Care Home: Newtown (65a)

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What the care home does well The home provides a good service to people with Autism Spectrum Disorders. People have good support to maintain their independence and make decisions about their daily lives. Risk assessment does not stop people from doing things they like to do or from experiencing new things. Care plans show how people want to be supported. Staff have built up good relationships with people and know how they communicate. The home continues to offer people different methods to help them communicate. Staff understand how people may be affected by autism. People use local facilities and contribute to the local community. People enjoy a range of activities both at the home and in the locality. People are encouraged to eat healthily and to choose what they like to eat. Health action plans mean that all aspects of people`s healthcare needs are fully met and monitored. People are protected by the company`s complaints process which is in a format accessible to them. People benefit from a home that is well decorated, comfortable, clean and well maintained. People have personalised their bedrooms to reflect their personality. Sufficient staff members are available when people need them for personal support and to be able to go out. Staff are experienced and well trained. A robust recruitment process means that no one starts working at the home until a check has been made on their suitability to work with people who may be vulnerable. Although newly in post and registered as manager, Miss Hibbs is competent, experienced and qualified to run the home. She has shown us that she manages issues well. What has improved since the last inspection? Medication is being correctly administered according to the prescribed instructions on the medication administration record. Staff check the medication administration record when giving medication. Decisions and judgements about the suitability of recruiting staff are recorded when necessary and appropriate induction and supervision is in place. The security of the grounds has improved as a new fence has been put up around the perimeter. What the care home could do better: People are not always safeguarded by the home`s procedures for administering their medication. There have been two recent medication errors. However the manager did take immediate action and no one suffered any ill effects. The home should make sure that its own procedures for regularly auditing medication are carried out.Whilst it is not staff`s responsibility to refer any allegations of abuse directly to the safeguarding procedure, they should know the process. Key inspection report Care homes for adults (18-65 years) Name: Address: Newtown (65a) 65a Newtown Trowbridge Wiltshire BA14 9AA     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: Sally Walker     Date: 2 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Newtown (65a) 65a Newtown Trowbridge Wiltshire BA14 9AA 01905459800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.craegmoor.co.uk Parkcare Homes Ltd Name of registered manager (if applicable) Miss Teresa Hibbs Type of registration: Number of places registered: care home 3 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 65A Newtown provides care and accommodation for up to three adults with a learning disability. All the people who currently live there are male. The home is operated by a subsidiary of Craegmoor Healthcare, a private sector organisation with four registered care homes for this client group within Wiltshire. Miss Teresa Hibbs is the registered manager and is also registered as manager of another care home nearby. The property is in a residential area of Trowbridge, overlooking a busy road junction. A range of amenities are available in the town itself. Larger centres, such as Bath and Bristol, are within reasonable travelling distance. The house is a detached two storey building. The front entrance is accessed by a set of steps leading up from the street. People who use the service have single bedrooms on Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home the first floor. There is a shared bathroom, which also has a shower. Communal areas are on the ground floor. There is a large lounge and dining room. The kitchen and staff office are also located downstairs. There is an enclosed back garden. Staffing for 65A is shared with the other larger home nearby. People also make use of some of the facilities there. The registered managers office is in a day centre near to both homes. The fees charged for care and accommodation range vary depending on the assessed needs of people who use the service. Information about the service is displayed on noticeboards in the home. CQC inspection reports are also publicised when they are received. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 26th August 2009 between 9.15am and 4.05pm. Miss Teresa Hibbs was registered as manager on 7th August 2009. We discussed our findings with Miss Hibbs at the end of the inspection. We looked at care plans, risk assessments, menus, medication, staffing rotas, staff recruitment and training records. We spoke with two people who use the service and with two staff members. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. Care Homes for Adults (18-65 years) Page 6 of 31 Miss Hibbs is also the registered manager for another home nearby. We looked at all the information we had been given so that we could decide what to focus on during the inspection. The last Key inspection was on 12th September 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: People are not always safeguarded by the homes procedures for administering their medication. There have been two recent medication errors. However the manager did take immediate action and no one suffered any ill effects. The home should make sure that its own procedures for regularly auditing medication are carried out. Care Homes for Adults (18-65 years) Page 8 of 31 Whilst it is not staffs responsibility to refer any allegations of abuse directly to the safeguarding procedure, they should know the process. