Care Home: Old Barn Close (4)

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What the care home does well The home provides a comfortable, safe and well-maintained environment for people living there. The home is well located for the amenities of the village. The home has a well written and informative Statement of Purpose and Service User Guide to provide current and prospective users, their families and professional representatives with comprehensive informattion on the service provided. The home maintains excellent liaison with NHS and local authority service before, during and after admission. Good arrangements are in place for carrying out and recording risk assessments. These aim to ensure that people living in the home can participate in a range of activities both while in the home and in the wider community. People are well supported in maintaining contact with their families. The health and personal care needs of people are well met, thus promoting health and well-being. Staff have access to a good range of training opportunities aimed at providing them with the skills they need to provide appropriate support to people living in the home. There is a positive and `person orientated` ethos in the home which helps to maintain an environment aimed at supporting people to develop their potential. What has improved since the last inspection? The opportunities for people living in the home to experience a wider range of activities in the community have increased. A new picture format of the complaints procedure has been introduced. Computer based `E-learning` has continued to develop. This provides part-time staff and those working unsocial hours with more opportunities to keep their skills and knowledge up to date and to maintain their continuing professional development. Staff retention has improved. What the care home could do better: The registered persons must ensure that the information required by the regulations with regard to the recruitment of staff is available from the time a new member of staff start work in the home (the registered service). The registered persons should establish an approach to quality assurance, to include a stakeholder survey, which enables it to obtain the views of a range of people with an interest in the service. The approach should include taking account of the views of the people living in the home. The registered persons should delete references to the former regulatory organisations, National Care Standards Commission and Commission for Social Care Inspection, in documents and insert the title of the current regulatory organisation, the Care Quality Commission. Key inspection report Care homes for adults (18-65 years) Name: Address: Old Barn Close (4) Gawcott Bucks MK18 4JH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Old Barn Close (4) Gawcott Bucks MK18 4JH 01280821006 01280821006 4oldbarn@nildram.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hightown Praetorian & Churches Housing Association Name of registered manager (if applicable) Mrs Lynda Jayne Wenner Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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 4 Old Barn Close is situated in a quiet residential area in the village of Gawcott. The village is a short distance from the town of Buckingham, which has a variety of shops and other local amenities. Gawcott is served by infrequent local bus services with more extensive transport accessible in Buckingham. The home is a modern bungalow and provides care to service users with learning and communication difficulties. The home has an enclosed garden which provides service users with a safe external area in which they can walk unhindered and in safety. All service users are accommodated in single Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 4 1 2 0 1 2 0 0 9 Brief description of the care home bedrooms. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in November 2009. The inspection included a visit to the service in Gawcott on 30 November 2009 between 10:00 am and 7:00 pm. The inspection methodology included: consideration of the Annual Quality Assurance Assessment (AQAA) submitted by the registered manager prior to the inspection; a review of the report of the last key inspection carried out on 12 January 2009; discussion with the registered manager and staff during the visit to service; examination of documents such as the homes Statement of Purpose, policies and guidance to staff; examination of service user support plans, examination of personnel records; discussion with a current user of the service, observation of practice; and, consideration of information received by us since the last key inspection. The AQAA submitted for this inspection was completed and submitted to the required timescale. The AQAA was well completed, comprehensive and detailed. Care Homes for Adults (18-65 years) Page 6 of 32 We also carried out a survey for this inspection. We received completed survey forms from staff and from health and social care professionals. The results of the survey have been taken into account in writing this report. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The registered persons must ensure that the information required by the regulations with regard to the recruitment of staff is available from the time a new member of staff start work in the home (the registered service). The registered persons should establish an approach to quality assurance, to include a stakeholder survey, which enables it to obtain the views of a range of people with an interest in the service. The approach should include taking account of the views of the people living in the home. The registered persons should delete references to the former regulatory organisations, Care Homes for Adults (18-65 years) Page 8 of 32 National Care Standards Commission and Commission for Social Care Inspection, in documents and insert the title of the current regulatory organisation, the Care Quality Commission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 