Care Home: HFT 34 Shipston Road

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What the care home does well People`s needs are assessed properly and they are given opportunities to visit and stay overnight to see if they like it before they move in so that everyone is happy with the final decision. Care plans are in place for people, which the provide the important information that staff need to support people properly. Most staff have worked at the home for a long time and know the people living there well. The home is small and friendly and people are involved in the everyday running of the home, such as menu planning, shopping for groceries, cleaning and food preparation. The people at the home enjoy the meals provided them. People are supported to set goals for themselves and to go places that they like. Two people have been supported to find part time jobs that they enjoy. Relatives and visitors are made to feel welcome. A person at the home made a cup of tea for the visiting inspector. People are supported to stay in touch with people that are important to them. Relatives and friends join in people`s Birthday celebrations. Staff support people to see health professionals where necessary, to ensure they get treatment where it is required and help them to stay in good health. People are encouraged to complain if they feel unhappy about anything and their concerns are followed up by the staff and the manager. Overall the home is well managed and systems are in place for ensuring that it runs smoothly and safely. What has improved since the last inspection? Where people have allergies this is recorded on their records so that people are not given things that might cause them harm. A new medication cupboard has been fitted in number 36 so that people no longer have to walk next door for their medication. This is more convenient as well as being a more dignified way to receive medication. More information has been included in some risk assessments. This helpful to new staff so that they have the information they need to support people safely. What the care home could do better: There is scope for increasing the information in a person`s risk assessment to explain restrictions placed on them due to their vulnerability in some situations and the measures to safeguard them. This should be agreed with the person`s social worker to ensure that the person`s liberty is not thought to be unreasonably restricted. The home does not currently keep a record of meals taken by people at the home. This is necessary so that people`s dietary intake can be monitored and checked, wherenecessary, such as in the event of an illness, which might be related to the food people have eaten. Overall the home is clean and in good condition but some carpets are stained or worn and need to be cleaned or plans made to replace them. Some good arrangements are in place for involving people in everyday decisions and engaging them in consultations about wider service developments. However the people at the home and their relatives have not recently been sent surveys to seek their views of the service provided them. The manager said that she would do this shortly. Overall staff are provided with a satisfactory range of training opportunities to equip them to meet people`s needs. However staff have not received Equality and Diversity training. This training prompts staff to recognise people as individuals with their own specific needs and wishes to be respected and supported. Also there has not yet been deprivation of liberty training for staff. This is necessary so that the manager and staff are clear about their role in ensuring that people are referred to Social Services for assessment where measures taken to protect them may impact on their freedom and liberty. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: HFT 34 Shipston Road 34/36 Shipston Road Stratford on Avon Warwickshire CV37 7LP     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: Kevin Ward     Date: 2 1 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 33 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 33 Information about the care home Name of care home: Address: HFT 34 Shipston Road 34/36 Shipston Road Stratford on Avon Warwickshire CV37 7LP 01789261105 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) : Home Farm Trust Ltd care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 9 The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (Code 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) 9 Date of last inspection Brief description of the care home 34 and 36 Shipston Road is close to the centre of Stratford upon Avon, which has a wide range of shops, leisure facilities and medical services. The home provides care and support services to adults with learning disabilities. The home consists of two large semi-detached houses, each having their own separate entrances and staff team. The houses provide small group accommodation, with each house having a lounge, dining room, kitchen and laundry. All bedrooms are single rooms. There are no en-suite bedrooms, and wash hand basins are not provided in peoples bedrooms. The two houses share a sleep in member of staff, who is based in one house. Residents in the other house are able to access the sleep in staff via a direct dial telephone. There is a large car parking area at the front of the properties and there is a large, well maintained shared garden at the rear of the property.This is currently under review. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home Residents are required to pay admission costs for activities and entertainments and to make a contribution to their holidays (staffing costs) in some cases where this is expensive. Service users are also expected to pay for their hairdressing, private chiropody toiletries and clothing, (although the manager reports that some clothing is also currently provided by the home). Care Homes for Adults (18-65 years) Page 5 of 33 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: The quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a key unannounced inspection, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Care Homes for Adults (18-65 years) Page 6 of 33 The inspection included seeing everyone at the home to get an impression of their views of the service. The inspection also included case tracking the needs of two people that live at the home. This involves looking at their care plans and records and checking how their needs are met in practice. Several other peoples records were also sampled to check how specific needs are being met by the staff at the home. Discussions also took place with three staff and the manager. A number of records, such as care plans, complaints records, and fire safety records were also sampled for information as part of this inspection. An annual quality assurance assessment was completed and returned by the provider in time for this inspection, providing the managers views of the homes performance during the last year. The current fees for the service are based on an assessment of individuals needs and currently range between 600 pounds and 776 pounds per week. The people living at the home pay an assessed contribution based on an individual financial assessment. What the care home does well: What has improved since the last inspection? What they could do better: There is scope for increasing the information in a persons risk assessment to explain restrictions placed on them due to their vulnerability in some situations and the measures to safeguard them. This should be agreed with the persons social worker to ensure that the persons liberty is not thought to be unreasonably restricted. The home does not currently keep a record of meals taken by people at the home. This is necessary so that peoples dietary intake can be monitored and checked, where Care Homes for Adults (18-65 years) Page 8 of 33 necessary, such as in the event of an illness, which might be related to the food people have eaten. Overall the home is clean and in good condition but some carpets are stained or worn and need to be cleaned or plans made to replace them. Some good arrangements are in place for involving people in everyday decisions and engaging them in consultations about wider service developments. However the people at the home and their relatives have not recently been sent surveys to seek their views of the service provided them. The manager said that she would do this shortly. Overall staff are provided with a satisfactory range of training opportunities to equip them to meet peoples needs. However staff have not received Equality and Diversity training. This training prompts staff to recognise people as individuals with their own specific needs and wishes to be respected and supported. Also there has not yet been deprivation of liberty training for staff. This is necessary so that the manager and staff are clear about their role in ensuring that people are referred to Social Services for assessment where measures taken to protect them may impact on their freedom and liberty. 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 9 of 33 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 33 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. Peoples needs are assessed before they move in and they are provided with information and support they need to assist them to move into the home in a sensitive manner. Evidence: A new person has moved into the home since the last inspection. They said that they liked the home and enjoy living there. The manager explained that the person was supported to visit the home and meet the people that live there and that their needs were assessed before they moved in to ensure that the home could provide the support required. This was verified on the homes computer records. The placement has been reviewed with the involvement of the social worker to make sure that the person concerned is happy at the home and that their needs are being met satisfactorily. A service user guide is in place at the home that also forms the service user contract. The document has been illustrated with pictures to make the information easier for Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: people to read and understand. This is good practice as it helps help people to understand the services to which they are entitled and what they are expected to pay. Two peoples contracts were viewed. One persons contract included the current fees and the other did not. The manager explained that there had been a mistake on one persons fees and that she was currently seeking clarification of the correct amount. A Statement of Purpose is also in place at the home, providing a summary of the homes aims and objectives. This is of particular benefit to social workers and others involved in finding suitable placements for people to assess what the home has to offer. Care Homes for Adults (18-65 years) Page 12 of 33 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. Peoples needs and aspirations are planned for with their involvement so that they can be met with the support of staff. Evidence: Two peoples care plans were viewed and documents were sampled on others files such as Person Centered Plans and risk assessments. The care plans and records are now recorded on a computer system. This is supplemented by paper files for the safekeeping of information received into the home from other professionals, such as behaviour guidelines and protocols drawn up with the involvement of nurses. The paper files also contain some helpful summaries about peoples preferred care routines. This information is particularly helpful for new staff, to give them an appreciation of peoples individual needs and how they like to be supported, before they have been trained to use the computer. Discussions with staff and the manager confirmed that the people at the home are independent in most aspects of personal care, although some prompting and support is necessary for some people e.g. shaving Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: and hair washing. The new care plans on the computer are fairly brief but provide the essential information necessary to