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The organisation has suitable procedures for admission should a vacancy arise. Evidence: Miss Hibbs told us that she was working on adapting the statement of purpose and service users guide into an easy read format. No one had moved in recently and everyone had lived at the home since 2001. At the last inspection we saw that the organisation had suitable procedures for when anyone needed to have an assessment to be able to live there, if a vacancy arose. In the AQAA Miss Hibbs told us there are clear guidelines and policies in place for new admissions as well as a detailed assessment package which will be undertaken in the event of a new admission. The Service has a Welcome Pack which contains information about the Service and on offer. Any enquiries regarding the service provided at 65a Newtown are followed up with visits and information if required. One of the healthcare professionals in a survey form ticked usually to the question about whether enough information is gained in assessments. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good support in developing their goals and maintaining independence. Care plans set out how people want to be supported by staff. People are encouraged to make decisions about their lives. Risk assessments make sure that people are safe. Evidence: Peoples goals and aspirations were recorded in their personal plans. Daily reports were set out according to peoples personal plans. They were pre-printed forms where staff reported on activities that people had been involved in, personal needs and interactions, imagination, communication, diet, medication and contact with family. Everyone was independent with their personal care. Some people needed staff with them and some people needed reminding to clean their teeth. Care plans identified whether people needed staff support during the night. Peoples individual communication methods were well known to staff. Staff told us how they offered choice. Care plans showed what people did if they did not understand what was happening and what staff should do to help them. Examples were: things Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: that help me feel better; things staff might notice that suggest I am depressed; staff will need to help me to cope with this and things that make me angry. Care plans identified how staff managed any situations where people would become anxious for any reason. Miss Hibbs told us that people did not have challenging behaviours. Care plans gave guidance to staff in different areas: how I get along with other people; coping with situations and risks for me and others and When I do this, this means that I want you to. There was guidance to staff on how to hold people safely if they or others were in danger for any reason. The guidance identified that holding techniques were only to be used by staff who had been trained and only when two or more staff present. Staff told us they did not use any of these restraining methods on people. We found no evidence that people liberty was restricted. Daily records showed how people and staff communicated with records of conversations or peoples responses in facial expressions and mood. Some people used some Makaton signs to communicate. There was a book which showed commonly used signs. We saw that staff communicated well with people and made sure that they knew what was happening. Miss Hibbs told us that she planned to introduce the Picture Exchange Communication System (PECS) and TEACHH (an educational communication aid for children). She told us that people who were coming to both services from schools would be familiar with using this communication aid. Miss Hibbs told us that she also planned to produce a DVD for new staff about how people wanted to be supported. People were mobile and could access all parts of the home. Risk assessments were carried out with regard to moving and handling, when in the vehicle, dealing with noisy places, sudden change of plan, fire, use of the kitchen and any equipment. People always had staff with them if they went out. There was information in peoples care plans about things for staff to consider when assessing capacity, consent and decision making for different aspects of their lives. Peoples parents or advocates also supported people with decision making. One of the healthcare professionals told us in a survey that the home always supported people to live the life they chose. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to be involved in different things that they like to do. People are well known and participate in the community. People maintain good contact with family and friends. People are encouraged to have a healthy diet. Evidence: People had their own preferred individual routines throughout the day. In the AQAA Miss Hibbs told us times for waking, going to bed, meals, etc are flexible and determined by the individual; however, there is also an understanding of a required routine in some cases due to Autism Spectrum Disorders. People had opportunities to attend the local college. Courses they were undertaking included cooking and healthy living. Other things that people did included: sewing, theatre trips, sports, swimming, bowling, skittles and pottery. Some people went to the local Gateway club and to see bands at the Civic Hall. They had been to the Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: balloon festival in Bristol. Staff contributed ideas for activities and kept a file on different things that were going on locally. People liked to use public transport and some people had been on a train to Weymouth and to Bristol and Bath to do shopping. People regularly went for long walks in the countryside. Staff told us that people were well known in the community and local shops. One person was involved in a local residents group and attended their meetings and helped deliver leaflets and newsletters. They also went to the groups skittles evening. One person went to a local church. Both homes shared two vehicles. People also went to a local educational farm to help with the animals. Miss Hibbs told us about the communal facilities attached to the other home that people use. In the AQAA she told us within this building we have a sensory room and an art room, and there is computer access, a skills kitchen and music facilities. All are encouraged to access this building for leisure and personal development with support from staff. It is recognised that opportunities provided at places such as Trowbridge College are becoming less available to people as they get older, and now would be the right time to develop this space and appropriately train staff to ensure that people still receive access to these learning opportunities. People were encouraged to maintain regular contact with families and friends and regularly went to stay with parents at weekends. Care plans identified other people who were important in peoples lives. Important dates and anniversaries were recorded together with how people felt about these days. People had a range of games, jigsaw puzzles and DVDs in the sitting room. One person was doing a jigsaw puzzle and one person was in the garden doing a drawing when we visited. One person used the local library. These library visits included a trip to the local cafe for cappuccino and cake. They also went into town to buy magazines. Some people were planning their holidays for later in the year. One person had been to a bungalow in Devon with some of the people at the other home. Another person had been for a long weekend at Minehead. There was an allotment attached to the other home nearby which people helped with. All the vegetables grown were used in the meals. The eggs from the chickens on the allotment were also used. Most of the food shopping was done on line and people helped put things away when the shopping was delivered. People went to the supermarket to buy other things. There was a four week menu in pictorial format. Staff told us that one day a week people had a takeaway meal which they chose. People could join the people who lived at the other home for Sunday lunch when their Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: housemates went home for the weekend. People were encouraged to have a healthy diet. Care plans stated that people should be given additional healthy foods, for example extra fruit, if they chose a less healthy option. One staff told us that a colleague was good at making home made soup that people enjoyed. People were involved in food preparation and liked making cakes. Records were kept of what people had chosen to eat each day. People could write in their daily records what they thought about each meal and whether they had eaten it. Any changes to the menus were recorded. Records were kept of what people liked to eat and food to avoid. Some people had had an assessment carried out for risk of choking and what staff should do if this happened. People went to some of the local pubs and restaurants. People had boxes of treats that were kept in the office. We were told that this was so that they did not eat them all at once. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good health action plans and have good access to healthcare professionals when they need to. People are supported in the way that they choose. Staff know how autism affects people and can support them with this. Generally people are protected by the arrangements for administering their medication. The manager is quick to take action if mistakes occur. Evidence: Each person had a healthcare action plan called All about my health. People had the support of their parents to compile these plans and make any decisions about continued healthcare. Peoples medical and health history was recorded. There was information about who supported people when going to the GP or dentist. The chiropodist visited people at the home. People were supported to go out to hospital or other appointments. Some people had epilepsy profiles which were regularly reviewed by the community learning disability nurse. Records were kept of any incidents, accidents or seizures. Body and head maps were used to show any marks or injuries if they occurred. People were regularly weighed. Care plans identified who to inform in peoples families if they had been to a medical appointment, to explain any treatments. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Miss Hibbs told us that the company employed specialist leads in Autism, behaviour management and healthcare who provided advice and training. The home also had access to specialist workers in the local community team for people with learning disabilities when needed. We looked at the arrangements for medication. Peoples medication was put up by the pharmacist in a monitored dosage system. People could manage their own medication following a risk assessment, Currently no one managed their own medication. Action had been taken to address the requirement we made that systems for the handling of medication must include maintaining accurate records about medicines administered to people. Action had also been taken to address the good practice recommendation we made that systems for administration and recording medication should be reviewed to reduce the risk of errors. The homes administration policy required that two staff gave the medication at the time that it was prescribed. They both checked and signed the medication administration record. Records were kept of any unused or unwanted medication returned to the pharmacy. Individual care plans recorded what medication people were taking and why they were taking it. There was information about how people expressed pain and what action staff should take. People had individual homely remedies that their GPs had agreed they could take with their prescribed medication. There was a British National Formulary (the Pharmaceutical Societys publication of medication) so that staff could familiarise themselves with different medication that people were taking. There were records of regular checks of the temperature in the medication cabinet. There was a written procedure in the medication administration record for when medication was to be given when it was prescribed to be taken only when needed. We saw that the records for one medication did not match the number of tablets held. Staff showed us the record for one tablet which had been dropped and could not be given. They said that medication was received centrally for both homes and checked by a senior member of staff. They also said that the medication would be audited regularly with records kept centrally. We saw that there were no records of when any medication was taken or returned when people went home. We looked at the audit records. This was a check of each persons medication. There had been no audit recorded for some time. Miss Hibbs told us that she would make sure that this was immediately carried out. Staff members competency in administering medication was regularly checked by either the manager or one of the senior team. There had been two medication errors Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: earlier in the year. Miss Hibbs had carried out an investigation and found that neither of the people who use the service were harmed. Disciplinary action had followed and staff given warnings. The staff members did not give medication during the investigations and received further training in the companys policy. Those staff did not work alone until the investigations were completed and their competency confirmed by the manager. Counselling services were made available to people to help them talk about bereavement and loss when they needed it. In the AQAA Miss Hibbs told us each Person Centred Care Plan contains a page for individuals and their carers to record any wishes and plans they may have in the event of illness or passing away. At this time the Service has not supported anybody to this end, however, the company has detailed policies in place for such events. One of the healthcare professionals ticked usually against the question as to whether peoples healthcare needs were properly monitored reviewed and met. They also ticked usually to the question to whether the home sought and acted upon advice to improve peoples wellbeing. They ticked usually to the question about whether the home supported people to manage their own medication or correctly where this was not possible. They said the home usually supported peoples privacy and dignity. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. System are in place for anyone to make a complaint about the service. Staff know how to report to the companys safeguarding process if abuse is suspected. Evidence: Each person had a copy of the companys complaints procedure. This was available in large print with diagrams and pictures to help people understand how the process worked. Parents and families had also been given a copy of the procedure. In the AQAA Miss Hibbs told us over the past twelve months the complaints procedure has been reviewed with the involvement of the Your Voice groups to ensure that it is more accessible to the people who use Craegmoor Services. We plan to gain clarification from the people using the Service on whether they fully understand how to make a complaint or raise a concern if they feel the need to. There were forms available for people to fill in if they wanted to complain about anything. One of the people we spoke with told us that they would talk to staff or Miss Hibbs if there was anything they were not happy with. We looked at the complaints log; no complaints had been received since the last inspection. One of the healthcare professionals in a survey form ticked sometimes when asked if the home responds appropriately if people raise concerns. People kept their personal money in the main safe. Records and receipts were kept of Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: all transactions. The accounts were regularly checked and audited. People were supported to understand money management and budgeting. Miss Hibbs told us that she would do an assessment if there were any issues for people and restrictions to their liberty. She went on to say that the company had appointed a person to take the lead on deprivation of liberty and mental capacity for people who used its services. We asked members of staff about how they would report any concerns or allegations of abuse. They were aware of the companys procedure for reporting any safeguarding issues and the whistle blowing policy. We said that although it is not staff members responsibility to directly report any incidents, they must be aware of the local procedure. We saw that staff had yearly training in safeguarding people who may be vulnerable. Miss Hibbs told us that she would inform the trainer of the need to make sure that training included using the local procedure. There were copies of the local booklet entitled No Secrets in Swindon and Wiltshire in the activities centre. People had copies of the local policy Keeping People Safe in Wiltshire with their care plans. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comfortable, clean, warm and well maintained environment. Evidence: Everyone had their own bedroom which they had furnished and decorated to suit their individual personalities. The bedrooms did not have ensuite facilities. There was one bathroom upstairs. Staff told us that people took it in turns to use the bathroom. Miss Hibbs told us she had requested a new bathroom and kitchen in the budget. People could have a key to their bedrooms or to the front door. Currently one person had these keys. A new fence had been put up around the perimeter of the gardens. The back garden was laid to lawn with flower beds. There was patio furniture and different sitting areas. The gardener told us they were planning to plant out the front garden now the fencing was completed. People used the washing machine in the kitchen with staff support if needed. The night staff did the ironing. People were involved in some household chores: doing their own laundry, washing up, vacuuming and polishing and collecting things for recycling. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The radiators had been guarded to make sure that people were not scalded if they came into contact with the hot surface. The home does not have a full fire alarm system. Smoke alarms had been provided, together with a fire blanket and extinguisher. Regular tests were made to make sure the equipment was working. Each person had an individual fire risk assessment with details of how they would be supported to get out of the home in the event of a fire. A fire risk assessment was available for the building. The company had introduced a new infection control policy which staff had signed up to. The home was cleaned to a good standard. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having staff available when they need them. Staff are experienced and well trained. A robust recruitment process means that people are protected from anyone who is unsuitable to work with people who may be vulnerable. Staff have good access to regular supervision. Evidence: The staffing rotas were for staff members working in both homes. Those staff members who were working at 65a Newtown were identified on the rotas. The rotas showed that there were a minimum of two staff members when all the people were at home during the day. At night there were one waking night staff and one member of staff sleeping in. Care staff worked in both homes for a month at a time. Staff work in teams with a team leader. The teams were regularly changed so that all staff members worked with each other. Staff told us that the main rota was kept in the managers office with each member having their own copy. We saw that there was a board which would identify which staff were on duty each day by their photographs, but it had not been compiled when we arrived. The home had a team of bank staff who were well known to people who use the service. In the AQAA Miss Hibbs told us staff shift times have been changed to give an extra period of cross over time. This provides forty five minutes of extra time to allow staff Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: to keep on top of new policies, update information, attend supervisions, etc. without taking support away from the people using the Service. Action had been taken to address the good practice recommendation we made that risk judgements about employing staff should be supported by a documented management plan for their induction and supervision. One of the staff who had returned to work at the home told us that they had been given an induction pack which they were working through. They told us that a POVA check had been carried out on their suitability to work with vulnerable people. They said they were shadowing a more experienced member of staff on all shifts until their Criminal Records Bureau certificate had come through. Staff recruitment and training files were kept centrally in the managers office adjacent to the other home. Miss Hibbs told us that she had restricted access to the companys data base on staff NVQ and Criminal Records Bureau certificates information. NVQ certificates were requested at interview and verified. Miss Hibbs told us that she had appointed three new staff to increase the staffing levels by three full time posts. She told us that generally the staff group was stable and most had been working there for some time. All new staff were inducted into their roles. New staff shadowed a more experienced member of staff during their period of induction. New staff would undertake the Learning Disability Award during their induction and commenced NVQ Level 2 on completion. All the recruitment information and documents required by regulation were on file. The company sent out the application forms and gained other information so that Miss Hibbs could short list who she planned to interview. All staff members had received training in autism. Miss Hibbs and two senior staff had attended a two day seminar by an expert in autism training. One of the staff told us they had good access to training and showed us the list of advertised training. They said they had training in the hall nearby or would go to other Craegmoor homes in the area. The said they