Care Home: Marshlands

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What the care home does well People have free access to the garden so can get fresh air when they want to.Some staff are longstanding and know service users well.There is day service held nearby so service users have opportunities to attend a range of events and activities.Staff noticed that a service user needed support at lunchtime and offered that support.People have been supported to choose their holidays this year.Staff are giving personalised support to help a person decide on a colour for their bedroom. What has improved since the last inspection? The AQAA says that there is a new information pack with photographs and comments by service users making it user friendly, there are boards in the dining room showing photographs of who is on duty and symbols showing the meal choices, there is a DVD of a regional your voice meeting, two people now go horse riding, health professionals and an advocate have visited the home, information about personal care needs is more detailed, there is a picture format complaints procedure and a service user has been involved in making a how to complain video, people have chosen a new sitting room carpet, 17 staff have attended a course on communication, the manager has completed an IOSH refresher course.We found that the use of Restrictive Physical Intervention has been stopped. Staff now use other methods like diffusion and distraction to manage problem behaviors.We found that peoples goals and aspirations are now recorded and supported.We found that potential risks to people are now identified, recorded and assessed to keep people safe but not restrict them.There is a water dispenser in the dining room so people can get a drink when they want to providing they have a cup. The kitchen is not locked so much so people have more access.Most people have more control of their medication and there are support plans in place to increase peoples control over their money What the care home could do better: So people live in a clean, attractive home, some parts of the environment need improving. For example one bathroom has no window covering and two toilets have broken blinds. Some carpets and floors need to be vacuumed and cleaned.People should be consulted and support plans constantly reviewed to ensure that opportunities for personal development and paid employment are not missed.To comply with the law and ensure that outcomes for people are improved, the AQAA must have more detailed information in all areas about what could be better, what has improved and what the plans are to improve.They must have the required policies and procedures so staff and service users know their role and responsibilities. Key inspection report Care homes for adults (18-65 years) Name: Address: Marshlands Dennes Lane Lydd Kent TN29 9PU The quality rating for this care home is: one star adequate 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: Kim Rogers Date: 1 3 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 32 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) 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 32 Information about the care home Name of care home: Address: Marshlands Dennes Lane Lydd Kent TN29 9PU Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Learning disability Additional conditions: 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 category: Learning disability (LD) The maximum number of service users that can be accommodated is 20 Date of last inspection: Brief description of the care home: Marshlands is a detached Edwardian property set in a rural location on the outskirts of Lydd, on Romney Marsh. The home overlooks farmland and has views across the Marsh. The house is set in its own extensive grounds. Access to the town of Lydd is possible by foot, approximately a 15 minute walk or very short car journey. Public bus transport is available from the main route through Lydd. Service users has access to several vehicles. The home is owned and operated by Park Care Homes (No2), Ltd (a Craegmoor Healthcare company), and is managed by Ms Claire Levy. Care Homes for Adults (18-65 years) Page 4 of 32 01797 320088 Marshlands@craegmoor.co.uk Craegmoor.co.uk Park Care Homes (no.2) Ltd Claire Levy 20 Number of places (if applicable): Under 65 20 Over 65 0 2 5 0 6 2 0 0 8 The home is registered to provide personal care and support to a maximum of 20 service users, however this number entails the use of double bedrooms, therefore the number of service users currently supported is 15. Bedrooms are located on two floors (ground and first) and one resident has a self contained flat. The home has one bathroom, three shower rooms, and 8 toilets for communal use. Communal space includes a large lounge, a separate smaller lounge, a kitchen, and laundry. Additional recreational space on site is available by way of a detached day service room. The fees range from about 400.00 to 1500.00 pounds per week. For more information about the fees and services please contact the Provider. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service How we did our inspection: This was an unannounced Key inspection of the service. This means that we assessed the Key Minimum Standards. The last Key inspection of this service was carried out on 25th and 26th June 2008. We made 3 requirements at the last inspection. We found that these three requirements have been met. Copies of this and the last report are available from the Provider or can be viewed on our website. During this inspection we spoke to the people who use the service. Two people showed us their rooms and we had a look around the home. We spoke to staff and the deputy manager and sampled various records. We made observations. Care Homes for Adults (18-65 years) Page 6 of 32 Two inspectors were at the home, one for just over four hours the other for two hours. One inspector made observations using the Short Observational Framework for Inspection or SOFI for 75 minutes. This involves observing service users and staff and measures peoples well being, engagement and participation. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved and how they intend to improve further. Some parts of the AQAA did not tell us much about how they intend to improve. This means that outcomes for people who use the service may not improve. For example in the summary section of what they do well the AQAA says new records kept. When asked how they intend to improve further this section says, ongoing. We looked at any notifications from the home about accidents and incidents. There have been 4 safeguarding alerts since the last inspection. This includes one alert made by us following the last inspection. This means that abuse or harm was suspected and the safeguarding coordinator at social services was alerted. The safeguarding coordinator investigates suspected abuse or harm of vulnerable people. One investigation remains open. For more information please contact the provider. We sent surveys to the people who use the service and to other stakeholders. People told us what they think about Marshlands. We received 7 out of 8 surveys back from service users and 1 out of 8 back from staff. What the care home does well: People have free access to the garden so can get fresh air when they want to. Some staff are longstanding and know service users well. There is day service held nearby so service users have opportunities to attend a range of events and activities. Staff noticed that a service user needed support at lunchtime and offered that support. Care Homes for Adults (18-65 years) Page 7 of 32 People have been supported to choose their holidays this year. Staff are giving personalised support to help a person decide on a colour for their bedroom. What has improved since the last inspection? The AQAA says that there is a new information pack with photographs and comments by service users making it user friendly, there are boards in the dining room showing photographs of who is on duty and symbols showing the meal choices, there is a DVD of a regional your voice meeting, two people now go horse riding, health professionals and an advocate have visited the home, information about personal care needs is more detailed, there is a picture format complaints procedure and a service user has been involved in making a how to complain video, people have chosen a new sitting room carpet, 17 staff have attended a course on communication, the manager has completed an IOSH refresher course. We found that the use of Restrictive Physical Intervention has been stopped. Staff now use other methods like diffusion and distraction to manage problem behaviors. We found that peoples goals and aspirations are now recorded and supported. We found that potential risks to people are now identified, recorded and assessed to keep people safe but not restrict them. There is a water dispenser in the dining room so people can get a drink when they want to providing they have a cup. The kitchen is not locked so much so people have more access. Most people have more control of their medication and there are support plans in place to increase peoples control over their money What they could do better: So people live in a clean, attractive home, some parts of the environment need improving. For example one bathroom has no window covering and two toilets have broken blinds. Some carpets and floors need to be vacuumed and cleaned. Care Homes for Adults (18-65 years) Page 8 of 32 People should be consulted and support plans constantly reviewed to ensure that opportunities for personal development and paid employment are not missed. To comply with the law and ensure that outcomes for people are improved, the AQAA must have more detailed information in all areas about what could be better, what has improved and what the plans are to improve. They must have the required policies and procedures so staff and service users know their role and responsibilities. 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 websitewww.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 11 Individual needs and choices (standards 6 – 10) ................................................... 13 Lifestyle (standards 11 – 17) .............................................................................. 16 Personal and healthcare support (standards 18 – 21) ............................................. 19 Concerns, complaints and protection (standards 22 – 23) ....................................... 21 Environment (standards 24 – 30) ........................................................................ 23 Staffing (standards 31 – 36)............................................................................... 25 Conduct and management of the home (standards 37 – 43) ................................... 27 Outstanding statutory requirements..................................................................... 30 Requirements and recommendations from this inspection ....................................... 31 Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People who use the 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’s needs are assessed before they move in so the home knows if they can meet those needs. There is information available to help people make a decision about moving in. Evidence: The Annual Quality Assurance Assessment or AQAA shows that a persons needs would be assessed with involvement from their families before they move into the home. The AQAA says that trial stays would be arranged so people get to know what it is like to live at Marshlands. We found that no new people have moved in since the last inspection. There is some written information about the home including a Statement of Purpose and Service User Guide. This information gives details of the facilities and services on offer. Some information is produced in a Makaton (symbols) format with words. We found that there is an information pack which has photographs of staff and service users and information about the home and facilities. This means that people have some user friendly information about what is on offer. Care Homes for Adults (18-65 years) Page 11 of 32 The AQAA says they could be better at having information in picture format and they plan to do this. They say they are also planning to make information about the home available on a DVD. We received seven surveys back from service users. All said that they had enough information before they moved in. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People who use the 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 the support they need to achieve their goals. Risks are supported and managed and people have support to make choices and decisions. Evidence: We sampled four service user plans and found that there is new care planning documentation. The deputy manager said that he, the manager and key workers have been working with service users to develop new individual plans for everyone. We found the new plans more user friendly in that they are clear, easy to follow and have photographs and symbols to support the text. We found that peoples needs are recorded with guidelines and plans for staff to follow to make sure these needs are supported. We found guidelines are clear and easy to follow. We found that service users and their representatives have been involved in developing the new plans. We found that personal goals and aspirations have been identified and recorded. There are plans in place showing, the support I need to achieve my goal. We found evidence that people have had support to achieve their goals. For example one person is now enjoying horse riding and another person had a trip of the Romney, Care Homes for Adults (18-65 years) Page 13 of 32 Hythe and Dymchurch Railway. We made a requirement at the last inspection to make sure that peoples goals and aspirations are identified and recorded and a plan in place for staff to follow so they give the right support by 30.09.08. We found that this requirement is met. The AQAA says that care plans now include information about some peoples personal goals and aspirations. They say they could be better at identifying and recording everyones goals. The AQAA says that care plans are person centred and that families and advocates are involved in developing care plans. We found that the risk assessment tool has been reviewed and that potential risks to people have been identified and assessed. This means that there is information about how staff can minimise risks to people without restricting them. We made a requirement at the last inspection to make sure that all potential risks to people are identified, recorded and assessed so that people are safe. We found that this requirement has been met. We found that the way people prefer to communicate is recorded in individual plans. We observed staff communicating effectively with service users. Since the last inspection some of the staff have attended a one day course on communication. The AQAA says that there is now a board showing who is on duty. We saw this board in the dining room which shows photographs of the staff on duty for that day and night. This corresponded with who was on duty that day. We found a board in the dining room showing the meal choices of the day in symbols and words. This corresponded to what was offered for lunch. The AQAA says they plan to produce this in photographs so people who do not know widget will know what the meal choices are without having to ask. Service users told us that they like the boards and know how to use them. This means that people can make choices and can find things out without having to ask. We found that people with communication needs have support to make decisions. For example one person is having support to choose the colour of paint for their bedroom by staff offering the primary colours weekly and recording what colour is chosen more often. All of the seven surveys received from service users said that people can make Care Homes for Adults (18-65 years) Page 14 of 32 decisions about how they spend their day, evening and weekends. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People who use the 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 the support they need to take part in a range of activities. People are involved in preparing meals and snacks and have a choice of food. Relationships are supported. Support should be reviewed to ensure that opportunities to develop the skills needed for paid employment are not missed. Evidence: We found that people have the opportunity to take part in a range of activities. Each person has an activity planner showing what they have the choice of from day to day. People said they enjoy going to college, work experience and attending daily sessions at the local community centre including art and craft and music. Two people are now going horse riding and they said they enjoy it. The AQAA says they could be better at supporting people to get more college and work placements. We found that there could be a missed opportunity for people to gain paid employment. Two people said they attend work experience but do not get paid. We asked staff about the possibility of developing peoples skills with the right support to Care Homes for Adults (18-65 years) Page 16 of 32 gain paid employment. Staff said they feel this could be possible in the future with the right support. People told us about recent trips to Chessington Zoo and Leeds Castle and about a planned trip to Thorpe Park. Some people went for a walk and a picnic on the day of the visit. Some people said they went to the local pub the night before and are looking forward to the Lydd community fun day next weekend. We found that people have support to go the local shops and parks and to use other community facilities. We found that people are involved when at home. For example we observed staff supporting people to make their own drinks and wash and dry up. We observed a staff member encouraging a person to help them with the lunch. One person was cutting the grass and others were gardening with support. There was a happy, relaxed atmosphere in the home and people gave the impression that they are supported in this way all the time. We found that the kitchen is not locked so much as at the last inspection and was open throughout this inspection. This means that people can come and go and help if they want to. We observed people helping prepare lunch and help with other tasks. There is a water dispenser in the dining room. The Provider told us that people go into the kitchen to get cups. The menu is now displayed in symbols and text with plans to display the choices in photographs so people know the choices on offer. We found that people had what was on the menu and some people chose to have something else. We observed that people are given the time and support they need to eat. We found that relationships are supported. A staff member supported a person to phone their family on the day of the visit. The person said they phone their family regularly and will be visiting them soon. Some people told us about their recent holiday to Great Yarmouth that they said they enjoyed. The AQAA says that they plan to support people to have holidays that suit their interests. One inspector carried out some observations using the Short Observational Framework for Inspection or SOFI. This tool was developed by Bradford University and is used to see how engaged and involved service users are and measures people’s state of well being. Care Homes for Adults (18-65 years) Page 17 of 32 Four service users were observed over 75 minutes. The SOFI showed that for 77 of the time people had a