considering using this service can be confident that the home has a thorough approach to assessing needs, that it carefully considers whether it can meet those needs before offering a place, and will provide the prospective service user with an opportunity to experience the service before accepting a place. Evidence: The service has an excellent informative Statement of Purpose. This outlines the size of the service, its location and environment. It describes the homes philosophy, the process of moving in, arrangements for review, organisational and staff structure, information on staffing, notes on staff training, fire safety, a confidentiality statement, the complaints procedure, and fire evacuation procedure. The Service Users Guide was updated in 2009. This outlines the purpose of the home, the service provided (note: references to the National Care Standards Commission in this section and on page 7 should be deleted infuture editions of the guide), information on how support is provided in the home, details of staffing, Moving In, and details on the fees and what they cover. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The service only accepts referrals from the Buckinghamshire Community Learning Disability Team. Both the Statement of Purpose and the Service Users Guide would provide prospective users of the service and their representatives with comprehensive information on the home. If the home has a vacancy - all places were occupied at the time of this inspection then a care manager making an enquiry on behalf of a client would provide the registered manager with information on the prospective user. This would include details of the most recent assessment of needs. If it is considered that the home may be suitable for the person, arrangements are made for the manager and a member of staff to conduct an assessment of the persons needs. This would include taking account of recent assessment by local authority and NHS staff where these have been made available. If it is agreed that the home may be able to meet the persons needs and the person seems likely to settle in then home arrangements are made for the person to visit. A process of visits of increasing duration (as agreed with the prospective user, their family or representative and the referring social worker) is arranged. If all goes well then an admission date is agreed. A review is held after three months to review progress. One person has moved into the home since the last inspection. Discussion with the manager and examination of records confirmed the implementation of a thorough process of assessment, liaison with local authority and NHS services, and consideration of the prospective users views during the course of the process. An appropriate support and follow up plan, in the context of the Care programme Approach (CPA), was agreed and there appeared to be good and effective liaison with statutory services since admission. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans are comprehensive, detailed and well maintained and provide a good basis for the care and support to meet required the needs of each person living in the home. Evidence: A support plan is in place for each person living in the home. Support documents are of varying levels of complexity. Those examined during our visit to the home were comprehensive, in good order, and were maintained to a very good standard. Support plans include a pen picture of the person, a diversity statement, year planner, information on care (e.g. bathing, continence, epilepsy), a communication profile, a list of things that are improtant to the person, food and drink likes and dislikes, risk assessments, and the persons preferred routine. Risk assessments were comprehensive and well written. Issues covered included, Moving and Handling, Travelling in a Car, Risk of Injury in the kitchen, Using the Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Shower, risks associated with trips out (e.g. Walks, Boat Trips, Road Safety, Swimming, Inappropriate behaviour), Bathing, and risks related to epileptic seizures. Support plans set out in detail the day to day support needs of each person. Support plans are reviewed monthly by key workers. Monthly summaries of progress and change were well written and up to date. The home had a pleasant and comfortable ambience on the day of our visit. Staff and users living in the home seemed to have a good relationship. Users were engaged in a number of activities throughout the day - sometimes on their own (listening to music or just relaxing in their own room or in the lounge), interacting with staff and others, or going out with staff for a while. Daily activity and other events are recorded in a diary for each person. Entries are made three times a day. Care Homes for Adults (18-65 years) Page 14 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 living in this home lead a varied and active lifestyle which reflects their interests and abilities. Managers and staff are seeking to expand the range of activities over the coming year. Meals are varied and nutritious. Evidence: Each person living in the home has their own Lifestyle Folder. This is in easy read and picture format and includes scanned in images. A trainer from Milton Keynes College visits every Tuesday to run a cooking session with users. This may include a themed evening such as food with an Irish association around St Patricks day in March - and similar occasions at other times in the year. Service users regularly attend a arts and crafts sessions and warmstone therapy and Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: massage in Wilmslow. The village itself has limited facilities although the home is planning to run a garden party and to invite neighbours in 2010. People in the home visit the village duckpond, go for walks in the area and visit a local garden centre. The home makes regular use of the shops and other amenities of Buckingham and Milton Keynes. These include the library, a large