had trained in health and safety, Control of Substances Hazardous to Health (COSHH), fire safety, infection control, descalation and breakaway techniques (managing behaviours that challenge) and equality and diversity. Staff told us about their previous experience of working in care with people in care homes or in the community. All staff members except three, who were newly appointed, had NVQ Level 2. The three new staff were undertaking the qualification. One of the team leaders had NVQ Level 4. Another team leader had NVQ Level 3. The deputy manager had NVQ Level 3 and was undertaking NVQ Level 4. Miss Hibbs had a training data base to establish Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: training undertaken and training needed for each member of staff. This included mandatory training together with epilepsy, autism and person centred thinking. There was a separate file of staffs training certificates. Recent training had included fire safety, medication from the supplying pharmacist, health and safety, food hygiene, infection control, CPI, speech signs and symbols, and moving and handling. Miss Hibbs told us that the company had an accredited training department. In the AQAA Mrs Hibbs told us all staff members are trained in equality and diversity as part of their mandatory training. All new staff members now undertake an LDQ and all are given the opportunity to achieve an NVQ. There is a diverse group of people working at and using the Service, with people of all ages from all walks of life. This ensures that everyone is able to recognise and understand each others differences and encourages a positive atmosphere. Staff meetings were held every month with minutes kept. Miss Hibbs told us that people who use the service were also invited to contribute to staff meetings. She showed us a note that one person had written for her to read to the meeting on their behalf. Part of the staff meeting was used as a training session. Staff had regular supervision every six weeks with one of the team leaders. Miss Hibbs supervised the deputy manager and team leaders. She told us that she had improved the provision of supervision as it had been difficult to ensure the sessions were taking place. She also said that the company had produced a new format for recording sessions. Staff had trained in the principles of supervision. Miss Hibbs reviewed and signed all supervision records. One of the healthcare professionals in a survey form ticked sometimes when asked if the managers and staff had the right skills and experience to support people effectively. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a manager who is competent, experienced and qualified. The home is run in peoples best interests. Peoples views are sought when developing the homes action plan for improvements. Systems are in place to ensure the health and safety of people, staff and others. Evidence: Miss Hibbs was registered as manager on 7th August 2009. She has had twelve years experience of working in a care setting and has been in a supervisory position for over seven years, with some time as deputy manager. Miss Hibbs had NVQ Level 4 and the Registered Managers Award. Miss Hibbs told us she had undertaken an induction with the company. She had also undertaken recent training in employment law, health and safety and financial management since coming to post as manager. Miss Hibbs was undertaking a Life Science Degree. Miss Hibbs told us she regular worked a shift so that she kept herself up to date with people. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: The company carried out an annual quality assurance review. In the AQAA Miss Hibbs told us the companys quality assurance programme ensures that the Service Manager completes regular self audits and that the Service is regularly monitored to ensure that its aims and objectives are being met fully. The audits carried out create an action plan for the development of the Service and this is measured to ensure that the systems in place are meeting the requirements. Individuals and the staff team are encouraged and supported to be part of the programme to gain a full understanding of the aims and objectives of the Service. Miss Hibbs told us that she had not yet received the companys action plan following their recent review of the responses. The company had a reward system for staff to suggest new ideas that would be put into practice to improve the service. Night staff carried out some of the health and safety checks, for example, recording fridge temperatures. They also recorded cleaning against the cleaning schedules. The home followed the companys maintenance manual for the different checks on facilities and services in the home. The manual showed which checks were to be carried out weekly, monthly or at other times during the year. The maintenance person dealt with minor repairs and maintenance. The company had supplied a list of preferred suppliers who had undertaken a Criminal Records Bureau check. A health and safety audit was carried out by a contractor in April 2009. The improvement points were actioned in May 2009. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Records must be kept of medication that is taken from and returned to the home, for example, when people go home. For peoples safety. 31/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 20 23 The home should make sure that its own procedures for auditing medication are carried out. Whilst it is not staff members direct responsibility to refer any concerns to the local safeguarding procedure, they should know what the process is. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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