Care Home: Hill Farm

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What the care home does well The home supports people with learning disabilities and a range of additional needs. Staff training is sought to make sure that staff are competent in supporting people with these specialist needs. Regular meetings are with the people who live in home so that they have an opportunity to make their voice heard. Where people have limited communication skills, their key worker advocates for the person. Each person has a health plan which clearly identifies the individual health care needs of each person living in the home. What has improved since the last inspection? People`s care plans are being developed and expanded so they contain more detail of the individual needs, wishes, support and encouragement in line with current good practice for the delivery of person centred care. People`s cultural and spiritual wishes concerning death and dying are now included in care plans. More focus is being placed on people developing independent living skills. Photographs are being used to record how people are achieving their goals. This has meaning for the person involved themselves and adds to their self esteem. The home is now aware of and discharging its responsibilities in recruiting care staff who are potentially safe to work with vulnerable people What the care home could do better: The Service User Guide and complaints procedure are produced in a format that has little meaning for the people living in the home. The staff team could be better at making sure that their actions and words always ensure the dignity of the people in their care. This is particularly important as many of the people in the home do not have the verbal skills to say if their dignity is not being maintained. The home is not doing all that it can to make sure that the service is run in best interests of the people who live in it. It has not sought the views of people living, working and visiting the home, through quality assurance questionnaires, for over two years. At the last inspection it was identified that the home is not undertaking monthly checks of the quality of the service. It is still not doing this. Requirements are being made that the home now meets these shortfalls. Key inspection report Care homes for adults (18-65 years) Name: Address: Hill Farm 15 Keycol Hill Sittingbourne Kent ME9 8LZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nicki Dawson     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Hill Farm 15 Keycol Hill Sittingbourne Kent ME9 8LZ 01795841220 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Forward Care (Residential) Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 9. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The home supports up to nine people who have a learning disability. A number of people who live in the home have behaviours that challenge. The home is a detached property with accommodation on two floors. There are nine single bedrooms, some of which are located on the ground floor. All bedrooms have call bell and television points. A passenger lift provides access to the first floor. There is a small garden to the rear of the home and limited car parking to the side. The home is within easy access to the M2 motorway and about two miles from Sittingbourne town centre. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 9 Brief description of the care home The home has told us that the current fee levels are £1,092 to £3124.87 per week, depending on the individual assessed need. Additional costs are chargeable for horse riding, external sensory sessions and one to one trips out. Care Homes for Adults (18-65 years) Page 5 of 32 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 inspection was unannounced, which means that the service users, staff and home manager did not know that the inspector was calling at the home. Key unannounced inspections are aimed at making sure that the individual service is meeting the National Minimum Standards and that the outcomes for people using the service promote their best interests. The inspection started at 9.30am and took just over 8 hours. All eight service users, two care staff, one administrator, the deputy and home manager were involved in the inspection to gain their views and knowledge of the level of care, provided by the service. The main areas of the home including a number of service users bedrooms were entered. A number of records to do with service users care and safety were looked at. It is now a legal requirement for services to complete and return an annual quality Care Homes for Adults (18-65 years) Page 6 of 32 assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The service returned their AQAA to us within the timescale requested. It contains all the information that we asked for, but needs to be improved by giving us more evidence about what it does well and how it has improved. Throughout this report the person who is in day to day charge of the home is referred to as the appointed manager. The registered home owner has chosen this person to manage the home on their behalf. The appointed manager has yet to apply to us to be registered. This process involves demonstrating to us that they have the necessary skills and experience to carry out the role of home manager. Care Homes for Adults (18-65 years) Page 7 of 32 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 on page 4. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 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 32 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. People who live at Hill Farm would benefit from information about the services and facilities available to them, being presented in way that they can understand. Peoples needs are fully assessed before they move into the home so that they can be sure that they will receive the right type of care. People who have specialist needs can be assured that these needs will be met. Evidence: All care homes are required to provide information about the service that they provide. This is to help people decide if a particular care home is somewhere that they would like to live. The homes statement of Purpose was seen. It contains the aims and objectives of the home. The Service User Guide contains details of the services and facilities that are available to the people living in the home. However, the information is not written in a way that people can understand. It is recommended that a guide is developed so that it can be understood by the people for whom the service is intended. In addition it is required that the size of all rooms in the home is Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: contained in the Statement of Purpose. No new people have moved to the home for a number of years. At the last visit to the home in July 2008, it was found that a full needs assessment is carried out to decide whether or not the home is a suitable place for the person to live. The aim of the home as set out in the Statement of Purpose is, Providing a high quality professional Residential Care Service for Adults with Learning Disabilities and associated mental health, physical disability, Autism, Epilepsy, Sensory impairment and Behavioural Management Problems. Evidence was seen in staff training records that most staff have received formal training in these areas specialist areas. Care Homes for Adults (18-65 years) Page 12 of 32 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. People who live in the home benefit from having a plan of care that gives clear guidance to staff as to how to meet their assessed needs. The home is working towards everyone having a care plan that is person centred. People are starting to benefit from being supported to take assessed risks as part of an independent lifestyle and to make decisions in their lives wherever possible. Evidence: Each person who lives in the home should have an individual plan of care that clearly sets out their health, personal and social care needs, together with the staff support that is required to meet these assessed needs. Three peoples care plans were examined. They all contained a clear summary of the persons main needs. The care plans are person centred in that they focus on things that are important to each person from their point of view. For example, I like to be given choices and point at what I want. When I am angry I bite my hand. The plans use pictures to present important information about the persons life, including their likes and dislikes, and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: communication needs. Individual goals have been set for people and evidence was seen that people who live in the home are supported to work towards them. For example, one persons goal is to develop their independence skills. A picture of this person cooking and making tea as well as written evidence is kept. This is of great benefit to the person concerned as they can look at the pictures and see for themselves how they are achieving their goals. It was noted that one aspect of the health support for a person living in the home did not reflect current practice. The appointed manager stated that all care plans are in the process of being updated and that more work is being undertaken develop person centred plans. People who live in the home have needs such as challenging behaviours, epilepsy, sensory impairment or autism in addition to their learning disability. Evidence was seen in the three care plans that were looked at that written plans are in place to minimise the effect of any potential risks. For example, guidelines are in place to help staff to identify when a person is becoming agitated. Strategies have been developed to help to reduce the possibility of any anxious and aggressive behaviours escalating if they present themselves. The staff training matrix shows that staff have regular training in how to manage behaviours that challenge. It is important that people who live at the home are able to make decisions and choices in their daily lives. The appointed manager acknowledges that this is an area in which the home could develop further. She was able to give lots of evidence that the home is working hard towards putting this important principle into practice. People who live in the home are regularly consulted about their life in the home. This is done through regular house meetings. Where people are not able to communicate their needs verbally, their key worker represents them. A house meeting took place on the day of the inspection. The home assists some people with looking after their money. The records for one person were looked at. They were found to be well organised, showing that monies are spent in the best interests of the people who live in the home. Care Homes for Adults (18-65 years) Page 14 of 32 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 who use the service are given opportunities to take part in activities in the home and in the community. People who live in the home do not always have their privacy and dignity promoted. People enjoy mealtimes and receive a healthy and varied diet. Evidence: The three care plans that were looked at show that each person who lives in the home has an individual activity programme. This programme is made up of activities in the home such as using sensory equipment or listening to music; trips out into the community such as to a cafe, drives and horse riding. Some peoples activity programmes include independent living skills such as doing their laundry or cooking. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: On the day of the inspection some people went out for a drive and others went horse riding. One person played the organ and engaged in some art work. Another person was supported to sort out their clothes and two people watched some television. One person spent some time showing the inspector photographs of recent events that have been celebrated at the home. These included Christmas and an annual holiday. It was evident from this person that being supported to enjoy special days and activities is very important to the people that live at the home. To maintain contact with family and friends, people are supported in making home visits where this is appropriate. Families and friends visit people at Hill Farm and telephone contact is also maintained between them. Generally care staff were observed interacting with the people who live in the home in a positive way. However, there were two exceptions to this good practice. At lunchtime one persons healthcare needs were discussed during the meal, which was undignified for the person concerned. In the afternoon a discussion took place between care staff about who had or had not been supported to go to the toilet, within hearing of everyone else in the room. Whilst appreciating that it is important that care staff communicate peoples support needs with one another, the conversation could have been more discrete to maintain peoples privacy and dignity. These incidents were discussed with the appointed home manager who acknowledged that this was not the best way to address the people living in the home. The inspector joined some people for lunch. It was observed that people who need help to eat are supported discretely. People who can take on more responsibilities are encouraged to do so, such as pouring their own drinks. A rolling menu is in place, which the cook says has been planned with input from the people who live in the home. People are given two meal choices for the afternoon and evening meal. One person said, The food here is good. At the last inspection it was found that although bedroom doors are lockable, no one holds a key to their own room. It was recommended that evidence was recorded as to how this decision had been made and who was involved the decision process. The appointed manager said that this has not been done yet. Care Homes for Adults (18-65 years) Page 16 of 32 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. Peoples access to health care services is improving. People receive their medicines safely. Evidence: It is important that people are supported in their daily routine in the way or at the time that they prefer. The home is currently working towards ensuring that peoples individual preferences and choices in their daily routine are accurately recorded in their care plans. The three care plans that were looked at all contain a health action plan. These plans clearly identify the health needs of each person together with the staff or health professional support that is needed to monitor and promote the persons health. As mentioned previously, one aspect of the health support for a person living in the home had not been updated to reflect current practice. Evidence from care plans shows that people who live in the home receive health Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: support from a variety of health care professionals including, psychiatrist, the community learning disability nurse, district nurse, optician and dentist. One of these healthcare professionals was visiting a person who lives at the home on the day of the inspection. They said that the appointed manager has worked very hard to support this person and their changing needs. They also said that any advise given, has been put into practice for this persons benefit. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of people receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form the medicine has been given or, if it hasnt been given, the reason why. On examination of this record it was found that there were no gaps in recording medicine, evidencing that people receive their medication as prescribed by their GP. Evidence was seen that only people who have been formally trained in the safe administration of medication are responsible for giving out medicines in the home. However, not all care staff demonstrated that they are aware of their full responsibilities of ensuring a persons well being, if an error is made in the administration of medication. This was discussed with the appointed manager, who said that she was confident that all staff would take the correct action in practice. A formal assessment of staffs competency in the safe handling of medicines is not carried out, although the appointed manager does observe staff administering medicines. The appointed manager said that she would formalise this process and in doing so make sure that all staff know how to discharge their responsibilities fully if a medication error is made. At the last visit to the home, it was found that peoples care plans did not contain information on their cultural and spiritual wishes on death and dying. People who live in the home and their family have now been consulted about this sensitive but important aspect of care, and their wishes have been recorded. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have opportunities to voice their concerns or complaints. The home could support this further, by producing a complaints procedure in a format that people who live in the home can understand, and by displaying this in the home, so that everyone can see it. People who live in the home benefit from the management and staffs increasing understanding of how to protect them from potential abuse. Evidence: Neither the home nor the commission have received any complaints about the service, since the last inspection, 18 months ago. Details of how people can make a compliant about the service are contained in the complaints procedure and the Service User Guide. The complaints procedure is not displayed prominently in the home, so that anyone who visits the home is aware of it. The appointed manager said that she would put the complaints procedure up on the notice board. As identified at the last visit to the home, it is recommended that the complaints procedure is produced in a format that can be understood by the people who live in the home. The appointed manager says that complaints from people who live in the home are usually raised at the regular house