Care Home: Maltings (The)

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What the care home does well One person had moved into The Maltings since the last inspection. Their needs had been well assessed before the move, so that a good decision could be made about whether The Maltings would be suitable for them. This person had made some introductory visits to the home. The outcome of the visits and the assessments had been written down. This meant that staff had good information about the person when they moved in. People have individual plans which provide staff with good information about what they like to do and how they should be supported. For example, there was information about people`s choice of drinks, the chairs that they prefer to use, and the order in which they like to do things when they get up. Risks are being assessed, which helps to ensure that the people who use the service are safe when in the home and when out in the community. The health of the people who use the service is being well monitored. People are well supported with seeing professionals from outside the home, so that their specialist needs are met. People are generally well protected by the way that the home deals with their medication. There are procedures in place which help to protect people from harm and help to ensure that any concerns are well responded to. Staff told us that one of the things that the home did well was the support that people received with their family relationships. Staff helped with the practical arrangements, so that visits could be made on a regular basis. There is a varied menu and people benefit from the individual support that they receive with their meals. The accommodation is generally homely and well maintained. There are communal rooms and a sensory room, which provide people with space for different activities. There is a good-sized garden, which includes an interesting range of features. People are supported by competent staff who have been safely recruited. Overall, the people who use the service benefit from a well run home. What has improved since the last inspection? Information about the home has been updated to reflect changes in the running of the home. Better information is available about financial matters, such as what the fees cover and what people need to pay for out of their own money. Individual support plans have been well developed, so that there is good information about people`s needs and personal goals. The plans clearly show when risk assessments have been undertaken, so that all the information in relation to a particular need is in one place.We were told that one person had been on holiday for the first time in five years and had `really enjoyed it`. Improvements have been made to the home environment. This was very noticeable in the lounge, which has been given a makeover and now has a more modern and coordinated appearance. The grounds have also received attention and access to the home has improved. Garden furniture has been bought and some new features installed, such as solar lighting and a gazebo. An in-house, I.T. based system of `e-learning` has helped staff to keep up to date with mandatory training. There is a more settled staff team. This helps to ensure that there is good continuity of support for the people who use the service. The registered manager, Mrs Wainwright, is now well established in the post. Mrs Wainwright is focussed on the needs of the people who use the service. The feedback that we received showed that people are confident about how the home is being managed. What the care home could do better: The people who use the service are generally well protected by the way in which staff are recruited. However, a record needs to be kept to show that any gaps in employment have been identified and the reasons for these discussed with the applicant. This is to ensure that there is good evidence of an effective recruitment procedure. We were told in the AQAA that one thing that the home could do better would be to fully develop the Individual Support Plans. We have made two recommendations in connection with the plans. These include ensuring that people`s progress with achieving their personal goals is more consistently monitored and recorded. This will help to ensure that people are making the progress that they are capable of, and that the goals continue to be relevant. We were told that there are plans to involve people in more community activities and be given the opportunity to try new things. A new vehicle is needed to ensure that the people who use the service, and the staff supporting them, have the use of a vehicle which is practical and comfortable for them. A lot of training was being delivered inhouse using the I.T. based system of `e-learning`. Staff members had mixed feelings about the use of `e-learning`. They told us that it was convenient to use, but it meant that there was less interaction with other people. Staff also commented about being offered a wider range of training. We have made recommendations about reviewing the home`s training plan and giving staff the opportunity to attend more external training courses. This is to ensure that staff receive training which reflects the diverse needs of the people who use the service, and helps them to develop their understanding and knowledge of learning disabilities. A senior manager from Voyage visits The Maltings regularly and reports on the conduct of the home. The visit format includes questions for staff and for the people who use the service. However, the question format is not appropriate for the people who use the service. We have recommended that the use of questions during monitoring visits to the home is reviewed. This is with the aim of finding a more appropriate means of gaining feedback about the quality of service that the people at the home experience. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Maltings (The) Brewers Lane Shelbourne Road Calne Wiltshire SN11 8EZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 2 6 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Maltings (The) Brewers Lane Shelbourne Road Calne Wiltshire SN11 8EZ 01249815377 F/P01249815377 Telephone number: Fax number: Email address: Provider web address: www.voyagecare.com Name of registered provider(s): Type of registration: Number of places registered: Milbury Care Services Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home The Maltings is run by Milbury Care Services Limited, a subsidiary company of Voyage Group Limited which trades under the name of Voyage. The property is owned by a housing association. The Maltings has places for three people with learning disabilities, who may also have a physical disability or a sensory impairment. The home is situated in a residential area on the outskirts of Calne. It is a detached Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 0 3 3 3 Brief description of the care home bungalow with a large garden. The accommodation at The Maltings includes three single bedrooms, a dining room, a lounge and a sensory room. One of the bedrooms has an en-suite bathroom. Other facilities include a kitchen, a utility area, two toilets, a shower and a bathroom. There is an office and a sleeping-in room for staff use. People who use the service receive support from the homes manager and a permanent staff team. The fee levels at the time of this inspection ranged from 1234.80 - 1505.90 pounds per week. Information about the home is available in a Statement of Purpose. Copies of inspection reports can be obtained from Milbury Care Services. They can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 36 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: Before visiting The Maltings, we had asked the manager to complete an Annual Quality Assurance Assessment known as the AQAA. This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. We sent surveys to the home so that these could be given out to the people who use the service, to staff members and to healthcare professionals. This was so that we could get their views about the home. We had surveys back from the three people who use the service, six staff members, and one healthcare professional. The surveys for the people who use the service had been completed by staff on their behalf. We also spoke on the telephone to three people who had family members living at the home. We looked at all the information that we have received about the home since the last Care Homes for Adults (18-65 years) Page 6 of 36 inspection. This helped us to decide what we should focus on during a visit to the home, which took place on 26th August 2009. During the visit we met with the people who use the service and with staff members. Mrs Wainwright, the registered manager, was present during our visit. We went around the home and looked at a number of records. The previous inspection of The Maltings took place on 22nd August 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? Information about the home has been updated to reflect changes in the running of the home. Better information is available about financial matters, such as what the fees cover and what people need to pay for out of their own money. Individual support plans have been well developed, so that there is good information about peoples needs and personal goals. The plans clearly show when risk assessments have been undertaken, so that all the information in relation to a particular need is in one place. Care Homes for Adults (18-65 years) Page 8 of 36 We were told that one person had been on holiday for the first time in five years and had really enjoyed it. Improvements have been made to the home environment. This was very noticeable in the lounge, which has been given a makeover and now has a more modern and coordinated appearance. The grounds have also received attention and access to the home has improved. Garden furniture has been bought and some new features installed, such as solar lighting and a gazebo. An in-house, I.T. based system of e-learning has helped staff to keep up to date with mandatory training. There is a more settled staff team. This helps to ensure that there is good continuity of support for the people who use the service. The registered manager, Mrs Wainwright, is now well established in the post. Mrs Wainwright is focussed on the needs of the people who use the service. The feedback that we received showed that people are confident about how the home is being managed. What they could do better: The people who use the service are generally well protected by the way in which staff are recruited. However, a record needs to be kept to show that any gaps in employment have been identified and the reasons for these discussed with the applicant. This is to ensure that there is good evidence of an effective recruitment procedure. We were told in the AQAA that one thing that the home could do better would be to fully develop the Individual Support Plans. We have made two recommendations in connection with the plans. These include ensuring that peoples progress with achieving their personal goals is more consistently monitored and recorded. This will help to ensure that people are making the progress that they are capable of, and that the goals continue to be relevant. We were told that there are plans to involve people in more community activities and be given the opportunity to try new things. A new vehicle is needed to ensure that the people who use the service, and the staff supporting them, have the use of a vehicle which is practical and comfortable for them. A lot of training was being delivered inhouse using the I.T. based system of e-learning. Staff members had mixed feelings about the use of e-learning. They told us that it was convenient to use, but it meant that there was less interaction with other people. Staff also commented about being