Care Home: Norwood 30 Old Church Lane

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What the care home does well The care home has a very welcoming atmosphere. Residents live in a homely environment, with quality furnishings, and decoration that is attractive, and meets the needs of people using the service. People using the service told us about how much they liked living in the home and that they were happy with their bedrooms. Comments included `I am happy here`, `I like my bedroom`, and `I can get up when I want`. Residents spoke positively of the staff, and knew the names of their key workers. The registered manager is experienced, and very motivated in continuing to ensure that people using the service are empowered to live the life that they choose as independently as possible, and that a quality service is provided to them all. The AQAA was completed extremely fully, and gave us very detailed information about the home and the service that it provides. There is close liaison with health care professionals, and other specialists as and when required by the residents. Feedback from health care professionals was generally very positive about the 30 Old Church Lane, and the service that it provides. People using the service have their views listened to, and respected. There are regular resident meetings, which they have the opportunity to attend. All the residents have a key worker, and co-key worker who supports them in many aspects of their lives. People using the service are supported to have the contact that they wish with relatives and friends. Holidays for residents are a regular feature of the care home. The home meets the cultural and religious needs of people using the service. Meals are chosen by people using the service and are varied and wholesome, and meet each person`s religious needs. Staff receive varied and appropriate training to ensure that they are skilled in carrying out their roles and responsibilities. Observation, and talking to staff indicated that staff were aware of each resident`s needs, and of how these needs are met. Interaction between staff, and residents was positive and respectful. What has improved since the last inspection? The two requirements and the recommendations from the previous unannounced inspection (31st July 2008) have been addressed. The home has significantly improved some aspects of the resident`s care plans, which include the development of a more `person centred` (the person being central to their plan of care) plan in picture and written format. Health care plans and risk assessments have also been developed and improved since the previous inspection. Some aspects of record keeping has been improved, and there are better systems in place to monitor the quality of the service that is provided to people using the service. Several areas of the home have been redecorated, and new furnishings and furniture have been bought to ensure that the home is an attractive and suitable environment for people using the service.The night staff needs have been fully reviewed and `wake night` staff are employed to work at night as and when needed by the people using the service, with the eventual aim to have a permanent `wake night` staff on duty. What the care home could do better: There could be improvement to the format of information relevant, and of interest to people using the service, such as the menu, to ensure that it is more accessible to residents who have difficulty in reading. Some bathrooms in the home could be redecorated, and some carpets including the stair carpet could be cleaned or replaced. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Norwood 30 Old Church Lane 30 Old Church Lane Stanmore Middlesex HA7 2RF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Norwood 30 Old Church Lane 30 Old Church Lane Stanmore Middlesex HA7 2RF 02089546566 02083857697 oldchurchlane@norwood.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Norwood care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The Registered Person may provide the following categories of service only: Care home only - Code 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 - Code LD The maximum number of service users who can be accommodated is: 8 Date of last inspection Brief description of the care home 30 Old Church Lane is a Jewish care home registered to provide personal care, and accommodation for 8 adults with learning disabilities. The proprietor is Norwood. The home is located on the outskirts of Stanmore. The shops, banks, restaurants, and other amenities of Stanmore are within a short drive or walk from the care home. Bus and train public transport services are located close to the care home.The home was opened in 1997, and consists of a large detached two-storey building, within a residential area. All the bedrooms are single. The home includes a flat where two people using the service are accommodated, and has an accessible well maintained enclosed garden. There is parking for several cars on the forecourt area of the care home. Fees vary according to the needs of the people using the service, and information Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home about the fees is accessible from Norwood. The care home has accessible information about the service that it provides. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 unannounced inspection took place throughout a day in July 2009. The previous key unannounced inspection took place on the 31st July 2008. There was one vacancy at the time of the inspection. We were pleased to meet and talk to several of the people living in the home. The registered manager was present during all of the inspection. A number of feedback surveys were supplied to the care home prior to the inspection. At the time of writing this report the Commission had received six surveys from residents, six from staff, and five from health and social care professionals. Documentation inspected included, residents care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. Observation was also significant tool Care Homes for Adults (18-65 years) Page 6 of 32 used in the inspection process, due to the varied communication needs of the people using the service. Assessment as to whether the requirements, and the recommendations from the previous key inspection had been met, also took place during this key unannounced inspection. 