Care Home: Hft - Orchard View

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What the care home does well Everyone has a care plan in place containing good levels of information that staff need to help them to meet their needs properly. People also have Person Centred Plans detailing their personal goals and aspirations for the coming months. The people at the home are helped to make choices, such as what they do and what they eat and they are involved in looking after their home. Regular meetings take place to help people to plan their week. People are supported to go out to places they enjoy, such as pubs, restaurants bowling and to plan outings and holidays. Staff at the home are friendly and attentive to the needs of people living there. The atmosphere in the home is relaxed and easy going for people. Staff support people to gain support from health professionals so that their health needs are met properly. The home is clean, well decorated and comfortably furnished. The people at the home have been involved in choosing the decor and furnishings and have been supported to personalise their bedrooms with pictures and other belongings. The home is well equipped to meet people`s individual needs and has excellent disability access for people who need it. We have received no complaints about the home. Staff at the home are provided with training to recognise and report any suspicions of abuse that come to their attention, so that the people at the home are kept safe from harm. Staff are well trained to carry out their work in a safe and sensitive manner. Vetting checks are carried out with new staff so that people are supported by suitable staff. A senior manager visits the home on a regular basis to check the home is running well. Suitable arrangements are in place for checking that fire Safety equipment is working properly. Fire drills are carried out so that everyone knows what to do in the event of a fire. What has improved since the last inspection? Information about people`s allergies to medication is now recorded on their medication sheets. This is good practice and helps reduce the possibility of individuals being given medication that is not good for them. The wooden structures in the central courtyard have received maintenance work and this makes a pleasant area for people to sit out during the summer. Lifting equipment in the home is being serviced to ensure it remains in safe working order. What the care home could do better: Some information in people`s contracts concerning extra charges is not clear and needsto be amended so that everyone is clear about what people are expected to pay for. The contracts should be seen and signed by relatives or advocates to show that people`s interests have been represented and their rights upheld. Whilst overall the home`s medication procedures are satisfactory there is scope for introducing regular checks of the medication system so that any shortfalls may be quickly identified and addressed. There has been no recent fire safety training at the home. This is necessary to ensure that staff are up to date with current fire safety practices so that everyone is kept safe in the event of a fire at the home. The manager said that training was planned to take place next week. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hft - Orchard View 7 Waterloo Road Bidford On Avon Warwickshire B50 4JP     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 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: Hft - Orchard View 7 Waterloo Road Bidford On Avon Warwickshire B50 4JP 01789490730 01789772790 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 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 6 The maximum number of service users who can be accommodated is: 6 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) 6 Physical disability (PD) 6 Date of last inspection Brief description of the care home The home is a purpose built, large bungalow for six people with severe learning and physical disabilities. It is part of the Arden Vale Scheme located on a rural campus of the parent body, Home Farm Trust. The site has another two unit home for a total of nine residents, and a large activity centre, which most residents use to some degree during the week. All bedrooms are single without en-suite facilities, there are vanity sinks in each bedroom. The home is fully wheelchair accessible. There are three bathrooms, two with specialist baths (easibaths) and a walk in shower room. There is an enclosed garden area. It is paved with border shrubs, water feature and garden furniture and is easily accessible for service users. The home is near to the village of Bidford on Avon, where there are a number of local amenities. Stratford is Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home approximately nine miles away, Redditch is twelve miles and Evesham is eight miles away, where there are a variety of facilities available. Full personal care is provided. Care Homes for Adults (18-65 years) Page 5 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: 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 31 The inspection included seeing everyone who living at the home. Two people were able to pass comment on the service. Due to the communication needs of other people it was not possible to get their views. 