Care Home: High Hurlands Community Homes

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What the care home does well A full schedule of weekday activities was provided by the community homes using the on-site facilities, which included a hydro-pool, a physiotherapy and music room, a multi-sensory room, a pottery and craft room, a sensory garden, a greenhouse and gardens and two horses, one for riding and one for carriage driving. The homes provided specially adapted vehicles for wheelchair users to enable service users to access the local community and for making trips to places of interest. Artwork produced by the service users was displayed, promoting their creativity; enhancing their self-esteem and confirming they were valued. The homes were very clean and well maintained internally and externally and provided a comfortable, safe and homely place for the residents to live. An excellent induction and a comprehensive training programme of mandatory and specialist training ensures the staff are up-to-date, well-informed and prepared to meet the needs of the residents. A relative of a service user commented in the quality assurance questionnaire they completed, `the quality of care my son receives is very good. He lives in a wellmaintained and comfortable home, supported by caring staff. He attends high-class onsite activities and has access to community services too. In all he leads a very full and active life.` A visiting healthcare professional, who was involved in training the staff on epilepsy on the day of the site visit commented, `this home provides an exceptional personal service with all resources offered, at a superior level, and incomparable with other services I visit. The staff are very committed, professional and cheerful and the family run business provides well for the staff.` What has improved since the last inspection? The Mental Capacity Act toolkit had been introduced to assess capability and best interest decision-making on behalf of service users. Improvements had been made to some of the cottages, including the decoration of a number of service users` bedrooms and communal areas. The exterior walls of all the cottages had been painted and new conservatories had been added to two of the cottages extending the dining areas and letting more light into the rooms. What the care home could do better: The homes continued to have systems in place to review and improve the services provided. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: High Hurlands Community Homes High Hurlands Estate Gentles Lane Nr Passfield Liphook Hampshire GU30 7RY     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: Christine Bowman     Date: 1 6 0 1 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.csci.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: High Hurlands Community Homes Gentles Lane High Hurlands Estate Nr Passfield Liphook Hampshire GU30 7RY 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): fizz@highhurlands.co.uk Miss Fiona Lovelace Carter, Mrs Alicia Lovelace Hackshall,Mrs Diana Carter Name of registered manager (if applicable) Miss Fiona Lovelace Carter Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 15 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home High Hurlands Community Homes are five three bedroom bungalows providing a service for fifteen younger adults with a Learning Disability some of who may have associated physical disabilities. Three service users are accommodated in each of the Care Homes for Adults (18-65 years) Page 4 of 31 care home 15 Over 65 0 0 15 15 Brief description of the care home small homes. Staffing is provided 24 hours a day. Service users are encouraged to maintain their independence and rules are kept to a minimum. Visitors are welcome and service users families are encouraged to play an active part in their relatives life. The home has well established links with local General Practitioners and nursing teams to support and enhance the service provided. The homes were developed and are managed by the High Hurlands partnership and are well established in the local community. The grounds extend to over 70 acres and a day service facility is provided on site. The home is situated in a rural part of the Hampshire country side and transport facilities are provided for service users to access local facilities in the nearest village of Liphook and larger towns in the area. Fees are available on request. 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: This inspection report includes information gathered about the service since the previous site visit on 22nd February 2007 under the Commissions Inspecting for Better Lives (ILB) process. An Annual Quality Assurance Assessment (AQAA) was completed, giving up to date factual evidence about the running of the homes and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Eight service users returned surveys, and four of them had indicated answers, with support from the staff. Four staff also returned surveys giving their views on the service. An unannounced site visit was conducted on 16th January 2009, to assess the outcomes of the key inspection standards for younger adults with respect to the service users living at the homes. The registered manager, Miss Fiona Carter, was on annual leave, so the Community Homes Care Homes for Adults (18-65 years) Page 6 of 31 Manager provided support for the inspection process by making service user and staff files and other documents available to be sampled. The Responsible Individual, Mrs Alicia Hackshall, was available for consultation throughout the day. A tour of two of the five cottages, providing accommodation to the service users was undertaken, and some of the service users bedrooms were viewed. Other communal areas on the estate, which provided facilities for communal use, were also viewed. A number of staff and visiting professionals were spoken with throughout the day. Owing to the complexity of service users needs, it was not possible to speak to service users about their views on the service they receive, so time was spent observing service users in their daily activities and the interaction between the service users and staff supporting them. Service user and staff records, maintenance certificates, complaints and compliments logs were sampled and the Statement of Purpose, the Service User Guide and some policies and procedures were viewed. What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 