Care Home: HWCGS

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What the care home does well Segal Gardens presented as a well maintained, comfortable and homely environment. The service continues to be managed by two experienced and qualified Registered Mental Nurses who are both registered with the Care Quality Commission. Both of the managers also have relevant management qualifications and are directors of the company (HWCGS). Service users appeared relaxed and comfortable in their home environment. The management of the service continue to work alongside staff to ensure high standards of care are delivered to the people using the service. During the inspection the management and staff were observed to communicate and engage effectively with the people they cared for in a positive, respectful and dignified manner. Assessment, care planning and risk assessment systems hve been developed to ensure the personal, health and social care needs of prospective and current service users are identified and planned for and their welfare safeguarded. Service users are encouraged to maintain contact with family members and to play an active role in the running of the home. Likewise, service users are supported to participate in a range of activities in order to lead fulfilling lifestyles. Segal Gardens remains part of ASDAN (Award Scheme Development Accreditation Network) and has on-site facilities to be able to offer education and accredited qualifications. Staff have access to induction, health and safety, national vocational qualifications and training specific to the needs of service users. Staff also receive direct support and supervision from the management team to ensure best practice. A programme of quality assurance and service monitoring has been established to ensure the service was run in the best interest of service users. Systems had also been established to ensure an appropriate response to suspicion or evidence of abuse and any concerns or complaints about the service. A large number of positive comments were received from the relatives of service users which are included in the report. Examples included: "Everybody treats X [a service user] very well." "Segal Gardens is much more than just a care home." "The standard of care provided in my opinion is excellent." "The care and support they offer is fantastic." "We feel very lucky to have found Segal Gardens. We can see for ourselves that the provision is working." A service user also reported "People are their to talk and listen to me." What has improved since the last inspection? This section is not applicable as no requirements or recommendations were made at the previous inspection which was undertaken on 16th May 2007. What the care home could do better: The Statement of Purpose should be updated, to ensure all the criteria of Schedule 1 of the Care Home Regulations 2001 is included. A copy of `The Handling of Medicines in Social Care` guidance issued by the Royal Pharmaceutical Society of Great Britain should be obtained for reference. The medication cabinet should be re-located and and records should be established to monitor the temperature of the area in which the medication cabinet is stored does not exceed 26 degrees centigrade. All MAR charts produced in-house (either in print form or handwritten) should be signed by the person producing the MAR and countersigned by another suitably trained staff member, to verify that the prescribed instructions recorded are as per the information on the original prescription. The complaints procedure should be updated to include the name and contact details of the Care Quality Commission. The absence of hot water valves should be risk assessed to confirm the health and safety of the people using the service is safeguarded. A statement by each employee as to the condition of their mental and physical health should be obtained as part of the recruitment process to ensure best practice and compliance with the Care Homes Regulations 2001. Arrangements should be made to ensure all staff are inducted in accordance with the Skills for Care - Common Induction Standards, to ensure compliance with national training objectives. The quality assurance system should be fully utilised to ensure best practice. Records should be established to evidence that the fire extinguishers are visually examined on a monthly basis and to confirm the outcome of weekly fire drills / training. Key inspection report Care homes for adults (18-65 years) Name: Address: HWCGS 436 Fleet Lane Segal Gardens Parr St Helens Merseyside WA9 2NH     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: Daniel Hamilton     Date: 2 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: HWCGS 436 Fleet Lane Segal Gardens Parr St Helens Merseyside WA9 2NH 0174428828 0174425941 hwcgscole@ukonline.co.uk Www.segalgardens.com/hwcgscare@ukonline.c o.uk HWCGS Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Damian Alan Leslie Cummings Ms Gillian Louise Gilmore Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD. Learning disability - Code LD. The maximum number of service users who can be accommodated is: 5. Date of last inspection 5 5 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Segal Gardens is owned by the company HWCGS. This company was formed by a group of experienced carers some of whom continue to work within the service in one form or another. The home provides care and support to five young adults that have various mental health problems and / or learning disabilities. Segal Gardens accepts referrals from all parts of the U.K. It is unique as it has two Managers who have achieved registered mental nurse status and who oversee the dayto-day running of the establishment. The home is situated in the Parr area of St. Helens. It is a detached bungalow with a separate detached extension which is used as an office. Two log cabins are also located in the gounds. One serves as a fitness suite and the other is used to offer educational support and training. The weekly fee for the service ranges from £1753.00 to £2100.00. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this service is 3 star. This means the people who use the service experience excellent quality outcomes. This unannounced inspection took place over one day and lasted approximately 8 hours. 