30 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the registered manager supplied the Commission with a completed Annual Quality Assurance Assessment (AQAA) document. This record includes required information from the registered manager (and/or owner) about the quality of the service provided by the care home, and of any planned improvements. This document had been completed very comprehensively. Reference to some aspects of this AQAA record is documented in this report. We thank the people living in the care home, staff, and the manager for their significant assistance in the inspection process. What the care home does well: What has improved since the last inspection? The two requirements and the recommendations from the previous unannounced inspection (31st July 2008) have been addressed. The home has significantly improved some aspects of the residents care plans, which include the development of a more person centred (the person being central to their plan of care) plan in picture and written format. Health care plans and risk assessments have also been developed and improved since the previous inspection. Some aspects of record keeping has been improved, and there are better systems in place to monitor the quality of the service that is provided to people using the service. Several areas of the home have been redecorated, and new furnishings and furniture have been bought to ensure that the home is an attractive and suitable environment for people using the service. Care Homes for Adults (18-65 years) Page 8 of 32 The night staff needs have been fully reviewed and wake night staff are employed to work at night as and when needed by the people using the service, with the eventual aim to have a permanent wake night staff on duty. 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 set out 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information needed to choose a home that will meet their needs. Prospective residents have their needs assessed, with their participation (or family member/friend), prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. People using the service have a contract/statement of terms and conditions with the care home. Evidence: The home has comprehensive information about the service that it provides to residents. This information includes a statement of purpose and a service user guide, which we noted had been reviewed this year. This documentation is recorded in picture and Easy English format. We were told that each person using the service has a copy of the service user guide, and that there were plans for this document to be updated with more participation from the people using the service. Information about the fees was accessible in each persons contract/statement of terms and conditions, which is Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: recorded in their copy of the service user guide. AQAA (Annual Quality Assurance Assessment) and previous inspection told us that the home has an admissions policy/procedure. There have been no admissions to the home since the last key inspection (31/07/08). We were told from the AQAA and the manager during this inspection that all prospective residents would receive an initial assessment of their needs, which is carried out by the manager, with the organisations funding team leader. We were told from the AQAA that during the assessment and admission process there is close liaison with the care manager from the relevant funding Local authority, and full participation from the prospective resident. We were told from the AQAA that the involvement of the individual (prospective resident) is of paramount importance, as is the participation of significant others in their lives. We were informed that each prospective resident has an individual transition plan that meets each persons individual needs and that it generally consists of a number of visits to the home before moving in. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. Evidence: Each person using the service has a plan of care. Three care plans were looked at. It was evident that the care plans had been improved and developed since the previous inspection. These care plans are based upon assessment of each persons needs. This assessment includes personal care, health care, continence management, memory and orientation, personality and behaviour, relationships and sexuality, morning routines, night safety and financial needs. Each of these identified needs included significant detailed guidance with regard to meeting the persons goals/needs and aspirations. We were shown some recently developed Person Centred Plans (plans where the person using the service is central to and takes a lead with regard to their care and other Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: support needs). These are recorded in picture, and written format, and were up to date, and evident of being working documents, so updated each time the persons needs changed. These plans/ wish lists indicated that each person using the service had participated fully (as they are able to) in their plan of care and support. The care plans showed evidence of having been regularly reviewed (with each person using the service) and staff had signed that they had read them. Staff feedback told us that they were given up to date information about the needs of the people using the service. Staff survey feedback forms told us that the care plans are updated regularly, and every time there is a change. Other comments included the manager is very proactive about handing over reviewed guidelines/care plans. The manager told us that each person using the service has a copy of their person centred plan of care and support. Records told us that the daily progress of each person using the service is monitored. People using the service spoke positively about the staff. Two residents told us the name of their key worker, and they spoke of their key workers supporting them with shopping and other activities. We were told that each person using the service has a key worker and a co-key worker. Information about the role and responsibilities of the key worker was accessible in the home. Staff were seen to interact with people using the service in a positive and respectful manner during the inspection. Residents spoke of making choices. These include shopping for; clothes, toiletries, and food. A person using the service told us that they could choose when to get up and go to bed, and what preferred activities that they wished to participate in. From talking to people using the service and from feedback surveys, and from records, it was evident that residents are supported to make decisions about their lives. We were told that resident meetings take place every month. Records of these meetings told us that residents participated in the meetings and had the opportunity to communicate their views of the service, and of their wishes and needs. It was