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. Other peoples files were also sampled for information. Discussions took place with two day staff and a night worker, as well as the manager. A number of records, such as care plans, complaints records, recruitment files 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. What the care home does well: What has improved since the last inspection? What they could do better: Some information in peoples contracts concerning extra charges is not clear and needs Care Homes for Adults (18-65 years) Page 8 of 31 to be amended so that everyone is clear about what people are expected to pay for. The contracts should be seen and signed by relatives or advocates to show that peoples interests have been represented and their rights upheld. Whilst overall the homes medication procedures are satisfactory there is scope for introducing regular checks of the medication system so that any shortfalls may be quickly identified and addressed. There has been no recent fire safety training at the home. This is necessary to ensure that staff are up to date with current fire safety practices so that everyone is kept safe in the event of a fire at the home. The manager said that training was planned to take place next week. 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable admission procedures are in place at the home. Contracts need to be amended to ensure that people have the correct information and that their rights are protected. Evidence: The manager explained that when new people are referred to the home their needs are assessed and they are given information about the home. The file of a person admitted to the home in the last year was checked. The file contained referral and assessment information, provided by Social Services, to support the development of a care plan for the person concerned. A care review report was also seen on file, as evidence that the placement was reviewed with the involvement of Social Services, after three months, to monitor the persons progress and happiness at the home. The manager explained that the person (with support from relatives) was encouraged to visit the home before moving in and stayed a weekend to get to know people. The manager said that more visits would have occurred, prior to the person moving in, but the move was hastened as the person concerned urgently needed to find new Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: accommodation. The manager said that the service user guide, containing information about the home also serves as a contract. Two peoples contracts were seen on their files. The contract has been illustrates with pictures to make it easier for people to understand. The manager also explained that a multi media information pack is being devised so that new people moving to the home can be provided with a DVD describing what the service has to offer them. The two contracts seen were dated October 06 but neither contract had been signed by the people at the home or their relatives. It would be good practice for peoples relatives or advocates to sign the contract, to demonstrate that peoples interests have been properly represented when agreeing the contract. The manager explained that people are provided with free transport for local journeys but have to contribute to the cost of staffing for holidays. This is referred to in the contract but the way it is written does not make any distinction between local outings and long distance outings or holidays. The manager agreed to amend the contract and arrange for it to be shared with peoples relatives so that they are clear about all the charges levied by the home. Care Homes for Adults (18-65 years) Page 12 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 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 planned for with their involvement so that they are met appropriately by staff. People are encouraged to make every day decisions so that they exercise some control over their lives. Evidence: Two peoples care plans were looked at and information in others was sampled. New care plans have been written on the organisations computerised system. Other guidelines, risk assessments and supporting documentation is also available in hard copies held on files. The electronic care plans and paper documents provide relevant information to help staff to meet peoples needs. Information is available explaining peoples communication needs and personal care routines and the way in which they like their care provided. This particularly important for people who can not easily tell staff what they want, in order that their known wishes may be respected. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Guidelines were in place to safely support a person who occasionally self harms. Comments by staff demonstrated a good awareness of what the person concerned was communicating by this behaviour and the actions to take to support their wellbeing. The records show that a community nurse has been involved to provide advice and support and GP advice was sought on the day of the site visit. The manager explained that that there is no current psychology support available in the local learning disability team but agreed to seek the support of relevant health professionals to agree and sign the guidelines to ensure that they remain appropriate. Eating guidelines were also seen for a person at the home. Staff demonstrated a good understanding of the eating guidelines and the communication guidelines that are to be followed when supporting the person to eat safely. The risk assessment covers what to do to reduce the possibility of the person choking and what actions to take in the event that the person does start to choke. Other risk assessments are in place for people, providing advice on the everyday management of risks associated with everyday living and individuals health needs, such as epilepsy protocols, going out in the community, moving and handling and safety in the home and activities, e.g. hydro pool. Person Centred Plans are in place for people. These documents contain lots of photographs about what people have done and achieved in previous months and serve as the basis for planning future goals. People are supported to attend meetings (circles of support) to make plans for the coming months, with support from relatives, staff and other relevant professionals on occasions. People were encouraged to choose what they wanted for breakfast and the menu is illustrated with pictures. Staff explained that pictures are also used to help people to choose what they want on the menu. Regular meetings are held at the home (notes seen) which include a celebration of the many activities undertaken by people and planning as well as discussing other matters. In the past this has been used to remind people of the adult abuse policy in place to safeguard them. The meeting records are illustrated with many pictures to help make them easier understood. The manager explained that people are involved in choosing their decor and shopping for some times of clothing where they are happy to do so. A person at the home confirmed that she had chosen her bedroom decor. 