Care Home: Marlow

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What the care home does well The home has an assessment process which enables the manager to decide whether Marlow can meet the needs of the individual. The ones we saw on this occasion were completed and were used to inform the care plan. The care plans were informative and advised staff what the strengths and abilities of the individual are as well as what they need to do support individual needs. Where individuals wished to be self caring or carry out an activity, we saw that there were risk assessments to lessen any identified problems. Daily routines in the home are flexible and people who use the service are encouraged to make choices for themselves and exercise personal autonomy as far as reasonably possible. One survey commented that "no effort is spared to ensure the physical, psychological and social well being of all clients, relatives and friends". Another said " Marlow and its staff and people who live there are all that an establishment should be. At the level at which it operates it is a centre of excellence". The home is regularly maintained and is comfortable with pleasant furnishing. The home safeguards people`s monies with their recording and storage. We saw that new staff had been recruited and that the home had carried out checks to protect people who use the service. New staff have begun induction training in working at the home. Staff have received updated training in many areas such as moving and handling. What has improved since the last inspection? A quality assurance programme is underway enabling people who use the service and their relatives to have a say about the running of the home. Following the last visit we made a requirement for the home to ensure that there was sufficient stock of medication and that the monitoring of stock was safe. When we visited we found that the home had met this and were monitoring medication monthly. We also required the home to send us notifications of events that affected the well being of people that use the service. We can confirm that we have received these notifications. What the care home could do better: No requirements for action were made on this occasion. Key inspection report Care homes for adults (18-65 years) Name: Address: Marlow 8 Nursery Lane Worthing West Sussex BN11 3HS     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: Val Sevier     Date: 0 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: Marlow 8 Nursery Lane Worthing West Sussex BN11 3HS 01903212405 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Rebecca Karen Ward Name of registered manager (if applicable) Mrs Ruth Lyall Brown Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 14. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home The home has been purpose built on the site of a demolished local authority care home in the town centre of Worthing. There is car parking at the front and patio garden to the rear of the house. Accommodation includes a fully fitted kitchen, a large lounge, dining room, laundry and staff office. Each bedroom is large and airy with fully accessible shower en-suite facilities. All have full ceiling tracking systems from bed to toilet. Furniture includes a wardrobe, chest drawers and bedside cabinets with lockable Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 14 14 1 9 1 1 2 0 0 8 Brief description of the care home drawers. Toilets and bathrooms are wheelchair accessible. The decoration throughout communal areas is neutral, bright and airy with good natural light and is domestic in appearance. Fees charged for living at the home range from one thousand three hundred and ninty nine pounds to three thousand one hundred and thirty six pounds a week. It should be noted that any fee information included in this report applied at the time of inspection and that people may wish to obtain more up to date information from the care home. Care Homes for Adults (18-65 years) Page 5 of 30 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 2 star. This means the people that use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 9th November 2009 between the hours of 09:55 and 3:00pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in November 2008. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Adults (18-65 years) Page 6 of 30 meeting the needs of people who live at the home. We met with the proprietor, manager, and two staff. We looked at two pre admission assessments, three care plans, medication records, staff files and training records and fire prevention testing and training records. At the time of writing this report we have received five surveys from staff three from health care professionals and five from people who use the service who were supported by staff to complete the form. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 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. People that use the service can be assured that their needs will be assessed to ensure that the home has an understanding of their care needs. Evidence: The AQAA for the home said: Following initial referral we obtain the social services assessment. This is analysed by the Provider, Rebecca Ward, who then contacts the care manager to arrange further assessment. Rebecca supplies literature in the form of a service user guide which is available in picture format where needed and link to the website which the social worker provides to the potential service user. Rebecca will then visit the service user in their current home. In attendance are the service user, social worker, family, advocate and any other professionals involved in the service users care. Rebecca Ward will complete a pre admission assessment which addresses every aspect of an individuals care, abilities, needs and wants. This assessment is completed with the service user using appropriate equipment or advocacy should the individual have communication difficulties. Following the assessment, if Rebecca feels a service can be offered, the next stage begins. The Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: service user and those involved in their care are invited to the home. The service user will visit and meet the other service users and compatibility assessed. If the visit is positive, Rebecca will develop a care package and calculate costs which are presented to the funding authority. Subject to the content of the care package being agreed by the social worker and service user, Rebecca will offer a place at the home. Before the the care plan is finalised, all aspects must be reviewed by the service user and their representatives. It will detail every aspect of an individuals care: Life history, Communication, Personal care, Psychological aspects, Medical and Health issues, Continence, Mobility, Clothing, Meal times, Night time care, Sexuality and Relationships, Family, Peer group, Cultural needs, Strengths, Likes, Dislikes, Activities, Community Living Skills, Risk Assessment and Money Management. When adaptations, specialist equipment and training is in place, transition can begin. The service user leads this process and the timescales are flexible. Day visits and then overnight stays happen before a move in date is agreed. We saw two pre admission assessments carried out by the home and these were supported with information from other health care professionals. We saw that there was information on individual needs based on their present and past medical history for example, communication and personal care. The assessment offered choices and space for individual issues to be written. For example medication particular to the individual which helps to alleviate epileptic seizures. Information from family carers on how to support their loved one was seen incorporated into the assessment. We also saw that the carers for example family or advocates were involved in helping to plan admission to the home once agreed. Where possible the people who may wish to use the service are involved in the assessmenst and this includes a visit to the home. On the day of our visit the registered manager showed us an updated pictorial service user guide, the home has changed the colour of the card this is printed on from red to white it seemed clearer. When we looked around some of the home we saw that these pictorial guides of what the home offers, were on the walls of the bedrooms. The manager said they liked to go through these with the people living at the home every so often. Care Homes for Adults (18-65 years) Page 12 of 30 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. The care plans detail the needs of the individual and support staff are to give and staff working practice helped to ensure that the privacy, safety and autonomy of people who use the service is promoted. Evidence: The AQAA for the home said:The care plan and associated risk assessments are implemented at the outset and all staff are fully aware of their contents. These documents are integral to the induction process. The care plan is reviewed and updated monthly. There is a system in place, whereby the service user meets with their key worker to discuss each aspect of the care plan. This information is recorded and then shared with the home manager. The information is then incorporated into the care plan which is then becomes a working document formulated by the service user, key worker and home manager. The care plan not only documents care requirements, but wants, aspirations, future goals and plans to achieve these. Risks associated with needs or behaviours are clearly documented, as are management Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: strategies. Service users are supported to make choices in their day to day lives without judgement or imposition by staff. Choices are respected and facilitated through positive risk taking to afford individuals the right to own decisions and consequences. Autonomy is always promoted and service users are provided with information so they can make an informed decision; an example of this is staff providing service users with information on all available college courses so that service users can make their own choice. Advocacy is encouraged and choices about lifestyle and self determination implemented into the care plan. Where service users do not need an appointee to manage their finances, they are supported to access their full benefit entitlement. Where service users require an appointee, the home manager will assist them in appointing an appropriate individual. We looked at care plans for two individuals living at the home and all documents associated with their care and support. On the first plan we saw that there was information on family and social support. There was information on how staff should support the individual. For example : how I communicate with you, with detailed descriptions of verbal and non verbal actions such as repeats words and phrases staff need to be observant and help stop this by engaging the person with something else. We saw information about specific things for this individual when having a bath for example the individual likes to and can be self caring however needs support and prompts and to have cotton wool in ears when having hair washed as has ear problems. We saw assessments for risk, moving and handling, nutrition, and tools used to monitor individuals pressure areas and support needs such as Barthel and Waterlow. These documents had been reviewed monthly and as needed. There were also assessments regarding mental capacity. There was information on what was important to the individual with the addition of likes and dislikes these included environment and activities as well as food. There was detailed information on how staff were to support the individual with their physical difficulties and what action they should take medically. We saw that staff have been trained in techniques specific for the individual. For the second care plan we saw that the individual had difficulty in expressing their needs although they could communicate. We saw specific information about likes and dislikes some of this was related to communication and what staff must and must not do. This individual can express themselves with non verbal behaviours which can be challenging for staff and others who live at the home; they are not to have access to knives, forks and spoons for example. Again we saw detailed information for staff on how to support the individual to remain as independent as possible. What staff can do to alleviate difficult situations for the person, for example full support when showering as the person doesnt like the process, staff use humour to help this along. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: We also sampled another care plan. We saw that all care plans had risk assessments for any area of concern for the individual such as moving and handling, walking about the home, wheelchair use, lap straps and physical issues which are balanced with the individual making life style choices and activities they wish to participate in. From observation and listening to staff interaction it would seen that staff are aware of the care needs of the individuals they care for. The care plans are reviewed regularly and as needs alter. The documents are kept in the managers office. Care Homes for Adults (18-65 years) Page 15 of 30 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 who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said:There is an extremely full activity programme in place at Marlow. It is personalised for individuals and a new one written every week to allow for flexibility where required. As well as fixed, regular activities service users are supported to be active and visible in their community. Marlow is situated in Worthing town centre which means that access is simple. Worthing is also well equipped to meet the needs of wheelchair users with dropped curbs and disabled access to shops, cinemas, pubs, theatres, restaurants etc. The proximity to the town centre and good Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: staffing ratios means that service users can be spontaneous and access the community in the same way as those without mobility difficulties. Drivers and adapted vehicles are also available should service users choose to go further afield. Service users are encouraged maintain links with existing networks and relatives, and are supported to develop friendships and new contacts with people unconnected to the home. Service users are viewed by staff as individuals and not a collective. Individual programmes are in place and personal preferences respected. Service users have their own private space which is entered only with their permission, and they are supported to own their space with decoration and personal possessions. All clothes are laundered individually with the service user being fully involved in the process. Service users are offered a wide and varied menu with nutritious, home cooked food available every day. Meal times and the menu are flexible. We noticed that one individual likes to be in the kitchen area when staff are preparing meals. The room is a kitchen diner so people can sit and observe staff preparing meals. The registered provider said that people at the home are enabled and supported to prepare basic meals and snacks and participate where they wish in the housekeeping of their home. We saw on the care plans that people who use the service go to the shops with staff to choose and buy provisions. We saw that the care plans for the people living at the home had details on college, day care, social activities, meals out shopping and swimming for example. Whilst we were there we saw that younger people who had not gone out for the day were in their activities room. Other activities we saw included aromatherapy, drama therapy, music therapy, physical fitness, horse riding, bowling arts and crafts and hydrotherapy. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that their health needs will be assessed and supported and that their medication will be handled safely. Evidence: The AQAA from the service told us: The service users at Marlow have high physical support needs and assessments are in place to ensure safe moving techniques are always adhered to. Specialist equipment is supplied and maintained. Personal care is carried out in the way in which the service users prefer and this is documented. Appropriate systems are in place in relation to gender for personal care practices. Staff are aware that a service users ability to carry out personal care tasks does not impact on their ability to be autonomous. Choices about how personal care is managed and personal presentation is expressed is of paramount importance. All service users are registered with a local GP, dentist and access the community teams for people with learning or physical disabilities. Specialist services at hospitals are also accessed. Monitoring systems are in place which include: Food and drink intake and continence. We observed that staff support people at the service with their personal care in a Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: private setting and dignity is always respected. We saw from the care plans that people who use the service are supported to develop their own routine, getting up, bathing and going to bed at a time they choose. Preferences on who supports service users are respected where possible, we saw indications of preference on a care plan and that this occurs when ever possible. We saw that assessments have been sought from an Occupational Therapist to ensure all equipment used is appropriate and more supplied if required. We saw from the training file that staff are trained to operate all equipment and the AQAA told us that it is regularly maintained. We saw that people who use the service have equipment specific to their needs, for example: mobile and overhead hoists, frames, standers and walkers. We saw examples of professional input received by people who live at the home recently included speech and language therapy, physiotherapy, occupational therapy, community nursing, Neurology and podiatry. Individuals with complex health needs are