support people, when combined with the paper documents. An epilepsy protocol was in place for a person with seizures and there was evidence on file to show that epilepsy nurses were current involved reviewing changes in the needs of the person concerned. The manager had drawn up behaviour management guidelines to assist in the management of behaviours believed to be related to the persons epilepsy and was seeking the nurses agreement to the guidelines. An epilepsy nurse specialist was visiting the day after the inspection. The manager said that this would include reviewing the epilepsy management protocol to make sure that this reflected changes in the persons needs. Risk assessments were seen on paper files, detailing a range of hazards associated with everyday life and peoples specific needs, such as bathing, leaving the house, epilepsy and traveling on the bus. The manager explained that due to concerns about an individuals vulnerability and needs they were discouraged from going out alone and spending time alone on the computer. The manager agreed to include the reasons in a risk assessment and and to agree any safeguards with the persons social worker to make sure that the liberty of the person concerned (or anyone else) is not curtailed unnecessarily. The people at the home confirmed that they are encouraged to take part in everyday decisions about their lives, such as what they eat and what they do. This was further verified in records of meetings held with the people at the home. The notes of recent meetings show that people were given feedback from a relatives meeting at which future accommodation planning was discussed, as well as domestic issues, such as the use of the telephone. Everyone confirmed that they are encouraged to shop for their clothes and personal items as well as foodstuffs for the home. One person said that she does not like shopping for clothes. Consequently staff help the person concerned to choose their clothes from catalogues. People also confirmed that they had chosen the decor for their bedroom and were involved in choosing furniture and other items of equipment for the home. People at the home confirmed that they are involved in person centre planning. This involves being supported to set personal aims and objectives to achieve. One person explained that they had achieved their ambition to see a pop group, McFly and that they were going to see them again. People are supported to share their wishes at a planning meeting (circles of support) with relatives, professionals and others they want Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: to invite, so that their aspirations can be supported and monitored. People are assisted to record their goals in a folder, illustrated with photographs of favourite people and events. Person Centred Planning is a good practice as it encourages people to take control over their lives and set goals that they might not otherwise achieve. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in the life of their home and community so that they enjoy a good social life. People are consulted and involved in menu planning in order that they are provided with the meals they enjoy. Evidence: All except one person at the home attend a day services, college courses or have part time jobs some days of the week. One person has chosen not to attend day services any longer and receives extra staffing to go out places. On the day of the site visit they were supported to go for a walk in the sunshine by the River Avon, which they said they enjoyed very much and went out for lunch with a friend the previous day. Several people at the home said that they had been to Evesham Country Park on the previous weekend, which was Easter Sunday and some went to the theatre the previous evening. Other examples of community outings given by the people at the Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: home and the staff included, bowling trips, getaway club (social club for people with learning difficulties), drama clubs, pop concerts, meals out, shopping and walks. One person had been supported to attend a Dr Who exhibition and another was planning to see The Full Monty musical and West Life in concert. Another person had plans to to go welcome the armed forces back from overseas in March and someone else was planning to join in the gathering planned for William Shakespeares birthday. Two people at the home have been supported to get part time jobs doing things they enjoy. One person works in a day a nursery and another works in a cafe. The people at the home confirmed that relatives and friends are encouraged to visit the home and to attend birthday celebrations. One person had recently celebrated their Birthday with a trip to the Pizza hut with friends. They also received a visit from relatives. The people at the home said that visitors are offered a drink and made to feel welcome. One person at the home has recently joined a dating agency for people with learning difficulties to widen their circle of friends. The training record show that some staff at the home have previously received sexuality and relationships training to help them to respond sensitively to individuals relationship issues. The manager explained that appropriate use is made of an independent advocacy service to help to represent indivduals interests, such as helping people to express their wishes about considering future living options. This was also verified in a persons records. A staff member explained that one person at the home is supported to attend church on Sundays in keeping with their wishes. Another person at the home said that they would also like to go to church. The manager said that she would seek a volunteer to support the person to attend church or make some other arrangements to support their wishes. The manager explained that people are encouraged to take part in everyday housekeeping chores, such as hoovering, dusting and tidying bedrooms and communal areas, laundry, grocery shopping an food preparation. This was also verified by people at the home and a wall planner in one of the