evident from records and from talking to staff and people using the service, that supporting residents to be empowered continues to be a significant aim of the service, and that staff have a good understanding of the various communication needs of residents. We were told that several people using the service have an advocate and/or befriender. It was evident from the inspection, staff, people using the services, and records that the service involves and consults (in various ways that meet each persons communication needs) residents fully with regard to meeting their needs, wishes and choices. The care home has a management of residents monies policy/procedure. We were told that all the people using the service have their own bank account and have support with managing their finances. We noted that records of each persons expenditure is maintained and that staff check residents monies during the staff hand over. It was evident that a person using the service was aware and involved in his finances. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: There was evidence of risk assessment documented in the care plans. These risk assessments had been developed and improved significantly since the previous key inspection. Risk assessment included bathing, road safety, night, fire, hospital admission, kitchen use, and unpredictable behaviour. These showed that they had been reviewed recently. Risk assessments in regard to safe working practices were available for inspection. AQAA told us that all staff attend organisational training on risk assessment within the first six months of employment. AQAA told us that the home has a clear and rigid Missing Persons policy and procedure in place. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills, and to take part in a variety of activities that meet their individual needs. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied, and wholesome, and meet the cultural and religious needs of people using the service. The menu information could be more accessible to residents. Evidence: The home is located close to a variety of community facilities and amenities, which include shops, restaurants, cafes, libraries, banks and parks. AQAA told us that the home has a varied day activities programme in place taking in to account of the development needs of each service user in line with their wishes. We saw information Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: displayed about each persons activities that they had planned and did take part in on the day of the inspection. People using the service told us of the activities that they participated in and enjoyed. These activities included taking part in a variety of leisure pursuits at resource centres. It was evident from talking to people using the service, speaking to staff, and from records that people using the service are fully involved in choosing the various activities that they want to participate in, and that these activities meet their individual needs. We were told from the AQAA that the variety of activities include educational courses, work placements, and community participation as well as in-house activities. A resident told us about a planned sailing activity that he was looking forward to, another resident spoke of enjoying their work placement. Another person using the service, spoke of shopping, seeing friends and family, and of their plans for a holiday to Disney Land. A resident told us about the recent celebration that he had had for his birthday, and another person indicated to us of how he wished to celebrate his up and coming birthday. A resident told us that he had some pet fish. AQAA told us that the varied day activities programme is constantly monitored and updated in line with the changing needs and wishes of people using the service. Other activities that people using the service take part in include; music, cooking, the Jewish Way of Life training, watching DVDs, going to the cinema and West End shows, swimming, and accessing the residents computer. A resident had a computer educational session during the inspection. A person using the service told us how much he enjoyed going bowling, and had gone to the cinema on the day before this inspection. AQAA told us that two people using the service have a work placement, and plan to achieve a qualification in food safety. We were also told that residents are involved in carrying out household duties. Residents were seen to clear the table after eating their meal. Care plans, staff, residents, and records told us how the cultural and religious needs of people using the service are met by the care home. We were told that people using the service have the opportunity to celebrate Shabbat every week. Staff and the AQAA told us how people using the service are supported to develop personal relationships, while giving them knowledge and understanding to deal with these relationships and by enabling people using the service to access professional advice, education, and support in this area. This is positive. Residents told us about their contact with their family. One person told us that they regularly go on holiday with, and stay for weekends with family members. Minutes of resident meetings told us that the wishes of people using the service with regard to activities and contact with family/friends are listened to by staff. AQAA told us of the various ways that the home keeps in contact with the family members/significant others of people using the service. This includes email and telephone contact. AQAA and the care plans looked at told us that each person using the service has a thorough and comprehensive eating and drinking section in their individual care plan. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: We were shown a menu, which we were told is planned with people using the service. There was also an actual menu that recorded any changes that were made to the original menu. The home could look at developing the format (i.e. in picture/photograph format of meals) of the menu so that that the information is more accessible to people using the service who might have difficulty in reading. Meals provided are all Kosher, and records told us that this is monitored closely. It was evident from records that meals provided were wholesome, and nutritious. We were told that the home has had significant input from a nutritionist. Staff told us about how healthy eating was promoted in the care home. People using the service told us that they chose what they wished to eat. During the inspection residents chose a number of different food and drinks for breakfast. Staff were knowledgeable of the particular dietary needs of people using the service. AQAA and staff told us that fresh food is bought (with residents) locally and that large items and other foods were delivered to the home. We were told that the two people living in the flat (part of the home) choose their meals, and shop for and cook(with support from staff ) all their own meals, and that they join the main part of the house for the weekly Shabbat meal. We were told that two days a week residents do cooking during Jewish Way of Life sessions. Meals during the inspection were unhurried and staff were seen to eat lunch with the residents. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People 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. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity, and privacy are put into practice. Systems are in place to ensure that medication is stored, and administered safely to people using the service. Evidence: It was evident from talking with staff, residents, general observation, and from looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their health care needs assessed and met. The care plans that were looked at, included up to date Health Action Plans of each person, which are specific to each resident and have clear guidance to maintain and monitor their health needs. Treatment and care for residents from health care professionals including the GP, dentist, chiropodist, psychiatrist, psychologist, and optician, were recorded. Attendance at specialist clinics and hospitals appointments were also documented. We were told that advice was sought as and when required from health care professionals, and that referrals were made in accordance to residents needs, and their changing needs. Records and the manager told us that each person using the service have clear Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: recorded guidelines and risk assessment in the event of them being admitted to hospital. This is very positive. We received very positive feedback from health care professionals, who told us that residents individual health care needs are always met by the service, and that staff have the right skills and experience to support individuals health and social care needs, and that staff respond appropriately to any concerns raised by health care professional or the person using the service. Comments from health care professionals included; the home puts the residents needs first, and in terms of nutrition, and health staff have a high level of knowledge in that area, and the home takes a genuine interest and is committed to the health and well being of its residents. AQAA told us of that residents are supported to lead a healthy lifestyle which includes taking part in a variety of activities that include organised challenges such as the Waterside Walk, South Africa bike ride, and Amalfi Coast trek. The manager told us that the home had guidance in place with regard to minimising the risk and responding to a possible outbreak of swine flu in the home. The home has a medication policy.We were told that all the people using the service require support with taking their prescribed medication. Medication is stored securely. Medication administration records were up to date. We were told that a pharmacist regularly inspects the medication storage, and administration systems in the care home. We were told by staff that the medication administration records were looked at by staff during staff handover meetings to ensure that the records were up to date, and that there were no gaps in recording. It was noted that whether or not residents have an allergy was not recorded on the medication administration records. A senior staff member up dated these records with this information during the inspection. We were told that all staff receive comprehensive medication training when they start their job, and that prior to staff administering medication to people using the service they receive a written and verbal test plus observation in the working environment, to ensure that they are competent to carry out the task. The manager told us that staff were shadowed by senior staff for two weeks whilst they administer medication to people using the service. We were told by staff and records that staff regularly receive refresher medication training. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. Evidence: The care home has a complaints procedure. A summary of which is recorded in the service user guide in an easy read format, and is also displayed in the home. The complaints procedure includes timescales with regard to responding to a complaint. There were no recorded complaints. We were told by staff that resident meetings are forums where people using the service have an opportunity to communicate any concern. A resident told us that he/she would speak to his/her key worker or the manager if he/she had a concern or complaint. Feedback surveys from people using the service told us that they know the complaints procedure and who to talk to if they were worried about anything. AQAA told us that the home will continue to support service users to use the General Complaints book and to try to follow through on their requests. The home has clear and robust policies and procedures with regard to the protection of people using the service. AQAA told us that the home has copies of all the funding Local Authorities safeguarding policies/procedures. A staff member who spoke with us and information from staff surveys told us that staff had an awareness, and understanding of the reporting, and recording procedures with regard to responding to Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: concerns or complaints, or of any suspicion or allegation of abuse. Staff, and records told us that staff had received training in safeguarding adults. We were told that that safeguarding adults training is included in the staff induction programme, and in the National Vocational Qualification (NVQ) in care that all staff have achieved or are in the process of achieving. AQAA and ongoing contact with the care home since the previous inspection told us that the manager has carried out a comprehensive review of residents night time needs, risks, which has led to wake night staff being being put in place as and when needed by people using the service. This confirmed that a previous requirement had been met. The service lets us know about notifiable incidents/accidents, and records them appropriately. AQAA told us that the home has policies/procedures with regard to counter bullying, dealing with violence and aggression, equal opportunities, diversity, and anti-oppressive practice, and whistle blowing. The care plans looked at included clear guidance with regard to meet the needs of people using the service who could on occasions challenge the service. We noted that the home has up to date information with regard to the Mental Capacity Act 2005/Deprivation of Liberty safeguards. The manager told us of the contact that he had with a Local Authority regarding this issue, and had looked at each persons individual needs, with regard to this. AQAA told us that the manager has developed and put in place Coping Strategies and recorded a number of scenarios of possible abusive situations that might occur in the home, and so ensure that staff are well supported and have the knowledge and understanding to respond appropriately and consistently when a person living in the care home might challenge the service. This is positive. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People 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 layout of the home enables residents to live in a clean, safe, well maintained, and comfortable environment, which supports and encourages their independence. Residents bedrooms, meet their individual needs, and are individually personalised. Evidence: The care home is a large detached house, which includes a flat that is shared by two people using the service. The house is located close to the amenities and facilities of Stanmore, and Harrow Weald. The inspection included a tour of the premises. The home is generally well maintained, and is very clean, light, airy and homely. The feedback surveys from a people using the service confirmed that they thought that the home was fresh and clean. The living environment is attractive, with furnishings of quality. Houseplants, ornaments, photographs, pictures, computer, music system, and a large television are located in the communal sitting room. There has been some redecoration of the communal areas since the previous key inspection (31/07/2007). This includes the sitting room and dining room areas. Some new furnishings have also been purchased. These include new quality dining tables and chairs. AQAA told us that a number of new pictures, photos, new furniture have been bought. A new kitchen has been recently installed, which has low work surfaces, and a central island where Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: people using the service can prepare food away from cooking hazards such as the cooker. Staff and a resident spoke positively of the kitchen. Residents were seen to access the kitchen freely. The home has an enclosed garden, which is well maintained. We were told that the garden is regularly used in the good weather by residents, and that some people using the service have participated in growing some plants including vegetables. A variety of garden furniture was seen to be accessible to people using the service. There are some areas,( ie bathrooms) of the home and the flat that could be redecorated. The manager told us that he had put forward quotes for further maintenance and redecoration of these areas. The stair carpeting and the carpet located in the passage way outside the upstairs bedrooms were stained in some areas, and should be cleaned or replaced. AQAA also told us that the decor of some bedrooms has been updated within the last twelve months. A person using the service kindly showed me their bedroom. This bedroom was individually personalised, with items that included their own television, music system, photographs and attractive furniture, of the persons choice. This resident (and other people using the service) told us (or indicated by gestures and sounds) that they were happy with their bedrooms. The laundry facilities are located away from food storage, and food preparation areas. Disposable gloves were seen to be accessible to staff and to others. We were told that people using the service are supported to be as fully involved (as far as they are able to be) in the laundering of their clothes. AQAA confirmed that the home has an infection control policy, and that staff had received infection control training. Care staff have been carrying out cleaning duties in the home. On the day of the inspection a domestic staff member commence employment to work part time in the home. Soap and paper towels were accessible with hand washing facilities in the home. AQAA told us that the homes recent Environmental Health Inspection gave the home a 5 star/excellent rating. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People 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. Staff in the home are trained, skilled and are in sufficient numbers to support the people using the service, and to support the smooth running of the service. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: The staff rota was available for inspection. It was evident from the this record that there were generally four staff on duty (plus a staff member in charge) during the day and a sleep in staff member on duty at night. We were told that there were sufficient staff on duty at all times to ensure that the varied needs of people using the service are met. The manager gave examples of the flexibility of staffing numbers on duty, particularly at night when a wake night staff member has been employed when a resident had been unwell. We were told by him that the aim was to have a permanent wake night staff on duty. This is positive. Staff meetings take place regularly, and records told us that they are well attended. Staff spoke of their role as key worker to residents. This includes supporting residents to lead a quality life as independently as they are able to, and to participate with residents in the review of their personal plan of support. Staff spoke of knowing the residents well, and of working as a team in the home. Staff follow a daily shift planner with regard to their duties. We joined a staff Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: handover meeting, which was a comprehensive discussion about the progress of each person using the service. Staff feedback surveys, records, told us that staff had received a staff induction when they started working in the home. A staff member told us that the induction programme helped a lot, and that it covered what they needed to know. Staff feedback confirmed that this induction ensured that they felt knowledgeable, and competent in carrying out their role and responsibilities in meeting the needs of people using the service. Comments from staff surveys told us that the Company provides a comprehensive training programme, which is regularly reviewed and updated to reflect training requirements to meet the individual needs of service users, and that