Care Home: Hill View Care Home

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What the care home does well The home is clean and comfortable and well-maintained. It provides a one to one service over a twenty-four hour period to the supported person. The planned structure of its operation supports a lifestyle that the supported person is comfortable and happy with. This individual said, " Staff treat me well, food is good, they talk to me well, the home is good. I love it." We have been informed by professionals who have known this person for many years of the substantial improvement in this person`s overall well being since living at Hill View Care Home. The supported person`s wishes and interests are considered in the planning of daily routines that ensure predictability and stability, meeting individual needs and enabling social inclusion in the community. There is a written timetable for each activity to assist the supported person in maintaining independence. This individual is very established within the local community. The supported person is involved in the day to day running of the home and has a choice of meals. The home ensures dietary needs are met and healthy eating menus are promoted. Personal and healthcare support is planned using a person centred approach. The support is based upon the rights of dignity, equality, fairness, autonomy and respect. The home`s management works collaboratively with multi-agency specialist services involved in the care and support of the individual, ensuring the person`s wellbeing and safety. Positive comments were received from senior healthcare professionals about the home. These included, " Very caring and thoughtful staff, learning when to stand back and when to intervene". Also, " The home has an excellent person centred approach to managing people with the most complex interplay of learning disability, mental health, physical health and developmental disorders. Excellent communication and commitment shown". What has improved since the last inspection? Risk assessments are in place for ensuring safe storage of medication specific to selfmedicating practice and storage of medication keys. There is an ongoing upgrading and redecoration programme which this year includes plans to redecorate all interior doors. The statement of purpose document now includes details of the staff training programme. The home has secured specialist training in autistic-spectrum disorders which individual staff and the manager have attended. Other specialist training is being sourced for the team. Changes have been made to the home`s records to make these more accessible to the supported person. What the care home could do better: It was agreed that the missing persons procedure will be further developed. An area for improvement to the staff recruitment practice and record keeping was discussed and we are confident this can be managed by the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Hill View Care Home 5 Essex Close Frimley Camberley Surrey GU16 9FH     The quality rating for this care home is:   three star excellent 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: Patricia Collins     Date: 0 1 0 6 2 0 0 9 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 29 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 29 Information about the care home Name of care home: Address: Hill View Care Home 5 Essex Close Frimley Camberley Surrey GU16 9FH 01252838199 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hillviewkher@aol.com Kher Khulpateea care home 1 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users ot be accommodated is 1 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 (LD) Date of last inspection Brief description of the care home Hill View Care Home is a small family operated care home providing personal care for one adult using its services. The home is some distance from the local shops and transport is provided. Ample care parking space is available at the front of the building and access to the front garden is by a steep flight of steps or use of a ramp. The property is a modern mid terrace two storey house set in a residential development. The accommodation is domestic in scale and character and comfortably furnished. There is one single bedroom on the first floor and an office/staff sleep-in room, bathroom, shower and toilet facilities. Ground floor accommodation comprises of a lounge and combined kitchen/dining room. The rear garden is small but nicely laid out on levels rising upwards, the furnished patio area on the lower level has a BBQ. Care Homes for Adults (18-65 years) Page 4 of 29 1 Over 65 0 Brief description of the care home Weekly fee charges are 2,464 pounds twenty four pence. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent 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: Date of last Key Inspection: 5th June 2007. The inspection visit was announced at short notice to ensure the availability of the person using the homes services. The visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was carried out by one inspector over six hours. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). key inspections are a major evaluation of the quality of a service and any risks it might present. We always focus on outcomes for people using services. All key national minimum standards (NMS) are reported on as evidence of outcomes. In carrying out this inspection all available information has been taken into account when making judgements about how well the home is meeting the NMS for adults. This includes accumulated evidence and our knowledge and experience of the home since its last key Care Homes for Adults (18-65 years) Page 6 of 29 inspection. We have also considered information in survey questionnaires received from the person using this service, two staff members and three healthcare professionals. Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. It provides quantitative information about their service, requiring assessment of the service against the National Minimum Standards (NMS) outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and its content was clear, of good quality and validated by evidence. This information was also used to inform judgements about services. The inspection process incorporated discussions with the person using the homes service and the owner/manager who is hereafter referred to in the report as the manager. We also briefly spoke with the deputy manager who is joint owner of the home and with a support worker. Indirect practice observations were made to assess the quality of service provision. We also sampled records and looked round the home and the garden. Care Homes for Adults (18-65 years) Page 7 of 29 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 Care Homes for Adults (18-65 years) Page 8 of 29 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people using this service and their representatives have the information needed to choose a home that will meet their needs.They can be confident their needs can be met because individual aspirations and needs are comprehensively assessed before admission. Evidence: The homes Statement of Purpose and Service User Guide were under review at the time of the visit. Since the last inspection information had been inserted in the Statement of Purpose regarding the staff training programme. The homes stated purpose is clearly set out. This is to provide a personalised community care service for one person, with an emphasis on maintaining and developing independent life skills. Service provision is tailored to meet the needs of the individual supported. This provides 24 hour support, communication structure and behavioural support to understand the environment and other people. The service aims to realise the supported persons full potential using a person centred approach to 24 hour programme planning, facilitated by a skilled, professional staff team. The programme combines structured personal support and social and leisure opportunities that Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: promote community inclusion and create a process of empowerment. The provider is aware of the need to ensure all statutory information is included in the Statement of Purpose. The service User Guide is written in a format that the supported person can understand. It includes an easy read complaint procedures and information about fee charges and additional charges. It also sets out arrangements for meeting the supported persons diverse needs. The person using this service received a personal copy of this document and prefers to keep this in the office. The records viewed and information obtained through discussions with the supported person and the manager confirmed significant time and effort was spent on planning the admission of the supported person. This person and their family were treated as individuals throughout this process. Also with dignity and respect for the life-changing decisions they needed to make. Comprehensive multi-disciplinary needs assessments were obtained prior to admission from various professionals. The manager also undertook his own assessment. The pre-admission process ensured the needs of the supported person could be met before agreement to the placement. The home works creatively and pro actively with a range of professionals to ensure the supported persons whole life needs are met. There is management recognition of the teams limitations and the manager knows when to consult professionals. We were told by the person using services, I like living here, I do what I like. My relatives came to see the home for me before I moved in. They were worried that if I came before everyone decided the place was right for me I would be upset if I wasnt allowed to move in. I was happy when I saw my new home and on the day I moved in. I like living here very much and I like all the staff. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The supported person is involved in decisions affecting their life, in the process of care and support planning and in the day to day running of the home. Care and support plans and risk assessments support an informed approach to risk-taking as part of an independent lifestyle. Evidence: We sampled a range of care documents as part of our case-tracking activity. This gave us some insight into the experiences of the person receiving services. We were also able to judge from this information whether the home is delivering the service it aims to provide, as detailed in its Statement of Purpose and its policies and procedures. We focused on how the supported person is empowered to be in control of their life and lead a purposeful and fulfilling life, as independently as possible. The supported person is encouraged to take an active role in the running of her home. Discussions with this person also with management and a support worker and all other available information in records and from our surveys indicate the service values the rights of the supported person. Arrangements are in place to encourage the supported person Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: to express their wishes and points of view through regular weekly meeting with staff and one to one psychological support. Examples of changes made in response to the wishes of the individual include increased access to services to meet the persons intellectual aspirations and needs. Visits to and from family members are facilitated and an annual holiday is organised which the supported person is involved in choosing and planning. This year the supported person is going on holiday to France with the manager and deputy manager and one support worker. Photographs were displayed in the home of other holidays the supported person has enjoyed since admission to the home in 2003. A person centred approach to care planning was evident. This is underpinned by robust risk assessments and multi-agency risk management decision-making. The plans represent the supported persons lifestyle, history, significant people in this persons life, communication style including choices of specific words, individual preferences, likes and dislikes,achievements, aspirations and hobbies.They are based on a full and up to date holistic assessments incorporating and addressing the six strands of diversity. In this respect the gender of support workers is all female. The homes management promotes disability equality and ensures the supported person is encouraged to engage in age appropriate activities. This person attends church and the home celebrates some religious festivals, respecting the supported persons Christian values. The use of social stories allows the service to respond very quickly and effectively to environmental