Care Home: Normans Close

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What the care home does well A recent letter from a relative was written to thank the staff for how well they care for the clients, and expressing their view that it "is a happy family". A health professional also commented recently that the staff "give good care to the clients, and take them out a lot". Our own findings confirmed these views. The clients are fully involved in all aspects of the running of the home and in decisions about their own lives. This is carried out using one to one meetings between the keyworker and clients using photographs and simple language; in-house meetings with the manager; and reviews with input from relevant health professionals, families and friends, advocacy and care management. Clients are encouraged to develop their individual living skills and to develop their communication skills. Support staff ensure that the clients can choose the activities which they wish to carry out. These may range from simple tasks such as flower arranging and sensory activity, or include visits to places like hotels and airports; train rides; and going to the seaside. There is very good management of clients` health care, with input from other professionals such as physiotherapy, doctors, consultants, dentist, speech therapist and opticians. The company ensure that good staffing levels are maintained, and that staff training is kept up to date. What has improved since the last inspection? This was the first key inspection for this service. What the care home could do better: The complaints procedure should be amended to include additional details for people to contact in the event of someone wishing to complain. The planned alterations to the premises will provide a much more suitable environment for the clients. Consideration should be given to landscaping the rear garden when the work is carried out, so that it can be used by the clients. Staff photographs need to be added to the recruitment files. We are confident that these matters are being attended to, and so no requirements have been given. Key inspection report Care homes for adults (18-65 years) Name: Address: Normans Close 5 Norman Close Maidstone Kent ME14 5HR     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: Susan Hall     Date: 2 3 0 9 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: Normans Close 5 Norman Close Maidstone Kent ME14 5HR 01622679962 01622679962 info.kent@futurehomecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Future Home Care Ltd Name of registered manager (if applicable) Mrs Linda Wade Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The home is owned by the NHS Trust and is leased by MCCH Society Ltd. for Future Home Care from the Primary Care Trust. Future Home Care is a company which specialise in Supported Living arrangements and Domiciliary Care, arranging individualised care for each client. The company is based in Birmingham, and there is a regional office in the centre of Maidstone. Future Home Care took over this home in April 2009. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 Brief description of the care home The home is situated in a quiet residential area of Maidstone, with easy access to the town centre and its amenities. There is parking space for several cars at the front of the property. Accommodation is provided in a detached bungalow, in single rooms. There is a good sized garden at the rear of the property. The premises are managed by MCCH Society Ltd. The current range of fee levels are being reassessed for all clients in this home, and depend on the individually assessed needs of each client. Further information can be obtained from the companys service manager. 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: The home is assessed as having a rating of Good, 2 stars. This was the first key inspection for this service, since it was registered with the Commission in April 2009. A key inspection includes assessing all the information obtained by the Commission, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The manager completed an AQAA within the required timescales, and it contained helpful information. A visit to the home was carried out by one inspector, and lasted for nearly four hours. During this time we (i.e. C.Q.C.) met all of the clients, and interacted with them where Care Homes for Adults (18-65 years) Page 6 of 31 possible; and talked with the three support staff on duty and the manager. We also talked with a visiting health professional. We observed staff giving care to the clients, and saw that the staff are patient, friendly, gentle and encouraging. The clients appeared to be relaxed and smiling, and several communicated that they are relaxed and settled living in the home. We inspected documentation including two personal care plans, which incorporate activity records, support guidelines, risk assessments, and health details. We also viewed the staffing rota, staff training matrix, recruitment files, maintenance files, and health and safety management. The home was seen to be clean in all areas. The premises are currently adequate in the short term, but are due to be totally restructured, starting in a few weeks time. All of the clients have been reassessed by care management as well as by Future Home Care, and will be having supported living arrangements. Two of the clients will be returning to this home when the alterations have been completed. We were impressed with the way in which Future Home Care have ensured that the clients are fully involved in all decisions about where they live and their lifestyles. 