supermarket, Church, pubs and cafe and the larger stores in Milton Keynes. A little further away people also visit National Trust properties in the area and shops, pubs and cafes in Stoney Stratford. Some respondents to our survey expressed a desire for more activities e.g. More money for day trips and outside activities; Make more staff available to enable residents to go out more; Sensory Experience may be good - arrange for residents to attend sensory sessions outside; and. More activities - More choice with the hours staff work. People are supported in maintaining contact with their families. Individual users have had holidays in Dorset and Norfolk in 2009. One person doesnt take a holiday but prefers to have days out. People living in the home have established their own daily routines but are free to vary these as they wish. People are involved in menu planning and individual preferences are taken into account. Meals are cooked by staff. Breakfast from Monday to Saturday usually consists of cereals, toast and hot drinks. A cooked breakfast is served on Sundays. Lunch is a light two course meal. items on the lunch menu towards the end of November 2009 included: Scrambled Eggs on Toast followed by Fresh Fruit; Baked Potatoes with Cheese and Onion followed by Angel Delight; and, Quiche and Salad followed by Fresh Fruit. The evening meal is the main meal of the day. Selections from the November 2009 menus included: Beef Stew, Potatoes and Dumplings; Fish and Chips with Peas and Tomatoes; and, Shepherds Pie and Carrots. A roast meat based meal is served on Sundays and Fish and Chips on Fridays. A health or social care professional who responded to our survey wrote This service provides excellent positive care to enable its service users to reach and maintain a very high level of independence. It supports excellently each service user to live a normal life as is possible to their disabilities. It recognises each person as an individual and seeks to develop each persons needs.... Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Another professional commended the home for helping the people living there to access the community and for supporting families and clients. Care Homes for Adults (18-65 years) Page 17 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 good 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 needs of people living in this home are met and promote their health and well-being Evidence: The detail of personal support is recorded in each persons support plan. All of the people living in the home are registered with a GP based in a group practice in the village. All are also registered with the Community Learning Disability Team (CLDT) in Buckingham. The CLDT include access to a psychiatrist and other professional staff in the specialty. District nurses are accessed through the GP. NHS dentistry is obtained through Milton Keynes Hospital. We were informed that an optician will visit if required. Each service user has a review of their medicines with their GP once a year. Influenza vaccination is obtained through the GP. Medicines are prescribed by the persons GP and are dispensed by Lloyds Pharmacy in Buckingham. The pharmacy offers a check on the homes arrangements for the control and administration of medicines once a year. A report for such a check for 2009 was not available at the time of our Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: inspection visit. Most medicines are dispensed in blister packs, four packs, each covering a weeks supply, for each person. Medicines are collected from the pharmacy and are recorded on receipt in the home. Medicines no longer required are returned to the pharmacy the same day. Medicines are stored in a locked cupboard in each persions room. The home has a refrigerator where medicines requiring storage under cool conditions can be stored. This was not in use at the time of this inspection. The medicines administration records (MAR sheet) are stored in a cupboard. Stocks are checked twice a day by staff. Staff are trained in the administration of medicines through attendance at a course at the organisations head office. Staff competence is assessed by the manager through three supervised practice sessions in the home. Staff have an annual refresher update on the subject. The arrangements for one person were checked in their room with their permission. The administration records included a photograph of the person and the current MAR sheet. With one exception the arrangements were found to be in order. The exception was a prescription for pseudoephedrine which was taken as required but was not prescribed as such. The manager undertook to follow this matter up. Care Homes for Adults (18-65 years) Page 19 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. The interests and well-being of people living in the home are protected by its procedures for dealing with complaints and safeguarding (of vulnerable adults) procedures. Staff receive training and support to enable them to respond positively and appropriately to occasional episodes of challenging behaviour. Evidence: The service is required to conform to the complaints policy and procedure of Hightown Praetorian and Churches Housing Association (HPCHA). This is included in the homes Statement of Purpose. Each person living in the home has a pictorial version of the procedure in their room. The registered manager told us that staff also explain the procedure to people. Some details in the pictorial version needs updating in the light of personnel changes since last printed. The home has not received any complaints involving people living there since the last inspection. One complaint from a neighbour regarding car parking in the vicinity of the home had been resolved. In April 2009 we received acomplaint from a concerned person regarding assaults on staff. This matter was referred to HPCHA managers to investigate. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: The organisation has a policy on the subject of safeguarding vulnerable adults. The home had a copy of the policy and of the Buckinghamshire Joint Agency Guidance on safeguarding. A copy of the Department of Health guidance No Secrets was available for staff. Staff attend training at the organisations head office in Hemel Hempstead. All staff are required to have update training annually. The home had copies of the leaflet on the Buckinghamshire confidential telephone line Careline. The home has contact with an advocate from an advocacy organisation in Aylesbury. The advocate used to Chair the meetings for people living in the home but due to cutbacks has recently had to change her role. The advocate regularly visits people living in the home. The organisation provides training to staff on responding to aggression. This includes training on Positive Approaches to challenging behaviour and a two day course on the management of violence and aggression. The home manages some monies on behalf of the people living there. This activity is governed by HPCHA policy and procedures. There is a limit on the amount of cash held. A lockable cupboard is in each persons room. All transactions are recorded and balances are checked twice a day by two staff. All but one person has a bank account. The arrangements are checked during proprietor (Reg 26) visits. The homes arrangements were audited by a senior manager on the morning of our inspection. All was reported to be in good order. Care Homes for Adults (18-65 years) Page 21 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 home provides a comfortable, safe and well maintained environment for the people living there. Evidence: The home is a detached bungalow. It is located in a quiet residential close, a few minutes walk from the centre of Gawcott. Gawcott is a small village about three miles from Buckingham and nine miles or so from central Milton Keynes. There is limited parking to the front of the home. The bungalow is set in spacious grounds and overlooks open countryside to the rear. Entry to the home is controlled by staff. The accommodation comprises four bedrooms, kitchen, dining room, living room, laundry, bathroom, shower room, and office. The rear garden is accessed through patio doors from the lounge. The garden has a pleasant patio, lawn, flower beds, greenhouse, and a vegetable plot. The garden is bounded by mature hedging, shrubs and fencing. There is a swing and areas for seating. Both the garden and the front of the house have hanging baskets which are looked after by a relative of a service user. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Bedrooms are a comfortable size and each has been personalised by the person living there. People using the service have been closely involved in selecting the colours of their room and of the lounge. The lounge and dining room are used throughout the day by staff and service users and overall, the home has a comfortable ambience which meets the needs of people living there. The exterior of the building had been repainted earlier in the year. The whole of the interior will have been redecorated by the end of 2009. There are plans to buy some new furniture when redecoration is completed. On the day of our visit all areas of the home were tidy and in good order. Standards of cleanliness were very good. The home was awareded a five star rating by the environmental health department when it was inspected on December 2008 under the Scores on Doors scheme. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for the recruitment, induction and development of staff are reasonably thorough and aim to ensure that people living in the home are supported by sufficient numbers of staff with the necessary qualities and skills. The home is not supported by the larger organisation in providing evidence of a robust recruitment process , which complies fully with the Regulations, at the time a new member of staff takes up post in the home. Evidence: At the time of this inspection there were 12 staff in post, including the registered manager. This level maintains two staff in the morning (7:30 am to 2:30 pm) and two staff in the afternoon and evening (2:30 pm and 9:30 pm). Between 10:00 am and 6:00 there are two additional floating members of staff to cover outings, visits to GPs and other activities in the community. At night (between 9:30 pm and 7:30 am) there is one waking member of staff on duty. The staffing at night is shared with a neighbouring HPCHA service for people with a learning disability which has one waking and one sleep-in staff. The registered manager told us that staff are very flexible and are happy to work flexible hours to enable users of the service to pursue activities in the community. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The home is supported in the recruitment of new staff by the organisations Human Resources (HR) department based at its head office in Hemel Hempstead. The HR department processes applications and prepares interview packages. The registered manager is responsible for shortlisting applicants. People living in the home are involved in staff appointments by meeting candidates for interview, having tea with them, and communicating their views to staff responsible for the appointment. This inspection included examination of one personnel file. Records were very well maintained. The file included a recent photograph of the person (part proof of identity), two references, a note on the persons health fitness for the post, and evidence that an Enhanced CRB disclosure had been received. However, the letter from the HR department was dated almost two months after the person had taken up post. If we had inspected this service in the period between the person starting work and the registered manager receiving the letter, the manager would not have been in a position to provide evidence that this essential part of the appointments process had been carried out. This standard of performance is not good enough. It was noted that the reason for leaving previous employment was not recorded. This should