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. 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: The people at the home attend a mixture of time being supported from home and attendance at the organisations day service that is situated on the same site. Comments by staff and the manager, activities records and photographs of activities, indicate that people have been supported to take part in a good range of activities e.g. hydro-pool, aromatherapy massage fortnightly, ten pin bowling, meals out, Cheltenham race course, sensory rooms, horse riding, garden centres , parks and other outing further afield. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: As noted above, the people at the home are supported to plan special outings and activities, as part of the Person Centred Planning process. One persons plan showed that she had been supported to see a sky diving display and been on trips to Weston Super Mare and the Black Country Museum and other outings. The manager explained that holiday arrangements are in place for most people. One person is planning a week of day trips and excursions. Comments by staff and information in records such as review notes show that the people at the home are supported to stay in touch with relatives and receive their support at meetings. A person at the home confirmed that she uses the phone to speak to her family on a regular basis. Photographs were seen of relatives taking part in peoples Birthday celebrations indicating they are made to feel welcome at the home. Comments by staff and the manager indicate that people are encouraged to do things for themselves where possible to maintain their independence e.g. one person who requires support to eat is encouraged to hold their utensil until they get tired and another person likes to wash and dry up and set the tables. The current menus provide a good variety of mealtime options for people based on the known likes and choices. As noted above, people are supported to plan the menus each week using pictures to help them recognise the foods on offer. The home has recently received a Heart Beat Award from Stratford city council commending them on their balanced healthy menus. Snack foods were available in the home for people to enjoy including cake, biscuits and fruit. Staff were seen to provide sensitive, unhurried individual support to a person who needs assistance to eat. The manager reports that none at the home currently has any special dietary needs to maintain good health. Care Homes for Adults (18-65 years) Page 16 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. People are provided with access to relevant health care professionals so that there assessed needs are monitored and met Evidence: The people at the home looked very comfortable and at ease when approaching staff, indicating they like them. Staff were observed to speak to people in a friendly, caring and to treat them with respect. A person at the home confirmed that they like the staff. People were observed to rise in an unhurried fashion in the morning before choosing breakfast. All personal care tasks were carried out in private behind closed doors, paying appropriate attention to peoples privacy and dignity. Entries on peoples health records indicate that they are being supported to gain access to health professionals to monitor and meet their assessed needs. On the day of the site visit the GP was called for a person thought to be in discomfort. As the person concerned was unable to voice their concerns verbally staff responded to the Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: persons non-verbal queues and behaviour. This was in keeping with advice recorded in behaviour guidelines. Comments by staff demonstrated a good understanding of the needs of a person with epilepsy, as recorded in an epilepsy protocol. This includes under what circumstances they should give extra medication in the event that the person concerned has a serious seizure. A nurse visiting the home to treat a person with pressure care needs spoke positively about the care provided by the home and said the staff are very good here, they always carry out our advice. Entries in peoples health notes show that they are supported to gain access to routine check ups such as dental checks and eye tests as well as support from other professionals, such as psychiatrists and community nurses. Two peoples medication records were checked. The records now include details of any allergies that people have to medications so that they can be avoided. Information is also in place informing staff of the reasons that specific medication has been prescribed, so they know why people are being given it. The manager said that no one at the home is currently prescribed any PRN (as needed) medications for the management of behaviour. The manger said that people are only given medication prescribed by the GP and that the home does not keep a stock of homely remedies currently. The manager said to make things easier in the event that people have an everyday illness, such as a cough or cold, she is seeking a suitable list of home remedies for each person from the GP so that these can be used when necessary without resorting to making an appointment with the GP at the time people are poorly. Entries in peoples medication records show that their medication is being recorded to show it has been given. Most medications are in blister packs, set up by the pharmacist. The amount received into the home is being recorded properly on the medication sheets. Where there are any additional tablets in boxes these are recorded on a separate accounting sheet to keep track of the number of tablets in stock. A persons boxed medication was checked and found to balance against the record. However the record contained a recording error where the previous entry had been made in the wrong column on the form. The manager said that she would review the format of the form to make it easier to follow. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Staff confirmed that they had received medication training and assessed before being allowed to give out medications. This was verified in staff training records and three staff medication assessments that had recently been completed by the manager. The manager said that she periodically checks medication sheets to see that it is being recorded properly and that tablets balance but there is no record currently retained at this time. The manager agreed to start regular audits of the medication system so that any medication errors or other shortfalls that may come to light can be quickly identified and addressed. Medication checks also feature in the senior managers monthly monitoring visits. Care Homes for Adults (18-65 years) Page 19 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. Suitable arrangements are in place managing 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 and the manager explained that there have been no complaints received at the service from relatives or others not living at the home. The people at the home 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. Entries in the complaints record and comments by the manager indicate that these matters have been followed up appropriately and where necessary extra professional support has been sought. Two staff on duty confirmed that they had been provided with safeguarding from abuse training and a new worker said that she had covered the policy in her induction and was waiting to go on training. The training records show that it has been over two years since most staff went on safeguarding from abuse training. The manager confirmed that training updates are planned to take place this year. Two staff spoken Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: to demonstrated a good knowledge of the different types of abuse they may encounter and how to report it. The people at the home have also previously discussed the complaints and whistleblowing in a house meeting (record seen) so help them to understand what they should do if they are unhappy about anything. 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. Care Homes for Adults (18-65 years) Page 21 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. People benefit from a clean, spacious, well equipped and maintained home that meets their needs. Evidence: The home is situated in a rural location in large grounds. All the rooms are at ground level and there is good wheelchair access throughout the home and garden. The central courtyard provides a pleasant area for people to sit out and enjoy the sunshine in the summer months. The home is well designed and decorated and attractively furnished with domestic style furniture. The front door hallway is used to present information for the people at the home and visitors. Pictures of people enjoying activities are attractively presented for people to look at. The bathrooms are well equipped to meet the needs of the people living at the home. Great efforts have been made to make these areas attractive and pleasant to use e.g. with pictures and ornaments. Peoples bedrooms are also well equipped. Where necessary specialist beds have been Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: provided for people and lifting equipment is available for people where required. Significant efforts have been made to personalise peoples bedrooms and to make them look comfortable and attractive. Overall the home was very clean. The home employs a cleaner and staff also complete some cleaning tasks. Staff were seen to wipe down kitchen equipment and surfaces after use. Protective clothing is available in the home and staff were seen to make use of this when carrying out personal care tasks. Red dissolvable bags are also available to provide a safe means of handling continence laundry. There was a odour in one bedroom. Comments by staff and the manager indicate that this being dealt with by frequent cleaning each day with specialist products and plans are in place to replace the carpet shortly. The paintwork at the front of the building is blistered and would benefit from repainting. Care Homes for Adults (18-65 years) Page 23 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. Suitable arrangements are in place for recruiting and training staff so that people benefit from suitable staff support. Fire safety training is needed to ensure that staff are updated on current fire safety practices to keep people safe in the event of a fire at the home. Evidence: The manager explained that there are always at least three staff on shift and additional staffing hours are provided at weekends where necessary to support two people who require one to one support to get out and about places. This was verified by sampling recent rotas. The manager reports that the core of the staff team has remained together for several years and their continues to be allow staff turnover at the home. The rotas show a pattern of familiar staff, providing consistency of care and support for people. The files of two new staff were checked. The file shows that staff complete an application form, including their job history and 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 planned