which may be important to the person. During our visit some people using the service appeared to enjoy pointing out photographs of their family, friends and events. Files also contain an assessment of the persons strengths and support needs, with long and short-term goals recorded. Each person living at the home has a separate file, which contains a pictorial handover sheet for both the morning and afternoon shift. This records medication, personal care, activities, mood, health issues and behaviours. Learning logs are also kept within this file (these are discussed further under Lifestyle outcome area) We discussed Mrs Arnolds plans to further develop communication aids for the people using the service. Mrs Arnold plans to look at each persons communication needs individually to assess which aids may be appropriate or not. At the time of our visit the Speech and Language therapist was visiting one person to provide a baseline assessment of their communication needs. At the last inspection we recommended that staff have the opportunity to learn some basic signing skills. Mrs Arnold confirmed that this had now been arranged and staff are booked on a two day basic signing course. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We also made a good practice recommendation regarding the use of appropriate terminology, when addressing the people living at the home. Mrs Arnold confirmed that staff have now attended training in Person Centred Planning, which addressed appropriate terminology and recording skills. We discussed how people living at the home make choices and decisions. One persons care plan records when given a choice I will usually pick the last thing that you say, so staff need to sometimes use points of reference, such as placing items in front of me and ask me which I would like. Staff explained how they offer choices with meals and clothes people may wish to wear. One persons file states If X has to make a major decision in her life, that she is unable to do herself, her care manager is to be contacted to request a best interests meeting in line with the Mental Capacity Act. Mrs Arnold has leaflets available which relate to the Deprivation of Liberties legislation. Both care plans and risk assessments were found to be very well ordered. Each section of the support plan is clearly indexed to the corresponding risk assessment for that particular activity. Risk assessments are reviewed as and when necessary and all staff sign to say that they have read the document. Where a persons assessed needs have identified a potential risk the risk assessment records how to deliver support, whilst maintaining the persons independence. At the previous inspection we made a requirement, which related to accessing the kitchen area. Mrs Arnold confirmed that this requirement had been addressed. She carried out individual risk assessments for each person living at the home and their ability to access the kitchen area safety. Mrs Arnold confirmed that the outcome was that the kitchen area should remain restricted at certain times to ensure the health and safety of all the people living at the home. It was noted during the day that staff supported people to access this area and make themselves drinks etc. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further opportunities for people to participate in appropriate leisure activities are currently being developed. Links with family and friend are maintained if appropriate. Peoples rights and responsibilities are recognised. Peoples dietary needs are met by a well balanced and varied diet. This judgement has been made using available evidence including a visit to the service. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: As mentioned in the summary of this report, during the day of our visit people living at the home were being supported to attend various activities. One person was visiting a garden centre, another person was shopping for items to personalise their bedroom. Two people were going to the pub or cinema in the evening. During the day one persons relative telephoned the home and requested that X visited them during the day to collect Easter Eggs for everyone at the home. Mrs Arnold arranged for staff to accompany X in the afternoon. Action has been taken to address the requirement set at the last inspection, relating to exploring further leisure opportunities for the people living at the home. Mrs Arnold reported that she is currently waiting for referrals from the doctor to enable people to access the local hydro-therapy pool. One person told us I love swimming; I am very good at it. Within our surveys people using the service commented, I would like to go on a holiday to Weymouth again, If I ask to go on the bus I always get taken and I go swimming, drives , music alive, shopping and skating. If I want to stay at home, I can. Mrs Arnold told us that some people living at the home are going to visit the London Eye and take a river cruise. Two other people are planning to do the same trip but in addition they are going to see Grease at the theatre. Mrs Arnold explained that some people living at the home prefer to spend time at the home and do not always choose to join in activities. This is respected by staff members. People were observed sitting in the garden, which is secluded and safe. Some people attend the Gateway club. It was reported that one person really enjoys going to dances there and having a pint of beer. Each person has an individual activity plan for the week. Activities include; ice