Care Home: Oakhurst Lodge

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What the care home does well The home encourages and supports the people who live there to be involved in planning their care needs. Care plans and other documentation used at the home is very detailed and provides clear instructions for staff to follow to enable them to provide support and care in a way that people prefer. This is especially important as people cannot all express their views and feelings verbally. The ethos of the home is one of inclusion and there is a strong commitment to enabling people to be included in all aspects of life within the home environment and the local and wider community. People are encouraged and supported to take everyday risks in a safe and planned way and make decisions about their lives with assistance as needed. People are supported to keep in touch with family and friends. There is a clear staff structure and staff have a good understanding of their roles. People`s views are taken into account and the home is constantly seeking new ways to include people in decision making processes. One health care professional commented, "From the contacts that I have had with staff and clients from Oakhurst Lodge the service is very professional and caring. I have been impressed". What has improved since the last inspection? There were not any issues identified at the last inspection requiring improvement. However the home continues to reevaluate the service that it provides to people. They have produced more information for people in formats suitable to their needs to aid them with understanding their rights. What the care home could do better: There were no requirements or concerns as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Oakhurst Lodge 137 Lyndhurst Road Ashurst Southampton Hampshire SO40 7AW     The quality rating for this care home is:   three star excellent 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: Chris Johnson     Date: 2 2 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: Oakhurst Lodge 137 Lyndhurst Road Ashurst Southampton Hampshire SO40 7AW 02380293589 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: john.caslake@cambiangroup.com Cambian Autism Services care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. 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 Oakhurst was originally a large private house that was converted for use to a care home. Its current owners (Cambian Autism Services) totally refurbished the property before it began operating its service in April 2007. The home provides a service for young adults aged between 16 and 25 years who have autistic spectrum disorders and it can accommodate up to 8 individuals. It is described in its prospectus/ service users guide as a stepping stone for among others individuals who were previously students at a 52 week residential school for students with special needs that is also owned by the same company. The building has 2 stories with bedroom accommodation on both floors. All bedrooms Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 8 Brief description of the care home are single occupancy and are provided with en-suite showers. The shared accommodation/communal space comprises 2 lounges, a dining room, learning area/activities room, sensory room, kitchen, laundry and 2 bathrooms, one of which is fitted with a Jacuzzi/spa bath. There is a large enclosed garden at the back of the building and an enclosed tarmac area at the front. The establishment is located in a small rural community on the edge of the New Forest within easy reach of Southampton and readily accessible by public transport. Amenities in the immediate locality include several shops, restaurants and pubs. The towns of Totton and Lyndhurst are both within a few minutes drive of the home and in the former a range of amenities normally associated with a large town are available e.g. library, leisure centre, college, supermarkets, churches, etc. 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: 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 purpose of this inspection was to assess how well the home is doing in complying with regulations and to assess what the outcomes are for people who live at this home. The findings of this report are based on a number of different sources of evidence. These included: An unannounced visit to the home, which was carried out over one day on 22 September 2009. We arrived at the home at 10:55 and completed the visit at 19:30. During the visit we looked at all key standards. Any regulatory activity since the last inspection was reviewed and taken into account including any notifications sent to the Care Quality Commission and the predecessor organisation the Commission for Social Care Inspection. The Commission for Social Care Inspection carried out an Annual Service Review (ASR) of the home on 25 September 2008 and this did not change the commissions opinion Care Homes for Adults (18-65 years) Page 6 of 31 of the service or raise any issues for concern. We requested that the manager complete an Annual Quality Assurance Assessment (AQAA) prior to this inspection. This was sent to us within the agreed timescale, was very detailed and proved to be an accurate reflection of the home. This document forms part of the evidence for this report. During this visit we looked at the physical environment including, peoples bedrooms and all communal areas of the home. We examined records, policies and procedures. We talked to people who live at the home and some members of staff. We observed staff during their day-to-day interactions with people living at the home. We also sent surveys to staff, health care professionals and people living at the home. The manager of the home supplemented our surveys with some that they had designed themselves and that were more appropriate to the needs of the people living at the home. At the time of writing this report we had received completed surveys from five people who live at the home two members of staff and two social and health care professionals. The manager was present during the visit to answer questions and discuss issues and verbal feedback was provided to him at the end of the inspection. 