weve done all the mandatory training provided by Norwood. AQAA told us that there is very little staff turnover. Staff feedback confirmed that they enjoyed working in the home. Comments included I love to work in this home, we share information. AQAA told us that the staff induction meets National Minimum Standards for the service, and that there is a staff training plan. We were told that staff attend several training days(including refresher training) each year. A staff member spoke of there being lots of training. Staff training records, including a training development plan, and certificates of training were available for inspection. Staff training included health and safety, infection control, 1st Aid, moving and handling, fire safety, safeguarding adults, medication and safe food handling training. Specialist training areas included; Person Centred Planning training, dementia care, basic mental health, and National Vocational Qualification (NVQ) level 2 and/or 3 in health and care. The manager told us that all except one member of staff (who had almost completed the course) have achieved NVQ level 2 or above care qualification. AQAA told us that as well as the manager, and two senior staff have achieved Level 4 in Care and the A1 NVQ Assessors Award. The home has a staff recruitment and selection procedure. Three staff personnel records (including the most recently employed member of staff) were looked at. These confirmed that appropriate required checks including an enhanced Criminal Record Bureau check (a check to gain information as to whether a person has a criminal record) was carried out. AQAA told us that these checks are carried out every three years. We were told by the manager that there were plans to ensure that people using the service would have the opportunity to participate in the staff recruitment process. AQAA told us that a resident has participated in a recruitment workshop. This is positive. AQAA told us that all staff have written contracts with clear job descriptions. Records, including the AQAA, and staff told us that staff receive regular 1-1 staff supervision and an annual appraisal, to ensure that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. Staff feedback surveys confirmed that they receive one to one staff supervision, to give them support and to Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: discuss how they are working. The manager told us that he ensures that staff receive supervision. A senior staff member told us that she had received staff supervision training. It was evident from talking to people using the service, records, and from observation that residents know the staff team well, including knowing their names. A resident confirmed that she liked the staff and that they are approachable. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People 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. The management, and administration of the home is based on openness, and respect, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. Evidence: The manager has managed the care home since 2006 and had worked in the home prior to this. He has also managed another care home within the organisation. He has significant experience of working with people who have a learning disability. He is well qualified, having completed NVQ 4 in care and the Registered Managers Award (RMA), and the A1 Assessors Award. AQAA told us that the manager works flexibly across shifts to ensure that he has accurate understanding of everything that happens within the service. We were also told that the manager updates his skills by doing appropriate training and that he and other senior staff attend conferences and external courses. It was evident from the completed AQAA, and from talking to the Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: manager that he is motivated and competent in ensuring that people using the service are provided with a quality service. Where there are areas for improvement that emerge, the service recognises them, and works to put systems in place to manage and develop them. A comment from a health care professional told us that they commended the manager on his tireless dedication to the well being of the residents. Another comment described the service as an emphatic caring home. Talking to staff, and looking at records (including the AQAA, care plans, health and safety checks, and staff training), confirmed that the home has systems in place to improve, and to monitor the quality of the service provided to people using the service. The manager told us that Norwood were in the process of developing a Quality Assurance policy/procedure. This should be completed. We saw a recent record of a comprehensive monthly audit of the home that was carried out by a representative of the organisation. The manager told us that feedback questionnaires are regularly supplied to stakeholders including relatives of people using the service and significant others, for their views of the care home and the service that it provides. There are policies, and procedures in place to ensure that people using the service are safeguarded. AQAA told us that Norwood is looking at developing some pertinent policies in user friendly format, so that they are more accessible to a wider range of residents. This is positive. AQQA indicated that some of the organisations policies and procedures had not been reviewed since 2003 and 2004. It should be evident that these are reviewed regularly. AQAA told us that four people using the service take part in a People First Residents Forum. Records told us that residents regularly participate in resident meetings. The home has a fire risk assessment. Records and the manager told us that appropriate fire checks are carried out. Fire drills take place. AQAA told us that a recent Fire Brigade Inspection showed no requirements and deemed all procedures and plans in place to be appropriate. The manager and records told us that equipment in the home is regularly serviced/checked by appropriate persons. Records told us that fridge and freezer temperatures are monitored closely. The employers liability insurance is up to date. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 17 The menu information could be in a better format (i.e. photographic or picture format) so that it is more accessible to people using the service, who have various communication needs and might have difficulty in reading. The Organisation should develop and distribute to its care homes a formal policy with regard to Quality Assurance. 2 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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