Care Home: Miller Farm

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What the care home does well Individuals were well supported by competent staff in sufficient numbers. Individuals can be confident that their care is tailored to them and that they are supported to lead active lifestyles based on choice both in the home and the community. The people living in Miller Farm can be confident that they were being listened too and any concerns they have are responded too. Miller Farm provides a homely, comfortable and safe place to live. What has improved since the last inspection? Whilst some improvements have been to the medication systems to protect the individuals this still remains an area of concern. The newly appointed manager has devised an action plan as part of the annual quality assurance assessment detailing improvements to be made over the next twelve months. What the care home could do better: Individuals would benefit from clearer plans of care offering staff guidance and ensuring a consistent approach. Individuals must be protected by the safe administration of medication and by ensuring that staff have the competence to fulfill their roles. Key inspection report Care homes for adults (18-65 years) Name: Address: Miller Farm 66 High Street Worle Weston Super Mare North Somerset BS22 6EJ     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: Paula Cordell     Date: 2 3 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 28 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 28 Information about the care home Name of care home: Address: Miller Farm 66 High Street Worle Weston Super Mare North Somerset BS22 6EJ 01934521288 01934515814 millerfarm@freewaystrust.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Freeways Trust Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Miller Farm is a small community home for younger adults with learning disabilities. Some of the people display behaviour which challenges carers or have severe communication difficulties. The home is on the main street of a suburban area, with easy access to the local shops and services. This is a main bus route for the local town and for Bristol, but the home also has its own minibus. 10 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 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: This was an unannounced visit as part of a key inspection process. The purpose of the visit visit was to review the requirements and recommendations from the visit in December 2006 and to monitor the quality of the care provided to the individuals living at Miller Farm. There has been one additional visit in June 2008 completed by the Care Quality Commissions pharmacist due to the number of notifications received in respect of medication omissions. Two requirements were made and compliance has been demonstrated. The Care Quality Commission has not received any complaints since the last visit. There has been a change of management since the last visit, one manager was in post from December 2008 to August 2009 and a new manager took up post in September 2009. Care Homes for Adults (18-65 years) Page 5 of 28 The visit was planned using information that has been received prior to the visit including notifications in respect of incidents that effect the wellbeing of the individuals, surveys from staff and people who use the service and general correspondence and the annual quality assurance assessment. The annual quality assurance assessment was completed by the manager and gave sufficient detail of where the service is now and what future improvements are planned over the next twelve months. The visit was conducted over six hours. Opportunities were taken to speak with people who use the service, staff, the deputy manager and the manager. Records were viewed in respect of the running of the home including care documentation, staffing and health and safety. A tour of the home was completed ensuring it was a safe place to live and work. Care Homes for Adults (18-65 years) Page 6 of 28 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. 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 7 of 28 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 8 of 28 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. Individuals have sufficient information to enable them to make a decision on whether to move to Miller Farm. Individuals can be confident that their care needs are assessed ensuring that the home is suitable and can meet their care needs. Evidence: There was a statement of purpose and service user guide. This had been reviewed and updated to reflect the recent management changes. Information clearly describes the service provided at Miller Farm. Individuals receive a welcome pack soon after they move in which the key worker goes through explaining to the individuals what is on offer, complaints policy and introducing them to life at Miller Farm. We saw an admission policy which is included in the statement of purpose. Evidence was provided to demonstrate that individuals had been fully assessed prior to moving to the home. Individuals were encouraged to visit the home prior to making a decision Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: to move there more permanently. This could be for a cup of tea, a meal and an overnight stay. The manager ensures that they obtain copies of the placing authoritys assessment and care plan and this assists in formulating the plan of care for the individual. Individuals spoken with during the visit said they had chosen to move there. One person said I like living here it is nice another said they had moved from another home and liked living here. Whilst another person said I am being supported to move back to Bristol as I prefer it there. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their care needs are being met. However, clearer guidance should be made to staff to ensure a consistent approach. Evidence: Three individuals care documentation was looked at to determine the outcome for people living in the home. The manager had recently instigated a review of the care documentation and was organising a day to day file which was not so cumbersome for staff. There was a file for each person containing daily notes, some of the care plans and a health action plan whilst other information had been stored in a box, loose leafed and separate from the day to day planning documentation. It would appear that much of the information that had been stored separately was still useful for example Listen to Me books, care plan reviews and reactive strategies and referrals and care plans from the Community Learning Disability Team. This information would be vital for the day to day planning of care and to guide staff on how to support the people living at Miller Farm. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: Staff said they had found the transition in management style difficult and confusing as they were not sure what plans to follow in respect of individuals and the boundaries that should be in place for people. However, it was evident that the new manager was working through the issues with staff, promoting choice and independence for the individuals living at Millers Farm and offering more guidance and support. Monthly reviews were completed with the individual and the key worker and a comprehensive report was completed. This included goals for the forth coming month, social outings, general review of the person including health monitoring. One member of staff said that they had not been given training to complete this and other paperwork prior to the new manager joining the team. However, they now feel better supported and have clearer guidance being given in respect of completing the reviews and other care related documentation. Care reviews highlighted goals for individuals to work on. The statements were quite broad, which could meant that would be difficult to implement or evaluate. For example to be more independent, to have a holiday, to reduce weight and to be more active. The lack of information means that it is up to the staff member to interpret which could mean an inconsistent approach. It was strongly recommended that the information be expanded to give clear direction for staff on who, how, when and how often. Some of the individuals had person centred plans that were pictorial and copies were seen on the bedroom wall for one person. One of the staff was a person centred plan facilitator and had received specific training to enable them to complete this. A member of staff said the plan was for all individuals to have a more person centred plan detailing their specific goals for the future. The PCP facilitators used in Miller Farm were from other Freeways Homes. The PCP facilitator who works at Miller Farm supports other individuals within the organisation. Risk Assessments covered a wide range of activities both in the home and the local community. These had recently been updated. Again a copy was not in the main day to day file to enable staff easy access to this information. Care Homes for Adults (18-65 years) Page 12 of 28 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. Individuals lead active lifestyles both in the home and the local community. Contact was being maintained with friends and family. Individuals were being offered a healthy diet. Evidence: Individuals had a structured day care plan of activities that they completed. Activities included attendance at day centres, college courses, gardening and media groups and support from a day care worker to complete activities that the individual enjoyed. Each person had a life skills day at home, where they were allocated one member of staff to support them with house hold tasks and an opportunities to go out in the community for lunch or shopping. Due to closure of one of the day services individuals had been consulted on what they would like to do with their time and it was evident that the activity plans are tailored Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: to the individual. For some this has meant an increase in activities being made available to them. One person said they liked to spend time in their bedroom and go out on their own with staff and this was supported. Activities are organised in the evenings including arts and crafts, relaxation with massage, karaoke, cooking sessions and DVD nights as well as going out to the local pub. Individuals spoken with said the staff regularly take them out at weekends into Town or to places they want to go. Daily records were seen confirming this. A member of staff said that none of the individuals want to go to church however, where a person expressed an interest then this would be supported. All the individuals who wanted a holiday have had one and those that prefer to stay local are supported with day trips. From talking with staff and the individuals it was evident that they could chose where to go on holiday and with whom. Photographs of holidays were displayed throughout the home. Individuals were actively supported to maintain friendships and maintain contact with family. Social events are organised in the home where family and friends could be included. Individuals confirmed they could have friends over for tea and could use the house telephone to keep in contact with family. Individuals are being involved in the running of the home through regular house meetings being organised. Minutes were being maintained of the meetings. Individuals are involved in the planning of the