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: 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. Care Homes for Adults (18-65 years) Page 8 of 31 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. There are good procedures in place to ensure that the home will be able to meet the assessed needs of new clients. Evidence: The statement of purpose is displayed on a notice board on the ground floor, and is amalgamated with the service users guide as one large document. This contains all the required information as outlined in Schedule 1 of the Care Homes Regulations, but would be better prepared as two separate documents, with a simpler version and specific information for clients, in the service users guide. However, it has been produced in colour, has several photographs, and uses large print and simple language. This means that family members, care managers or advocates can use the document to assist clients in understanding the information. There are very good processes in place for assessing clients prior to coming into the home, ensuring that all aspects of care are assessed. This includes items such as the management of personal care and hygiene, health and medication, support with Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: domestic tasks and meal preparation, budgeting, leisure activities, and contact with family and friends. The manager obtains the care management assessment, as well as using the Future Home Care assessment process. Prospective clients are enabled to visit the home for as many times as they need to prior to admission. This can include taking part in activities or meal times; and enables clients to start getting to know other clients in the house, and some of the staff. Arrangements can also be made for overnight or weekend stays, with appropriate support from their existing carers. The house is due to have major building alterations made to it, and all clients will be moving out. Two clients will move back in when the building processes have been completed. We were able to see how the procedures have been developed to assist clients though this process. The clients have been fully involved in the decisionmaking about where they live in the future. All clients are provided with contracts for care via their local authority; and have licence agreements with MCCH Society who own the building. Care Homes for Adults (18-65 years) Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients are fully involved in their care planning, and are supported in making decisions about every aspect of their lives. Evidence: Each client has a personal care plan, which is developed with their full involvement. The plans contain detailed assessments, support guidelines, risk assessments, communication passports, arrangements for health care, medication details, and behavioural guidelines where needed. We viewed care plans for two of the clients, one male and one female. There is very comprehensive data, and it shows that there is ongoing consultation with the clients for all aspects of their lifestyles. The care plans are reviewed each month by the manager, the client, and their keyworker; and full reviews are carried out every six months with the client, keyworkers, manager, family support, and other relevant people as applicable e.g. social worker or advocate. The reviews are recorded in a simple format with lots of pictures and large print, so that the clients can show their agreement or disagreement Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: with different aspects of their care. For example, a client might smile or clap their hands when shown a photograph of a previous activity in which they were involved. Since Future Home Care took over the management of the home in April 2009, all clients have been allocated with care managers, and with independent advocacy. This ensures that their wishes are always given precedence, and that decisions are made by the client or by others who are acting in their best interests. Documentation confirms that there is a good understanding of applying the Mental Capacity Act, and enabling clients to make their own decisions where they can, and being provided with appropriate support where they need this. All clients are allocated with keyworkers, and these allocations are carefully worked out to ensure that the most suitable staff are matched with each client. As well as one to one reviews, there are house meetings once per month, when clients, support staff and the manager meet together to ascertain if there are any ideas or concerns which clients wish to voice. This meeting is carried out in a manner which involves the clients as much as possible, and with each one invited to share their views. The staff work together with the clients to identify risks to the clients health and well being; and to put risk assessments in place to show how these risks can be minimised. Care plans contain individual risk assessments for items such as choking, assisting to walk indoors, managing medication, and the risk of falls; and showing the preventive action to be carried out. Support staff complete daily records for each shift, and these are correctly signed, dated and timed. They include any specific events which have occurred, as well as routine care given and activities carried out. Clients documentation is stored in a locked cupboard so as to promote confidentiality. Care Homes for Adults (18-65 years) Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients are actively encouraged and supported in developing their individual living skills, and in carrying out leisure activities. Evidence: Care plans show that clients are enabled to develop their daily living skills, such as brushing their teeth, getting dressed, and taking part in daily household tasks. This might involve making the bed, or cleaning their bedroom, with one to one support from the staff. One client was seen taking part in meal preparation, and was also involved in choosing the menu for the day from two choices. Care plans also show how clients are developing with communication; and this is mostly non-verbal. Support workers learn to understand the clients specific ways of communicating by facial expressions, grunting, smiling, clapping, pushing items away etc. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Specific therapy programmes are available for clients, including reflexology, aromatherapy and massage; taking part in keeping active classes; and enjoying sensory items. One client was seen relaxing to visual sensory items, and listening to soothing music, in their own bedroom. The staff ensure that clients spiritual needs are discussed. For example, one client likes to sing hymns, and enjoys watching Songs of Praise on the television. Support staff will take clients to places of worship if they wish to go. There are excellent contacts with the community, and opportunities for the clients to take part in their choice of leisure activities. At each review, the support staff discuss activities from the previous month, and obtain the clients feedback in regards to how much they enjoyed new experiences. The staff use photographs to clarify which activity they are talking about. Recent individual activities have included visits to the seaside, a ride on a train to Victoria station, a ride on the London Eye, country rides, and visits to places such as Headcorn Air Show, and Leeds Castle. Two residents were looking forward to having tea in the Grand Hotel in Brighton the next day; and there are other group activities such as cinema and theatre visits, a garden party and barbecues. Clients also take part in swimming and keeping fit, and some go out to a beauty therapist for different treatments. The home has its own transport vehicle; and clients may be taken out in staff cars or on public transport, according to individual risk assessments. Clients are encouraged and supported in keeping in touch with families and friends. There is a list in each care plan file showing who the important people are in each clients life, and all contacts are recorded. Clients are also encouraged to take part in the daily routines of the home, within their capabilities. Monthly reviews show areas where the clients are developing their skills, which might include small steps such as buttering bread, helping to tidy their rooms, and assisting with laundry or cleaning tasks. Staff recognise that there are times when clients do not want to have company, and need to be left quietly, and this is respected. Clients are actively supported in food choice and meal preparation. There are large photographs of meal choices and snacks, to help them to choose. Clients take part in food shopping for the home, laying tables, clearing and washing up. They are individually assessed for the type of cutlery or cups which are best for them, so that they can be as independent as possible with eating and drinking. Risk assessments Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: show if clients need supervision due to a risk of choking. It was apparent during the inspection visit that this supervision is gently provided, with support staff sitting and chatting with clients while they had their breakfast. Clients are weighed each month, and menu choices take into account any special diets and foods which are most suitable for each client. Nutritional assessments are followed up with requests for input from health professionals if indicated, such as a dietitian, or a speech and language therapist, who advise in regards to swallowing difficulties. Care Homes for Adults (18-65 years) Page 17 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. Residents are sensitively supported in managing their personal care; and there are effective procedures in place for monitoring health care. Evidence: Personal care plans include very good information showing how clients are supported with personal hygiene care, toileting, bathing, showering and dressing. As well as support guidelines for staff, each client has a communication passport, which explains (using a series of photographs and simple writing) how each task is carried out. This includes the clients routine for everyday tasks such as if they prefer a bath or shower; if they need support with brushing their hair or cleaning teeth; and if they can get dressed and undressed without assistance. Clients choose their own clothes as much as possible, and staff help them to assess if they need warm clothes or cool clothes according to the weather, and where they are going. The care plans include clients preferred daily routines such as the times they usually get up or go to bed, and the order in which they like things to be done (e.g. dressing before breakfast). Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: The home has very good support available from health professionals and specialist advisers. This includes the Community Learning Disability Team, physiotherapists, occupational therapists, speech and language therapist, specialist nurses such as epilepsy nurses, consultants such as clinical psychologists or psychiatrists, GPs, and dentists, opticians and chiropodists. Some clients attend regular hydrotherapy sessions or keep fit classes. A physiotherapist visited one client on the day of the inspection visit, to re-assess a client whose mobility had increased, and this had also increased the risk of falling. Each client has a detailed health assessment called the OK health check, every six months, or more frequently if indicated. These include medication reviews, as well as assessments for all aspects of health such as weight, BMI, hearing, vision, continence, oral care, foot care, and medical conditions. Clients are supported in visiting doctors and medical appointments; and there are additional assessments to identify if clients need specific medication such as sedative or pain-killing medication prior to any medical intervention e.g. blood tests or dental treatment. Additional charts are maintained for clients if they are unwell, for example, food and fluid intake charts, to ensure they have sufficient intake. We viewed some charts, and these were well completed. Medication is stored in a locked cupboard, within another locked area. There is sufficient storage space, and external medication is kept separate from internal. Most medication