Care Home: Hillview Farm

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What the care home does well The home looks at people carefully, before they are asked if they would like to live there, to make sure that it can help them in the best way. People who live in the home have very good written plans for how the staff will help them to live as they want to. People have a lot to do with this and staff make sure that they agree with what is written down. The home makes sure that it helps people to make as many decisions as they are able. It helps them to do as much for themselves as they can, as safely as possible. The people who live in the home are given lots of opportunities to do things that they like to do, during the day and in the evenings, so that they do not get bored or fed up and can enjoy their lives as much as possible. The staff help people to look after themselves properly and in the way that people like to be helped. People are helped to look after their health so that they can be as fit as possible to enjoy themselves. People are helped to behave in a way that does not upset themselves or other people, so that they feel better about themselves and can enjoy their lives more. The home make sure that people know how to complain, if they are not happy, so that things can be put right and people can be made to feel more comfortable. The house is very well looked after, it is clean and tidy and looks very nice. There is plenty of room and it is a nice place to live. The staff are nice and the people who live in the home are happy to talk to them and let them help them with everything they need help with. Staff are taught things so that they are able to help people in the best way they can. The staff are good at talking to people and make sure that pictures and things are used to help people understand anything that is written down. The manager is very good, people can talk to her and she runs the home in the best way, for the people who live there. The home has good ways of looking at how it helps the people who live there, the residents are asked to say what it is like to live in the home, all the time and something is done if people are not as happy as they could be. What has improved since the last inspection? There was nothing that the home had to do better at the last inspection, although people who live in the home said they had even more things to do, which they enjoy. What the care home could do better: The home must make sure that they write down exactly what they have done if they have to help people to stop doing things that might be dangerous to themselves or others. They can then, look at what they did to make sure it was the best and least dangerous thing to do. The home should look at who would be the best person to visit the home every month, so that the owner knows what is going on there and he can make sure people are being treated well. Key inspection report Care homes for adults (18-65 years) Name: Address: Hillview Farm Ashmore Green Road Ashmore Green Thatcham Berkshire RG18 9ER     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: Kerry Kingston     Date: 0 9 1 1 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: Hillview Farm Ashmore Green Road Ashmore Green Thatcham Berkshire RG18 9ER 01635861496 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): HILLVIEW.FARM@tiscali.co.uk Mr Kevin Roy Tarbox Name of registered manager (if applicable) Mrs Helen Louise Parkin Hannah Sheather Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Hillview Farm provides accommodation and care for up to seven adults with learning disabilities. The home is situated in a semi-rural area between the town centres of Newbury and Thatcham. The accommodation that is provided is all within the same building and all of the bedrooms are single occupancy. Four bedrooms have en-suite facilities. The home also provides day services if service users wish to take up this option. Activities include horticulture, animal husbandry, woodwork, art and crafts. The home also has its own vehicle to assist service users with transport. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 7 Brief description of the care home The range of care needs within the home is diverse and complex. Several service users have needs, which can challenge the service. There are currently seven service users living at Hillview Farm. The fees are from £1250.00 to £2250.00 per week, depending on indivudals assessed needs. 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: The last Key Inspection of this service was on the 17th of April 2007. This is a report for the key inspection, which took place between 1.30pm and and 5.30 pm on the the 9th November 2009. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Care Quality Commission and completed by the service manager. Surveys returned to us by people who use the service (seven were sent and all were returned) , surveys returned by staff of the service (five sent and returned) and surveys completed by other professionals (three sent and two returned). Discussions with a senior staff member and six of the seven people who use the service, took place. Observation of people and their interactions with staff took place during the visit to the Care Homes for Adults (18-65 years) Page 6 of 29 home. Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service was also taken into account when producing this inspection report. 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: The home must make sure that they write down exactly what they have done if they have to help people to stop doing things that might be dangerous to themselves or others. They can then, look at what they did to make sure it was the best and least Care Homes for Adults (18-65 years) Page 8 of 29 dangerous thing to do. The home should look at who would be the best person to visit the home every month, so that the owner knows what is going on there and he can make sure people are being treated well. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. The home ensures that people are properly assessed so that they can be sure that they can meet their needs. People are involved in all aspects of the assessment process and it is their decision whether they move in. Evidence: There have been three admissions since the last Key Inspection of the home, all plans of care included a detailed assessment of the individual prior to admission and supporting assessments from other professionals, as appropriate. The admissions procedure is designed to meet the needs of individuals who are coming to live in the home. The individual is consulted at all times during the assessment and admission process. The placement is reviewed by all the interested parties, including the resident at six weeks, three months and six months, as necessary, to ensure it is still suitable and everyone is happy with it. Comprehensive records are kept of the admission and settling in period, including how staff support the person to settle into their new home. One of the people who has been most recently admitted to the home said that at first they didnt like it but after they had been helped to settle down they now love living Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: there. They believe that it meets all their needs and the staff are very helpful. All residents have individual terms and conditions as part of their plans of care, these include their personal responsibilities as well as the services. All relevant paperwork is produced in a format suitable for the individual, with widget or simple language and pictures used, as appropriate. 