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. 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 8 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 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes assessment process is thorough. This ensures that no one is admitted to the home unless the home and the person concerned are certain that it is right for them and will meet their needs. Evidence: The previous inspection of the home carried out on 2 October 2007 found this outcome area to be good. We also carried out an Annual Service Review (ASR) on 25 September 2008 and that did not raise any concerns or issues in this outcome area. The annual quality assurance assessment (AQAA) stated that Prior to admission into this establishment all young people are assessed by the Head and either the Teacher or Registered Manager of Oakhurst. This process is logged on an Pre assessment form. Where appropriate young people are invited to visit Oakhurst. We produce a person specific guide to Oakhurst prior to admission. The home had only had one new person move in since our previous visit in October Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: 2007. During the most recent visit we looked at records and discussed the assessment process with the manager to ascertain how the home and the person concerned had decided whether the home was right for them. We saw that records had been maintained of the assessment process and that this was as described within the AQAA. The person concerned had visited the home on three occasions before they moved in providing them with the opportunity to look around the home including the vacant bedroom, interact with staff on a planned outing supported by staff from the previous home and to meet the other people living at the home and have a meal there. We also saw that the home had all pre admission assessment material including their own assessment. We saw that the person concerned had been supplied with information about the home and that this was in a format appropriate to their needs. This included; pictorial information about the home, photographs of the home and facilities, information on how people living at the home could make a complaint including photographs of people that they could contact such as the manager if they had any concerns. The home had also provided the person with information on keeping safe and how the home protected people, peoples rights and responsibilitys towards others living at the home such as knocking on doors and before entering rooms and seeking permission before using something belonging to someone else. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are involved in planning their care and support needs. Care plans provide clear instructions for staff to follow and enable them to provide support and care in a way that people prefer. People are encouraged and supported to take everyday risks in a safe and planned way and make decisions about their lives with assistance as needed. Evidence: We reported at the last inspection of the home, carried out on 2 October 2007, that care plans were, detailed and comprehensive, setting out the support and help that each person living in the home needed and how it was to be provided. The documents looked at during this most recent visit including the care plans demonstrated that the home had continued to sustain this level of care planning and support. During our visit to the home we examined the care plans and associated documents Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: such as risk assessments in respect of three people who live at the home. Each person had been assessed by the home as to their level of level of independence and assistance needed in areas such as self care, using the toilet, bathing, dental care, dressing, grooming, mealtimes and domestic skills. Care plans also covered peoples communication needs and their methods of communicating their needs with clear descriptions of verbal, gestural and visual communication methods used by the individual. Each person had a Communication Passport. These were written in the first-person and were person-centred. They had all been written from the persons perspective describing how they communicated different emotions, wants and needs. Examples of these were, I find it easier to understand you if you speak to me like, Other things that effect whether I am able to listen, How I tell you how I feel I am upset or cross, Things that upset me or make me cross. When I get upset or cross it is helpful if you, When I want you to go away, and Things that may frighten me. We saw recorded evidence that care plans had been kept under regular review and that any changes in someones support needs are recorded and that appropriate steps are taken to accommodate changes. Due to the communication needs of people living at the home it was difficult for us to discuss their involvement in their care planning. However in discussion with staff and through recorded evidence we saw that people are encouraged and supported to contribute to their plans and that their personal opinions and wishes and goals are incorporated into care planning, with strategies to achieve these. Each person living at the home had a key worker who ensured that documentation was completed for goals that had been agreed with the individual and that these had been actioned. We also saw evidence that other significant people in the persons life such as parents and social workers had contributed and attended review meetings. Discussion with staff during the visit and the responses to surveys demonstrated that staff are kept up to date with any changes in peoples support needs, that they have full access to care plans. Staff told us that any changes to someones care plan is identified and communicated at the start of a shift and via a communication book. We observed people living at the home to take part in activities as described within their care plan. All care plans seen provided detail of different behaviours that individuals displayed. These were listed and provided a description of when they may happen, to whom, strategies to use and general instructions for staff. Risk assessments were examined and found to be in place for behaviours and or risks for each person inside and out of the home. Comprehensive risk assessments had been undertaken for all activities and there was a clear policy on undertaking particularly hazardous activities. The home demonstrated that they adopted a policy of supporting Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: people to try new things and to take risks within a safe and risk managed environment. We observed people to be supported to carry out behaviours associated with their diagnosis in a safe and controlled way ensuring that it did not impact on others. There was evidence from the annual quality assurance assessment (AQAA), observation, discussion with staff and people living at the home and documents such a house meeting minutes, that people living at the home were encouraged and supported to make decisions about their daily lives. 