supervision Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: and further evidence of periodic supervision and appraisals was recorded on staff files. The manager said that she was trying to catch up with some staff members planned supervision sessions and had drafted a supervision plan for this purpose, which was on display in the office. Staff confirmed that they had received training on Health and Safety related training related subjects, such as fire safety, food hygiene, moving and handling and first aid. The training records show that in some cases it is approaching three years since staff have received certain courses, such as first aid, food hygiene training and safeguarding from abuse. The manager confirmed that updates are planned and evidence of this was seen on the training plan. So far this year, most staff have received epilepsy training, moving and handling and Health and Safety and Mental Capacity Act training and the training plan shows that first aid training will take place shortly. Fire safety training has not been provided to most staff for several years. The manager said that new DVDs have been purchased for this purpose and that she has undertaken fire marshall training. The manager said that staff would be provided with fire safety training very shortly, at next weeks planned team meeting. The manager reports that 6 of 11 staff now hold National Vocational Qualifications (NVQS) at level 2 and that two staff are training for this qualification. Three staff are also completing NVQ level 3 as part of their professional development. These courses are designed to equip staff to carry out their work roles effectively. The training records show that staff have not been provided with equality and diversity training. This was confirmed by the manager. This training increases awareness of peoples diverse needs and preferences which are to be respected and supported. Care Homes for Adults (18-65 years) Page 25 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. Overall the home is well managed and monitored to ensure that it runs satisfactorily to the benefit of the people at the home. Evidence: The manager has many years experience of working with people with learning difficulties and 19 years experience of working people with learning difficulties. The manager holds the National Vocational Qualification (NVQ) level 3 in Care and has recently completed the NVQ 4 in care management. The manager agreed to research how she may complete additional training modules to achieve the NVQ 4 in Care building on her NVQ 3 in Care qualification. There are number of measures in place to support the smooth running of the service. The fact that it is small scale 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. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: 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 meeting staff and the people that live at the home and identifying any shortfalls in the service and setting objectives for the manager to achieve. The manager said that surveys have not been sent peoples relatives but explained that she maintains close contact with them to keep them informed of events in peoples lives. The manager agreed to send surveys to relatives and professionals to seek their views of the service. The records show that regular house meetings take place with people to make everyday plans and discuss issues. One person also attends a Home Farm Trust consultation group, which includes people from other services to contribute ideas to service developments and campaigns, such as better access for people with disabilities. The access to the Orchard View and surrounding Home Farm Trust premises was previously improved following such consultations. Staff confirmed that they have regular staff meetings to discuss peoples needs and policy issues and this was verified in team meeting records. As previously noted suitable systems are in place for recording and monitoring peoples money to ensure that expenditure is accounted for. 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. Comments by staff indicated a satisfactory awareness of the fire safety drill in the event of a fire at the home. As previously noted fire safety training is overdue and the manager said that she would be providing this training promptly. 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 27 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 28 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 5 Peoples contracts should be amended to make clear any extra charges, such as contribution to staffing expenses and transport costs when traveling on long journeys. Peoples relatives should be encouraged to view and sign their contracts to demonstrate that their interests have been properly represented, so that their rights are protected. Proceed with plans to arrange for an appropriate health professional to check and agree behaviour management protocols where necessary, such as where there may be self harming behaviour. proceed with plans to introduce regular audits of the medication system, so that any shortfalls in practice may be quickly identified and addressed, to further support safe medication practices in the home Proceed promptly with plans to provide staff with fire safety training to support safe practices in the event of a fire. Staff should be provided with equality and diversity training to further increase their awareness of peoples individual needs and preferences, which are to be respected and supported. Page 29 of 31 2 5 3 9 4 20 5 6 35 35 Care Homes for Adults (18-65 years) 7 37 The manager should complete extra training to achieve the NVQ 4 in Care or equivalent to fully equip her for her role in the home. Proceed with plans to survey the views of relatives and professionals so that they can contribute to the development of the home. 8 39 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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