Care Home: Hillcrest

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What the care home does well There are many areas where this service is providing a good to excellent service. The service is able to provide and clearly demonstrate its ability to meet peoples divers and at times challenging needs. The service actively promotes personal development and increase skills of independent living to support and empower the person to make and take active changes in their lives. The service has a sound assessment and admissions procedure in place which is tailored to meet the needs of the individual rather than being service lead. The skills and the abilities of the staff working at the service are very specialist and during the inspection people were directly and indirectly observed to be working extremely well with the person as an individual and secondly with a person who has autism. Staff were very respectful and dignifying of all people. The service strives to ensure, encourage and empower people to gain and to have access to activities and educational and employment opportunities. The service employs a skills coordinator who supports all people to increase and gain experiences in, for example work based employment and or experience. Two people have a paper round and one person is supported to work at Tesco`s. The care plan is detailed and is completed with the person at the centre of the it. There are goals and objectives set for the people to work towards with their agreement. It was observed that these were agreed by the person and in the best interest of the person. During the inspection a number of people were observed to be engaging in a variety of activities and had just returned from bowling. Medication systems in general are good with the manager making internal audit checks with details retained. Environmentally the service is run to represent as the persons own. Each bedroom is individualised and reflects the diversity of the person. The service is located within easy reach of local community based activities and amenities. One person who uses the service asked "yes", when asked if they liked living at Hillcrest. The manager and the team ensure that the service is always run in the best interest of the people who use the service. Health and safety and risk management are given a high priority with records being well maintained. One staff member commented that the management of the service is pro active and open in their approach. What has improved since the last inspection? Medication practices have improved since the last inspection. The service is able to demonstrate its ability to recognise where areas of further development is required. Areas of improvement have been highlighted and evidenced during the inspection and in the Annual Quality Assurance Assessment (AQAA). What the care home could do better: The service has identified that it needs to further develop the Health Action Plan for thepeople who use the service. The Royal Pharmaceutical Guidelines for Care Homes would benefit from being available at the service. A number of areas were identified during the inspection with regrades to medication, however these were discussed in full with the deputy manager of the service and an agreement was determined for action to follow. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hillcrest Hillcrest Harrowden Road Wellingborough Northants NN8 5BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Hillcrest Harrowden Road Hillcrest Wellingborough Northants NN8 5BD 01933272281 01933272281 sue@tebmar.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tebmar Ltd Name of registered manager (if applicable) Mrs Susan Tebbutt Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: All service users accomodated within the home will have a condition that falls within the spectrum of Autism. Date of last inspection Brief description of the care home Hillcrest provides long term residential care for up to five young adults. This is a specialist service, providing 24hour care for younger people aged 22 to 33 years of age with Autism. The home is a five bedroom detached property situated on the outskirts of Wellingborough town centre, close to a local bus route. There is a separate large activity room for educational sessions and leisure activities and the home also provides a sensory room for relaxation. There is an attractive, well-maintained garden to the rear of the property, providing a secure outdoor recreation area. 5 Over 65 0 care home 5 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting two people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 5 of 31 We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff and the people who use the service. In addition to this information is gathered from relatives and or visitors to the service if available. The visit took place between 09:30am and 14:30pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the deputy manager. The fee range for the service ranges from five thousand seven hundred and forty seven pounds per calender month to nine thousand five hundred and forty one pounds per calender month. The fee does not include personal items and toiletries and any personal expenditure. What the care home does well: What has improved since the last inspection? What they could do better: The service has identified that it needs to further develop the Health Action Plan for the Care Homes for Adults (18-65 years) Page 7 of 31 people who use the service. The Royal Pharmaceutical Guidelines for Care Homes would benefit from being available at the service. A number of areas were identified during the inspection with regrades to medication, however these were discussed in full with the deputy manager of the service and an agreement was determined for action to follow. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre and post assessments are carried out for all people who use the service, ensuring that that their needs and any change in needs are identified and systems implemented to support the individual. Evidence: The service has a Statement of Purpose with complies with the criteria set out in schedule 1 of the National Minimum Standards. There is also a comprehensive Service Users Guide. This information is made available to existing and prospective individuals and their representatives. It was noted that this information was not on display in the service. This is due to the complex needs of the people who use the service, however this was readily available in the office as required. The service ensure that the Commission for Social Care Inspection reports are available in the home and are accessible. Due to the complexity of need of the people who use the service, these reports are kept in the office. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: There have been no recent admissions to the service, however individual plans of care evidenced that the service has robust admission procedures in place, including comprehensive assessments conducted by the service to ensure that they are able to meet the needs of prospective people. Assessments from funding authorities are also obtained and held on file. The assessment pro forma is detailed and does explore individuals diversity needs, including age, gender, disability and sexual orientation. Prospective individuals would have the opportunity to visit the service on a number of occasions before deciding whether they would like to live there. Each person has an individual service agreement in place which specifies the terms and conditions of their stay. It was noted that where an individual was unable to sign or unable to have the capacity to know what he or she was signing that action would be taken to ensure that a relative or significant had signed. New individuals are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This is clear, jargon free, easy to understand and gives a very clear understanding of what individuals can expect. A number of people who use the service appeared very relaxed and comfortable within the service. One person who uses the service was able to respond yes when asked if they liked their home. Due to the limited communication abilities and the need for any individual to build a relationship with the person before fully engaging with them, it was at times challenging to gain direct information. Due to this other methods of gathering information was used to ensure that the service was able to support people and encourage positive outcomes for the people who use the service. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that their care plan details sufficient information in order for staff to appropriately support them. Evidence: The key principle of the home is that people using the service are in control of their lives and they direct the service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. The care plan is developed with, and owned by the person using the service. It is based on a full and up to date holistic assessment. It includes reference to equality and diversity and clearly addresses further diversity issues such as race, gender, religion, belief and age. The AQAA states that All of the service users have an individual person centred plan that identifies their individual needs and how those needs are met. Care objectives are Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: written up covering all aspects of the persons daily life for the support staff to follow. The care objectives are reviewed and amended on a monthly basis by the key worker and manager. Regular care team meetings ensure consistency and continuity of approach, which is essential when working with autism. The plan is person centred and focuses on the individuals strengths and personal preferences. The manager of the service devises a learning and development plan which supports and builds on the skills of the individual. Each of the care plans are separated and recorded as individuals areas of need. The focus of the care plan is to identify the need, areas of how to support the individual to improve the area of need and how to increase independent living skills within the specific area of need. Plans are all different individualised and they include evidence that the service values improving outcomes for people using the service. It was noted that the person centred plan did not mention that the individual had autism. Whilst the care plan focuses of the individual rather than the diagnosis and or issue it would be helpful to obtain a holistic picture of the person in order to fully understand their needs. The service clearly knows and records the preferred communication style of all individuals, and uses new and innovative methods that enable the person to fully participate. This includes communication charts, information about communication styles, communication passports, intensive interaction, objects of reference, photographs, visual timetables, drawing and signing or symbols. The care plan can be easily used by people who are not familiar with the individual to deliver a personalised and consistent person centred service. Plans should be reviewed regularly, and as the individuals needs change. The AQAA states that Every service user has an individual schedule in a format appropriate to their understanding, this could be pictorial, written words, just a single word etc. The schedule communicates the individuals daily activities, choices and decisions to be made for that day, this is using the TEACCH form of communication. All of the service users have in-depth risk assessments completed to ensure their safety and welfare is paramount. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a pro active approach to supporting people to take life experiences. The service works creatively and actively with other services and organisations to ensure that the persons whole life needs are met, and goals addressed. The service recognises its own limitations and when to seek support from others to meet the individual needs of people. The home acts upon the results of consultation with residents and their representatives. The home makes sure that good practice is modelled and developed Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: throughout. During the inspection a number of people were directly and indirectly observed. The people appeared relaxed and calm in their own environment. One person using the service was directly seen using her communication aid with staff. One person using the service did interact with the inspector and said hello on a number of occasions. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they are fully supported, empowered and enabled to maintain and develop appropriate and fulfilling lifestyles in and outside the service. Evidence: The service has a strong commitment to enabling individuals to develop or maintain their skills, including social, emotional, communication, and independent living skills. It was directly observed during the inspection that people are supported and encouraged to develop and maintain daily living skills. Individuals are supported to identify their goals, and work to achieve them. People who use the service have the opportunity to develop and maintain important personal and family relationships. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices.The AQAA states that regular contact is maintained by all service users with their families with a combination of telephone, visits, stays, letters, communication books and holidays. We have our annual BBQ every year in which all parents and or advocates, service users and staff are invited to gather socially and catch up with everyone. The staff team support with communication skills, both within the service and in the community, to enable individuals to fully participate in daily living activities. People are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. It was noted that a number of people who use the service are accessing employment opportunities and work based experience with the support from staff. Two people have a dedicated paper round. The preparation for the paper round is completed by four individuals who use the service. One person has a permanent placements at Tescos, however a further two individuals are welcome at the store on alternative weeks. Individuals can access and enjoy the opportunities available in their local community, such as using public transport, library services, the local pub, and local leisure facilities, bowling and eating out. The service has recently purchased a Wi Nintendo, a large trampoline and gazebo area to the garden. The staff also confirmed that people can have access to the internet. The service employs a vocational co-ordinator who works specifically with individuals on educational, training and employments opportunities. This is in line with the service ethos and approach to working within a TEACCH system. The service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community. They take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. The AQAA states that the service has introduced monthly themed foods of the worlds evenings on the menus to try and introduce our service users to the diversity of others cultures. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: During the inspection a number of people that use the service returned from a trip out. The individuals looked calm and appeared to have enjoyed their trip out into the community. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that their health care needs will be well managed. Evidence: People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are recorded in each person centred plan. It was noted that the service is in the process of introducing a personal health care action plan. This would further expand on the information and detail provided in the care plan regarding the persons health care needs. Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff were directly seen to offer respect, privacy and dignity and are sensitive to changing needs. Personal preferences are noted i the individuals care plan. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: People are supported and helped to be independent and can take responsibility for their personal care needs. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. They work with individuals regarding any refusal to take medication. The service has a satisfactory record of compliance with the receipt, administration, safekeeping, and disposal of drugs. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. Care plans are person centred and contain clear information about the individuals wishes, choices and decisions as their health deteriorates. In general medication systems were well managed and the manager completes internal audits to ensure that systems are being followed as per the services policy and procedure. During the inspection several issues were identity and discussed full with the deputy manager. A number of medications were observed to not have the date opening added to the bottle or the box. In addition to this room temperatures were not being recorded where medication was being stored and a number of medications were not being administered as per the prescriber instructions. It was noted that these changes were due to the person not requiring this medication on a regular basis. This was discussed in full with the deputy manager of the service and immediate corrective action was taken and agreed to be continued in the future. On this occasion requirements were not made as the deputy manager agreed to comply. The AQAA determines that improvements have been made by the service within the last twelve months and states that Devised a quality assurance system around the medication system and or stock control, which also gives the individual feedback. Evidenced all changes made to individuals personal plans. Staff understand and are sensitive to the particular religious or cultural needs of the individual or their family. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service operates a robust complaints policy and procedure ensuring that the people using the service can be assured that their concerns and complaints will be well managed. Evidence: The service has an open culture that allows people to express their views and concerns in a safe and understanding environment. Staff were directly observed supporting people in an empathetic manner and were able to support people and understand if something was concerning them. The internal quality assurance system and feedback from the people who use the service and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand. It can be made available on request in a number of formats including other languages, large print, audio etc to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The service keeps a full record of complaints and this includes details of the Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: investigation and any actions taken. The AQAA states that We use observations of each service user, reading their body language, looking for signs of being unhappy or any unusual behaviour of which people with autism would display if upset or unsure of the situation. Complete incident forms for every incident that has taken place. Encourage staff, parents and or advocates and other professionals to give us feedback through our anonymous suggestion box in the porch. The service understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. The AQAA tells us that have been no referrals to safeguarding and no complaints have been made in the last twelve months. Incidents are well recorded in all instances. Training of staff in safeguarding is regularly arranged by the service. The AQAA states that Devised a chart that shows how many incidents per month per service user and the pattern or reason for that behaviour occurring. Devised a feedback form for service users to complete with help about the service they have received. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a service which is comfortable, well maintained and safe. Procedures followed by staff ensure that safe practices are maintained and meets peoples needs. Evidence: The provider and manager have ensured that the physical environment of the service provides for the individual requirements of the people who live there. The living environment is appropriate for the particular lifestyle and needs of the individuals and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. The environment reflects the differing needs of the people using the service and reflects their individual cultural, gender, religion and or belief needs and choices. People are encouraged to see the home as their own. It is a very well maintained, attractive service and has very good access to community facilities and services. The management has a proactive infection control policy and they work closely with their own staff and external specialists, to ensure that infections are minimised. People who use the service are fully involved in decisions about the decoration and any Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: changes in their communal and personal accommodation. Individuals have personalised their rooms and can use their own furniture if they wish. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people in domestic tasks and as part of developing or maintaining independence. The AQAA states that We provide a comfortable, clean and safe homely environment equipped specifically for adults with autism. All bedrooms have en-suites and are individually decorated in the persons preferred colours and or textiles. We have a large enclosed garden that is well maintained. We have a sensory room that we use for relaxation and massage as well as having time for themselves. The kitchen is spacious and well equipped to promote the independence when undertaking cooking, and has separate hand washing facilities. The lounge/diner is used for mealtimes and social gatherings. Our laundry room has good washing facilities. All bedrooms promote high levels of privacy and have locks or other innovative ways of promoting privacy. People who use the service are in the process of developing the skills to use keys dependant upon their ability. The service is always very well lit, clean and tidy and smells fresh. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by staff who are very well trained and competent to meet their needs. The procedures for recruiting staff are thorough and ensures that the people who use the service are protected from harm. Evidence: People who use the service appear to have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the service is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Staff members undertake external qualifications. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for individuals and is not led by staff requirements. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: way. There is a structured training plan in place and the forth coming training includes Health and Safety, fire safety, risk assessment and risk management, food hygiene, autism awareness, first aid, depression and anxiety and abuse. The AQAA states that We provide in-house training for all staff to attend, some topics included are, Autism and TEACCH awareness, fire safety, food hygiene awareness, safeguarding adults, valuing people, health and safety awareness, person centred planning, common induction standards, confidentiality, teamwork, care objectives, and mental capacity act. All the training sessions are specifically written to meet the staff teams needs. We buy in other training such a first aid, medication and team-teach (physical intervention). The majority of staff hold an NVQ qualification and have a good selection of skills and abilities. All staff receive regular supervision and appraisal sessions. We have a low staff turn over, with an open door approach for staff to seek advice and guidance whenever they need or want it. The staff are knowledgeable about the specific needs of each service user we have and follow their individual person centred plan. All staff have a statement of terms and conditions and are CRB checked. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff recruited confirm that the home was clear about what was involved at all stages and was robust in following its procedure. A random selection of staff files occurred and were complaint with the National Minimum Standards. One staff member commented that the team is well managed, supported, caring and are genuinely interested in supporting the people who live here. A further staff member commented that I cant fault the manager, she is very open. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hillcrest can feel confident that they are living within a service that is very well managed. Health and safety and management systems are in place that ensure people are protected at all times. Evidence: The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. The manager is able to describe a clear vision of the service based on the organisations values and corporate priorities. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity, human rights and person centred thinking are given priority by the manager who is able to demonstrate a high level of understanding and demonstrate best practice in these areas. The AQAA received from the service also Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: determines that they are planning to make improvements in the provision of person centred planning and training. The ethos and leadership style of the service supports and enables people to express their diversity needs including their race, gender, sexuality and age. The manager is able to demonstrate through robust operational systems and professional experience that they are knowledgeable and highly competent in a range of areas. The manager ensures that staff follow the policies and procedures of the service. Practice and performance are discussed during supervision, staff training and team meetings. One member of staff commented and confirmed that these areas are explored in these one to one and group sessions. There is strong evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. The AQAA contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to the people who use the service. The service demonstrates a high level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. The service has efficient systems to ensure effective safeguarding and management of residents money and valuables, including record keeping. People are supported to manage their own money where possible. Those who do not currently have the skills are encouraged and supported to develop to become as independent as possible. They have access to their records whenever they wish. Record keeping is of a consistently high standard. Records are kept securely and staff are aware of the requirements of the Data Protection Act. The home has a comprehensive range of policies and procedures to promote and protect residents and employees health and safety. There is full and clearly written recording of all safety checks and accidents. The manager, senior team, and staff at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. These principles are taken into account in all aspects of the running of the service. The manager ensures that all staff are trained in health and safety matters. Individual training records reflect this and regular updates are planned ahead. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: The AQAA states that Registered manager has the RMA/NVQ 4 in care qualifications, along with significant experience of autism spectrum disorders and managing the home. All certificates and licences are displayed. Annual development plan for staff. Seeking feedback from parents and or carers on the service provided to their son/daughter. Anonymous suggestion box for anyone to give feedback and or comments on the service provided. Ongoing monitoring and reviewing our policies, practices and procedures. A further staff member commented that the management and staff team are very supportive and we are all here for the good of the residents. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The service should ensure that that reference to the persons full needs are held within the care plan in order for staff to full understand the holistic needs of the individual. Health care plan should be introduced to the service, further expanding on the current level of information available. The service would benefit from having the The Royal Pharmaceutical Guidelines for Care Homes available. Homely remedies used within the service should be administered in agreement with the allocated General Practitioner. 2 19 3 4 20 20 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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