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. People who live at this home are encouraged and supported to undertake social, educational and leisure activities. The home promotes inclusion and seeks to support people to take part in peer appropriate activities within the local and wider community. People are supported to keep in touch with family and friends and are supported to make their own choices and input into daily life within the home. People living at the home enjoy a balanced and healthy diet. Evidence: People living at the home have told us in the surveys that they like living at this home. People have said that they are given choices that help them to decide what happens to them and what they do. People named a number of different activities that they Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: had the opportunity to take part in and named several that they liked. These included; use of the sensory room at the home, use of the garden, books, going out in the homes bus, going out in general, cooking, art, attending clubs, spending time in their bedrooms, watching television, use of the exercise bike and games. One person told us that they particularly liked attending a local youth club, going swimming and shopping. On arrival at the home three people had gone swimming accompanied by three members of staff. Another person was at a local college supported by the manager and another staff member. It was the persons first day at college and two members of staff had gone along to provide the person with additional support and to ensure that the first few days at college went as smooth as possible for the person. A second person was due to start a course at the local college the day following this visit. The manager explained that this was seen as an improvement by enabling the people living at the home to access and use community based activities and resources. The home places a lot of emphasis on providing the opportunity for people who live there to develop skills in all areas of their lives. The homes statement of purpose states, We aim to provide experiences and teach skills that will enable our students to develop as much independence as possible and prepare them to live happily within the community. The staff group at the home included a teacher and teaching assistants. People who live at the home follow individual timetables and these include work skills and living skills. We saw evidence to support this in the care plans, peoples individual timetables and records of activities and through discussion with staff and people living at the home. The home had been working toward supporting people to gain paid work in the community. This has proved a challenge so far due to peoples needs. However the home had supported people to set up a mini enterprise making sandwiches to sell to staff. The manager said that the home had been both active and successful at increasing links with the local community and would like this to continue. People living at the home had been involved supporting community events such as litter picking, delivering the Parish Councils newsletter to the local community, visits to local restaurants and the pub. The youth club that several people attend is not specifically for people with a disability and this was enabling people at the home to mix with their peers in the community. We know from the previous inspection that people are supported to maintain contact with family and friends. The AQAA told us that Young people are supported to maintain regular contact with their families and carers via phone calls, emails, letters and visits. These take place in a variety of places dependant upon need. This was supported through recorded evidence and feedback from people who live at the home. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: At the time of this visit the home was looking into the viability of using Web cams for home communication for some people. We saw examples of menus while at the home. The menu options were varied and it was evident that healthy eating is promoted. The home uses a lot of fresh produce there was plenty of fresh fruit around the home for people to help themselves to. People living at the home had cultivated a vegetable patch in the garden with staff support. People are fully involved in menu planning and go shopping with staff twice a week. One person had opted to collect milk and bread from a local shop on a daily basis. The freezer had a lot of homemade alternatives that could be chosen by someone if they did not wish to have the menu choice. People are encouraged and supported to assist with meal preparation and on the day of the visit several people prepared the vegetables. Meal times are flexible and we saw evidence that they are planned and timed to fit in with peoples daily routines and activities. Currently the menus are only available in written format. Due to the communication needs of some people who live at the home a pictorial format would be more appropriate and this was discussed at the time of the visit. 