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. People know their assessed and changing needs and have long and short term goals identified, to enable progress to be monitored. They are actively encouraged to make as many decisions as possible about their lives and are helped to be as independent as they are able. Evidence: Plans of care for four people were seen. The plans of care include a person centred plan, developed from the initial assessment and with the individual who signs to say that they agree with it. It also includes goals and is reviewed a minimum of annually or as often as necessary if issues arise. Those who are able,write their own person centred plan and agreements with regard to their responsibilities to help staff to carry out the plans of care. For instance an agreement to have their TV on a timer to switch off at 11pm and to tell staff if they want it on later and how it will be turned off. The plans of care include all the necessary information about all all aspects of peoples life, such as a health action plan, activities and personal care. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: People do not have advocates, but most are able to advocate for themselves and are positively encouraged to do so. Everyone has family contact and families are very active in supporting their family members. People are encouraged to make decisions for themselves whilst being made aware of their responsibilities, they make agreements about how they will be supported with their care. There is evidence of people being involved in all aspects of daily life and learning the consequences of their behaviour and actions such as not participating in a work project involving animal care, if they do not accept and carry out the responsibilities this entails. The home has communication boards, as appropriate although all residents are able to communicate verbally to a greater or lesser degree. Pictures are used where it will help understanding and widget is used for some people to assist with their understanding of written documents and records. Risk assessments are in place for any areas that may present a risk and these are also agreed with individuals. They minimise risks whilst allowing them maximum independence. Comments from fellow professionals included, they provide individually tailored care plans, adapt care plans as needs change and they record and communicate effectively. People who use service spoken to said, we can choose what we want to do and we have meetings to talk about things. It was apparent that people are very involved in developments as they all knew about the building of the new home, in the grounds and other developments in day care activities. Care Homes for Adults (18-65 years) Page 14 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. People are given opportunities to take part in interesting and rewarding activities and are supported to take part in a variety of community activities. They are offered balanced and nutritional meals that they are fully involved in choosing, preparing and sometimes growing component parts. Evidence: Everyone has day activities plans included in their individual plans of care. Day care programmes are tailored to meet the needs of individuals, even though the service provides day care on site, people are encouraged to access local community and external services if it meets their needs more effectively. People told me that they go to college in the day time and in the early evenings. One person described that they are now going on a specific college course for more days of the week than last year as they had asked to increase their attendance. They described how the home has changed its routine to enable them to get to college on time. People are supported to Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: gain work experience, outside of the farm, one person has been found a work experience officer specifically to look for appropriate employment for them. People use the local leisure centre, go horse riding both on the farm and to an external venue and attend social clubs (including a pub club), where they meet up with friends. Shopping,cooking and other domestic chores are included in their day care programme. if appropriate, to increase their independent living skills. I.T equipment is available for use by the people who use the service. People complete academic achievement award courses and one person is completing an NVQ in equine care. People told me that they had gone out to a carnival at the weekend and not returned until the early hours of the morning, impromptu outings are not unusual and much enjoyed by people. Those people who wanted to were able to go on holiday this year, it was noted in the AQAA that it was something the home was trying to arrange. Comments from care managers surveys included, there are a range of opportunities including involving people in the wider community,they encourage family links and they develop independent living skills. Comments from residents surveys included, I do lots of different things in the evenings, I do lots of new things and work with the horses. Staff survey comments included, We give the best possible chance for people to lead the lives they wish, service users are offered a range of activities to participate in, if they want to and great day service opportunities and varied leisure activities. Residents told me that they always have lots to do, described some of their individual hobbies, which they are encouraged to pursue and said they made choices about activities. Daily notes are of a good standard, they record peoples activities and reaction to them so that they can make judgements about whether they are successful or not. Some staff surveys suggested that there are not always enough staff to enable people to pursue individual activities of their choice but this was not evident, on the day of inspection. Contact with families and friends is positively encouraged, as recorded in the home. All people have some contact with families and some have close personal relationships with people outside of the home, these are supported, as necessary. Menus are presented pictorially, so that people know what they are having on the day. They choose breakfast and lunches on a daily basis and the main meal is chosen by residents who are also rotad to help with food shopping and food preparation, often as part of their independence skills. People said