offered a wider range of training. We have made recommendations about reviewing the homes training plan and giving staff the opportunity to attend more external training courses. This is to ensure that staff receive training which reflects the diverse needs of the people who use the service, and helps them to develop their understanding and knowledge of learning disabilities. A senior manager from Voyage visits The Maltings regularly and reports on the conduct of the home. The visit format includes questions for staff and for the people who use the service. However, the question format is not appropriate for the people who use the service. We have recommended that the use of questions during monitoring visits Care Homes for Adults (18-65 years) Page 9 of 36 to the home is reviewed. This is with the aim of finding a more appropriate means of gaining feedback about the quality of service that the people at the home experience. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 11 of 36 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. Information is available about the home, which helps people to make an informed choice about where to live. Peoples needs are assessed before they move in, so that a decision can be made about whether The Maltings will be suitable for them. Evidence: A Statement of Purpose for The Maltings was available in the home. This had been updated to reflect changes in the running of the home since the last inspection. People who lived at the home had received a Service Users guide. This included information about the home and the service that people could expect to receive. We had made a requirement at the last inspection that there must be better information provided about financial matters, such as what the fees covered, and what people needed to pay for out of their own money. We saw that information about this has now been included in the Service Users guide. For example, there was information about how meals are paid for when bought outside the home. The Service Users guides had been written in a user-friendly way. However, they had Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: not been produced in formats that would meet the communication needs of the people who use the service. We were told in the AQAA that one of the things that the home could do better would be to ensure that appropriate documents were made available in individualised formats to meet peoples needs. A copy of the last inspection report for The Maltings was readily available in the home. Two people had lived together at the home for several years. One person had left The Maltings since the last inspection and somebody new had moved in. Mrs Wainwright told us that the move had gone well and the person was now well settled. Information about this persons needs was being kept in a personal file. The home had obtained an up to date community care assessment (CCA) from the persons funding authority. The CCA included a planned schedule of visits that the person would make to The Maltings, so that they could see the home and meet with people. These visits had taken place. A staff member told us that a visit had also been made to the care service where the person had been receiving respite care. Notes of these introductory visits had been kept. They included a number of things that had been learnt about the person during the visits, such as how they got on with other people. This helped to ensure that staff had good information about the person when they moved in. Mrs Wainwright had also carried out a pre-admission assessment of the persons needs. A copy of this was kept on their personal file. The assessment covered a range of areas, such as health, medication, diet, communication and financial affairs. Care Homes for Adults (18-65 years) Page 13 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual support plans are being well developed, so that there is good information about peoples needs and personal goals. The people who use the service have limited capacity to make informed decisions and they benefit from the support that they receive from staff. Risks are assessed, which helps to ensure that people are safe in their daily activities. Evidence: It was reported in the AQAA that each person had an Individual Support Plan, which was based on an assessment of their needs. We were told that these plans had replaced the previous care planning documentation. In their surveys, we asked staff whether they were given up to date information for example in the care plan about the needs of the people they supported or cared for. All the staff members responded Always to this question. We saw that each person had an Individual Support Plan on their personal file. These Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: were comprehensive documents which showed the support that people needed in different areas of their lives. There was information recorded under the heading My preferred routines. This provided very detailed descriptions of what people liked to do and how they wished to be supported during the day. For example, there was information about peoples choice of drinks, the chairs that they preferred to use, and the order in which they liked to do things. Dates had been added at the top of the pages, which showed when the information had been reviewed. We thought that it would also be useful to add a comment about the outcome of the reviews although there was no section for this on the forms. Other information was recorded under the heading My Plan of Support. This included a range of forms which covered peoples needs, for example in relation to physical health; mobility; relationships; personal care; behaviour; and activities and holidays. Short and long term goals were recorded for each area of need, together with guidance for staff about how to deliver support. We had recommended at the last inspection that peoples progress with achieving their goals was