houses. Comments by people at the home confirmed that they are happy with the food provided and that they are involved in reviewing the menus from time to time. The current menu is seen to provide a satisfactory variety of meals for people and the manager said that people can have an alternative if they dont fancy what is on the menu for the day. Currently a record is not kept of changes to the menu to reflect these changes. The manager said that she would set up a food taken record so that Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: any changes to the planned menu may be tracked. Comments by the manager indicate that a balance is struck between encouraging healthy eating and respecting peoples wishes e.g. the manager was seen to encourage a person at the home to take a cereal bar rather than a higher fat snack option. On the morning of the site visit some people made their own breakfast cereals and toast and others were supported to do so. One person made the inspector a cup of tea and another was seen to do a very good job of drying up and cleaning the kitchen. People also confirmed that they take it in turns to make packed lunches. A reasonable variety of snack foods were available in the home, including yoghurts, cereal bars and fruit. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain independence and assisted to gain access to relevant professionals where necessary so that their health-care needs are met. Evidence: Comments by people living at the home confirmed that they like living there and are fond of the staff that support them. One person said I like them all, they are all nice. The staff work across the two houses and the manager explained there are short periods of time when people are on their own in the house but that they have autodial telephone numbers to summon support where necessary or can find staff in the adjoining house. People confirmed that they are always able to find a member of staff when they need one. One person said if I need staff I just go next door. On the morning of the site visit, three people were seen on their own in the house for a short period. They were observed to be very business like and independent in cleaning up after breakfast and getting ready to go out for the day. Staff were observed to be friendly and respectful when talking to people or giving them prompts and reminders to do things and the people at the home looked Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: comfortable and ease with the staff that support them. A good rapport and friendly banter was also observed on occasions, lending a light and relaxed atmosphere in the home. Everyone at the home looked well groomed and dressed in age appropriate fashionable clothing. One person was seen to wear nail varnish and another female wore a nice beaded necklace, indicating that people are supported to take a pride in their appearance and maintain a good self image. Comments by staff and entries in peoples health records indicate that they are supported to gain access to support from health professionals to monitor their health needs. For example one person has been receiving support from epilepsy nurse specialist and had previously received dietician support to gain weight. The weight records show that this had been successful. Good work has also taken place to offer the support of an independent advocate to assist a person to consider their living options and check that they are happy living at the home. Staff confirmed that they have had epilepsy training and recently attended Think Positive training to help them to understand and sensitively respond to occasional challenging behaviour. Another persons records show that they have been supported to attend post-operative health monitoring appointments and tests to support their ongoing good health. Since the last inspection a new medication cabinet has been installed in number 36 so that people do not have to walk next door to receive their medication. On the morning of the site visit people were given their medication one at a time in private. The member of staff giving out the medication correctly signed the record after giving it to people one at a time, in keeping with safe practice. Three staff on duty all confirmed that they had received medication training and had been assessed to give out medication. Copies of completed assessments were seen on file and staff training records confirmed that medication training has been provided recently. The manager said that following recent training she intends to write protocols advising staff when people should receive their PRN (as necessary) medication, to ensure that everyone is clear under what circumstances medication should be given. Recent medication sheets were sampled. The medication sheets indicate that staff are properly recording medication. One persons medication is being monitored regularly at the hospital which results in ongoing amendments to their prescribed medication. The home is keeping a copy of the hospital pharmacy when changes are made, (sample seen) and the amendments are being reflected in the medication records. However it has not been the practice of the service to keep a running total of the amount of medication used Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: and left in stock for the person concerned. The manager said that she she would introduce a record to address this so that all medication is clearly accounted for. The manager also said that she would set up a log to help keep track of the paperwork related to this persons medication changes so it can more easily be found when required. The day following the site visit the manager faxed us information to show that these matters had been addressed. Where others have boxed medication in place, e.g. paracetamol, a running record is already in place. Two different medications were counted up and found to balance correctly with the running totals recorded. People are encouraged to take an active role in managing their own medication where appropriate. Two peoples medication risk assessments were seen. One persons self