is administered using a Boots monitored dosage system. There are no controlled drugs (CD) in use, and no storage for these. The manager is aware that a CD cupboard would have to be purchased and fitted if these were prescribed for any clients. There are very good systems in place for assessing when as necessary medication should be given, with clear individual guidelines for each item. There are also good systems for checking medication out of the home and back in again with support workers, so that they can carry any possible emergency medication with them (e.g. for epilepsy). All support workers are trained in administering medication, and the manager has ongoing checks in place for competency. All medication administration is checked with two staff on duty, unless any item has to be given at night. The night support worker would then check the records with the next staff member coming on duty in the morning. As well as countersignatures for all items administered, all tablets and medicines are counted and checked. We viewed the Medication Administration Records (MAR charts), and found them to be well maintained, with clear records. Clients personal care plans include information about their wishes in regards to death and dying. This may be supplied by the clients family members if the client does not Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: show any understanding or awareness of death. Care Homes for Adults (18-65 years) Page 20 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. Residents are confident that their viewpoints are taken into account, and that their concerns and complaints will be dealt with appropriately. Procedures are in place which help to protect residents from abuse. Evidence: The complaints procedure is included in the service users guide, and states that any complaints will be responded to within five days, and investigated and followed up within twenty-eight days. The procedure could be improved to include the contact details of the service manager; and needs amending to include the contact details for the local Social Services department and for the Care Quality Commission. We are confident that this will be carried out, and so a requirement has not been given. The procedure has been put into a simplified picture format for clients, and is kept on the notice board where it is easily available. MCCH Society, who manage the building, have also provided a complaints procedure for any complaints in regards to the building. A minor complaints record book has been implemented, as well as forms for following the formal complaints procedure. There have been no complaints during the past year. All clients have monthly review meetings, as well as daily contact with their key workers, and this provides them with the opportunity to share about any concerns or Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: complaints. All staff are trained in the protection of vulnerable adults (POVA), and the training matrix confirmed that this training is kept up to date. Clients personal care plans demonstrate where they are particularly vulnerable to risks of abuse or exploitation, so that staff are fully aware of clients individual risks. There are good procedures in place to protect clients from financial abuse, as well as from physical harm or neglect. Clients finances are managed by an appointeeship with Kent County Council, and clients have individual advocates to assist in all aspects of their lives. Small amounts of money stored on clients behalf is carefully recorded, with all debits and credits recorded and all receipts retained. These individual accounts are audited every month. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises provide a comfortable and homely environment for the clients, and are due to be completely restructured during the next few months. Evidence: The bungalow is situated in a quiet residential area at the edge of the town, with easy access to public transport and the towns amenities. It currently provides adequate accommodation, with small bedrooms, a dining room, kitchen and a lounge. There is a bathroom with an assisted bath, and a wet shower room. There is a separate utility area for laundry, and a sleep-in room for staff. Within the next month, all of the clients are moving out into alternative accommodation while the whole property is being stripped inside and re-structured. It has previously been used as a home for five clients, but is being restructured to meet the needs of three clients in the future. Each client will have a large bedroom, with their own en-suite bathrooms, each with an assisted bath. As this is a bungalow, it is a facility which will be suitable for wheelchair users. The staff have noticed that clients with reduced mobility often benefit from a warm bath, and so baths are being fitted in, as opposed to showers. Two of the current clients will be returning, and a third client is moving in from Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: another company home nearby. The clients will be taken to visit the bungalow during the building processes (even if they cannot go inside at first), so that they can see the progress being made. At later stages, they will be involved in choosing colour schemes and furnishings. New furniture will be purchased for the communal areas. The restructuring process will include the provision of applicable security and fire safety. A conservatory is to be added at the rear of the property, leading out on to the patio. There is currently a garden area which cannot be used as there is a steep bank, and consideration should be given as to how to alter this area so that clients can access it. The home is equipped with necessary equipment such as grab rails, raised seats and sensory equipment. There is a mobile hoist, which can be used for lifting clients from the floor if any of them fall. Each client has their own hoist sling for good infection control management. The utility area includes a washing