meetings and a record is kept of this. The home is currently subject to a safeguarding vulnerable adults investigation. The Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: appointed home managers understanding of her responsibilities to people who live in the home has increased following this investigation. She is now aware that any potential abuse between people who live at the home should always be reported to the local authority to ensure their safety. Evidence was seen that the home has produced an action plan to address the shortfalls in the service that the local authority has identified. The staff training matrix shows that the majority of the staff team have received formal training in how to protect vulnerable adults. Staff who were spoken to during the inspection, stated that they felt confident to report any potential abuse taking place in the home to a more senior member of staff. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a safe, clean and comfortable environment that is well maintained. Evidence: People who live in the home have the use of two lounges and a dining room. All rooms were being used by individuals or groups of people on the day of the inspection. There is a secluded back garden and patio area, with tables, chairs and benches. Bedrooms for people who live in the home are situated on the ground and first floor. There is lift access between the two floors. Some bedrooms were entered and seen to contain peoples personal belongs and items of interest. A number of bedrooms have recently been decorated and looked bright and colourful. Radiators have been guarded to minimise the risk of scalding if people fall. Windows have been restricted to minimise the potential of people falling and injuring themselves. People are provided with call bells so that they can call for assistance when needed. When the bell was rung during the inspection, there was a quick response from a member of staff on duty. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: On the day of the inspection the home was found to be clean. There is a separate laundry room and some people who live in the home are supported to launder their own clothes. The staff training matrix evidences that most staff have received formal training in how to minimise the spread of infection in the home. Care Homes for Adults (18-65 years) Page 22 of 32 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. The people living in the home benefit from there being enough staff on duty to meet their needs. To make sure that the needs of people who live in the home are met in a satisfactory way, the home is working towards developing a rolling staff training programme. People are protected from potential harm by the homes recruitment practices. Evidence: The staff rota evidences that there four or five care workers on duty to respond to peoples needs for assistance from the morning until the evening. The high staffing levels reflect the need that some people require one dedicated member of the care staff to look after them. During the evening and the night time, there are two staff that stay awake to attend to the needs of the people living in the home. The care workers are supported in their work by a cook and cleaner. On the day of the inspection there were five members of care staff on duty. The two senior members of staff on duty are permanent members of the staff team. The third member of staff is based at another care home owned by the company. The other two Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: members of staff are agency staff. The appointed manager said that the three additional staff all regularly work in the home, and that they have a good understanding of peoples needs. This was confirmed by the senior care staff on duty. The staff training matrix evidences that all staff who work in the home are trained to National Vocational Qualification (NVQ) level 2 or above. This exceeds the National Minimum Standards. This award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. Before new members of staff are employed at the home a number of checks need to be carried out to make sure that all members of staff working at the home are suitable to care for vulnerable service users. Files were seen for three members of staff. All the relevant checks and documentation including Criminal Record Bureau enhanced disclosures, two references, contract of employment and application form were included showing that the recruitment process followed protects the service users. It is recommended that were agency workers are employed, a record of when they are first employed by the home is kept. The appointed manager is responsible for making sure that care staff have the skills they need to support the people who live in the home. The appointed manager said that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. In addition to the introductory training, care workers undertake a number of training courses that develop their skills in caring for the people that live in the home. The staff training matrix records the training that each member of staff has achieved. It is colour coded to identify the date that the training took place and to act as a prompt for when new or refresher training needs to be booked. There are some gaps in this record indicating that a few members of staff require training in keeping people safe, handling food safely, moving people safely and how to maintain good standards of hygiene. The administrator said that she is due to book more training to fill these training gaps, but this was not evidenced on the rota. It is recommended that a training plan is developed to ensure that all staff training needs are met. The supervision of care staff is important so that staff have the opportunity to discuss care practice, the philosophy of the home and their own development needs. The two staff files viewed showed these staff had recently received formal supervision. Evidence was seen that regular staff meetings are held, which give staff the opportunity to voice their views. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are starting to benefit from some of the actions being undertaken by the appointed manager. People who live in the home are not being put at the centre of everything that the home does. The home is working towards promoting the health, safety and welfare of the people who live there. Evidence: The manager who is registered with us to manage the home on a day to day basis has discharged his duties to the appointed manager for over a year and a half. When we last visited the home in July 2008 we were told that the appointed manager would be applying to us to be the registered home manager. To date we have not received an application and it is required that we receive such an application in the next three months. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The Statement of Purpose states that the appointed manager has many years experience in working in residential and nursing care. She has been responsible for the day to day running of Hill Farm for over eighteen months. She has completed one of the formal qualifications specified by the National Minimum Standards and is currently studying towards the other. These awards are recognised by the commission to be useful because they help to make sure that people who manage residential care services have the competencies that are necessary to do so. The appointed manager was observed communicating with the people who live in the home in a personal way. There was one exception to this where she did not set an example of good practice to her team members. This was discussed with the appointed manager who acknowledged her error in judgement. Staff, who were spoken to, said that they felt supported by her management style. One person said of the appointed manager, She listens. She is there for you. The appointed manager has a clear vision of how to develop the service for the benefit of the people who live in it and has she demonstrated that she is working towards providing more person centred care The Statement of Purpose identifies that one of the objectives of the home is that, Progress is measured through Auditing Surveys and Quality Assurance. The home has its own Quality Assurance Manager who is responsible for ensuring that the quality of care provided is to a high standard. However, the last time that people who live in the home and their representatives were surveyed about their views of the home was in July 2007. It is required that the views of all interested parties are sought immediately. Once the survey questionnaires are returned, action should be taken to address any areas of the service identified as needing improvement and a report must be written summarising what has been done. Evidence was seen that the home carries out its own system of internal audits, to make sure that the homes policies and procedures are adhered to. At the last visit to the home in July 2008 it was noted that although the registered providers of the company, Forward Care, visit the home regularly, monthly reports of these visits are not recorded. This is still not being done, despite the home being supported to obtain the relevant information at the last inspection. Regulation 26 of the Care Homes Regulations 2001 states, Visits shall take place at least once a month and shall be unannounced. The person carrying out the visit shall prepare a written report on the conduct of the care home. A requirement is being made that the registered providers discharge their responsibilities appropriately. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The deputy manager has told us that there are no people living at the home subject to a deprivation of liberty authorisation under the Mental Capacity Act 2005. The appointed manager made a declaration in AQAA (annual quality assurance assessment) that all items of equipment in use in the home remain in good working order. The records concerning the maintenance of fire equipment were looked at and evidence that regular checks are carried out to make sure that equipment is kept in good working order. The records of fire drills did not clearly evidence that all staff participate in regular fire drills so that they know what to do to make themselves and people who live in the home safe if there is a fire at the home. It is required that this shortfall is addressed. Due to the current ongoing safeguarding vulnerable adults alert, the home has increased the number of checks to help ensure the safety of people living in the home. As mentioned previously, the appointed manager has developed a staff training matrix which identifies the staff training needs of the whole team. She is aware that some staffs training is out of date but has yet to make plans to make sure that all staff are trained in the necessary areas of fire, health and safety, moving and handling, infection control, and safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 28 of 32 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 32 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 1 39 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided by the care home and send a copy of the next findings to the Commission. This will make sure that the views of people living in the home and their representatives are taken into consideration when providing the service. 13/04/2010 2 39 26 The registered person shall 28/02/2010 write a report of their monthly unannounced visits to the care home, which shall include interviewing service users and their representatives and staff, and an inspection of the premises. A copy of the next three such visits shall be sent to the Commission. Care Homes for Adults (18-65 years) Page 30 of 32 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 The registered person will then be able to judge if a satisfactory level of care is provided in the home. 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 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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