be recorded where the applicants last job was in the care sector. Personnel files, apart from including relevant information on the persons appointment, also include notes of a review carried ot at three and six months after starting work in the home, supervision agreement, supervision records, and NVQ related papers. With regard to National Vocational Qualifications, of the 11 staff in post (excluding the registered manager), seven had acquired NVQ at level 2, one at level 3, and three were due to start NVQ training in the near future. All staff undertake a six month induction - this corresponds with the probationary period. Staff have access to a comprehensive programme of training. This starts with the induction programme which includes Moving and Handling, Emergency First Aid, Fire Safety, Diversity, Food hygiene, Care of Medicines and Epilepsy. The training programme also offered training on Person Centred Planning (PCP), Positive Approaches, Preventing and Responding to Violence, Mental Capacity Act 2005. Training is provided at the organisations head office or through E-Learning (computer based). The registered manager told us that staff have also been able to take up training in Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Adult Social Care subjects offered by Milton Keynes Council. Training records record the date the member of staff attended training and when refresher or update training is required. Personal supervision of staff is well established in the home. Sessions are planned and typed notes are maintained. All staff have an annual appraisal. Care Homes for Adults (18-65 years) Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well managed service which aims to meet the needs of people living in the home, to support people to be as independent as they wish, and to enable people to participate in the wider community. Evidence: The registered manager was appointed in December 2008. The registered manager holds the Registered Managers Award (RMA), NVQ in Care at Level 4, and is an NVQ assessor. Before taking up this post the manager managed a service for people with Autism. Before that the manager has had many years experience in Learning Disability including 7 years in management positions. The registered manager is therefore, well qualified and experienced for her job. In terms of the ethos of the service the manager told us that she aims to create a Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: homely environment with a positive attitude. The key aim is to support the people living there, to support their independence as much as possible. The manager believes that managers need to be involved, to be on the floor, and not to make too much of an issue when incidents occur but also to make sure that staff and users are supported. Staff seen during our visit echoed much of this. Team work was described as good. Staff turnover had decreased over the past year and staff retention had improved. Rapport with people living in the home was said to have improved and there is more consistency in the management approach. It was felt that there was a stronger people orientation now compared to previous years. It was felt that the home had much improved since the last inspection. We would agree with this. The atmosphere was quite positive throughout the day of our visit and staff and service users seemed to have a comfortable and positive relationship. We were informed that Hightown Praetorian and Churches Housing Association (HPCHA) is developing a format for quality assurance in learning disability services. It already had a format for conducting stakeholder surveys and a survey had been carried out in 2009. The results had not been made available to the home at the time of this inspection. The manager had a development plan for the home and a copy was made available for this inspection. The plan including objectives on, staffing, service users (including activities and holidays), finance, care planning, and action where required under the Mental Capacity Act 2005. An internal report Major achievements of Old Barn Close noted progress on users of the service (home now full), staff (full staff team), the building, activities, social interactions, holidays, proposals for day trips, and staff training. HPCHA managers carry out regular proprietors (Reg 26) visits. Notes are retained of visits. The home has a calendar of key events for the year under the title Cycle of Approach. Arrangements for maintaining safe working practices within the home appear satisfactory. The home is subject to the Health and Safety policies of HPCHA. All staff have attended Health and Safety training. With regard to fire safety we were informed that a fire risk assessment was carried out in April 2009. Contracts are in place for the maintainence of fire safety equipment. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: Fire training is carried out at head office as part of induction and basic training and thereafter through computer based E-learning training. A fire drill, which includes evacuation, is carried out quarterly. The home was last inspected by the fire service in October 2008 - no recommendations were made. Fire alarm points, emergency lighting and fire exits are checked weekly. The home has a comprehensive fire evacuation file file. The homes fire electrical circuits were last tested in March 2008. Portable electrical equipment (PAT testing) was tested in August 2009. Gas appliances were tested in June 2009. 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 1 34 19 The registered persons must 31/12/2009 ensure that evidence that the information required under Schedule 2 is available in the registered service on the day a new member of staff takes up post. To protect people living in the home from the appointment of staff unsuited to working with vulnerable adults. 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 31 of 32 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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