menu through the monthly house meetings. The menu seen demonstrated that individuals had a varied and nutritious diet available to them. Individuals confirmed they could make drinks when needed. The lunch time meal was unhurried and a social occasion with the staff and individuals sharing a meal together, discussing what had happened in the morning and what plans were being made for the afternoon. Individuals were offered a choice of sandwich filling, salad, crisps and fruit. Special diets were catered for. Advice had been sought from a Dietician and Speech and Language Therapist where relevant. Care Homes for Adults (18-65 years) Page 14 of 28 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. Individuals personal and health care needs were being met. Individuals may be at risk due to the lack of recording on the administration of medication. Evidence: Each person had a health action plan that detailed how they would like to be supported with their personal and health care needs. Good records were maintained demonstrating that the health care needs of the individuals was being addressed. All the individuals were registered with a local GP, dentist and optician. Other health care professionals involved included a Community Learning Disability Nurse, Psychiatrists, Dietician, Chiropodist, Occupational therapist and Speech and Language Therapist. The records seen demonstrated that appointments were clearly documented and followed up where relevant. From talking with staff it was evident that they were aware of the Mental Capacity Act. Best interest meetings had been organised where staff were concerned about the capacity and health of an individual involving appropriate professionals. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: The medication system was looked at during the visit. We had received a number of reports last year about medication errors. Because of this our Pharmacy Inspector reviewed the system in June 2008. Two requirements and one recommendation was made. This included ensuring the medication administration record includes clear instructions for as and when required medication and that there is a record of medication leaving the home for example when individuals go on holiday. These had been addressed and the requirements met. There was a clear record of medication entering the home and disposal. However, there were gaps in the administration of medication. An immediate requirement was left with the manager. The manager responded in writing within 24 hours of the visit clearly stating what actions were being taken to address the concern. This included training for staff who had the responsibility for administering the medication and improving the daily auditing. Some staff when asked about medication training stated this is only completed when they first commence in post as part of the induction. During this time they are supervised until they are confident and complete a questionnaire ensuring they have both the knowledge and the competence. This was not being periodically updated or reviewed. However, some staff had attended training with the pharmacist but again this was not periodically updated. Care Homes for Adults (18-65 years) Page 16 of 28 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. Individuals could be confident that their concerns will be listened too and acted upon. Good systems were in place to ensure that individuals are protected from harm. Evidence: We saw an organisational policy in place which clearly details how the staff should respond to a complaint and the timescales. This was available in an accessible format. A record of complaints was maintained including the nature of the complaint, what had been done to alleviate the concern and the outcome. It was evident that the staff were addressing the concerns within a reasonable timescale where possible. Complaints related to interpersonal relationships and noise levels. It was evident that positive measures had been taken to address the concerns. One person had requested a move back to Bristol and this was being supported in a positive manner with a social worker being involved. The organistation had whistle blowing and other policies and procedures to ensure individuals are protected from harm. It was evident from talking with staff and the manager that they had a good awareness of the procedure to follow in the event of an allegation of abuse being made. Staff had attended safeguarding in the home and with North Somerset Council. The manager said that this had recently been updated for all staff. This was confirmed in their training records. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: There were good systems in place to protect the finances of individuals. Care files contained risk assessments which included the level of support offered to individuals and any potential risks. A random check on finances was completed. Amounts held in the home corresponded with the record and expenditure was supported by a receipt. Two staff members and where possible the individual had signed for expenditure. Finances were audited by the provider on a monthly basis and by the organisations financial department. Financial policies and procedures providing guidance to staff had been seen at previous visits. There were up to date records of individuals belongings. The day to day care files did not contain behaviour support plans. However this was being addressed by the manager at the end of our visit. She was extracting this from the homes computer. As part of this process she said she would review them to ensure they were current. Some of the individuals were being supported by the local Community Learning Disability Team and person centred plans had been drawn up to assist when the