that the food is very good and they can have alternatives if they do not like what is on the menu. Fresh food and vegetable is often obtained from the farm, which some people are involved in producing. Care Homes for Adults (18-65 years) Page 16 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 home meet the personal care,emotional well being and health needs of the people who live there very well and in the way that individuals want. They ensure that medication is administered as safely as possible and is regularly reviewed. Evidence: Peron centred plans are included in plans of care, people who use the service are very involved in developing these and they detail how I expect to be treated which notes how people want to be helped and supported. They also include various agreements about how staff will deal with certain areas such as one person signing an agreement about what will happen if they display certain behaviours in a specific situation. It is detailed what staff will do what the individual will be expected to do and what will happen if they cannot react in a safe way. People likes, dislikes and preferences and how they make choices is clearly detailed in the plans of care. People told me that they are helped by staff all the time. A care manager commented that the home have a consistent approach and persevere with people and they are excellent at thinking outside the box. A staff member Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: commented that it provides an excellent environment for service users to fulfil their goals. Two people, who use the service, described what they wanted for themselves, in the future and thought they were working towards it. The person centred programmes are individually tailored to meet the very diverse needs of the people who use the service, for one person staff had to adopt a new approach to their sexuality and recognise their right to that sexuality, supporting them in a responsible way. Staff were observed working sensitively and effectively with people, who appeared to be very confident and comfortable to communicate and interact with staff and each other. Staff members commented that the needs of the service users are at the forefront of our work and we meet service users needs. The plans of care include a health action plan that outline what support people need to ensure they remain as healthy as possible.For example one person sees a psychiatrist, a psychologist, the dentist, the optician, the GP and any other specialists, as necessary. People have regular health checks and the home make appropriate referrals if they need any support or advice about the care of an individual. Weight records are kept, if necessary and healthy eating is encouraged, the home are guided by advice form the individuals G.P. A detailed record of any appointments or contacts with health professionals is kept on peoples files. One person administers their own cream but no-one, currently, administers their medication. This is kept in a locked cupboard. The home use the Boots monitored dosage system. Staff do not administer medication unless they have been trained and judged as competent to do so. The senior staff member said there had been no medication errors, to her knowledge, during the past 12 months, the Commission have received no notifications of medication errors and records seen on the day of the inspection visit, were accurate. The pharmacist completes regular visits,they made no recommendations on their most recent visit. The home has individual guidelines for the use of medication prescribed to be taken as necessary, one person has this support to help with their behaviour control . People have their medication reviewed regularly to ensure it is still necessary and appropriate. Care Homes for Adults (18-65 years) Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a comprehensive complaints procedure and listens to people if they have complaints or concerns. Staff know how to protect people from all forms of abuse and the people who use the service feel safe and confident to talk to staff. Evidence: The home has a robust complaints policy and procedure which is produced in a simple format for individuals to use, if they want to. There have been no complaints since there were complaints about one person who no longer lives in the home. Residents felt scared to be with them and their placement was reviewed as a result. Residents are asked at monthly key worker meetings (key sessions) if they have any complaints or concerns and are reminded how to make a complaint. People told me that they do not have anything to complain about and that they feel comfortable to talk to any of the staff if they are worried about anything. The home have comprehensive safeguarding polices and have dealt with three safeguarding incidents very effectively, they inform all the necessary agencies and ensure that people are kept safe. Risk assessments are developed, if necessary. Staff were knowledgeable about safeguarding and protection of the people they work with. Staff are trained in safeguarding matters, this training is up-dated, as necessary. The Commision has received no information from other parties, with regard to Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: complaints or safeguarding issues, about this home since the last inspection. Restraint has been used four times since the last inspection, detailed incident records are kept but there could be more detail about the actual restraint used and what action has been taken to minimise the risk of recurrence. Staff are trained in the use of restraint techniques and use the least physical methods but this is not always recorded clearly. Peoples behavioural plans do not always include detail of the restraint techniques that can be used and at what stage of behaviour they should be used. People who live in the home said that they always feel safe especially now that one resident has moved. One resident survey commented that, the home makes sure that everyone is safe and know where everyone is all of the day. People, generally do not have appointees and look after their own finances with varying degrees of support, as noted on the plans of care. Parents are sometimes appointees and staff then assist people with their personal allowances. Financial records were not seen but the senior staff member explained that receipts and records are kept as necessary. Care Homes for Adults (18-65 years) Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house is exceptionally clean and well kept. It reflects the ages and personalities of the people who live there and provides a comfortable and pleasant environment to live in. Evidence: The home has ground floor and first floor private accommodation, one room seen was spacious and totally individualised by the service user. She said that she is happy with her room although she would like an en-suite facility however the shower room is close to her room and a bath is available for use on the first floor. There are spacious communal areas which include a main lounge/dining room a further dining area, a small sitting/activities room plus the staff office. Residents were observed to be using all of the communal space, depending on their choice of who to communicate with and the activities they were choosing to do. The house was exceptionally clean and well kept with good quality furniture and fittings, presented in a modern way, that reflected the ages and personalities of those who live there. There is a spacious garden for people use, separated from the farmyard and day activities buildings. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: There is a spacious kitchen with a large cooker and necessary equipment, this was very clean and tidy, on the day of the inspection. There is a well equipped laundry all set up to enable people to help with domestic chores, as part of their development programme. A staff survey comment was, a nice environment, and a resident said that they loved the house. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a properly qualified staff team, in sufficient numbers to meet the needs of the people who live there. Evidence: The home has seven full time, staff in total. There are a minimum of two on duty during day time hours and one person sleeps in at night. Three of the six surveys returned by staff said that there are not always enough staff to meet peoples individual choices, however on the day of inspection residents said that there are always staff available if they need them and it was also noted that extra staff are rotad on duty, if any special activities/trips are planned. Spontaneous outings and activities also occur, and staff will work extra hours to ensure people enjoy themselves. Staff retention is very good with a very small staff turnover. Agency staff are not generally used, staff shortages being covered by staff doing additional hours, sickness rates are low. Resident survey comments included, I get on well with the staff and other service users and staff do everything really well. Staff comments included,staff work as a team and it is a consistent staff team with low turnover. There were three comments about staffing levels, there could be more staff, need more staff and the home could have more staff to cater for individual choices. Recruitment records for staff were not seen, on the day of the visit, as the manager Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: was not available. The senior staff member said that all the necessary checks are completed at the recruitment stage and people do not start work until a CRB check is completed. She said that the registered manager has recently drawn up a new recruitment check list to further ensure that all the necessary checks have been completed. People who live in the home are told when they are recruiting and residents have sat in on interviews and been involved in candidate selection. Six of the seven staff have an NVQ2 or above qualification and all staff complete the necessary Health and safety courses on a regular basis. Fire training did not look to be completed as often as required but at a recent fire inspection visit this was not noted by the fire officer. Staff are given good opportunities for training, as described by the senior support worker and are experienced and knowledgeable. The Senior support worker was able to assist me in all areas of the inspection, and had detailed knowledge of all areas of the care given by the home. A staff training and development plan for the home was not available although there was evidence that staff complete a variety of training courses to help them to meet the varied needs of the people in their care. One staff member was spoken to at length, but others were very busy meeting the needs of the people who use the service. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has had a change of manager since the last inspection, it is still very well managed in the best interests of the people who live there. The home has ways of looking at the quality of care it offers , which include the people who use the service and keeps everyone as safe as possible Evidence: The manager has been registered since October 2008, she has an NVQ 4 and Registered Managers Award. She has over ten years experience of working with people with learning disabilities. A staff member said that the management team are very open and supportive, people who live in the home said that they can talk to manager or owner whenever they want. The manager is supported by a deputy and senior support worker. Other comments from resident surveys included,I like living here, The home do everything well, I am happy, its a nice place to live and its good on the farm. The home has regular regulation 26 visits, these are completed by someone external to the company, whilst this may be a good quality assurance tool regulations state Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: that the provider or his representative should complete the monthly visits. The last regulation 26 report available, on the day of the visit, was completed in June 2009. The senior staff member undertook to discuss this issue with the manager who she advised would review the sytem of regulation 26 visits, in accordance with regualtions and standards. The quality assurance processes are robust and involve the people who use the service at all levels. Key workers meet with people on a monthly basis and ask them about their lives and if they are happy with their care, activities, staff and all aspects of their lives. Questionnaires are sent annually to residents, their families and other professionals. The responses are collated and actions taken, if necessary, records are kept of the survey responses and the results of the responses. 2009 questionnaires resulted in six families responding that they are very happy with the care offered as are the people who use the service. Responses match the survey responses received by the Commission. A sample of Health and Safety maintenance records seen on the day of the visit, showed that the home complete regualr Health and Safety checks, as necessary and keep up-to-date records of them. The fire officer completed a visit on the 4th November 2009 and made a recommendation, which is being dealt with. A visit by the environmental health officer in 2008 resulted in a very good rating. The home has generic risk assessments to ensure the safety of residents and staff. Accident and incident reports are kept but could include more detail about how the home is to minimise the risk of recurrence. 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 1 23 13 To keep a detailed record of the nature and method of any physical restraint used. To enable the service to check that the method of physical restraint used was the safest, most effective and most appropriate method of assisting an individual to control their aggressive behaviour. 01/01/2010 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. 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