31 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is available in a suitable format, to inform prospective service users about what the home has to offer them, and a full assessment of their needs is carried out to ensure the home is able to fulfil them. Evidence: There had been no new admissions since before the previous site visit and the home held a waiting list of prospective service users. The AQAA recorded that, a full assessment of prospective service users needs, is carried out by two senior members of the management team. Visits to the home are arranged, and the prospective service users compatibility with current service users is taken into consideration when a vacancy arises. Service user files sampled, confirmed full needs assessments had been carried out and signatures of relatives/representatives confirmed they had been involved in the process. Information with respect to equality and diversity, including ethnic, cultural, religious and special dietary needs had been collected to ensure that an individualised Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: plan of care could be collated. Care management assessments were also included in the files sampled. Assessments included a family history, personal care needs, daily living skills and abilities, educational needs and health and social care needs. Senior staff spoken with stated that interested parties were invited to visit the home at least once and prospective service users were provided with a personalised service user guide illustrated with photographs of the home and their bedroom, the communal rooms, specialised equipment and other shared facilities on the estate including the hydro-pool, the multi-sensory room, the pottery, the arts, crafts and music room, the greenhouse, the homes minibus and the horse and carriage. 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. Service users needs and goals are met and their relatives and representatives are involved in compiling their plan of care. Service users are supported to make decisions and their rights and choices are promoted and protected. Independence is promoted through the balancing of the risk factors involved. Evidence: Care plans sampled had been reviewed and up-dated regularly and covered the service users personal care, health and medical needs, communication, activities, social interaction, sexuality and behaviour. Service users goals to promote independence were recorded and very clear and detailed instructions to the staff of actions to take, in supporting the service users to achieve their goals, whilst carrying out their daily routines, were included. Service users also had person-centred plans, which had been written from their point of view indication their likes, dislikes and aspirations. One service user liked listening to music, going to the seaside, swimming, having facials at the salon and needed to spend some time alone, be sociable with familiar people and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: keep calm and relaxed. Service users also had a circle of support map showing all the people involved in their lives and the roles they fulfilled. Records confirmed that service users had key workers allocated to them for consistency and continuity. Care plans viewed, showed that some service users were able to make some simple decisions using their individual communication aids. Since the previous site visit, the Mental Capacity Act training and the use of the toolkit had enabled service users capacity for decision-making to be assessed and where necessary, decisions in their best interests were made on their behalf, with input from healthcare professionals and families. The registered manager was the nominated appointee for the majority of service users personal allowances. Records showed all transactions, receipts were retained and regular audits were undertaken to safeguard the service users interests. Risk assessments were individual and recorded hazards to service users and control measures to reduce risks. The worst possible outcome, the likelihood of the hazard occurring, the level of risk and additional controls were all identified. Service user files sampled confirmed that all activities, in which the service users took part, had been risk-assessed prior to taking part in them. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users take part in wide range of appropriate activities that take account of their needs and preferences. They are supported to maintain personal relationships and to be part of the local community. Service users dignity and rights are recognised and they have the opportunity to make the most of their abilities. They are offered a healthy diet that reflects their individual tastes and dietary needs. Evidence: A full schedule of weekday activities was provided by the community homes using the on-site facilities, which included a hydro-pool, a physiotherapy and music room, a multi-sensory room, a pottery and craft room, a greenhouse and gardens and two horses for riding and carriage driving. The homes had also been provided with specially adapted vehicles for wheelchair users to enable service users to access the local community and for making trips to places of interest. Individual service users Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: timetables showed that they engaged in many and varied activities throughout the week including walking, music, gardening, horse riding, horse grooming, swimming, project work, cookery and community integration. On the day of the site visit three service users been working on a project in one of the cottages in the morning and had helped in the preparation of lunch. The work they had completed on a project entitled Colours was viewed. In gathering material for the project, photographs had been taken on visits to many places of interest including, Alice Holt Forest, the Hillier Gardens, Arundel Wetlands Centre, Uppark (National Trust house and gardens), West Dean Gardens, Portsmouth Historic Dockyard, a fire station, Porchester Castle, The Royal Naval Museum and the Watercress line (steam railway). Photographs showed the service users collecting feathers on a visit to Bird World for making feather pictures. Creative artwork inspired by the visits and using a variety of materials, had been completed by the service users. Celebrations such as Christmas and Divali also inspired creative