Care Home: Kenilworth (Banstead)

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What the care home does well Residents live in a clean, well decorated, homely environment with their private accommodation personalised to reflect their age, preferences and needs. Residents clearly benefit from the, relaxed and gentle lifestyle offered at the home. A sample of residents, staff and relatives experiences at the home included "it is a nice quiet environment which suites both of the men that live here" "they all get on very well he thinks the world of the owner" "since being there he is much more stable they have done an excellent job" "I can not speak highly enough about the home they are very good wonderful people" and "to my knowledge the home looks after him very well, he always looks happy and well dressed". Resident`s lives are enriched through opportunities to take part in meaningful, age appropriate and enjoyable activities. Resident`s are supported to maintain relationships with their families and friends. Mealtimes and arrangements for eating are determined by residents and provide choice and variety. Resident`s benefit from the provision of flexible and respectful personal and healthcare support that respects their privacy and dignity and encourages choice. Prompt medical advice and intervention is sought with a resident commenting "If I am not very well they call the Dr straight away". Relatives, residents and staff all felt able to share any concerns they had with a relative commenting "I would have no hesitation in raising any concerns and any little things are addressed straight away at this home". The home regularly reviews aspects of its performance through a program of seeking feedback with views clearly being listened to and acted upon. Residents benefit from a stable staff team who know them and who are employed in sufficient numbers to get the support they need. All persons consulted spoke positively about the staff and comments included "staff all my family they are all very nice" and a relative commented "staff very good, he is always talking about them when he is home with us". The home was well run with residents benefiting form a clear ethos and leadership approach. Comments about the manager included "nice lady" "always helpful" and "very good very flexible". What has improved since the last inspection? All of the shortfalls noted at the previous inspection have now been addressed. This has improved residents safety through more robust recruitment practices, better risk management from the risk of accidental scalds and through staff receiving the necessary training for them to be able to work safely with residents. Arrangements are now in place to ensure that the home is always contactable should staff have to leave the premises on the homes business. Gradual improvements have been made to the environment which has included the creation of an internal smoking area, new fire doors, some internal redecoration and new television. This has helped to create a pleasant environment in which to live. What the care home could do better: Information about the home should be provided in a format that is accessible to the residents using the service, for example through the use of easy read, pictures or symbols. This is recommended to enable residents to be aware of what to expect when living there and help ensure that they are aware of their rights and responsibilities while residing at the home. Care planning needs need to be person centred and reflect the range of residents needs and provide staff with the guidance to be able to provide individual consistent care and support. In order to further improve practices and update staffs knowledge in changes in good practices guidance and legislation in the care of people who have a learning disability and mental health, specialist training is need in these areas. Key inspection report Care homes for adults (18-65 years) Name: Address: Kenilworth (Banstead) Kenilworth (Banstead) 74 Diceland Road Banstead Surrey SM7 2ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 1 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 31 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 31 Information about the care home Name of care home: Address: Kenilworth (Banstead) Kenilworth (Banstead) 74 Diceland Road Banstead Surrey SM7 2ET 01737361858 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Gamini Wijewardena,Mrs Balapuwaduge Wijewardena care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number to be accommodated is 3 The registered person may provide the following categories of service only: Care home only (PC) to service users of the following gender: Either whose primar care needs on admission to the home are within the following category Learning disabilty (LD) Date of last inspection Brief description of the care home Kenilworth is a converted domestic detached property situated in a residential road on the outskirts of Banstead Village in Surrey. The home is registered to provide residential accommodation for up to three people who have a learning disability. The home has been owned by joint providers Mr and Mrs Wijewardena since 1997, with Mrs Wijewardena also the registered manager. Local facilities are nearby such as shops and pubs. The home also has its own transport which is accessible to residents and staff. The premises are presented across two floors with access to the first floor via stairs. Residents accommodation is for single occupancy only with one bedroom providing en Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 2 6 1 1 2 0 0 8 Brief description of the care home suite shower facilities. Communal space consists of two lounge areas, one being a smoking area, dining/kitchen area and an office on the ground floor. There is a private secluded garden with patio area and carport to the rear of the garden. The homes literature states that it aims to promote independence, privacy and dignity for residents and encourage them to lead a full and valued lifestyle in the community. The manager reported that the current range of fees are from £999.24 to £1,036.61 per week, depending on room, the services and facilities provided which are based on an individuals level of need. Extras such as: newspapers, hairdressing, chiropody, some transport, toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two star. This means the people who use the service experience Good quality outcomes. The information contained in this report has been comprised from an announced inspection undertaken over five and half hours, from 11am to 4.30pm, and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment (AQAA) within the date requested. This provided a good standard of information about the home which was used to inform the inspection process. This is the homes second key inspection within twelve months. The inspection was facilitated by Mrs Therese Wijewardena (registered manager) and joint provider Mr Gamini Wijewardena. The focus of the inspection was to look at the experiences of life at the home for people living there and the progress made towards addressing the shortfalls noted at the previous inspection. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection consisted of being shown the communal areas, and being invited to view residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff, during lunch time and over the morning and afternoon period. Two residents, three staff a social care professional and two relatives were consulted as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Six were returned in total, one from a resident who was supported to complete the form by persons external to the home, one from a resident who completed it themselves, three from staff and one from health care professionals. Their feedback is included in this report. There were two residents living at the home at the time of the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? All of the shortfalls noted at the previous inspection have now been addressed. This has improved residents safety through more robust recruitment practices, better risk management from the risk of accidental scalds and through staff receiving the necessary training for them to be able to work safely with residents. Arrangements are now in place to ensure that the home is always contactable should staff have to leave the premises on the homes business. Gradual improvements have been made to the environment which has included the creation of an internal smoking area, new fire doors, some internal redecoration and Care Homes for Adults (18-65 years) Page 8 of 31 new television. This has helped to create a pleasant environment in which to live. 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides both prospective and existing residents, with information about what services are provided and what to expect when living at the home with some of this information needing to be in a more accessible format for residents. . The way in which prospective residents are assessed ensures that the home admits only those residents whose needs can be met by living at the home. Residents needs are being met through the home providing an age appropriate, relaxed and gentle lifestyles. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home. However, it is recommended that the service user guide be in a format that is more accessible to the people for whom the home is intended, for example through the use of symbols, easy read and Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: pictures. This will help ensure that residents are aware of the services and facilities provided and of their rights and responsibilities while residing at the home. There have not been any new admissions to the home for many years. Therefore the admission process was assessed in respect of the systems in place when a referral has been made. The manager was clear on the level of residents needs the home could meet and aware of an admissions process that would ensure that a range of information is gathered about prospective residents needs to ensure a smooth transition to the home. The residents currently residing at the home have lived there since the late 1990S with ages ranging from 56 to 59 years old. Residents are assessed as having low to medium level of needs and have learning disability and mental health needs. Through observation, looking at records and feedback from residents, staff and relatives, evidence was gathered that the home is meeting the range of residents needs through providing a relaxed, age appropriate and gently lifestyle. However as noted under standard 35 of this report some further staff training is needed to improve staffs knowledge of changes in good practices guidance and legislations when caring for people with a learning disability or mental health needs. All persons consulted spoke positively bout their experiences at the home. A health care professional fedback to my knowledge the home looks after him very well, he always looks happy and well dressed. Relatives fedback they all get on very well he thinks the world of the owner since being there he is much more stable they have done an excellent job and I can not speak highly enough about the home they are very good wonderful people. A resident spoke of how much they liked to live at the home and felt that this was their own family. Staff consistently spoke of the friendly homely atmosphere provided with a staff member commenting it is a nice quiet environment which suites both of the men that live here. The manager stated that prospective residents are provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. The first six weeks of residency is looked upon as trial occupancy. Each resident had been provided with a terms and conditions of residency some years ago. Subsequently the providers have developed a newer version and agreed to provide each resident with an updated version which includes being in a format that is more accessible to them, through the use of easy read, pictures or widgets. This is to Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: help ensure that they are aware of their rights and responsibilities while residing at the home. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process does not currently evidence the range of residents needs being supported or provide staff with the guidance they need to be able to meet these needs in an individual and consistent way. The home balances the rights of residents to take reasonable risks as part of an independent lifestyle. Services are designed to provide appropriate care and support in ways, which encourages participation and choice for the residents Evidence: Each resident had a plan of care, which also combined as a risk assessment on the risks faced and posed by each individual. Both care plans were viewed and these showed that they recorded the basic needs for each resident and did not reflect the level of support and input being provided for each resident. There is a stable staff team who demonstrated a good understanding of the needs and preferences of each Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: resident. However, it is necessary that care plans identify the range of assessed needs for each individual and provide staff with the guidance they need in order to be able to provide individual and consistent support. The providers showed enthusiasm for also improving the care planning process through greater use of person centred care planning principals, which creates a care plan designed around the individuals needs. A resident expressed little interest in being involved in the development and review of their care plans, but felt able to ask to see them at any time. Care plans recorded that they are regularly reviewed to ensure that any changes in residents needs and preferences are being identified. Daily notes are recorded on each resident, which recorded the actions and events that have occurred. These were written in a respectful and none judgmental style. However to promote good practices the recording in daily records should also be based on the residents individual aims and objectives in order to be able to easily assess when goals and needs are being worked towards and achieved. The home has a developed system in place for enabling residents to take responsible risks as part of an independent lifestyle. Core risks faced and posed by residents are assessed and measures to reduce or manage the risk is generally recorded for staff to follow. However in order to further promote residents safety the manager agreed to complete a risk assessments on a residents independent access to the community in order to identify any potential areas of risk. Residents were encouraged to make decisions in their daily lives and were heard to be given choices by staff about where they wanted to go, what they wanted to eat and drink, and how they wanted to spend their day. The providers had identified the need for further staff training around new legislation (Mental Capacity Act) which relates to residents rights to make decisions in their lives. They had also identified the need to include more details in care plans regarding residents capacity to make decisions. Residents participate in the day to day running of the home in accordance with the range of their individual preferences and strengths. The home is proactive in involving residents in as much of planning their day as possible. One resident was observed involved in light domestic duties and assisting to make lunch and a light snack. Staff demonstrated an awareness of good practice about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to take part in meaningful, age appropriate and enjoyable activities which help to enrich their lives and promote independence. Residents benefit by being supported to maintain relationships with their families and friends. Mealtimes and arrangements for eating are determined by residents and provide choice and variety. Evidence: Opportunities are available for residents to learn and use practical life skills for their personal development. This included involvement, in domestic and other housekeeping tasks as well as residents participate in activities in and outside of the home. A relative spoke of how the home has provided the support and stability Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: needed for their relative to improve their behaviour and independence. One resident undertakes part time work as part of an independent lifestyle as well as undertaking college courses in the past. The home has its own transport which is used to access a variety of social and leisure resources in the community such as local shops, bowling and restaurants. Residents are involved in a scouting group where they participate in a wide variety of events and activities. Residents and staff spoke enthusiastically about the annual overseas holiday, which this year was undertaken in Cyprus to enable a resident to participate in aspects of their cultural background. In response to what the home does well, a health care professional fedback support clients to maximise their potential in the community. Although the home has a computer for residents and staff to use this does not have internet access. A staff member felt that this would be beneficial to help residents and staff find out about local events and to further develop a residents computing skills. This was fedback to the providers. It was evident that residents are actively supported and encouraged to maintain family links through visits to their family, having family visit them at home and through telephone contact. Relatives fedback that they were able to visit at any reasonable time and of being made to feel very welcomed when they did visit. On the day of the inspection, it was observed that the routines of the home were reflective of residents individual needs and their preferences. Residents were able to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. Staff spoke of the flexibility in daily routines regarding meal times, going to bed, rising and bathing. Staff reported that residents are involved in menu planning, shopping for food and in some cases help prepare meals and snacks. Menus showed that a very flexible and varied diet is offered, including a residents favourite of take away meals. The inspector had lunch with a resident, staff and the providers where the meal was presented well, with the residents personal preferences respected. Mealtimes and arrangements for eating are tailored to meet the individual residents needs and what events and activities were occurring that day. It is practice for staff to also eat the meals provided with residents which helps to promote a positive social environment. Both residents spoke positively about the food and being involved in choosing what they ate and of being able to access hot drinks and snacks if they wanted throughout the day. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the provision of flexible and respectful personal and healthcare support that is individual, respects their privacy and dignity and encourages residents to remain as independent as possible. The medication systems are well managed promoting good health and residents safety. Evidence: Staff said that none of the residents currently require much physical support instead they prompt and motivate residents to maintain their own personal appearance. Staff consulted with showed an understanding of good practices in preserving residents rights to privacy and dignity when providing support. Staff were able to give many examples of how they promote these rights in their every day care practices. Residents are supported to access a range of health care services, to meet their individual needs and their health action plans. There was evidence of current involvement from General Practitioners, specialist nurses, opticians, chiropodists and Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: dentists. A resident said If I am not very well they call the Dr straight away. A relative praised staff for taking such prompt action regarding a recent health issue which if left would have been extremely serious. It was reported that none of the residents accommodated are assessed as safe to administer their own medication. The medicine administration practices observed was seen to be safe and the records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Good practices were noted in the management of (As prescribed ) Medication which provided staff with guidance on when they should be administered. The providers and staff demonstrated a good awareness of the needs of older residents and services and facilities were aimed appropriately for the age range of residents being accommodated. The providers were clear at the point of which the home would not be able to continue to safely meet the needs of individuals due to physical needs or palliative care. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An effective complaints procedure and appropriate adult protection policies and practices helps to protect the rights and interests of residents. Evidence: There is a complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All residents, staff and relatives consulted with said that they felt able to share any concerns they had with providers and where they have raised minor concerns in the past these have been addressed promptly. A relative said I would have no hesitation in raising any concerns and any little things are addressed straight away at this home. The manager reported that there have been no formal complaints made since the previous inspection. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with said that they had undertaken the necessary training in safeguarding adults and prevention of abuse and generally showed an understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual preferences and lifestyles. Evidence: The premises are a converted domestic property located in a residential area which is within walking distance of local amenities and transport links. One resident spoke of how importance it was to be able to access the local community by themselves. The home is well decorated and maintained with the providers reporting that some painting of bedrooms, new fire doors, creation of an internal smoking area and a new boiler has been completed since the previous inspection. Much effort is made to create a homely feel with relatives commenting on how quiet and calming the environment is. Communal space consists of a lounge, kitchen/dining and smoking lounge with a new TV having recently been bought for the lounge and a residents fish tank is displayed there. A conservatory is used as a staff office and sleep over room. There is an enclosed rear garden with patio area which residents are involved in maintaining. Bedrooms seen were individualised with residents personal effects and reflected their Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: preferences and lifestyles, both residents demonstrated how much they liked their bedrooms. A resident spoke of how they are responsible for keeping their bedroom clean and tidy. There are sufficient number of toilets and bathrooms located around the home including one bedroom providing shower en suite facilities. The home is not designed to offer a service to people with a permanent physical disabilities and the stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. However the providers were mindful of the potential decreased mobility as residents become older. Consistent feedback was received that standards of hygiene and cleanliness are good which was also confirmed during the inspection. Systems are in place for the control of infection with staff undertaking hygiene and cross infection training. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable staff team who know them and who are employed in sufficient numbers for residents to get the support they need and who are robustly recruited to promote residents safety. Staff know how to work safely with residents as they have received all of the mandatory training they need, however to ensure that staffs knowledge is updated in changes in good practices guidance and legislation some further specialist training is needed Evidence: It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. Staff spoke about the good levels of communication between themselves and the providers. The tasks of the day appeared well organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who was supporting them. Residents, relatives and staff consulted with felt that there was always sufficient staff on duty for residents to get the support they needed when they wanted it. A resident displayed many sings of positive body language in their interactions with staff. This Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: included touching, smiling and laughing. The home employs a small staff team who have worked at the home for some time and staff consulted with showed a good understanding of the preferences and needs of both residents and who clearly had a good rapport with them. All persons consulted spoke positively about the staff a resident said staff all my family they are all very nice. A relative commented