more consistently monitored and recorded. Mrs Wainwright said that peoples goals were discussed at staff meetings, although there was no formal system for monitoring and recording progress on a regular basis. We thought that this record would provide useful evidence at review meetings, when peoples needs and goals were being formally discussed. We were told in the AQAA that one thing that the home could do better, would be to fully develop the Individual Support Plans. We saw that the plans of support had been worked on and completed over several months. One change since the last inspection has been to introduce a system of cross-referencing in the plans to show when a risk assessment had been undertaken. This was something that we had recommended at the last inspection, so that all the information in relation to a particular need would be readily identified. We saw that risk assessments had been undertaken in relation to tasks and activities involving the people who use the service. Risk assessment records were contained on peoples personal files. They included information about safety measures, and guidance for staff which would help to ensure that peoples activities went smoothly. For example, we read that one person liked to go bowling, but there was a risk that they would interfere with other peoples games. There were guidelines for staff to follow about how to prevent this from happening. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: We met with the people who used the service, although there was very limited verbal communication possible. Staff told us that they had got to know each persons likes and dislikes, which was important because people could not always make their preferences known. We were told of occasions when people were encouraged to make decisions, for example about what clothes to wear. Peoples personal files included Communication Passports, which described how people expressed themselves. We were told in the AQAA that the staff members had helped to write peoples individual support plans, and that their experience of supporting people over many years had enabled them to recognise the different forms of nonverbal communication which people used. During the visit we observed people using the different areas of the home and being able to choose where to spend their time. People had their own rooms which they could decorate and personalise as they wished. Care Homes for Adults (18-65 years) Page 16 of 36 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. People are provided with a range of activities that include their involvement in the local community. They receive support which helps them to maintain relationships and make choices in their daily lives. There is a varied menu and people benefit from the individual support that they receive with their meals. Evidence: We arrived at the home at 9.30 am. One person was out at a local resource centre and we met them when they returned home later in the day. Two people were getting ready to go swimming at a public pool. Information was recorded on peoples personal files about their daily routines and how they spent their time during the week. On some days, people attended local authority Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: run day services. There were other times on the day about what to do. People who weekly food shop at a local supermarket. provided an overview of what people had significant events or issues arising. during the week when decisions were made use the service were involved with the Daily reports were being written which done and whether there had been any The home had its own vehicle, which meant that trips out could be easily be arranged, as long as one of the staff on duty was an authorised driver. Mrs Wainwright said that there were plans to change the homes vehicle to a different model. This was mainly so that there would be more space for people, and for items such as wheelchairs that were sometimes needed. Staff said that people liked going out. It was reported in the AQAA that the homes plans for improvement included providing people with the opportunity to try new things. We were also told that one person had been on holiday for the first time in five years and had really enjoyed it. There were rooms in the home where people could participate in different activities and spend time apart from each other when they needed to. This included a large lounge with a television, and a separate dining room that could also be used for table activities. The garage had been converted into a sensory room, which we were told one person in particular liked to use. The garden was being well developed as a recreational area. Peoples personal files included information about their family backgrounds and diverse needs. For example, we read in one persons file that they did not have any faith needs and did not attend church, but they would like the opportunity to go to a local church at Christmas because they enjoyed carols. It was also recorded that this would be kept under review in case I change my mind. We thought that this was good practice, as it did not assume that peoples needs in relation to diversity would not change over time. One staff member told us that people were well supported with their family relationships. People had close relatives who lived locally. Staff helped with the practical arrangements, so that visits could be made on a regular basis. Information was included on peoples personal files about their important relationships. Birthdays and significant dates were recorded, so that people could be supported with sending cards and keeping in contact at important times. We spoke to three people who had family members living in the home. They told us that the home kept them up to date with significant events. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: During our visit, the two people who had been swimming in the morning returned to the home for lunch. Staff made sandwiches with different fillings, which were then cut up so that both people could manage these themselves with minimal assistance from staff. The two people each had a support worker sitting by them to encourage and prompt with eating. Staff knew where people liked to sit at the dining table. People had their main meal in the evening. Staff told us that the people who use the service could not always make their preferences known, but knowledge about their likes and dislikes had been gained over time. This was then taken into account when the menus were written each week. We looked at examples of the menus, which showed a varied range of meals being served. The daily report forms included details of the food that people had eaten. This helped to ensure that peoples nutritional intake was monitored and followed up if necessary. Information was recorded in peoples individual support plans about their particular needs and likes and dislikes. This highlighted areas of risk, such as choking, and provided guidance for staff about how to reduce these. Care Homes for Adults (18-65 years) Page 19 of 36 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. Peoples personal and health needs are met. They are mostly well protected by the homes procedures for dealing with medication. Evidence: Peoples personal files included guidance for staff about their personal care and health needs. Information was recorded under headings such as My Health and My Plan of Support. Risk assessments and support plans highlighted particular areas of need, for example in relation to epilepsy, mobility and bathing. Overall, these records provided a detailed account of peoples individual needs. Some sections were less informative. For example Autism was mentioned in one persons My Health record, although no information about this had been recorded under the heading How it might affect me. People looked well supported with their personal appearance. They had their own rooms where personal care could take place in private. One person also had an ensuite bathroom. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: The staff team included one male support worker, which Mrs Wainwright and staff said was particularly beneficial for a male user of the service. Mrs Wainwright told us that the home had a policy for personal care, which meant that female users of the service would only receive personal care from female support workers. Staff confirmed that this policy was being followed. The people we spoke to on the telephone, with family members living at the home, told us that they thought the home was meeting peoples care and health needs well. Daily reports were being written which included observations about peoples health and welfare. Overall, there was a lot of information recorded about on-going health matters. This showed that staff were aware of the importance of supporting people in this area. Peoples weights were being recorded regularly, to help identify any significant changes which might need to be followed up. Health Action plans had not yet been written with the people who use the service. The home had recently received booklets to be completed in connection with this. In their survey, the healthcare professional commented that they were impressed by the standard of care at The Maltings. They responded Always to the question Does the care service seek advice and act on it to meet peoples social and health care needs and improve their well being. They also confirmed that peoples health care needs were being properly monitored, reviewed and met by the service. Staff supported people with making appointments with healthcare professionals. People were registered with local GPs and there were arrangements in place for seeing dentists and opticians. Reports were being kept of peoples contact with healthcare professionals. These records showed how particular health conditions had been followed up. This helped to ensure that there was good information when peoples health needs were being reviewed. We read about the support that people had received from outside professionals, such as a consultant psychiatrist and specialists from the community team for people with learning disabilities. The people who use the service received support from staff with managing their medication. We read that a consultant psychiatrist had recently reviewed peoples prescribed medicines. There was a locked cabinet for the storage of medication. The home did not have a medication cabinet which complied with the current requirements for the storage of controlled drugs. These drugs were not being prescribed at the time of our visit. One person was prescribed a PRN (as required) medicine in connection with their epilepsy. This particular medication is exempt from the requirements for controlled drugs, although it is strongly recommended that it is stored and recorded as one. Staff Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: members told us that they had received training before being able to administer this medication. Staff members had received training in medication handling and the homes medication procedures. Records were being kept of medication received into the home and of its administration to people. Changes to peoples medication had been documented and signed. Care Homes for Adults (18-65 years) Page 22 of 36 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. People who use the service are dependent on others to raise any concerns and complaints on their behalf. There are procedures in place, which help to ensure that any concerns are followed up and people are protected from harm. Evidence: Milbury Care Services Ltd (Voyage) had produced a leaflet about concerns, complaints and suggestions. It was reported in the AQAA that the people who use the service had a copy of an easily accessible complaints plan. However, we were also told that people would not have the capacity to