person was being challenging to the service and others. The plan seen was in an accessible format and included pictures and symbols. The acting deputy manager said this would be good to cascade to all the individuals in the home. At the time of our visit the plans were held in the office separate from mains files so was not easily accessible to staff (see comments in outcome area 2). Staff had received annual training on supporting individuals that challenge. This looked at positive interventions including diversion tactics, relaxation and keeping the environment calm as much as possible. Staff said that often one persons behaviour can trigger another especially noise as some people find this a trigger to their own behaviours that challenge. It was evident that staff were knowledgeable about the people living in Miller Farm and looked at preventative means rather than punitive. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a safe, pleasant and comfortable place to live that is suited to their needs. Evidence: Miller Farm is on the main road leading through the village of Worle. It was in keeping with the local neighbourhood and close to local amenities including shops, a library and public houses. A bus stop was sited a short walk from the home enabling individuals to have access to the centre of Weston Super Mare and links with Bristol. The home had a complete refurbishment three years ago. The home remained well kept, decorated to a good standard and provided a comfortable and homely place to live and work. Each person had their own bedroom which their could decorate to their liking and make homely by personalising it with pictures and personal possessions. Three individuals showed us their bedrooms and it was evident that they were proud of their personal space. One person was listening to music and another was relaxing watching the television, the third was looking at photographs. Individuals spoken with said they could move freely around their home. Bedrooms were lockable and individuals were offered a key if they would like. From talking with the deputy it was evident that some Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: individuals did not like people entering their bedrooms without permission and this was respected. Staff were observed knocking on doors prior to entering. Three of the ten bedrooms have ensuite facilities. Individuals had one large lounge area, a smaller lounge on the first floor and a large dining area with further seating for individuals. All areas were homely and comfortably furnished. Leading off from the dining area was a small conservatory which the staff were planning to turn into an arts and craft room. This lead on to the garden. Individuals had access to a relaxation room containing specialist equipment. A staff member had creatively decorated this room making it a very comfortable place to relax. Individuals had access to sufficient bathing facilities and toilets throughout the home. These were adequately stocked with toilet rolls and hand washing facilities. All bathrooms seen were lockable which could be overridden in the event of an emergency. The home had hand rails situated throughout and low level light switches for individuals that may use a wheel chair and ramp access to one part of the home . There was a specialist bath but staff said this was rarely used as people prefer to shower. It was evident from talking with staff that where individuals needs change advice would be sought from the appropriate professional on any equipment that would be required to meet the needs of the person safely. The kitchen area was clean and well maintained. Systems were in place to ensure that good food handling principles were applied. An environmental health officer visited this year, however, the home was not sure of their rating. Clarification should be sought from the local Environmental Health Department. Staff confirmed that the recommendations that had been made during this visit had been actioned. All areas of the home were clean and free from odour. Cleaning schedules were in place and being completed on a daily basis. There was some staining to the carpets on the lower floor. The manager said that they were in the process of buying a carpet cleaner to tackle this. This was confirmed on a memo on the staff notice board. No requirement was made. A maintenance/driver was employed to assist with the day to day maintenance. It was evident from talking with staff that there was a good response to repairs. Good practice would be for the maintenance person to keeps a record of all repairs Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: undertaken to enable an audit to be completed as much is verbally communicated by staff or individuals living in the home on a day to day basis. There was a cracked tile in the kitchen and curtains hanging off in the hallway. These were addressed during the visit. There was a separate laundry facility sited away from the kitchen. Staff said that the equipment was appropriate to meet the laundry needs of the household. There was good infection control measures in place. Adequate hand washing facilities were in place and staff had access to gloves and aprons. Routine daily cleaning of door handles was completed to assist with minimising infection. Care Homes for Adults (18-65 years) Page 21 of 28 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. Sufficient and trained staff support the people living at Miller Farm. Evidence: Miller Farm was being staffed 24 hours a day. There was a minimum core staffing level of 2 care staff. However from looking at the rota and talking with staff it was evident this was being exceeded. Throughout the week there were staff providing one to one with individuals as