skating, watching football, meals out, music alive, gym, arts and crafts, nail care, foot spa and DVDs. Within our surveys one staff member reported X is shown activity board and picture cards everyday to make decisions. Another person commented Whenever x gets her coat, staff oblige her by taking her out. Since she has been in post Mrs Arnold has introduced Learning Logs. These are completed following an activity or trip out. They record who was there, what worked well, what was learnt and what didnt work so well. A monthly evaluation is then Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: carried out by Mrs Arnold. People take responsibility for helping to keep their rooms clean and tidy, if they wish to do so. One sampled file states X enjoys carrying out small household tasks. Another file records X enjoys vacuuming and folding washing. During our visit to the home we observed staff supporting a person to make themselves a drink. People are able to decide what time they choose to go to bed and get up, depending on activities etc. One person has recently had a bad foot and it was noted that staff were encouraging them to rest it throughout the day, so they would be fit enough to go out later. Staff explained why they should rest it and ensured that the person understood why they were asking them to rest. One person living at the home told us that they were planning to go to the barbers for a haircut. Staff members were observed asking them which particular hairdresser they would like this time. The person was able to say by name who they would like to cut their hair. One person told us that they had visited their mum for Mothers day, with staff support. Within our surveys one person confirmed I go home every other weekend, my mum picks me up. The manager explained that people living at the home have the opportunity to visit other local Voyage homes, to meet up with people or attend special events. There are pictures of the menu for the day on a notice board in the kitchen. On the day of our visit the board showed that breakfast choices were a fried breakfast, cereals, toast and fruit juice. The evening meal was fish in white sauce, carrots and new potatoes. Mrs Arnold confirmed that her allocated food budget was very good. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans provide clear information on how people prefer their personal care to be carried out. People using the service have access to healthcare professionals to ensure their needs are met. Medication appears to be well managed. This judgement has been made using available evidence including a visit to the service. Evidence: As mentioned previously in this report, all support plans sampled clearly record how the person receiving the care prefers to have their routines carried out. Any interactions or changes to the plans are clearly detailed and link with a risk assessment if they pose a potential risk. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Staff members attend mandatory training in manual handling as part of their induction. Documentation evidences that Occupational Therapist support is sought when required. Within our surveys one relative commented They always give support to my relative. Im quite satisfied by the care that X receives. The last time I visited was three years ago and I was quite impressed with the care and attention the residents received. Where people may display behaviors that challenge, support plans list possible antecedents and distraction techniques to be used. Staff told us that Xs behaviors have decreased a great deal since they have been at the home. The home access support and guidance form the Consultant Psychiatrist when needed. Staff members confirmed that they attend training in Non Violent Crisis Physical Intervention. People living at the home are monitored to ensure they maintain a healthy weight. It was noted that one person had become very thin, so the manager contacted the dietitian. Following their advice the person has now gained weight. Mrs Arnold added that an Occupational Therapist referral has also been made to look at possible aids and equipment, which may be available to further support this person. The manager is waiting for Annual Health assessments to be completed for some people living at the home. Mrs Arnold reported that they were waiting for the GP to be trained so they could complete the assessments. Two people are registered with separate doctors and have had their assessments completed. Mrs Arnold has developed a monthly Health Plan, which is completed by staff. This records all aspects of the individuals health and well being. A copy of the evaluation is sent to families monthly. This ensures that they are kept fully aware of any potential health issues or outcomes from appointments attended. One health care professional commented within their survey I know to my knowledge, staff, manager and entire home co-operate well in meeting every need of the people living in this home. Within support plans contact details can be found for specific health care professionals such as the Community Nurse, Occupational therapist and Speech and Language therapist. As part of the inspection process we looked at the arrangements for managing medication. At the time of our visit no one living at the home was able to self Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: medicate. We sampled the Medication Administration Records (MAR) and found them to be in order with no unexplained gaps or entries. Mrs Arnold reported that one member of staff administers the medication and this is usually herself or a senior staff member. There is a photograph of each person living at the home on the front of their MAR sheet, to ensure that they can be safely identified. Policies and procedures are in place for medication and for the use of as required (PRN) medication. A daily stock check of medication is completed. Mrs Arnold explained that staff complete their medication training on the EL Box, (a system where training is completed electronically) which she reports is very comprehensive. There are refreshers, which take place on the El Box, in addition to in house questionnaires. Staff we spoke to confirmed that they complete training in the safe handling of medications. They confirmed that they do not administer medication until they are deemed competent to do so. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to raise concerns, if necessary and be confident that they will be listened to. People are safeguarded from any form of abuse. This judgement has been made using available evidence including a visit to the service. Evidence: Responses to our surveys indicate that the majority of people know how to make a complaint or raise a concern if they need to. The home has a complaints procedure and policy in place. There is a complaints log in the home, which records any complaints received, actions taken and timescales. We noted that on 6/3/09 a compliment had been left by one visiting relative. The complaints procedure is available in alternative formats if required. Each person living at the home has a pre addressed post card to post to Voyage if they are not happy with the service provision. Within our survey one comment included X has been shown the complaints procedure in an accessible version. Another person commented I would speak to manager if I was not happy. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The local authority recently received an anonymous complaint from a member of the public. Correct procedures were followed and the matter was fully investigated by the home. Regular resident meetings take place in the home. Copies of the minutes were sampled. The last meeting was held in January 2009, when the service user guide was discussed and day trips. The minutes include photographs of people looking through brochures. Mrs Arnold reported that by having the minutes in pictures and photographs the meeting is easier for people to reflect back on. Staff members we spoke to confirmed that they know how to report any suspected abuse. Mrs Arnold confirmed that all staff are trained in Safeguarding Adults. The home is signed up to the local protocols No Secrets. The system for looking after peoples money was checked and found to be in good order. We asked Mrs Arnold to ensure that the Statement of Purpose clearly details what people are expected to contribute towards when eating meals away from the home. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a pleasant and homely environment for the people who live there. It was found to be clean and hygienic at the time of our visit. This judgement has been made using available evidence including a visit to the service. Evidence: The home continues to be fit for purpose and provides an environment, which is appropriate to the needs of the people who live there. We toured the building and found that many areas have been redecorated and plans are in place for new carpet to be fitted to some bedrooms and the hall way and stairs. Two new leather sofas have been purchased along with a new plasma television screen. During our visit the maintenance person was redecorating the lounge area. Downstairs there is a large pleasant conservatory, which has an electric organ and a guitar available for use. One area of the conservatory has a large dining area, where meals are taken. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: The kitchen leads off the conservatory and was found to be well equipped and clean and hygienic. Swindon Borough Councils safety and food team carried out an audit on 4/8/08 and the home was awarded four stars. There is a small lounge area situated at the front of the home. This has a television and comfortable seating. On the day of our visit it was being used for a music and sing song session. This room has a bed settee and is used as a sleep in room for staff. All bedrooms are personalized with ornaments and photographs. Some people have televisions and music systems. The garden is well maintained and provides a pleasant and safe area for people to sit. There is a hand rail and slope for easy access. The garden is laid to lawn and has shrubs and plants. Bathrooms and en-suites were found to be clean and hygienic throughout the building. We asked Mrs Arnold to relocate a box of rubber gloves further away from the toilet, to reduce the risk of cross infection. There is a utility room where all toxic materials are safely locked away. One washing machine and one drier provide sufficient facilities for the needs of the home. Within our survey we asked, what could the home do better? One staff member commented Make sure things, such as washing machine etc are fixed on time whenever there is a break down. Otherwise this can sometimes be a big issue to both staff and members using the home. Generally within our surveys comments received were positive with regard to the cleanliness of the home. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff appear to be sufficient in numbers, properly recruited, inducted, supervised and trained. This judgement has been made using available evidence including a visit to the service. Evidence: At the time of our visit the manager reported that there was one staff vacancy. There are 4-5 staff on duty in the morning and 3-4 in the afternoon. At night there is one waking night staff on duty and one member of staff sleeping in. Within our surveys one staff member commented It will be nice when we are fully staffed so we can build more of an activities programme in the afternoon. A positive feature of this service is that staff are recruited from a variety of ethnic groups to reflect the local population. Mrs Arnold told us that the induction process is completed on the El Box. This includes information on policies and procedures and Corporate information. One recently appointed member of staff described their induction to us. They confirmed that for one week they shadowed a more experienced member of staff and mainly observed how routines were carried out. They also accompanied other staff when they were supporting people within the community. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The staff member told us that they had completed their mandatory training and had previously achieved a National Vocational Qualification (NVQ) level 2 in care with their previous employer. We also met with a longer serving member of staff. They confirmed that they are up to date with all of my training. They added that they have completed their Learning Disability Award Framework (LDAF) and were waiting to complete their NVQ 2. However they felt that this was not happening as quickly as they would like. As part of the inspection process we examined recruitment files, which indicated that people are recruited properly. All files sampled showed that safeguarding checks have been made with the Criminal Records Bureau (CRB) and against the Protection of Vulnerable Adults (POVA) list. Proof of identification and two references had been sought prior to appointment. Within our survey one member of staff commented It took me 6 months to start work due to checks being processed. In addition to mandatory training such as basic first aid, manual handling, health and safety, basic food hygiene, infection control, medication, and POVA, some staff have attended training on Ageing, Illness and Disability. Fire awareness training is completed in house every two months by a member of staff who is an ex fire officer. Mrs Arnold reported that the area manager notifies her when a member of staff is due to attend refresher training. A training matrix is kept within the home. Staff meetings are used as a forum to look at specific areas of practice. At the last meeting discussion took place on the Codes of Practice, POVA and the No Secrets protocols. Staff sign to confirm they understand. Mrs Arnold reported that she is encouraging staff to fully participate in discussions. Evidence shows that staff are regularly supervised. One member of staff reported I have no concerns now in this house, everything is perfect, we get regular supervision, I am very happy here another person told us supervision happens now and remains confidential I always get my notes now. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service benefit from a home, which is well run. Overall, this is a service where people are safe and listened to. This judgement has been made using available evidence including a visit to the service. Evidence: Mrs Arnold has been in post since December 2008. In this time she has introduced many new positive ideas to the service. Staff that we spoke to, spoke well of Mrs Arnold and the changes she has made. One comment included Things have turned around here, its good with Sam, care plans have changed and improved. Things are easy to access; its changed for the good. Mrs Arnold has applied to CQC to become the Registered manager and is currently awaiting her fit person interview. Mrs Arnold holds the Registered Managers Award (RMA) and has an NVQ 4 in care. She also has a D32/33 qualification. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: As mentioned earlier in the report, regular residents meetings take place and minutes are in picture format. Regular management audits are carried out by a senior manager. The last one was completed 26th January 2009. These audits consider all of the National minimum Standards. Voyage complete annual service reviews, which form the annual development plan for the service. Health and safety is managed well, within the home. All necessary checks are carried out regularly, such as hot water temperatures, fridge/freezer temperatures and probing of hot food. All radiators are guarded to ensure people are kept safe. The home has a current Gas Safety Certificate and small electrical appliances were checked on 30/06/08. Environmental risk assessments are in place and kept under review. Each member of staff has a designated health and safety responsibility within the home. Mrs Arnold explained that she carries out weekly health and safety spot checks around the home. The accident book showed two entries since the beginning of 2009. Completed forms are then sent to the Health and safety manager, who then audits them. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 23 To explore how the Service User Guide might be adapted to suit individuals needs. The Statement of Purpose should detail the amount that people will be expected to contribute towards meals taken away from the home. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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