stressors and supports this persons ability to solve problems in every day life. Records show there are agreed working practices that staff are aware of, to support and ensure the safety of the person using services. The home collaboratively works with a range of professionals. Coping strategies have been developed to assist the supported person in dealing with environmental stressors,with an emphasis on a low stimulus approach.A guidance document is used outlining the supported persons communication and behaviours that challenge services and setting out how staff should respond. The feedback received from other professionals was overall very positive. The need for a more consistent approach by staff however was highlighted by one professional. The homes management is aware of this and work is in progress for a response phrase book to be produced to uniform verbal interaction and response of all staff, to further reduce anxiety triggers. Areas of discussion with the manager included comment on the missing persons procedure and prevention plans. It was evident from care records, risk assessments and discussions with the manager that safeguards are in place to minimise risk of this type of incident. The robust planned action in response to this eventuality needs to be Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: recorded in the missing persons procedure. Care Homes for Adults (18-65 years) Page 15 of 29 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. The supported person is offered a healthy diet, participates in age, peer and culturally appropriate activities and is part of the local community. The supported person is encouraged to be involved in the running of the home and individual rights and responsibilities are recognised. The supported person is assisted in maintaining personal and family relationships. Evidence: Through discussions with the supported person it was evident that the individual was comfortable and happy with their lifestyle, despite the firm structures in place. Individual wishes and interests are considered in the planning of daily routines that ensure predictability and stability. The supported person has a written timetable setting out times for each activity to assists the person in maintaining independence. This individual is very established within the local community and attends church, fetes and other community events at the local community centre. The supported Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: person uses local leisure facilities and sometimes uses public transport to access a work placement, adult education services and other neighbouring towns. The timetable is reviewed quarterly and tends to be seasonally adapted in accordance with the persons preferences. An activity that the supported person enjoys is membership of a well being group through which there is opportunity to use gym equipment. The supported person also enjoys keep fit/dancing classes. Contact with family members is supported and facilitated by the home. The family members take an active interest and are involved in the supported persons care. The supported person also has four to five stays with family members over the course of the year. The supported person regularly writes to them, occasionally inviting them for a meal or friends for tea. The supported person has free access to all areas of the home and has an agreed daily time quota for making telephone calls to family and friends. The supported person spoke about their involvement in the running of the home and other activities enjoyed. These include some domestic tasks, for example helping with food preparation, setting and clearing the table for meals, shopping for food and doing personal laundry. The supported person has enjoyed doing voluntary work in a charity shop one day a week for the past six years. Also has opportunity to develop and maintain life skill at day services and adult education college. Course attended include cookery, pottery and coping with emergencies. The supported person relaxes by watching television, enjoying in particular favourite soap programmes and listening to music, particularly their favourite 70s and 80s record collection. The supported person is involved in purchasing food provisions and has a choice of food. At the time of the inspection the menu was being planned by the person using picture card tools. The home ensures dietary needs are met and healthy eating menus are promoted. The picture card tools also aid understanding of a balanced diet. The homes fridge was well stocked with fresh fruits and vegetables and dairy produce. The supported person is encouraged by staff to take interest in growing lettuce planted in the back garden and the homes recycling project. The supported person receives assistance in financial budgeting and has a weekly allowance, choosing what this is spent on. Care Homes for Adults (18-65 years) Page 17 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that the person using services receives is based on individual needs assessments and medication practices are safe. Care and support practices are based on the principles of respect, dignity and privacy. Evidence: The supported person receives effective personal and healthcare support using a person centred approach. The support received respects rights of dignity, equality, fairness, and autonomy. This was evidenced from feedback from the supported person and by the detailed support records. These were well written, providing a clear audit trail of arrangements for meeting the complex holistic needs of the individual. A care programme approach multi-agency care plan and crisis management plan has been agreed and is reviewed six monthly. Care managers visit on a regular basis to review and monitor the placement. Several specialist services provide support from the local Learning Disabilities Team. Regular reviews by this team ensure prompt referral to relevant services when new needs are identified, for example for anxiety management. Currently the supported person is receiving an NHS aromatherapy/anxiety management service at home each week. Discussions with the manager confirmed specialist support is always accessible and is much valued. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: The supported person has grown in confidence when in accessing health care services. The manager attributed this partly to the person being able to retain the same general practitioner despite changes in home address and catchment area, though this is about to change. Effort has been made to increase the supported persons awareness of the role played by different services which had reduced anxiety when in contact with health care professionals. The supported person is encourage to manage their own healthcare as much as possible. Observations confirmed clear guidelines and risk assessments in place specific to behaviour management. The supported person has monthly one to one psychology support. Coping strategies for reducing stressors are regularly evaluated. Discussions with the supported person confirmed the individual writes about the days experiences and both positive and negative thoughts. This individual finds it helpful to discuss what is written with the manager as an aid to understanding their environment. Feedback from professionals was overall positive about the homes management of the needs of this individual. Staff are trained and competent in healthcare matters and a programme of medication training is in place. There is an efficient medication policy, procedure and practice guide. Staff have access to this written information and understand their role and responsibilities. The home has a sustained record of full compliance with the administration, safekeeping and disposal of medication. The medication cupboard is located in a safe place and a monitored dosage system is used. Visual medication prompt cards are used which provides a visual cue to identify each prescribed tablet and provide information about what each prescribed medicine is for. A risk assessment is in place for storage of the medication key. The supported person has, for the past two years, successfully managed their lunch time medication. A read and see booklet with symbols of their prescribed medication has been developed to support the persons understanding of their medication. A risk assessment has been carried out for the self-administration of lunch time tablets through secondary dispensing practice and other self-administration practice relating to creams and ointment. Care Homes for Adults (18-65 years) Page 19 of 29 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. The person using this service is enabled to express any concerns through staff and is overall protected by policies and procedures. Evidence: We have not received any complaints about this service since the last key inspection. The complaint procedure is in the service users guide also an easy ready format using symbols to enable accessibility for people with communication difficulties. The procedure makes clear the home has an open culture in dealing with and responding to complaints. The supported person was issued with a copy of the complaint procedure which is kept in the office by choice. The homes records show there have been no complaints received by the home since the last inspection. Time is set aside each day for the supported person to talk to staff about any concerns. Areas of discussion with the manager included the need to record any low level concerns expressed by the supported person, that might arise and the action taken. This will demonstrate the home listens to and takes seriously all concerns and complaints. Survey feedback from the supported person confirmed awareness of who to inform if unhappy about anything. Discussions with this individual confirmed they are able to self-advocate and would talk to the manager, staff, family and friends. Staff who responded to our survey confirmed they were clear of the homes complaint procedure. There have not been any safeguarding issues referred under the local safeguarding Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: adults procedures since the last inspection. The manager said he had received safeguarding training and records sampled show a programme of safeguarding training in progress. Some staff who also work for other health and social care agencies have received this training though their primary employers. Recognising and responding to abuse and neglect is also covered in the staff induction. The need for staff to demonstrate they have read and had access to the homes safeguarding policy and procedure was discussed and the whistle blowing procedure. It was agreed that amendments necessary to both procedures would be implemented. Also that a copy of the latest local multi-agency safeguarding procedures would be obtained for staff reference. The manager and staff are aware of the new legal framework relating to deprivation of liberty. It was positive to note the manager and some staff had undertaken mental capacity act awareness training.The need for management to be aware of the new vetting and barring scheme was also discussed. Care Homes for Adults (18-65 years) Page 21 of 29 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. That the physical environment can meet the changing needs of the person using this service along with her cultural and specialist needs Evidence: The home is domestic in scale and character and personalised to reflect the interests and wishes of the person receiving services. The supported person has full access to all areas and is in control of how their room is arranged. The home is comfortably furnished and decorated to a good standard. The emphasise is on achieving the right balance in the environment between low stimulus and homeliness. The kitchen had been upgraded with kitchen units and new appliances at the time of the last inspection. The manager told us that new work surfaces had been fitted in this area since then. There is an ongoing redecoration programme which includes plans to redecorate all doors and redecorate the kitchen/dining room and hall. The home was clean and hygienic throughout. Systems are in place to control the spread of infection. The front and back garden was well maintained and there is a furnished patio area at the rear of the home. A programme of routine maintenance is in place and service contracts were up to date. Care Homes for Adults (18-65 years) Page 22 of 29 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 person using this service is overall supported and protected by the homes recruitment policy and practice. Staff are trained and skilled and in sufficient numbers. Evidence: The home has a small team of