medicating risk assessment contained good levels of information to advise staff of the support they are to provide the person concerned. The other risk assessment (self medicating vitamins)contained far less information. The manager explained that this is because the person concerned has been managing their vitamins independently for a long time and there are no known errors. The manager agreed to include clearer guidance in the risk assessment to ensure that staff are clear about the level and frequency of the support and monitoring they are meant to be providing. Immediately following the inspection site visit the manager amended the risk assessment and has introduced a record to keep a check of the vitamins given and taken so that any discrepancies may be identified and appropriate action taken if any concerns arise. The manager said that only one person at the home has a known allergy. The persons file was checked and this information had been appropriately recorded on the medication record. Care Homes for Adults (18-65 years) Page 21 of 33 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. Suitable arrangements are in place to respond to peoples concerns and complaints and staff are trained to recognise and report suspicions of abuse so that people are protected from harm. Evidence: There have been no complaints made to us about the home since the last inspection and the manager explained that there have been no complaints received at the home from relatives or others not living at the home. The people at the home confirmed that they are are encouraged to raise any concerns and complaints in an open way. An easy read complaints form is available for people to use to record their complaints with help from staff where necessary. This is reflected in the complaints log which shows that peoples concerns are recorded and time is taken to talk through any resulting actions. The complaints raised by people at the home were largely related to occasional tensions in group living and behaviours related to peoples needs. Entries in the complaints record and comments by the manager indicate that these matters have have been followed up appropriately and where necessary extra professional support has been sought. Three staff on duty confirmed that they had been provided with safeguarding from abuse training, including the types of abuse that might be encountered and how to Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: report it. The people at the home have also discussed the complaints and whistleblowing in a recent house meeting (record seen) so that they know who to see if they have any concerns. Two peoples money records were checked. The records show that staff sign to show what peoples money has been spent on and receipts are also kept as evidence of expenditure. The manager routinely checks the money each month on a financial reporting sheet and a record of a recent money audit was seen, carried out by a person independent of the home. There have been allegations or incidents at the home, since the last inspection that have necessitated investigation under multi agency procedures. Care Homes for Adults (18-65 years) Page 23 of 33 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. People benefit from living in homely, comfortable, small scale environments that are clean and hygienic. Evidence: The home is made up of two semi detached houses that fit in very well with others in the neighbourhood. The home is situated close to Statford town centre making it easy for people to make use of the shops, park and other facilities. Overall the home is comfortable and well furnished and provides comfortable, homely accommodation for people. People confirmed that they had chosen the colours of their bedroom decor and some other items, such as TVs and music playing equipment. People have been supported to personalise their bedrooms to their liking with pictures, family photographs and other belongings. Some of the carpets in the communal areas, most notable the hall, stairs and landing carpets are stained where drinks have been spilled. A bedroom carpet is also looking stained and worn in one of the bedrooms and needs cleaning or plans for replacement. This was brought to the attention of the manager to address. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Everyone at the home is ambulant and able to walk upstairs and grab rails are in place in bathrooms to help people to balance in the shower or get in and out of the bath safely. The kitchens and other areas of the home were clean and there were no unpleasant odours in the home. A schedule is in place to remind people of light domestic tasks that require attention which are supported by staff where necessary. The laundry rooms in both homes were tidy and organised and stocks of cleaning materials were stored away safely. Protective aprons and gloves are stored in various places about the home to support good hygiene practices. No one at the home has continence needs that would indicate the need for an industrial washing machine with sluice settings. Care Homes for Adults (18-65 years) Page 25 of 33 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. Suitable arrangements are in place for recruiting and training staff so that people benefit from a team of well trained and suitable workers. Evidence: The manager explained that there are always at least two staff on shift and additional staffing hours have been provided to support a person at the home to get out and about places instead of attending a day service, in keeping with their wishes. This was verified by sampling recent rotas. The rotas show a pattern of familiar staff, providing consistency of care and support for people. The manager explained that there has been one new staff member recruited to the home since the last inspection. The new staff members recruitment file was checked. The file shows that appropriate vetting checks have been carried out, prior to the person starting work, including Criminal Record Bureau Checks and two references. Staff at the home confirmed that they receive regular planned supervision and further evidence of this was seen on staff files. An induction training certificate was seen on the new staff members file, as evidence that new staff are trained and supported in their jobs. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Staff confirmed that they receive regular training training updates on Health and Safety related training related subjects, such as fire safety, food hygiene, moving and handling and first aid. Similarly staff confirmed that they had been provided with challenging behaviour training (Thinking Positive training) and safeguarding against abuse training. This was verified in staff training records that were sampled. The manager reports that some staff have also had Mental Capacity Act awareness training, provided by the organisation. The manager reports that all except one new member of staff have completed National Vocational Qualification (NVQ) level 2 and that the new staff member has now been registered for this training. One senior worker is completing NVQ level 3 and another is registering for this training. These courses are designed to equip staff to carry out their roles effectively. The three staff on duty confirmed that they held NVQs relevant to their work role. The staff training records show that staff have not yet been provided with equality and diversity training and deprivation of liberty safeguards (DOLS) training. The manager said that she would refer staff for these courses. Equality and diversity training prompts staff to recognise, respect and support peoples individual needs and wishes. DOLS training is necessary so that staff and managers are aware of the process for referring people to Social Services when there are concerns that restrictions placed upon their daily lives to keep them safe may deprive them of their personal liberty. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management monitoring systems are in place so that people benefit from a well run service. There is scope for consulting with people again to seek their views on the quality of the service they receive. Evidence: The manager holds the Registered Managers Award, which is designed to equip her for her role at the home. The manager also has 4 years experience of managing the home in addition to a number of years experience of working with people with learning difficulties. There are number of measures in place to support the smooth running of the service. The fact that it is a small service means that the manager has daily contact with the people living in the home, making it easier to pick up any concerns they might have. The manager explained that senior managers visit the home each month as part of the organisations quality assurance programme. The records show that this includes Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: identifying any shortfalls in the service and setting objectives for the manager to achieve. The manager said that surveys have not recently been sent to the people at the home to seek their views of the service but said that she would be sending them out shortly. The records show that regular house meetings take place with people to make everyday plans and discuss issues, such as how to complain and whistleblowing. Some people also attend a Home Farm Trust consultation group which includes people from other services to contribute their ideas to service developments across the organisation. One person at the home has been invited to take part in peer quality audits which they are currently considering. Staff confirmed that they have regular staff meetings to discuss peoples needs and policy issues in addition to planned supervision sessions. As previously noted staff record any money passed to individuals to spend and the records are checked monthly by the manager to make sure that the money balances correctly. A record of a recent financial audit was also seen, indicating that suitable systems are in place to safeguard peoples money. The fire safety log was checked. The log shows that fire equipment is being routinely tested and maintained to make sure it is working properly in the event of a fire. A landlord gas safety certificate shows that gas appliances have recently been checked and records show that electrical equipment has also been tested to make sure it remains in safe working order. The hot water records show that hot water temperatures are being monitored to reduce the possibility of anyone being scalded. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 9 Write a risk assessment providing suitable safeguards for the person who is considered vulnerable when out alone and when using the homes computer. Agree the risk assessment with the persons social worker to ensure that the safeguards are proportionate and do not unnecessarily curtail the liberty of the person concerned or others at the home. A record should be kept of meals taken by people at the home, where this is different from the menu record so that it possible to keep track of the food provided. Protocols should be introduced for PRN (as necessary) medications so that everyone is clear about the circumstances under which medications, such as paracetamol should be given to people. Staff should be provided with Equality and Diversity Training to further equip them to recognise and support peoples wishes, needs and personal preferences. Staff should be provided with deprivation of liberty safeguards training so that everyone is clear about the circumstances under which people should be referred to Social Services for assessment e.g. when there are concerns that restrictions in place to protect them may Page 31 of 33 2 17 3 20 4 35 5 35 Care Homes for Adults (18-65 years) compromise their liberty. This is necessary so that peoples rights are protected. 6 39 Action should be taken to seek the views of the people at the home and other relevant people so they can further contribute to the development of the service. Care Homes for Adults (18-65 years) Page 32 of 33 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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