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. People are fully supported with their health care needs and have access to a range of specialist health care support. People receive personal support in the way they prefer and according to their needs. Evidence: From evidence recorded in the care plans and from observations and discussion it was evident that people were receiving support with their personal care needs in line with their needs and preferences. Care plans and associated documents provided us with enough information to demonstrate that health care needs are being met and that people have access to a range of health services. Each person had a health file containing medical meeting notes, evidence of medication reviews, a history of inoculations, medication history, a record of any health related concerns and evidence that action been taken to address these. Records were also available for all appointments attended such the GP, consultants, dentists and opticians. Feedback from health and social care professional surveys were very positive. Both responses told us that the monitored, reviewed and met peoples social and health care needs properly and that the home sought and acted upon advice appropriately. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: The medication administration records were checked for three people during the visit. From examination of these records it was evident that staff were following correct administration recording procedures. The home has a written medication policy and clear procedures. As part of this procedure the home requires two members of staff to sign the medication administration records each time any one is administered any medicine. The first signature being that of the administrator and the second of the witness. This procedure had been followed for checking in medicines received into the home and for logging any medicines returned to the pharmacy. We saw that the home had a system for regular auditing of the records. All medication records examined during the visit had been maintained in line with the homes written procedure. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes policies and procedures serve to protect those who live there. Evidence: The annual quality assurance assessment (AQAA) stated that, There is clear complaints procedure that all staff are aware of and have access to. There is a young persons complaints policy. The policy is supported during the young peoples house meetings. All members of staff who were spoken with or whom completed a survey told us that they were aware of the policy and knew what to do in the event that someone had a concern about the home. Everyone living at the home that we spoke with or who completed a survey told us that knew who to complain to if they were unhappy about anything. They all felt that they could tell staff their worries or concerns and some named additional people such as advocates, family and social workers. At our previous visit to the home in October 2007, we reported that the home did not have an alternative format of the complaints procedure other than the written one. This has now been addressed with the introduction of a pictorial guide to making a complaint and these included photographs of individuals that people could contact or tell their concerns to such as manager. There was guidance on display within the home to inform people about abuse and how to keep safe. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The home supports people to manage their finances. Each person is risk assessed as to their ability to manage their own finances. At the time of this visit no one had been assessed as being able to solely manage their own finances. However recently two people had been supported to open high street bank accounts and were managing their finances with support. This was something that the home had identified at the previous inspection that they wanted to achieve. The AQAA stated that the home were intending to continue to develop peoples money management skills at a level they could understand. During our visit we examined the financial records of two people. All transactions had been recorded and receipted as per the homes policy and the storage facilities were safe and secure. What was noted was that not everything of value looked after on someones behalf had been recorded. This was discussed with the manager who agreed to implement this. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, safe and clean home. Evidence: During the visit to the home we saw all communal areas and several bedrooms. On arrival, the home was found to be clean and tidy and smelt pleasant. Each persons bedroom had been personalised and reflected the persons individual interests and they had been able to choose their own colour schemes. Accommodation at the home consists of eight single bedrooms with en-suite shower facilities, two bathrooms including a Jacuzzi bath, two lounges, a dining room, kitchen, sensory room, meeting room and reception. Adjoining the house is an additional learning base equipped with a practical area, computers and an interactive white board to facilitate visual learning. There is a large garden with rest and recreational areas, all within a safe and secure environment. From observation people were relaxed and at home in the environment and free to access their rooms and other areas as they so chose. The decor and furnishings were in good order. The manager said that there were plans to replace the carpets in the lounge and hallway and replace some furniture. The home had recently acquired some exercise equipment and the manager said that they Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: hoped to build a log cabin in the garden at some point in the future to be used as a gym. People living at the home are encouraged and supported to keep the house clean and tidy. Additionally the home employs a grounds person, maintenance person and a cleaner. The kitchen and bathrooms were all seen and it was evident that infection control procedures were being followed. Paper towels and hand soap dispensers were in use used and the home had a cleaning schedule in place. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers to meet the needs of people living at the home. They are well trained and undergo a thorough recruitment process. Evidence: We looked at the staff rota for the day of the visit and this proved to be a true reflection of the actual staff on duty. We also saw that the staff rota had been planned for the forthcoming weeks and that arrangements had been made to cover staff leave. Staff were asked whether there were enough staff to meet the individual needs of all the people who live at the home one person answered Always, another said Sometimes and all others responded Usually. Staffing levels was an area identified by some staff as something that could be improved. However we could not find any evidence to suggest that staffing levels were not appropriate for the needs of the people living at the home at the time of our visit. Each shift is led by an assistant team manager leaving the manager as supernumerary and therefore able to attend to the day to day management of the home. At the time of our visit the following staff were on duty, a senior teaching assistant, two teaching assistants, an administrator, a cook, an assistant team manager, the manager and four learning support workers. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Previous inspections of the home have demonstrated to us that the home carries out a thorough recruitment procedure. The Annual Quality Assurance Assessment (AQAA) provided evidence that this is still the case. The results of staff surveys were that all staff confirmed that they had been through a thorough recruitment process and that their induction had been thorough. During the visit we looked at the recruitment records of three members of staff who had been employed by the home since the last inspection. We saw that the home had followed an appropriate recruitment process and that this included; the submission of an application form, an interview, the receipt of two written references and that in all cases these had been verified by a phone call to the referee to ascertain authenticity. Criminal Records Bureau and Protection of Vulnerable Adults checks had all been completed prior to the staff commencing work at the home. Evidence was seen to verify that all three members of staff had been inducted into the home and that they had completed an induction programme that was linked to the Skills for care induction standards. We talked to staff who had recently undergone their induction. This had consisted of a corporate induction off-site for a week learning about policies, procedures and undertaking training generic to the organisation. This was then followed by a week long induction at the home that included several days of shadowing other members of staff. The staff member said that during their induction at the home they had accompanied staff whist they supported individuals to help gain an understanding of each persons support needs. All staff contacted felt that they received training that was relevant to their role, helped them meet peoples needs and kept them up to date with new ways of working. Staff records showed that staff receive training in core areas such as health and safety, medication, first aid and abuse. Several staff commented on the friendly and supportive atmosphere between colleagues. One person said, The teams work well and there is plenty of cross team support. Staff were aware of their specific roles and responsibility and clear of who they were accountable to. Shifts were well organised with a dedicated handover period at the beginning of each shift whereby people were allocated their roles for the day. Although each person had a key worker and tutor all and staff members are allocated individuals to work with. This is rotated to ensure that each staff member builds a relationship with everyone living at the home and becomes familiar with their support needs. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Our observations were that staff were friendly and supportive toward the people living at the home. Staff and people living at the home were observed to be relaxed in each others company. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed and safe environment. Peoples views are taken into account and the home is constantly seeking new ways to include people in decision making processes. Evidence: The homes registered manager has several years experience of working with people with autistic spectrum disorders. The manager currently holds an NVQ Level 4 and is working toward his Registered Managers Award. Feedback from other people was that the home was run professionally and effectively. One person commented, From the contacts that I have had with staff and clients from Oakhurst Lodge the service is very professional and caring. I have been impressed. The previous inspection of the home did not raise any concerns and there were not any outstanding requirements. The annual quality assurance assessment (AQAA) completed by the manager prior to this visit proved to portray an accurate assessment and reflection of the service and was very detailed. The manager has demonstrated that he has been able to sustain the level of support provided to people at the home Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: as found at the last inspection in October 2007. Data recorded in the Annual quality Assurance Assessment(AQAA) told us that policies and procedures are kept under regular review and examination of a sample of these confirmed this. The AQAA also gave details and evidence that maintenance checks, tests and servicing of equipment are carried out on regular basis. Evidence seen during the visit substantiated this. Examination of the fire logbook demonstrated that regular and thorough testing and servicing of the homes fire detection and firefighting equipment and other appliances had been carried out as appropriate. The home had systems in place to evaluate and monitor the quality of the service that it provided. We saw that an independent person employed by the organisation visits the home on a monthly basis to monitor the effectiveness of the service. Records showed that during these visits people living at the home were consulted and spoken to staff were interviewed, the environment and upkeep of the home was monitored and records were examined. Alongside this internal audits are carried out and regular individual and group meetings for the people who live at the home are held. 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. 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