part of their additional funding and for day care. Staff were also spending one to one time with individuals as part of their life skills day on a weekly basis. Throughout the week there were additional staff employed including a driver and an administrator. On the weekends three staff work to enable individuals to access the local community. Two waking staff provide cover at night. Staff spoken with during the visit said that the staffing levels maintained were adequate to meet the needs of the individuals. From the conversations it was evident that the individuals have benefited from a stable staff team with very little staff turnover. A member of staff said that the home had recently recruited another full time member of staff to assist with one to one sessions with individuals offering more stability and consistency. Many of the staff spoken with during the visit had worked in the home in excess of five Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: years however a new member of staff commended the staff on the welcome and support they had been given. Staff described a period of being very unsettled because of changes in management support. The home has not had a registered manager since December 2008. Staff said they were unsure what the boundaries were for individuals and the changes of management style has made this more confusing. Staff confirmed that regular meetings and supervisions take place. Staff complete an in-house induction and the Learning Disability Qualification. All had completed this within the organisationals timescales with good records being maintained. Newly appointed staff had completed all statutory training as part of their induction including first aid, manual handling, fire and health and safety training. These were then being updated annually. Other training attended included a values day in relation to supporting people with a learning disability, financial training, medication, safeguarding and medication training. This was confirmed in conversations with staff, the deputy manager and by the training records. The annual quality assurance assessment provided evidence that 13 out of nineteen staff had a National Vocational Qualification in care. This is good practice as the government target has been exceeded to ensure that 50 of the workforce have an NVQ in care. The manager had developed a training appraisal to ensure that it was relevant to the needs of the individuals living in the home and that staff have the appropriate knowledge and skills. Training was being audited by the manager and during the monthly visits (Regulation 26). Care Homes for Adults (18-65 years) Page 23 of 28 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 newly appointed manager should offer the staff and individuals more stability and clarity in their roles. There are good quality assurance initiatives in place. Individuals safety is paramount. Evidence: There has not been a registered manager since December 2008. A subsequent manager took up post from that date but resigned in August 2009. A new manager Mrs Margaret McGregor commenced in post in September 2009. The Care Quality Commission has been kept informed of the changes and the interim management arrangements. Mrs McGregor has many years of experience of supporting individuals with a learning disability and has managed other Freeway homes. Mrs McGregor has completed a National Vocational Qualification in care at level 4. Staff as previously mentioned described an unsettled period in relation to the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: management of the home and the lack of direction. It was evident that this was being addressed. Staff said the new manager was open and approachable. One member of staff said that they felt more supported and clear guidance was being given to them on their role. Mrs McGregor had a good awareness of the legislation and her responsibilities and how the service can be improved to the benefit of the people living there. The Annual Quality Assurance Assessment gave a good description where the service is now and where improvements can be made. Good quality assurance systems were in place including audits of the environment, care reviews, medication audits and the training analysis for staff including supervisions and support. In addition the provider was completing monthly visits (Regulation 26). The reports are informative and assess the quality of the care and the general running of the home. Records relating to health and safety were looked at. It was evident good systems were in place to minimise risk without curtailing individuals independence and control over their lifestyles. Risk assessments were seen relating to Care of Chemicals Hazardous to Health and food preparation good systems were in place to ensure the safety of the individuals. However, records relating to food temperature probes were not routinely being recorded. Fire records were well maintained demonstrating that individuals are protected in the event of a fire. This included routine checks on the equipment, fire training and staff participation in fire drills. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 1 20 13 Ensure that records of 23/11/2009 administration of medication are maintained and that any gaps in signing is investigated. To safeguard the individuals. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 6 Ensure there is clear instructions for staff on the goals for individuals. Ensuring a consistent approach. 23/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Staff to attend regular training in medication and a record of competence is kept at least annually. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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