machine and a tumble dryer; and there are locked cupboards for storing chemicals. Care Homes for Adults (18-65 years) Page 24 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. Good staffing levels are maintained. Staff recruitment and training procedures are well managed. The clients benefit from having a dedicated and caring staff team. Evidence: Staffing numbers have been increased since Future Home Care took over the running of this home. There are always three support staff on duty from 8 a.m. until 10 p.m, as well as the manager during the day times. This provides mostly one to one care for clients, and sufficient time to take them out on most days. There is one support staff sleeping in at night, and another senior staff member on call. All staff are supported in training and studying for NVQs. The manager and deputy are NVQ assessors. There are currently 72 per cent of staff with NVQ 2 or higher. All staff are trained in learning disability, with an initial induction followed by training for the Learning Disability Qualification (LDQ). Staff were seen to interact well with the clients and with each other. They are very patient, and sensitive, and give clear and calm directions to the clients, and lots of encouragement. Staff recruitment is well managed. Recruitment files are stored at the regional office in Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Maidstone, and we viewed two staff files there. Applicants are required to provide a full employment history, proof of identity, and training records; and POVA first and Criminal Record Bureau (CRB) checks are carried out. Two written references are taken, and the company complete interview records and an occupational health check. There were no staff photographs on file, although staff have their photographs taken for their ID badges. The service manager said that she would ensure that staff photographs are also held on file in the future, in accordance with Schedule 2 of the Care Homes Regulations. As we are confident that this is being carried out, a requirement has not been given. The staff training matrix confirmed that all mandatory training is kept up to date. This includes first aid, health and safety, moving and handing, basic food hygiene and infection control. Staff are also routinely trained in the protection of vulnerable adults, medication, and fire awareness; and are being trained in how to apply the Mental Capacity Act 2005. New staff have a comprehensive induction, and shadow other experienced staff until they are assessed as competent to work alone. There are monthly staff meetings, enabling all staff to have input into the life of the home. There are also out of house meetings for a whole day every three months. This provides opportunity for team building and additional support and planning. Other staff who know the clients well are brought into the home for this day. All staff have individual one to one supervision every month. A set format is used, so that the supervisors are prompted with discussing previous issues, training needs, personal development, and any new issues with staff or clients. 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. The manager provides a clear sense of direction for the staff and clients, and enables them to be fully involved in day to day decisions about the running of the home. Evidence: The registered manager has many years of experience in caring for people with learning disabilities; has a health qualification; and is completing an NVQ 4 in leadership and management. She has a clear vision for the home and the service it provides, and demonstrates good leadership skills to the rest of the staff. Staff meetings help to provide an ongoing forum for staff to be involved in all aspects of the running of the home, and there are day to day discussions at hand overs. There are effective systems in place to monitor the quality of the home and its development. This includes house meetings for clients and staff; feedback obtained from families, friends and health professionals; and monthly monitoring visits from the companys quality assurance manager. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: The home keeps a written record of compliments as well as complaints. Two health professionals have recently stated that they are impressed with the staff and the care given to the clients; and that they feel that they look after the clients very well. Future Home Care have formulated new policies and procedures, and these are kept in an accessible place for the staff. We viewed the medication policies; policies for dealing with allegations of abuse; and the policy for supporting a client who is going to hospital. These have clear directions and are suitably worded. All policies and procedures are kept up to date, and staff are informed of any changes made and sign to state that they have read these. Records are generally well maintained and stored appropriately. We viewed two folders for health and safety and for fire safety. These confirmed that fire alarm points are tested every week; fire safety awareness training is updated yearly; fire extinguishers are checked monthly; and there are fire and emergency procedures in place. Other checks include routine testing of hot water temperatures for taps to which clients have access, as well as checking the water temperature prior to each bath; and checking the temperatures of the fridge, freezer and medication cupboard each day. House risk assessments and weekly room checks are carried out; and the homes vehicle has routine checks for tyre pressures, wipers, and seat belts etc. We viewed some of the maintenance records for gas safety and hoist maintenance, and these were up to date. Accidents and incidents are recorded using Future Home Cares own documentation; and also using accident books which comply with the Data Protection Act and HSE legislation. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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