supported by community nursing, we saw from care plans and daily notes that this has enabled people with complex health needs to access all necessary medical interventions in a timely manner, including pre arranged treatment at Accident and Emergency. We looked at the medication storage and administration records. The records of all medication arriving at and leaving the home are kept. A stock audit of all medication is carried out weekly. Medication is administered using the Monitored Dosage System and there are medication procedures. Medication is kept in a locked cabinet. Medication is stored separately for each indivdual. Internal, external and as required medication is stored separately. Refrigerated medication is kept in a locked container in the fridge. All staff receive training and sign to confirm they fully understand the medication policy. Staff administer the medication using the 5 steps. Staff sign the MAR sheet. There are no controlled drugs kept at the home. Behavioural medication is avoided and cognitive therapies employed instead. The pharmacy complete regular inspections of the medication practices. In the event of error, clear procedures are in place. No homely remedies are kept at the home. All medication is prescribed. All service users consent to taking medication prescribed to them. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure enables those people using the service to know that any complaints will be taken seriously and responded to. People living at the home are safe guarded by the homes safe guarding adults procedures Evidence: The AQAA for the home said: At Marlow concerns and complaints are taken seriously and responded to promptly. Where possible they are resolved on the day they are made. The management structure means that the home manager and provider are always available to address concerns without delay. This means the complaint does not escalate. Adult protection and abuse is a matter which is also taken very seriously at the home. As with complaints, any suggestion of abuse of any type is fully investigated and addressed immediately. We saw that the written complaints procedure is available to all service users, families and others who visit the home. We were told that complaints are fully investigated and all involved parties are informed of the outcome. The compaints procdure was dispalyed in the office and it includes the timescale of response and the address of CQC. The AQAA told us that there are whistle blowing and adult protection policies at Marlow. We saw that staff are made aware of them and sign to confirm they have understood them. We saw that the induction, gives staff training on the different types Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: of abuse. Adult Protection and identifying signs of abuse training is given to all staff. Staff are trained not to dismiss an allegation no matter how minor. All allegations are recorded and investigated. There are very clear guidelines about dealing with an allegation which include making sure the person making the allegation is safe, seeking immediate back up from a manager, taking statements, not questioning the perpetrator and contacting the police, local authorities and CQC. As part of the recruitment process CRBs and POVA checks and references are sought. Physical intervention is not used at Marlow and service users financial affairs are monitored with stringent recording procedures which prevent finanacial abuse. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. We saw that there was information about the Mental Capacity Act and Deprivation of Liberty. We also saw on a care plan that an assessment had been carried out regarding capacity involving the family support of the individual, social services and health. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. Evidence: The AQAA for the home said: Marlow is a purpose built house in a residential area. There are no signs identifying it to be any different from any other property on the road. The home is decorated to a high standard in a modern and contemporary way. There is colour and space which makes the home feel light and airy. It fully meets all environmental care standards. The layout of the home allows infection control procedures and the transportation of waste to carried out effectively. Appropriate laundry equipment and handwashing facilities are available. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are heated with under floor heating, all pipe work is covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The household equipment is domestic in scale and in keeping with the decoration. The decoration is contemporary and the furniture modern. All areas of the house are accessible to all service users via level access. The home has a large accessible garden with paved areas. Marlow is situated in the town centre so service users have full access to local facilities. The AQAA also said that adaptations to meet service users needs are done sensitively and in keeping with the decoration of the home so they do not appear intrusive. We saw that there is hoisting available on the ceiling so that people who use the service can be transferred from bed to bathroom in one move. We saw from the training files that staff are trained in infection control and handwashing facilities were seen to be available in all the key areas. Gloves and aprons were seen to be used. There are clinical waste facilities and soiled waste away from the kitchen and dining area and food storage areas. The laundry floor and wall surfaces are impermeable and a sluice facilty is available on the washing machine. Soiled laundry is washed at the appropriate temperatures. Care Homes for Adults (18-65 years) Page 23 of 30 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. Current recruitment practices at the home help to protect the people who use the service. Staff have received all the mandatory training that is expected each year, and training to help them meet specific individual needs. Evidence: The AQAA for the home said: Staff are recruited