5 residents were living in HWCGS Segal Gardens at the time of the visit. A site visit took place as part of the unannounced inspection and a tour of the premises was completed. Two of the residents care files were case tracked (their care files were examined and views of the service obtained). This process was not carried out to the detriment of the other residents who were encouraged to join in the inspection process using their preferred methods of communication and engagement. A selection of staff and service records were also looked at and the registered manager, secretary, three residents and 2 care staff were spoken with during the inspection. Care Homes for Adults (18-65 years) Page 6 of 32 Reference was made to an Annual Quality Assurance Assessment (AQAA) which was completed by the owner / registered manager before the visit. This document enables a registered person to undertake an assessment of the service, prior to an inspection. Survey forms were also distributed to residents / relatives and staff and telephone calls were made to the relatives of four of the residents. Comments included in the report are taken from the survey forms and from feedback received from residents and / or their relatives. All the key standards were checked as part of the inspection process. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: Segal Gardens presented as a well maintained, comfortable and homely environment. The service continues to be managed by two experienced and qualified Registered Mental Nurses who are both registered with the Care Quality Commission. Both of the managers also have relevant management qualifications and are directors of the company (HWCGS). Service users appeared relaxed and comfortable in their home environment. The management of the service continue to work alongside staff to ensure high standards of care are delivered to the people using the service. During the inspection the management and staff were observed to communicate and engage effectively with the people they cared for in a positive, respectful and dignified manner. Assessment, care planning and risk assessment systems hve been developed to ensure the personal, health and social care needs of prospective and current service users are identified and planned for and their welfare safeguarded. Service users are encouraged to maintain contact with family members and to play an active role in the running of the home. Likewise, service users are supported to participate in a range of activities in order to lead fulfilling lifestyles. Segal Gardens remains part of ASDAN (Award Scheme Development Accreditation Network) and has on-site facilities to be able to offer education and accredited qualifications. Staff have access to induction, health and safety, national vocational qualifications and training specific to the needs of service users. Staff also receive direct support and supervision from the management team to ensure best practice. A programme of quality assurance and service monitoring has been established to ensure the service was run in the best interest of service users. Systems had also been established to ensure an appropriate response to suspicion or evidence of abuse and any concerns or complaints about the service. A large number of positive comments were received from the relatives of service users which are included in the report. Examples included: Everybody treats X [a service user] very well. Segal Gardens is much more than just a care home. The standard of care provided in my opinion is excellent. The care and support they offer is fantastic. We feel very lucky to have found Segal Gardens. We can see for ourselves that the provision is working. A service user also reported People are their to talk and listen to me. Care Homes for Adults (18-65 years) Page 8 of 32 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have access to information on the service and have their needs assessed prior to moving into Segal Gardens. This ensures people are able to make an informed decision about whether the service is able to meet their needs and ensures the care and support needs of prospective service users is identified and planned for. Evidence: The Annual Quality Assurance Assessment (AQAA) for Segal Gardens detailed that a Statement of Purpose had been developed together with a service specific brochure to provide information on the service provided at Segal Gardens. The AQAA also highlighted that service users were only admitted to Segal Gardens based upon a full and comprehensive assessment of needs by qualified practitioners and confirmed a procedure for referral and admission was in place. Examination of the Statement of Purpose revealed that the document had last been reviewed during September 2009. The registered manager was advised to update the document to also include details of the fire precautions and emergency procedures, Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: together with the number and size of rooms to ensure the document contained all the information required under Schedule 1 of the Care Home Regulations 2001. A separate Service User Guide was also in place which had been developed using signs and symbols. Only one service user had moved into the home since the last inspection. Admission information was found to be in place in the form of a referral document that is completed by the service prior to admission. This covered key aspects of the individual in terms of medication, family contact, education, social activity, ethnicity, communication, self-concept, social support and safety etc and provided an opportunity for parents and carers to contribute towards the assessment process. In addition to this psychiatric reports and other key assessment and background information was found to be in place. Discussion with the registered manager and staff confirmed the service continues to carefully plan and prepare people for potential admission to Segal Gardens. This process includes opportunities for service users to participate in introductory visits to further enhance the assessment process and to enable service users and their representatives to make an informed decision about whether the service is able to meet their needs. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The changing needs of service users are appropriately planned for and supported to promote and safeguard independence, choice and wellbeing. Evidence: The Annual Quality Assurance Assessment (AQAA) for Segal Gardens confirmed that the service had developed a policy on Individual Planning and Review. Two files were selected to view during the visit. One was for a service users who had recently moved into the home and the other was for a service user who had lived in Segal Gardens for approximately 5 years. The care plan for the new service user was still in the process of being developed at the time of the visit however the other care plan viewed had been completed in full. The care plan viewed was found to be person centred and based upon the Activities of Daily Living model. The plan outlined information on Assessment, Planning, What staff will do and What X [Service user] will do in a clear way for staff to follow and a Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: review system was in place. [Please note that upon completion of the inspection the Commission received written confirmation from the Registered Manager that the outstanding care plan had been completed in full]. In addition to the above, another care plan had been produced in a format suitable for the communication needs of each person and there was evidence that individuals had been consulted on the contents. Support staff spoken with during the visit demonstrated a sound understanding of the needs of the people they cared for and an awareness of the range of supporting information they could access. Care plans covered all areas important to the individual together with key information on other areas such as meals, education, occupation and the level of support that individuals require in their daily lives. Care plans continue to be supplemented by daily progress notes and a handover book was in place which enabled short summaries of key information to be made known to staff. Service users were encouraged to participate in the inspection process using their preferred methods of communication and the registered manager, secretary and staff were observed to communicate and engage effectively with the people they cared for in a positive, respectful and dignified manner. The people living at Segal Gardens continue to be supported to take responsible risks as part of their daily lives. Risk assessments had been developed which clarified why risk assessments are necessary for each individual and outlined the specific personal and environmental risks associated with each person, required interventions and the likely response from individual service users. Comments received from the relatives of service users regarding the standard of care provided was good. Feedback included: The staff are very caring and they work well together as a team. Everybody treats X [a service user] very well. They have really helped X [a service user] and he is very happy and developing his independence. Segal Gardens is much more than just a care home. The standard of care provided in my opinion is excellent. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: The care and support they offer is fantastic. The love, support and attention that X [a service user] receives is second to none. We feel very lucky to have found Segal Gardens. We can see for ourselves that the provision is working. A service user also reported People are their to talk and listen to me. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals, activities and routines are well managed, flexible and varied to enable service users to have choice and control over their lifestyle. Evidence: All education and occupation undertaken by service users continues to be based on involvement in the running of Segal Gardens or through involvement in the local community. Segal Gardens is also part of ASDAN (Award Scheme Development Accreditation Network) and is able to facilitate education and accredited qualifications awarded by the learning skills council. This system is available to any service user, regardless of their past educational history and counts towards future educational goals. A separate log cabin is available as a base for these activities and an additional log cabin has been built since the last visit in order to provide a fitness suite for service users to access. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: One relative spoken with reported that The Education system has been of enormous benefit. Segal Gardens is located in a quiet residential area of St Helens and has the means to also ensure that each individual has access to local facilities. Public transport routes are close by and the home has its own transport in the form of a multi-purpose vehicle. On the day of the inspection, three service users were observed to return home from different activities including shopping and ten pin bowling and one service user reported that they had enjoyed using gym equipment in the fitness suite. A daily activity planner was found to be in place for each service user and records highlighted that service users continue to be encouraged and supported to assist in general housework i.e. shopping activities, laundry and food preparation and a range of person centred activities both within the home and the local community. As previously reported, most individuals do not come from the local area and rely on staff to advise them on local activities etc. Links with the community are extended to a community centre based next to the home and this is used frequently. Community (service user) meetings are also coordinated every two months and are used to discuss any issues or events concerning the operation of the home. Surveys were distributed to all family members by the management of Segal Gardens in addition to telephone calls which were made to four family parents following the inspection. Feedback received from the people using the service or their representatives confirmed all service users are able to maintain regular contact with family members and that they were able to meet in private. Previous inspection records highlight that all service users have access to computers and each have an email account and are therefore able to also maintain contact with relatives via e-mail and telephone. A dining area is available in addition to a kitchen. The kitchen is well equipped and domestic in scale. Kitchen duties are in place and on display using a symbolic form. A two week menu plan has been developed in consultation with service users and this is updated periodically to reflect seasonal changes. Menus viewed offered a choice of wholesome and nutritious meals and records of each persons dietary intake / meal choices were maintained. The service has a substantial weekly food budget and all food shopping is obtained from local supermarkets with the assistance of service users. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive ongoing support with their personal, health care and medication needs to ensure a healthy lifestyle. Evidence: Discussion with the registered manager and staff and examination of records highlighted that the people using the service required different levels of support with their personal care. As noted at the last inspection, none of the service users received intimate personal care but all required prompting and assistance with their emotional and health care needs and support with promoting independence, daily living skills and personal safety. Each service users personal care and support requirements had been outlined in care plan documentation and the registered manager and staff spoken with demonstrated a good awareness of each service users physical, social and emotional needs together with the principles of good care practice and need to promote privacy, dignity and independence when providing care to the people using the service. All service users continue to be reliant on the staff team to ensure that their health Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: needs are met. Health care appointment records viewed highlighted that service users were supported to access a range of health care services subject to individual need such as general practitioners, chiropodists, dentists, psychiatrists and opticians etc. Examination of the Annual Quality Assurance Assessment (AQAA) for Segal Gardens confirmed policies and procedures were in place for the Control, storage, disposal, recording and administration of medicines. The registered manager was advised to also obtain a copy of guidance issued by the Royal Pharmaceutical Society of Great Britain for reference. A staff signature checklist was available and a service user identification system had been established. Copies of patient information leaflets had also been obtained for reference and the the manager reported that all staff designated with responsibility for administering medication had completed appropriate training. Medication was securely stored in a lockable cupboard in the kitchen area. No controlled drugs were stored on the premises at the time of the visit and no medication required cold storage. At the time of the visit none of the service users had routine responsibility for managing their own medication. Arrangements had been made for one service user to self-administer medication when on leave or an activity of their preference which was subject to an ongoing risk assessment process. The Medication Administration Records (MAR) of the five people living in the home were viewed during the visit. It was noted that MAR had been produced by senior staff using a computer and a separate record of medication received into the home was maintained for reference. Although no issues of concern were noted regarding the recording of medication administered, the registered manager was advised to ensure that all MAR charts produced in-house (either in print form or handwritten) are signed by the person producing the MAR and countersigned by another suitably trained staff member to verify that the prescribed instructions recorded are as per the information on the prescriptions. Furthermore, the registered manager was advised to re-locate the medication cabinet and to establish records and monitor the temperature of the area in which the medication cabinet is stored, to ensure the temperature does not exceed 26 degrees centigrade. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been developed to listen and respond to complaints and to safeguard and protect service users from abuse. Evidence: A complaints procedure had been developed by the Registered Provider (HWCGS) as previously noted which was on display on a notice board in symbolic form as well as contained within a written procedure. At the time of the visit the procedure was in need of revision to include the name and contact details of the Care Quality Commission. The Annual Quality Assurance Assessment (AQAA) for Segal Gardens detailed that there had been no complaints or safeguarding referrals or investigations in the past 12 months. It was not possible to verify the information in the AQAA as the complaint log record for the service could not be located. The registered manager was recommended to re-establish a record which he agreed to do. No concerns, complaints or allegations have been referred to the Care Quality Commission in the past 12 months and the relatives of the people using the service confirmed that they had no concerns regarding the service and were aware of how to complain should the need arise. The AQAA confirmed that procedures for the Disclosure of abuse and bad practice (whistle blowing) and Safeguarding Adults and the Prevention of Abuse were in place Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: as noted at the last inspection. On the day of the visit a copy of the local authoritys adult protection procedure could not be located and this should be addressed The registered manager and two support staff were spoken with during the visit. The manager and staff demonstrated a sound awareness of the different types of abuse, reporting procedures and their duty of care to protect and safeguard vulnerable adults from abuse. Discussion with the manager and previous inspection reports confirm there is no need for restraint to be practised in the home and that staff have received training in respect of challenging behaviour and awareness in the legal aspects of individuals rights as well as techniques to diffuse situations. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Segal Gardens is a pleasant and well maintained home. This provides service users with a safe, clean and comfortable environment in which to live. Evidence: Segal Gardens is owned by the Registered Provider (HWCGS). The registered manager reported that the property continues to receive ongoing investment, refurbishment and maintenance as required. There is an understanding that some changes to the environment or individual accommodation can have an effect on individuals and this is linked to specific disabilities e.g. autism. As a result, efforts are made to minimise unnecessary changes to the environment and the staff team are aware of this. The owners therefore continue to maintain the building as much as possible themselves and hire contractors when necessary for specialised building work or the servicing of equipment. On the day of the visit the premises appeared to be maintained to a good standard both internally and externally and the grounds were well tended. The Annual Quality Assurance Assessment (AQAA) for the service detailed that a maintenance programme was in place and that in the last 12 months the service has developed a secondary lounge area with sky television, console access, flat screen television and new seating facilities. The management team were recommended to establish a health and safety Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: checklist to assist in the periodic monitoring of the premises in addition to a maintenance book which is used to record work in need of attention. Furthermore, the management team were advised to risk assess the absence of hot water valves. The home is decorated to a high standard throughout. A lounge is available as well as a kitchen and dining area. Bedrooms are located on both lower and upper floors. The inspector was invited by two service users to view their bedrooms and they were both found to be well decorated and personalised reflecting the interests and preferences of each service user. The home blends in with the local community and cannot be identified externally as a registered care home. A local community facility is located next door and this is used on a regular basis as evidenced through daily planners. The home is located so that there are links by road to the local town as well as public transport. The home employs a part-time domestic who works three hours per day as there is still an expectation on service users to be involved in all aspects of the daily running of the home. On the day of the visit the environment was found to be clean and hygienic and the AQAA confirmed that policies and procedures were in place for communicable diseases and infection control. A laundry is available and is located in a separate building. This is a well-organised facility with industrial appliances in place. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been established to ensure staff are correctly recruited and trained for their roles. This offers protection to service users and ensures they are in safe hands. Evidence: Segal Gardens had a staff team that consisted of two registered managers, 15 permanent support workers and a domestic. At the time of the inspection there were five people living in the property. Examination of rotas highlighted that the care home was usually staffed with a minimum of three staff on duty from 08:00 am until 09.30 pm. Management hours and support is also available each day in addition to the minimum staffing. On a Tuesday, Wednesday and Thursday an additional member of staff works from 10:00 am until 5:00 pm to provide wider educational support. During the night there is one waking night and a sleep-in on duty. The Annual Quality Assurance Assessment (AQAA) for Segal Gardens confirmed the service had a policy on Recruitment and employment, including redundancy. The records of three staff who had commenced employment at the home since the last inspection were viewed during the visit. All the necessary records required under the Care Home Regulations 2001 were in place (with the exception of a statement by each Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: employee as to the condition of their mental and physical health). The AQAA for Segal Gardens detailed that 12 (79.99 ) of the 15 support workers had completed a National Vocational Qualification (NVQ) at level 2 or above in Care. At the time of the visit the service did not have a training matrix in place. Discussion with staff and examination of training records and certificates highlighted that staff had completed a range of mandatory and service user specific training during their employment at Segal Gardens. This included; induction, fire training, first aid, food hygiene, infection control, autism, challenging behaviour and safeguarding. It was noted that the staff induction system was not based upon the Skills for Care Common Induction Standards and advice was given to the manager on this issue. As previously noted, the two registered managers of the service have nursing qualifications and continue to use this expertise to train staff and make them aware of various issues associated with mental health as well as learning disabilities. A relative spoken with stated The staff put their heart and soul into their work and another reported Im very happy with the management and staff. They keep me up to date with any issues concerning the welfare of X [a service user]. Feedback received from staff via discussion and surveys confirmed they also received structured support and direct and indirect supervision as part of their role. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Segal gardens is well managed and systems are in place to ensure the home is run in the best interest of the people using the service. Evidence: Segal Gardens continues to be managed by two qualified Registered Mental Nurses who are both registered with the Care Quality Commission. Both of the managers have many years experience in this role, have relevant management qualifications and are also directors of the company. All the management team have significant experience to undertake their role and continue to use this experience to provide training to the staff team. The management team also have access to other external resources in order to keep up to date with issues concerning younger adults with learning disabilities or mental health issues. The management team are committed to their role and continue to work closely with staff to deliver the highest standards of care for the people using the service. Feedback received from staff via surveys and discussion confirmed they received Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: support and direction in their role. A range of positive comments regarding the service and the management and their leadership skills were received as follows: The home identifies the service user needs and puts a structured and relevant plan in place. Works as a team and that the home managers always have a hands on approach. The service makes sure residents are all well cared for a priority. Treats staff excellently. The home does well in all aspects and the care for all the young residents is fantastic. There is a fantastic feeling in the home which makes it a good / safe place to work / live. The managers are always supporting you to reach your goals after a supervision. I think the home is performing well at this present moment. Its a safe, sound and supportive place. I love working here and couldnt imagine working under any other managers. There is a warm feeling about the home which makes it a fantastic place to work. I feel it [Segal Gardens] provides a safe and stable environment for the young people and their needs and enables them to partake in tasks in a safe and dignified manner. The home gives good support to both staff and residents and gives everyone the chance to gain qualifications that are suited to their role. It has a good management team who is able to keep all staff involved in the daily running of the house and has regular supervisions to help maintain this. I really enjoy working for this home because it has given me the opportunity to move for ward with my role. It is also understanding with personal needs. The service continues to use three forms of quality assurance. One involves stakeholder surveys that were last done in September 2009. This involved comments from service users, their relatives and other agencies that are involved in the home. The service has also uses the annual quality assurance document from the Care Quality Commission to determine any improvements that the service may need. In addition to this, the service has purchased a quality assurance system from Mulberry House. Advice was given to the manager on how the quality assurance system could be further developed and implemented within Segal Gardens. For example, the quality Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: assurance system from Mulberry House had not been utilised within the service for a prolonged period of time. Community (service user) meetings are also coordinated every two months and are used to discuss any issues or events concerning the operation of the home. Information received via the Annual Quality Assurance Assessment (AQAA) for the service confirmed policies and procedures had been developed on Health and Safety. Likewise, the dataset section of the document confirmed that equipment within Segal Gardens had been routinely serviced with the exception of portable electrical equipment. It was noted during the inspection that the Registered Provider (HWCGS) had systems in place to undertake Portable Appliance Testing independently and records were in place to confirm the testing had been completed periodically. Fire records were viewed during the visit. Records confirmed that the fire alarm and emergency lighting system had been routinely tested. The registered manager was advised to also establish records to evidence that the fire extinguishers were visually examined on a monthly basis and to maintain records of weekly fire drills to ensure best practice. An up-to-date fire risk assessment was in place and staff have received mandatory training as confirmed through interviews and examination of training certificates. Accidents are recorded and information is in place in relation to reporting incidents. Certificate of registration and insurance is in place. Risk assessments have been completed as well as a Control of Substances Hazardous to health (COSHH) risk assessments. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 1 The Statement of Purpose should be updated, to ensure all the criteria of Schedule 1 of the Care Home Regulations 2001 is included. All MAR charts produced in-house (either in print form or handwritten) should be signed by the person producing the MAR and countersigned by another suitably trained staff member, to verify that the prescribed instructions recorded are as per the information on the original prescription. The medication cabinet should be re-located and and records should be established to monitor the temperature of the area in which the medication cabinet is stored does not exceed 26 degrees centigrade. A copy of The Handling of Medicines in Social Care guidance issued by the Royal Pharmaceutical Society of Great Britain should be obtained for reference. The complaints procedure should be updated to include the name and contact details of the Care Quality Commission. The absence of hot water valves should be risk assessed to confirm the health and safety of the people using the service is safeguarded. Page 30 of 32 2 20 3 20 4 20 5 6 22 24 Care Homes for Adults (18-65 years) 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 7 34 A statement by each employee as to the condition of their mental and physical health should be obtained as part of the recruitment process to ensure best practice and compliance with the Care Homes Regulations 2001. Arrangements should be made to ensure all staff are inducted in accordance with the Skills for Care - Common Induction Standards, to ensure compliance with national training objectives. The quality assurance system should be fully utilised to ensure best practice. Records should be established to evidence that the fire extinguishers are visually examined on a monthly basis and to confirm the outcome of weekly fire drills / training. 8 35 9 10 39 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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