support workers employed on a part time basis. We were told by the manager he is an equal opportunities employer. The staff files sampled overall demonstrated robust recruitment procedures including face to face interviews. Some shortfalls in practice were discussed and it was agreed these would be rectified. Specifically the home must ensure a full employment history is obtained for all prospective employees and any gaps in employment are probed and satisfactorily explained. Records keeping practice should extend to maintaining records of interviews and of equal opportunities monitoring. The manager was advised to ensure the recording, storage,retention and disposal of Criminal Record Bureau (CRB) disclosures for staff is in accordance with CRB policy. Records must be retained to evidence checks carried out against the national list of people unsuitable to work with vulnerable adults (POVA List) before staff take up post. Staff cover is provided throughout the 24 hour day, seven days a week. There is always a manager or qualified nurse accessible either on the premises or on call. Staffing levels are determined by the needs of the individual and one staff member Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: sleeps in at night. The need to maintain a duty rota with details of the hours worked by staff was discussed and agreed with the manager. Staff have clearly defined job descriptions and understand their role and responsibilities. The support workers continue to be employed by other health and social care providers in addition to working at Hill View care home.The home has benefited from the strategy of recruiting staff with prior relevant qualifications, training and experience. This has ensured a skilled and competent staff team able to meet the complex needs of the person using its services. The staff group are highly motivated to their continuing professional development. All had received induction training within the first six weeks of taking up post at the home. An ongoing training programme was evidenced providing staff with statutory and service specific training and opportunity to attain national vocational qualifications relevant to their roles. The manager and some staff have undertaken service specific training in autistic spectrum disorders and further training is planned. The person using this was positive in the feedback about staff, stating, Staff treat me well, good food, they talk to me well, the home is good. I love it. Survey feedback from staff confirmed they receive up to date information about the needs of the person supported and their induction had covered all they needed to know. They said they received training relevant to their role which keeps them up to date with new ways of working and feel well supported by management. A staff member commented, The home provides a happy, relaxed environment and the needs of the person supported are always at the forefront of the running of the home. All staff are supportive and professional in their approach to the person supported and each other. It is a pleasure to work at Hill View. Care Homes for Adults (18-65 years) Page 24 of 29 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. The home is competently and safely managed. Quality assurance systems should be further developed to ensure the views of the supported person underpin selfmonitoring reviews. Evidence: The home owners are the designated manager and deputy manager and were both present at the time of the inspection. The manager works full time and the deputy manager stated she worked a minimum of one full day a week at the home. The manager is a qualified mental health nurse and has a degree in business economics. He has extensive experience in working with people with dual diagnosis of mental health disorders and learning disabilities and has relevant management experience. The manager was encouraged to consult with an NVQ assessment centre to confirm the business management qualification attained is equivalent to the NVQ Level 4 in management and care. The manager has not obtained the Registered Managers Award qualification and it was suggested he explore using his prior qualifications and experience to attain the Leadership and Management Award qualification in the future. The deputy manager is also a qualified mental health nurse. Her career includes Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: experience as an occupational therapy assistant and employment as a community psychiatric nurse. The deputy manager also has extensive experience in the care and support of people with a dual diagnosis. The manager and deputy manager have defined roles and responsibilities. The manager has overall responsibility for ensuring the home meets its aims and objects and for compliance with all relevant legislation. He is responsible for its financial management as well as general management and administration. He ensures staff are trained and competent to deliver the care plans.The deputy managers key responsibilities are directing and overseeing the support of the person using services ensuring individual needs are met and the running of the home. The homes atmosphere was warm and friendly and the pace of its management and operation organised to meet the needs of the supported person. It was evident from observations and all available information that the home is efficiently and effectively managed, ensuring the safety and well being of the supported person. Quality assurance (QA) systems include audits carried out against the national minimum standards. The quality assurance assessment (AQAA) we require the manager to complete and sends to us annually is also used as a quality tool. It was agreed that the homes QA process will be more inclusive of the views of the person using services and other stake holders through use of survey questionnaires. Also agreed that an action plan would be drawn up of any proposed changes and developments. Since the last inspection changes had been made to records to make these more accessible to the person supported. The home has a policy on safe working practice supported by robust risk assessments, service maintenance inspections and regular health and fire safety audits, ensuring the safety of the supported person and staff. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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