from a diverse base which means the service users receive a varied and balanced care package. Service users needs are met from a staff group with a broad range of skills and experience. The home is fully staffed with a qualified team and no agency staff are used. Bank staff are fully inducted and trained. A robust recruitment procedure is in place which means the correct staff are employed at the outset. There is low staff turnover which means consistency for the service users. Staff receive training as required from a variety of sources which equips them to understand the needs of the service users and requirements of the Care Standards Act 2000. Staff receive statutory training as well as their NVQ and service specific training. A full induction takes place over a period of weeks and staff are only deemed competent to the satisfaction of the home manager. A probationary period applies and bi-monthly supervision is in place. All staff receive a copy of the GSCC handbook and are expected to adhere to the principles contained within it. Service users meet candidates at interview and their views are sought. All staff receive a job description and full terms and conditions. Regular staff meetings Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: are held to discuss client need, home management and general practice. Several people have been employed since we last visited the home we looked at four staff files. We saw that for three of them there were two references, there was evidence that a CRB had been requested and that a POVA First check had been carried out and they were dated before the employee commenced work at the home. On one file we saw that two references had been received from one referee, the manager admitted that she thought she had two references from different sources and said that she would follow up and obtain a second reference for this individual. All staff information is kept at the home in locked cabinet in the managers office. There were no concerns following the last visit to the home about training undertaken by staff. We saw a training plan for staff for 09/10 we could see what staff had done and what was planned. All staff have undertaken food hygiene, fire safety and moving and handling. Staff have also been instructed by specialist nurses on the safe and appropriate ways of administering medication to people who have epilepsy. Two of the four staff who returned surveys said that they had received information in their induction to do the job, two others said that they had mostly received enough information. Care Homes for Adults (18-65 years) Page 25 of 30 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 systems and procedures monitor and maintain the quality of the service provided and which, promote the safety and welfare of those living and working in the home. Evidence: The AQAA for the home said:The home has an open door management style, where all service users, visitors and staff can access a manager immediately on any given day. The home managers offices are situated in the heart of both parts of the home, so their presence is apparent. Managers are therefore aware of what is happening on the floor and always available. There is robust quality assurance system in place which is implemented regularly by the provider. As well as addressing the practicalities of the running of the home, service user views are sought and contribute to the plan and the goals set out in it. Staff training is of paramaount importance and all statutory training kept up to date. Staff are supported to complete their NVQ, and the manager identifies training needs which are specific to the client group or the home. The manager will offer this in house or source it externally if required. The manager also oversees all heath and safety matters and is aware of all relevent legislation and Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: updates in residential care. The manager keeps records of all incidents, accidents, training, policy changes and updates, environmental health visits, fire visits etc. We saw that the certificate related to the homes registration was displayed in the office and has the details of the core registration for the home. The registered manager Ruth Brown has completed the registered managers award and has updated in the following areas, moving and handling, health and safety, appointed first aid, basic food hygiene, protection of vulnerable adults, and administration of epilepsy medication. The registered provider for the home is Progress Housing and the responsible individual is Rebecca Ward. As the responsible individual for the home she carries out regular visits to the home and keeps a record of these once a month. We saw that the manager has undertaken staff and resident meetings. The residents commented on food, staff, activities and the homes environment. The registered provider told us that the home currently does not send surveys out to relatives or other interested parties about their experiences of the home. The focus is about the people who live at the home and their views. We saw that the home manages personal money for people who live at the home, in that they hold this and keep records of what is spent and the balance. We also saw on one care plan that the staff are working with the individual to understand the value of money and budgeting. The staff have begun a savings chart. A photo of what the individual is saving up for is cut into sections and every Monday they put a piece of the picture onto the chart and when the picture is complete they go to town to buy it. We saw the policies available to staff and that when these are altered or amended the staff sign to say that they have read them. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment has been tested regularly and that staff have received training every six months. Care Homes for Adults (18-65 years) Page 27 of 30 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 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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