staff very good, he is always talking about them when he is home with us. It was previously required that there is always staff available in the home at all times. Staff confirmed that there is a minimum of two staff on duty during weekdays with one staff member remaining at the home when residents are out. If this staff member has to then go out, on the homes business then the providers confirmed that the phones are diverted to the staff members mobile. This ensures that the home is contactable at all times, this is particularly important as one resident goes out independently and may need to get in touch with the home. The personal files of two newly appointed staff were inspected and these showed that the shortfalls noted at the previous inspection had been addressed. The recruitment process followed includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. This helps to ensure that only staff who are suitable to work with vulnerable people are employed. Although the manager had seen copies of staffs identity documents in order to complete CRB checks, copies had not been retained in the staff files. The providers provided written confirmation within twenty four hours that copies had now been obtained and stored in staff files as evidence of their identity. Staff on duty confirmed that they had undertaken all of the mandatory training necessary for them to work safely with residents this included safeguarding adults, infection control, health and safety, medication, first aid and fire. Several members of staff are trained nurses who have retired. The providers reported that several staff are in the process of completing or are about to commence National Vocational Qualification (NVQ) training in order to ensure that the majority of staff have this formal training. Not all staff had undertaken recent training in caring for people who have a learning disability or mental health needs. This is necessary in order for staff to be updated in good practices guidance and changes in legislation. The providers agreed to ensure that staff had this additional training by early 2010 to help further improve and update practices at the home. The providers reported that new staff complete the industry Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: recommended minimum induction standards. This helps to ensure that all new staff entering into the care industry have a minimum level of initial training. Staff confirmed that there is a formal programme of supervision and direct supervision with the providers working along side staff each shift. All staff consulted with felt well supported by the providers to undertake their roles. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well run with residents benefiting form a clear ethos and leadership approach. The home regularly reviews aspects of its performance through a program of feedback with views clearly being listened to. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: One of the joint providers is also the registered manager who originally trained as a learning disability nurse. The manager confirmed that they have also undertaken the recommended National Vocational Qualification (level4) in both management and Care and the Registered managers award. All persons spoke posatively about the manager /providers with particular reference to their apporacability and caring nature. A relative said they all get on very well he thinks the world of the owner. A resident Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: fedback that the manager was a very nice lady. Staff comments included always helpful and very good very flexible. The other provider also works regularly at the home and undertakes much of the general administration. There are several mechanisms in place for the home to obtain feedback on the quality of the services and whether it is achieving its aims and objectives. These include annual placement reviews, residents and staff meetings and feedback surveys. The providers reported that changes to the menu and environment have been undertaken in response to feedback. Staff spoke of the openness of the providers to new ideas with a staff member saying they listen and support the staff and listens to my request and suggestions about the home. Written guidance is available on issues related to health and safety. Records submitted by the providers prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. It was reported that no recommendations were made from the last visit by Environmental Health. The manager reported that hot water is regulated by mixer values and are checked regularly. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The provider reported that a fire risk assessment had been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The provider reported that recommendations made from the fire risk assessment have been addressed. It was previously required that risk assessments are completed on uncovered radiators from the risk of accidental scalding. The provider confirmed that after consultation with the local Environmental Health office risk assessments have been completed which they said the Health and Safety Executives confirmed were appropraite. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 That care plans provide clear 08/01/2010 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs. To ensure that residents range of needs are assessed and the appropriate guidance provided for staff on how to meet these needs in an individual and consistent way. 2 35 18 That staff receive the specialist training necessary to undertake their roles safely and meet the needs of people who have a learning disability or mental health needs. To ensure that staff are updated in good practices guidance and changes in 12/02/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 legislation effecting people with a learning disability and mental health needs. 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 That the information provided about the home for service user be in a more accessible format to help ensure that they are aware of their rights and responsibilities and what to expect when living at the home. Care Homes for Adults (18-65 years) Page 30 of 31 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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