positive state of well being. For 55 of the time service users were engaged with staff or another service user. For 68 of the time people were engaged in a task. Based on the observations we found that staff have the skills and expertise to support and develop people and that the lifestyles they are experiencing suit them as individuals Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience Judgement: People who use the 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 the support they need with their personal and health care. Medication practice is safe and people have more control. Evidence: We found that details about peoples personal care needs is recorded in individual service user plans. There is more detail about how people prefer to be supported. This means that people get the support they need in the way they prefer. People said that staff give them the support they need with personal care. The AQAA says they plan to make sure that everyone has their personal care needs recorded in greater detail. We found that any risks relating to personal care have been assessed to safeguard but not to restrict people. We found that health needs are recorded in individual plans. This is clear and easy to read and follow. Any meetings with health professionals are recorded with the outcome shown. Records show that staff have supported people to access health professionals when needed. Care Homes for Adults (18-65 years) Page 19 of 32 People now have a health action plan. This has information about peoples health needs and is supported with large print and pictures to make it user friendly. We found that most people have more control over their medication. People now have their medication stored safely in their rooms and have the right support to take their medication at the right time etc. This means that people have more privacy when taking their medication. One person said they much prefer this. The service user said that staff go with each person to their room and pop tablets into their hands or watch them do it, and then sign the book. They said it was much better this way and they are very happy to have medication stored in their room. The acting team leader said that she has had training in medication administration and she regularly shadows other staff to observe practice. The AQAA says that people have regular medication reviews. Since the last inspection the manager has reported an incident related to medication administration to us. The manager managed this incident and has taken action to prevent it happening again. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know who to complain to. Service users have been exposed to the risk of abuse and this risk has now been reduced. Evidence: We found that there is a complaints procedure displayed in the home. This has large text, symbols and pictures to help make it user friendly. A service user told us that they have been involved in making a video about how to complain. This has been shown to service users. The deputy manager agreed that it could be used as an ongoing reminder about speaking up not only at Marshlands but at other company homes. All seven surveys from service users said that people know who to talk to and how to complain. We found that there is a complaints book with no complaints recorded. The AQAA says that service users are reluctant to use the complaints book. This may show that the suitability of the book may need reviewing. The AQAA shows there has been one complaint since the last inspection. For more information please contact the Provider. There have been a total of four safeguarding alerts since the last inspection. This includes one alert made by the Commission following the last key inspection. An alert is made to the safeguarding adults coordinator at Social Services when possible Care Homes for Adults (18-65 years) Page 21 of 32 harm or abuse is suspected. Three alerts are closed and one is open. This means that there is an ongoing investigation. The manager has taken steps to ensure the safety of service users while this investigation continues. A member of staff, who has left the home, has been reported to the Protection of Vulnerable Adults list by the manager since the last inspection. This means that the staff member may have caused harm or abuse to one or more service users. For more information please contact the Provider. We found that staff know what abuse is and how to report any suspected abuse. There is a safeguarding and whistle blowing policy. The AQAA does not mention how they safeguard people from harm and abuse. At the last inspection we made a requirement that any use of restrictive physical intervention, punishment and time out must be clearly documented with agreement from the service user as detailed in the Minimum Standard. We found that this requirement is met. The deputy manager said, following the last inspection, they have reviewed how they manage problem behaviours. The use of restrictive physical intervention, punishment and time out has stopped. The deputy manager said staff now use other strategies like swapping with another member of staff to diffuse and manage situations. This has lead to a reduced number of incidents and less risk of harm to service users. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained but some areas need improving and cleaning. Evidence: We found that the home is generally well maintained but some parts of the home need attention. For example one bathroom on the ground floor has no covering at the window. Two of the ground floor toilets have broken blinds with clear glass at the windows so people outside can see in. One of the ground floor toilets has a wobbly handle on the flush making it difficult to use. This means that the home does not feel homely. The AQAA says they could be better at making the home feel more homely but does not say how they plan to do this. We found some parts of the home are not clean. For example there are some stains on the dining room floor and radiator cover, dirt on the corridor carpet and stains to a service users bedroom carpet under their sink. The deputy manager said that waking staff are carrying out cleaning tasks until the newly recruited domestic staff starts work at the home soon. He said he hopes the cleanliness will improve with a new domestic staff in post. Care Homes for Adults (18-65 years) Page 23 of 32 The AQAA says that service users helped to choose a new sitting room carpet and that a person is having support to choose a paint colour for their bedroom. We found that people have free access to the front and back gardens. This means that people can fresh air when they want to. Since the last inspection there is less restriction on access to the kitchen. This means that people can generally get in and out of the kitchen if and when they want to. All seven service users surveys said the home is always clean and smells fresh. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained staff to meet peoples needs. Recruitment checks are robust protecting service users. Evidence: We found that there are five staff including a team leader on duty for fifteen service users. There are three staff on duty at night. The manager and deputy manager usually work Monday to Friday and are on call when needed. This inspection was carried out on a Saturday and the deputy manager came in to assist the inspectors. We found that the company organise mandatory training for staff. The deputy manager said that all staff are up to date with mandatory training. Some staff have attended training related to peoples needs like person centred planning, communication, diabetes and epilepsy. The AQAA shows that just over half of the staff have a National Vocational Qualification, NVQ, in care at level 2 or above. They say they could be better at having more staff with an NVQ. The AQAA shows that 8 out of 19 staff have left the home in the last year. Care Homes for Adults (18-65 years) Page 25 of 32 We spoke to two new staff who both said that service users were involved in the interview process. Staff said they completed application forms and had interviews. Staff confirmed that they had Criminal Records Bureau checks and gave references. The AQAA shows that recruitment checks are carried out before a person starts work at the home. We found that the induction for new staff is in line with the Minimum standard. Staff said they have the opportunity to attend regular staff meetings and one to one meetings. We observed staff offering people choices and encouraging people to be involved in things like making snacks and drinks and gardening. We observed staff giving discreet and positive support when needed. The Short Observational Framework for Inspection, SOFI observation showed that for 55 of time service users were engaged with staff Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed. People’s health and safety is protected. There are systems in place to monitor practice. They must have all of the policies and procedures they need so people know their roles and responsibilities. Evidence: We found that there is the same manager, deputy manager and area manager in post as at the last inspection. The manager has been at the home for about six years and has the qualification required by the Minimum Standard. As at the last inspection the manager has no qualification relating to peoples needs, that is learning disability. The manager was not at the home for this inspection. The rota shows the manager does not work at weekends. The manager is on call every other weekend. The deputy manager, who was on call, came in to assist us. The manager completed the AQAA. The AQAA is not very detailed and does not tell us much about what they think could be better and how they intend to improve outcomes for people. Care Homes for Adults (18-65 years) Page 27 of 32 The AQAA says they have improved in this area by the manager planning to attend a one day course about autism and by completing an IOSH, a health and safety award, refresher course. The AQAA says they plan to improve by ensuring staff are all compliant with training related to peoples needs. The AQAA says they plan to improve by maintaining standards, audit, review and implement but does not say what is to be audited, reviewed and implemented. In the summary the AQAA asks what they do well. The AQAA says regular company audits. They say they have improved by new records kept and plan to improve says ongoing. Without clear plans of how they intend to improve, outcomes for the people who use the service may not improve. The AQAA says they have policies and procedures in place but the tick list of required policies shows they do not have over 20 policies they need. This includes a policy on values, sexuality and relationships, recruitment and record keeping. This means that service users and staff do not have any reference material about what the company policy is so will not know what is expected of them. The AQAA does not tell us much about how they support equality and diversity and how they intend to further promote it. The AQAA says they promote equality and diversity by enabling people to personalise their bedrooms, wear clothes of their choice and choose activities. They train staff, one person has an advocate, support people to go to church and offer individual care packages. They plan to further promote equality and diversity by using symbols, sign language and photographs. The AQAA gives only one barrier to improvement and this funding which, it says, limits opportunities for people. They do not say how they plan to overcome this barrier so outcomes and opportunities may not improve. The AQAA shows that staff have training in areas related to health and safety and hold regular fire drills. The AQAA shows that the required checks are carried out of premises and equipment. Care Homes for Adults (18-65 years) Page 28 of 32 One service user takes part in health and safety meetings. They seek people views about the service by holding monthly service user meetings and company forum meetings called Your Voice. People are involved in reviewing their care plans. They say people can use the comments and complaints book but are reluctant to use it so this may not be an effective tool. They do not say how they seek the views of stakeholders like family, friends and professionals linked to the home. The changes they have made based on peoples views are limited to changes to the menu, paint colours for the home and holiday destinations. Three service users have been involved in the recent recruitment of staff. They plan to make sure that people with communication needs can air their views. Following a your voice meeting a service user will now attend staff meetings. An area manager continues to make regular visits to the home to monitor practice. The company also carries out audits. The deputy manager said the last audit was about nine months ago. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes No 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 30 of 32 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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