make a formal complaint, and that their parents had been given a copy of the complaints procedure. We were also told that regular meetings were being held with significant others, when people could feedback any concerns that they had regarding the service. Mrs Wainwright said that the home had not received any complaints during the last year. No complaints or concerns have been raised with the Commission during this time. All the staff members who completed surveys confirmed that they knew what to do if somebody had concerns about the home. In their surveys, we asked the people who use the service whether they knew who to speak to if they were not happy with Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: something. Staff members had commented on their behalf Indicates distress to staff; Staff who know me can identify if Im unhappy and would act accordingly and I make my ways known with expressions and actions. We also asked in the surveys whether people knew how to make a complaint. The comments included My parents have all information and do this on my behalf if needed; Staff do this on my behalf or parents and Yes, my mum has all the information. The three people we spoke to who had family members living in the home told us that they knew who how to make a complaint. They also said that they would be able to approach the homes manager if they had any concerns. Policies and procedures had been produced about the prevention of abuse and the responsibilities of staff. A copy of the No Secrets booklet was displayed in the homes office. This gives guidance about the local multi-agency procedures for the reporting of concerns and allegations of abuse. Staff confirmed that they received training about abuse and the safeguarding of vulnerable adults. This was included in the homes programme of mandatory training. There have been no safeguarding adults referrals or investigations during the last year. Body maps were being used in the home to identify and record any physical changes in the people who use the service, which could be seen as a cause for concern. People received support from staff with the management and safekeeping of their personal money. Mrs Wainwright told us that Milbury Care Services were appointee for one person who uses the service, and that this had been arranged with the persons funding authority. Records were being maintained of the personal money that the home kept safe on behalf of the people who use the service. As reported under the Choice of Home section, better information was being recorded about what the fees covered, and when people might need to use their personal money. Mrs Wainwright also told us that people contributed their mobility allowances towards the costs of transport when going out, for example when using the homes vehicle. The amounts that people contributed varied, although this did not appear to be linked to their actual use of transport. Care Homes for Adults (18-65 years) Page 24 of 36 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. People have accommodation that meets their needs. The home is kept clean and tidy. Improvements are being made which help to ensure that people have an interesting and well maintained home environment. Evidence: The Maltings is in a quiet residential area of Calne. The home is well located for getting into the town centre. The close proximity of the A4 meant that people were also well placed for getting to other towns and the countryside. We reported at the last inspection that the property had not been designed with a wheelchair user in mind, and that there were shortcomings in how well the environment met peoples needs. Since the last inspection, the person who was using a wheelchair had moved out of The Maltings. The people who currently use the service did not have mobility problems that required the use of wheelchairs in the home. We saw that there had been a number of improvements to the environment since the last inspection. This was very noticeable in the lounge, which had been given a makeover and had a more modern and co-ordinated appearance. This has been helped by the removal of an old stone fireplace. We were told in the AQAA that there were also plans for the kitchen and bathroom to be refurbished. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: In addition to a large lounge, there was also a dining room and a sensory room. These rooms provided people with a choice of communal areas with different outlooks. We were shown peoples bedrooms. People had been well supported with personalising their rooms, so that they reflected peoples known preferences and interests. One person had an en-suite bathroom. Other people used a bathroom and toilet which were close to their rooms. Most areas of the garden were well established. There were shaded sitting areas and a sun house. The grounds had also received attention since our last inspection. Access to the home has been improved. Garden furniture has been bought and some new features installed, such as solar lighting and a gazebo. Large, painted plant boxes, personalised with peoples names, had also been placed where they could be seen from the lounge. We thought that the garden was being developed very well. It was large enough for further features and areas of interest to be created over time. The garden at the front and on one side of the house was being maintained for use by the people who live at the home. We had been told at the last inspection that there were plans to undertake work on the other side of the property to make this area safe for the people. We saw that paving stones have been put down since the last inspection. However there had been problems with how they had been laid, which Mrs Wainwright said was being followed up with the housing association that owns the property. The accommodation looked clean and there were no unpleasant odours. There was a utility room where the laundry was carried out. This was located beyond the kitchen. There were systems in place for reducing the risk of cross-infection when moving soiled items through the home. Staff members had received training in infection control. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent staff who have been safely recruited. An in-house programme ensures that staff members undertake regular training. Participation in other training would assist staff in their professional development, for the benefit of the people who use the service. Evidence: There was a staff team of six permanent support workers. The homes manager, Mrs Wainwright, also supported the people who use the service with their day to day needs as was evident during our visit. The staff team included a male support worker and female support workers, to support the male and female users of the service. This meant that the homes policy on gender and personal care could be properly implemented. The deployment of staff during the day varied, depending on peoples activities. Two staff members slept in at night. In their surveys, we asked staff whether there were enough staff to meet the individual needs of all the people who use the service. Four staff responded Always to this question, and two staff Usually. The people we spoke to on the telephone, who had family members living at the home, told us that they Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: thought there was good continuity of staffing at the moment and that the staff were meeting peoples needs well. We were given information in the AQAA about the staffing arrangements. One staff member had been appointed during the last year. The staff team included staff who had worked at the home for several years, and others who had joined the team more recently. In their surveys, and during our visit, staff members commented positively about the staff team and how staff worked well together We were told in the AQAA that the staff team had built up a good knowledge of the people who use the service, in relation to their needs and preferred daily routines. This knowledge had been incorporated into peoples Individual Support Plans, so that it would be available to new staff. One staff member had left during the last year. We looked at the recruitment records for three support workers who had been appointed since the last inspection. Checklists had been completed to show the dates on which references had been received and other checks completed, for example in relation to Criminal Record Bureau (CRB) disclosures the POVA (Protection of Vulnerable Adults) list and the applicants identity. We read that one staff member had started in the home after the POVA list had been checked, but before the outcome of their CRB disclosure was known. This person confirmed that they had been supervised and had a limited role in the home until their CRB disclosure was returned. All the staff members who completed surveys confirmed that their employer had carried out checks on them before they started work. The recruitment checklist included the heading Employment History, with a statement about the need for any gaps between posts to have been discussed. We saw that one persons application form for employment did show gaps between posts. This appeared to be for family reasons, although there was no record made to confirm the reason and to show that it had been discussed with the applicant. We were told in the AQAA that all staff had completed an accredited programme of induction. We asked staff in their surveys whether their induction had covered everything they needed to know to do the job when they started. There was a mixed response to this. Four staff members responded Very well one Mostly and one Partly, After their induction, staff members were expected to continue their development by completing a National Vocational Qualification (NVQ). Four support workers had Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: achieved NVQ in care at level 2 at the time of our inspection. There was a training matrix which gave an overview of when mandatory training had been provided. This also helped to identify when refresher training was due. Staff members also had their own individual training records. The staff we met during our visit, and those who completed surveys, commented on the on-going training that was being provided. We were told that all mandatory training courses were being provided. A lot of training was delivered inhouse using an I.T. based system of e-learning which staff accessed on an EL Box. Staff said that the exception to this was training in manual handling and first aid. Staff members had mixed feelings about the use of e-learning. They told us that it was convenient to use, but it meant that there was less interaction with other people. One staff member commented Go back to face to face training - not all on the EL Box. There was also a comment about offering a range of training, other than statutory, which would help staff to understand and meet the needs of the people being supported. Staff said that training in the protection of vulnerable adults was being provided using e-learning. A comment was made that it would also be useful to receive this training from a source outside the home. This would help staff to develop their knowledge of the local procedures, from somebody who works in the field. We were told in the AQAA that some additional courses had been put on the EL Box during the last year. It was planned in the next 12 months to do more research into specialised courses for the staff. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a well run home. Procedures are in place, which help to ensure that improvements are made and people benefit from a safe environment. Evidence: Before becoming the manager at The Maltings, Mrs Wainwright had gained management experience as the deputy manager at another care home. She also knew The Maltings from having previously worked at the home in the role of senior support worker. Mrs Wainwright was registered as the manager of The Maltings in May 2008. As part of the registration process, the applicant is required to show that they are a fit person to manage the home. Fitness refers to a number of personal attributes, such as having integrity and being of good character. The applicant will also have demonstrated that they have the qualifications, skills and experience that are necessary for managing the care home. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Mrs Wainwright has completed the Milbury Care Management Development Programme since being registered as manager. This provided the theoretical evidence for the NVQ at level 4 in Leadership and Management in Care, which Mrs Wainwright told us she was undertaking. Staff spoke positively in their surveys and during our visit about their experience of the home and how it was being managed. The people we spoke to on the telephone expressed their confidence in the way that the home was being managed. They also felt that the manager was approachable. The relationships between people at the home appeared to be friendly and positive. Mrs Wainwright worked alongside staff members and provided hands on support to the people who use the service. This meant that she had got to know people well and understood their needs. A senior manager from Voyage visited the home regularly and produced reports about the conduct of the home. The visit format included questions for staff and for the people who use the service. This was so that they could give feedback about the home, with different areas being looked at each month. However, the question format was not appropriate for the people who use the service and N/A had been recorded on occasions. Milbury Care Services had produced a system of quality assurance, which included Operational Reviews. The most recent of these was carried out between January and March 2009. The report contained an action plan for improvements and areas to develop further. These included looking at menu planning and the use of complaint cards for the people who use the service. We were given information in the AQAA about the arrangements being made for servicing equipment and appliances in the home. We were told that the companys health and safety policies and procedures had all been reviewed and updated during the last year. During our visit we went around the home and saw that covers had been fitted to the radiators. We were told that temperature regulators had been fitted to the hot water outlets to reduce the risk of scolding. A record was being kept of weekly checks of the hot water temperatures. A range of other checks were being recorded, including a monthly health and safety audit. We saw records of risk assessments that had been undertaken in relation to the home Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: environment. These covered a varied range of activities, such as the disposal of clinical waste, using the garden mower and cooking. There was a fire risk assessment and a plan for evacuation. Care Homes for Adults (18-65 years) Page 32 of 36 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 33 of 36 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 34 19 A record must be kept to show that any gaps in employment have been identified and the reasons for these discussed with the applicant. This is to ensure that there is evidence of an effective recruitment procedure which protects the people who use the service. 27/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 That peoples progress with achieving their goals is more consistently monitored and recorded. This will help to ensure that people are making the progress that they are capable of, and that the goals continue to be relevant. This is a recommendation from the previous inspection. That a comment about the outcome is added when the support plans are reviewed. This will help to ensure that the plans included up to date information which reflect peoples current needs. Page 34 of 36 2 6 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 3 13 That the plans to change the homes vehicle are progressed as a matter of priority. This to ensure that the people who use the service, and the staff supporting them, have the use of a vehicle which is practical and is comfortable for them. That Health Action plans are completed in conjunction with the appropriate healthcare professionals. That a cupboard which meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 is installed in the home. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. That a record is kept to show when the emergency medicine for epilepsy has been taken out of the cupboard and of the amount remaining on each occasion. This is to ensure that the medicine is being well accounted for, and the reasons for any changes in quantity are clearly identified. That information is recorded in peoples personal records about the use of their mobility allowance and how this contributes to the cost of transport. This is so that there can be no misunderstandings about how peoples money is being used. That, where appropriate, staff are given the opportunity to attend external training courses, which builds on the training that they have received through e-learning. That the homes training plan is reviewed in order to include a wider range of subjects. This should include subjects which reflect the diverse needs of the people who use the service, and which will help staff to develop their understanding and knowledge of learning disabilities. That the use of questions during monitoring visits to the home is reviewed. This is with the aim of finding a more appropriate means of gaining feedback about the quality of service that the people at the home experience. 4 5 19 20 6 20 7 23 8 35 9 35 10 39 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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