cookery and dressing up, all of which was recorded in photographs. The AQAA recorded that no service user is able to take up employment due to their complex and multiple disabilities, but as part of their Day Service, they are enabled to visit local employers and observe work taking place such as the army, garages, tyre fitters and catering. Service users were also supported to access all local services such as shops, churches, cinemas, pubs, restaurants, leisure centres, theatres and libraries. Close links had been formed with local schools, the pupils of which, visit the service users and invite them to school productions. Visitors were welcomed at the homes and one relative wrote, in their quality assurance questionnaire, myself and my wife always receive an extremely warm welcome from the staff, when we visit. All the relatives who responded to the homes quality assurance questionnaire confirmed that communication was very good. Service users preferences with respect to food was recorded in their care plans and one service user, whose file was sampled, especially liked lasagne and would like it for tea everyday. The use of aids was also recorded and instructions to the staff to safeguard service users from hot drinks. Staff personnel files sampled, confirmed that food hygiene certificates had been obtained for the safe handling of food. The AQAA recorded that service users were not able to make choices from menus, but their likes and dislikes were well-known to the staff and well-documented in their care plans. Some service users were observed eating their lunch with the staff in one of the cottages, in pleasant surroundings and in a relaxed and unrushed manner. Food diaries were kept of food consumed and service users weight was monitored monthly. The manager stated that advice would be requested from a dietician if required. Care Homes for Adults (18-65 years) Page 16 of 31 Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support from the staff in the way they prefer and their physical and emotional health needs are recorded for the staff to follow. Safe procedures are in place to support the service users to access their medication. Evidence: A care plan sampled, recorded how one service user was able to choose the shampoo they preferred, squeeze their toothpaste onto the brush and apply their hair gel. Their support needs with respect to all aspects of personal support were clearly recorded in detail with instructions to the staff of exactly how the assistance should be given. The promotion of the service users privacy and dignity in intimate care was well documented. A staff member confirmed in a survey they completed that they were always given up-to-date information about the needs of the people they support and staff members were observed supporting the residents in a respectful manner. A staff member commented, all care plans are very clear and easy to follow, and they are regularly up-dated. Records confirmed that service users had been assessed for aids and equipment such as hoists and standing frames to assist with their mobility and to enhance their lives. Records confirmed that service users were registered with a Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: General Practitioner and referred as necessary to other relevant healthcare professionals. All the service users had an exercise activity programme overseen by a physiotherapist. Service users had Health Action Plan showing how a positive healthy lifestyle was promoted and how they were supported to access annual dental checks, optician appointments and other therapists as required, including out patient appointments at NHS hospitals. A service users day service timetable included motor skills/exercise activities on four occasions throughout the week, swimming, sensory activities, horse riding and osteopathy to support their health needs. The medication administration records for two residents were sampled, neither of which were assessed as able to self-medicate. Information was clearly recorded, a sample of staff signatures kept and also records of medication received and returned to the pharmacy. Most of the medication was supplied was in blister packs and suitable storage was provided. The staff training records confirmed that all the staff had accessed medication training and the administration of specialist drugs in respect of epilepsy. A visiting healthcare professional, who was involved in training the staff on epilepsy on the day of the site visit commented, this home provides an exceptional personal service with all resources offered, at a superior level, and incomparable with other services I visit. The staff are very committed, professional and cheerful and the family run business provides well for the staff. 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. As service users cannot express their concerns, the homes provide service users relatives or representatives with a complaints procedure to follow, should they have concerns about the home, and they are encouraged to express any concerns they may have on behalf of the service users. The care homes safeguard the service users from abuse, neglect and self-harm and ensure the staff know how to make a safeguarding referral. Evidence: The AQAA recorded that no complaints had been received by the service over the previous twelve months and the CSCI had not received any complaints on behalf of this service. The complaints procedure was displayed and included the necessary contact details and timescales by which the complainant could expect a response. The manager stated that all the service users relatives and representatives were given a copy, and that they were also encouraged to voice any complaints during the review process. Service users were unable to express their views and were unable to complain, but the staff understood them very well and responded to facial expressions and body language. Good records were kept to indicate how each person would communicate when unhappy or distressed and what staff should do when this happens. The home received many compliments from relatives and representatives in their quality assurance questionnaires including, we appreciate the efforts made to keep our daughter comfortable and happy. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The community homes had a copy of the local authority safeguarding adults policy and procedure and a whistle blowing policy to inform the staff of how to safeguard the service users from harm. Staff training and development logs contained certificates to confirm they had received the protection of vulnerable adults training. The staff recruitment process safeguarded residents. Records confirmed that the staff, whose files were viewed, had been through rigorous recruitment checks including Criminal Record Bureau and the Protection of Vulnerable Adults list checks prior to the offer of employment. The AQAA recorded that over the previous twelve months no safeguarding referral had been made by the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable, homely and safe environment, which is adapted to meet their needs and is clean and hygienic. Evidence: High Hurlands Estate was accessed by a winding country lane from the village of Passfield and located over-looking the rolling countryside of the South Downs. There was a large car park at the gated entrance of the estate and a drive leading to the house with further car parking for the homes vehicles at the front of the building. The large country house was separately registered as a nursing home for younger adults and the five community homes had originally been accommodation for nursing and support workers prior to opening as care homes. They had been converted and specially adapted to cater for the needs of younger adults with complex needs. The environment was well maintained and a very pleasant place for the service users to live. The offices for the registered manager, the community homes manager and the responsible individual were within the nursing home and a number of the facilities were shared. Weekday lunch was cooked in the main kitchen for everyone attending the day care facility, mostly, the manager stated, but flexibility was allowed for and sometimes the main meal was cooked in the community homes by the staff. Inside Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: the entrance hall of the nursing home were displays of art work and pottery completed by the service users and enlarged photographs of them happily enjoying activities such as horse-riding and playing instruments. A Noahs ark with the animals embarking two by two, created in clay by service users, fired, painted and glazed, formed the centrepiece to the display and was a masterpiece, that anyone would have been proud of creating. Excellent facilities were provided in the adapted outbuildings surrounding the house including a hydro-pool, a physiotherapy and music room, a multi-sensory room and a pottery and craft room. A large sensory garden had recently been created, containing a variety of sensory plants and herbs and a specially designed original water feature. The garden was decorated with pottery items produced by the service users including tiles and wind chimes and provided an outdoor covered seating area for the enjoyment of the service users. Four of the community homes were located along a private road and down the hill from the house and the fifth was situated adjacent to the nursing home. Along the route were more shared facilities including a greenhouse with an enclosed garden for growing vegetables, plants and flowers, also decorated with pottery items. There was a picnic and barbecue area adjacent to a large farm shed, which had been supplied with heating, lighting, water and cooking facilities for communal use. Service users played ball games and roller-skated on the tennis court, the manager stated. Two horses provided riding and carriage driving activities for the service users and care plans recorded that some service users enjoyed grooming the horses and helping to care for them. The four cottages formed a small community and all had their own large, enclosed gardens supplied with trampolines, swings, shades and seating for the service users to enjoy in the summer months. A tour of two, of the single story, cottages was undertaken. In one of the cottages, lunch, which had been cooked in the home, had just ended and the three service users, who had been completing project work on things of wonder with their day care staff in the morning, were enjoying a period of relaxation, before their afternoon activities. The dining room/kitchen had been much improved by the addition of a good quality, double-glazed conservatory, which gave the room a light and airy feel and provided extra communal space for the service users. The furniture and fittings were of good quality, and of a domestic nature making the rooms feel homely. The separate sitting room contained large leather chairs and a sofa, a television, music centre and framed pictures on the walls. A story tape was playing and a service user was enjoying a foot massage. The second cottage had also been improved by the addition of a conservatory. Over the past three years, all the cottages with the exception of one, had been improved in the same way. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Bedrooms, sampled were personalised. One service users bedroom had an adjustable bed and hoist, ceiling and bedside lights and mobiles hanging from the ceiling, a display cabinet containing china animals, display shelves full of soft toys, photographs of the themselves on outings, good quality furnishings and a television. All the bedrooms were well colour co-ordinated according to the taste of the service users and individually furnished. Bedrooms did not have en-suite facilities but the shared bathrooms were well equipped to suit their needs. All areas of the homes were clean and fresh and accessible by wheelchair users. Domestic laundry facilities were provided in each of the homes in utility alcoves beside the kitchens. The AQAA confirmed that soiled linen would be taken to the laundry facility at the nursing home and not carried through the kitchen area, should sluicing be required. The AQAA recorded that all staff receive infection control training at induction and certificates in staff training and development logs confirmed this. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safe recruitment practices, appropriate induction and mandatory and specialist training prepare the staff for the supportive role and to meet the service users individual needs. Evidence: The AQAA recorded that, Staff attitudes and characteristics are assessed at interview and during ongoing support and assessment, and it is expected that all the staff respect the service users we support. Observations of staff working with service users on the day of the site visit, was that they did so with kindness, understanding and knowledge of the people they were supporting. Records confirmed that more than 50 of the staff team had already achieved a National Vocational Qualification (NVQ) at Level 2 or above in care. Staff, who completed surveys, confirmed there were always enough staff to meet the individual needs of the people who use the service and the home reported a good level of staff retention resulting in consistency and continuity for the residents. Two senior managers conducted interviews of prospective new staff and successful candidates were offered a post subject to two satisfactory references and a satisfactory Criminal Record Bureau enhanced disclosure check, the manager stated. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Although service users were not able to participate in the interviewing process, prospective employees were introduced to service users and reactions were taken into consideration as part of the process. The recruitment documentation of two staff, recruited since the previous site visit, were sampled, confirming that all the necessary checks had been received before a post was offered and that the process was fairly conducted under the principles of equal opportunities. New staff completed a comprehensive induction programme based on the Skills for Care Common Induction Standards, which introduces new care staff to the caring role and promotes the service users rights to be treated as an individual, and have their equality and diversity needs respected. Induction training included, Experiences and Needs of the service user, Principles of Care and Develop as a Worker. After the initial induction, staff worked alongside a senior support worker learning their service users specific needs for at least two weeks. Even when they were considered competent, new staff continued to be supervised, the manager stated. Induction training was well documented on the staff files sampled. A training and development manager was responsible for coordinating the training of new and existing staff, and for sourcing other training resources as required. Staff training and development files included certificates to confirm they had received training in infection control, epilepsy, fire safety, moving and handling, communication, health and safety, first aid, food handling, care planning, abuse and neglect, medication administration, gastrostomy, autism, challenging behaviour and Makaton. The manager stated that community home key workers attended a supervision skills course and that staff were encouraged to achieve NVQ at level 3. Equal opportunities training was included within the induction. A staff member commented in the survey they returned, High Hurlands provides its residents with a very high standard of care and support. Residents lead a full life and their individual needs are met to the full. Staff are given a high standard of training with opportunities to develop in their role. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a well managed home, which is run in their best interests. Their health, safety and welfare is promoted and protected. Evidence: The registered manager Miss Fiona Carter was on annual leave at the time of the site visit, but the community homes manager and the responsible individual, Mrs Alicia Hackshall, were available to assist with the inspection process. The registered manager was well qualified, having completed the Registered Managers Award and a National Vocational Qualification (NVQ) at level 4 in care. She has also had in excess of eighteen years of experience in managing a service for people with severe learning and physical disabilities. The AQAA recorded that she also undertakes period training that is relevant to her role, and keeps herself up to date through her membership of the Registered Nursing Homes Association and the Hampshire Care Association. The Community Homes manager, who over-sees the day-to-day running of the homes, also holds an NVQ at level 4 in management. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: The Community Homes annual quality assurance surveys had been returned and they contained many positive comments from service users relatives and representatives, including, the quality of care provided to our daughter has been excellent. Throughout a difficult year, her additional needs have been recognised, and the staff have done everything possible to assist her, excellent service and the facilities are excellent, my daughter always seems happy when I visit, which I am sure is to do with the wonderful care she has, and the quality of care my son receives is very good. He lives in a well-maintained and comfortable home, supported by caring staff. He attends high-class on-site activities and has access to community services too. In all he leads a very full and active life. The collated feedback to relatives and representatives, who had completed surveys, contained very positive results. The highest scores were achieved for making relatives and representatives feel welcome at the cottages, for the quality of the on-site facilities, for communication and for the overall quality of the service provided. The Annual Quality Assurance Assessment (AQAA) completed by the community homes manager and sent to the Commission for Social Care Inspection (CSCI) recorded that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body and certificates for the central heating and the fire safety audit, sampled, confirmed they had been carried out in 2008. The Control of Substances Hazardous to Health (COSHH) had been appropriately risk assessed to safeguard the service users. Policies and procedures and codes of practice in relation to Health and Safety had all been reviewed in a timely manner to ensure the staff were kept up-to-date with current legislation and practice. The staff training and development files confirmed that training in moving and handling, food hygiene, first aid, fire training, health and safety and infection control had been regularly updated to keep them informed. Records were kept of accidents and other serious incidences and the home kept the CSCI appropriately informed of such events. There was an ongoing programme of maintenance and repair. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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