Care Home: Oldway Heights

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What the care home does well The home`s admission policy ensures people`s needs are fully assessed before a decision is made about whether to offer them a place or not. The home has a wide mix of people accommodated, some of whom have multiple needs for both physical and mental health care. People said that mostly they "rubbed along well". The home is expanding the opportunities available for people to follow. There is an activities organiser who makes sure opportunities are available for both group activities and 1:1 time. People at the home have in the last year been wheelchair ice skating, sailing, baloon rides and wheelchair dancing. They plan to go ski-ing, horseriding and possibly archery in the coming year. The home have responded to people`s requests for more activities at weekends. The home has a vegetarian meal option available daily. People can choose to have their main meal at lunchtime or have it kept for the evening.Other diets can be catered for. Accommodation is on two floors served by two passenger lifts. Corridors and doorways are wide enough to allow for wheelchairs. The home has an activities room with computer access. Staff were clear about people`s support needs and their roles as key workers. They said they were happy in their working role, and worked well as a team. People told us: "Mrs Jane Bastafield is a great manager" "Makes service users feel like they are at home" "Most of the time my need are met" "Staff are always polite. The food is good" "I think the caring is excellent, the staff are very polite and very attentive and i have no complaints" "Whatever I need is always available. The staff treat me well". Care plans are being developed that are more person centred and take into account people`s aspirations and lifestyle preferences. The home has policies for Equlity and diversity including with the recruitment of staff. What has improved since the last inspection? Since the last inspection the home has completed a large extension to the first floor, joining two previously disconnected areas. This has provided additional ensuite rooms and an additional lift. Several rooms have had new windows fitted. Thr manager has become registered. This means she is accountable for ther day to day operation of the home along with the owner. She is also taking her NVQ level 5, which is an advanced management level qualification. This is commendable. The menus have been revamped and are due to be seasonally altered soon. The amount and variety of activities available has increased. A package for staff training has been purchased and is being delivered. What the care home could do better: Care plans need some reworking to take into account a more person centred approach, history and social history, and proper goals/action plans for each individual. Care plans would also benefit from additional information being available on people`s lifestyle choice and communication needs. Risk assessments must be kept updated to minimise the risk of any harm to people living at the home or staff. The home`s complaints procedure may benefit from being made available in other formats to make it more accessible to people with communication difficulties or visual impairments. People may benefit from a more systematic and proactive plan for the assessment and management of their health care needs. All medication, including medication kept by Individuals must be kept safely. Staff must receive training in Mental Health, person centred planning and de-escalation techniques. A first aid risk assessment should be provided and assessments undertaken for Legionella and Asbestos. Key inspection report Care homes for adults (18-65 years) Name: Address: Oldway Heights 40 Headland Park Road Paignton Devon TQ3 2EL     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: Michelle Finniear     Date: 2 1 0 1 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Oldway Heights 40 Headland Park Road Paignton Devon TQ3 2EL 01803527088 01803664738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Jacqueline Ann Privett,Mr Barry Michael Privett Name of registered manager (if applicable) Mrs Jane Bastafield Mr Barry Michael Privett Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 39. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical Disability (Code PD) Mental disorder (Code MD) Old age, not falling within any other category (Code OP) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 39 0 39 0 39 Brief description of the care home Oldway Heights is a large detached two storey building situated in Paignton, Devon, close to local facilities (a short walk away). The home predominantly provides care to younger adults who have physical disabilities and/or mental disorder. The home has also retained its registration to care for the elderly, to allow the elderly clients already at the home to remain there. A maximum of 39 people of either gender can be resident in the home. The emphasis of the home is to ensure that people with a disability are able to have a good quality of life and to this end the home has provided a number of aids and adaptations to both support peoples care needs and allow them to retain as much independence as possible. The home is seved by two passenger lifts. The home also offers a day care service. Fees are individually based on each persons needs and care package. Copies of the homes inspection reports are available in the home. Care Homes for Adults (18-65 years) Page 5 of 29 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: To complete this Inspection we visited the home for two full days over two weeks; we spoke to the people who live at the home and visitors who were there; we sent questionnaires to people who live and work at the home; we talked to the staff on duty and sat in on a morning handover to see how staff duties are allocated for the day; we looked at the records the home keeps; we looked at their policies and procedures; we looked at the way medicines are kept and administered; we looked round the home; and we asked the owner to complete a document called an Annual Quality Assurrance Assessment or AQAA. This tells us what the home has developed in the last year and how they plan to develop in the future. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection the home has completed a large extension to the first floor, joining two previously disconnected areas. This has provided additional ensuite rooms and an additional lift. Several rooms have had new windows fitted. Care Homes for Adults (18-65 years) Page 7 of 29 Thr manager has become registered. This means she is accountable for ther day to day operation of the home along with the owner. She is also taking her NVQ level 5, which is an advanced management level qualification. This is commendable. The menus have been revamped and are due to be seasonally altered soon. The amount and variety of activities available has increased. A package for staff training has been purchased and is being delivered. 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 29 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 29 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. Systems for pre-assessment should help ensure people moving to the home are able to have their needs met. Information is available to help people make a judgement about whether the home is the right place for them. Evidence: On the first visit we spent time looking at the information provided about the home and how people were assessed for suitability before they moved in. We looked at six peoples files, spoke to four people about their admission to the home and spoke to the staff and management about the systems involved. The home has information available about the services provided at the home in a statement of purpose and service user guide. This information is currently being updated and made more accessible to people. This might for example include being available in Braille or on audiotape for people with visual impairments. This information is available in peoples rooms for future reference. It includes information Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: on staff qualifications, services and facilities available and any rules for the home, for example whether people can keep pets. It also contains a copy of the homes contract for residency. This helps people understand what they can expect to receive for the fees paid and what rights they have regarding their accommodation. People who completed questionnaires for us for this inspection mostly told us that they had been asked if they wanted to move to the home. Some people had been admitted many years ago and could not remember the circumstances of their admission, but other people we spoke to on the visit said that they or their supporters, such as relatives or a social worker had chosen the home on their behalf. We spoke to the manager about how a recent admission had been carried out. This had involved an initial referral from the care trust, containing information about the persons needs, and then a visit to the home from relatives to look at the facilities provided. The homes management then went to the persons previous placement and carried out a full preadmission assessment. From this they compiled a plan of care which was discussed and agreed with the person themselves and their family members. This helps to ensure that the home is clear about the full extent of the persons needs, and ensures that they can provide any equipment or facilities necessary before the person comes to live at the home. From the individuals point of view they know that the home is able to meet their needs and are clear about what arrangements have been made for their care. Some people may require specialist assessment and input from health care professionals before a decision is made. People have opportunities to spend time at the home before making a decision about moving in if they wish. This might include for example coming to stay overnight, or spend time during the day at the home meeting other people who live there. The manager endeavours to ensure people referred will mix with the other people who already live at the home. For this reason some people are not admitted, even though they may meet the homes registration criteria. The home provides for a small number of daycare clients. Care Homes for Adults (18-65 years) Page 11 of 29 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. Care plans and risk assessments may benefit from some development, but generally peoples day-to-day needs are assessed and met. People have opportunities to take part in and have a say in the running of the home. Evidence: Each person living at the home has a support plan which indicates the support or care they need on a daily basis and how those needs are to be met. Some people we spoke to were aware of their plans and the content, other people felt they had been consulted but did not know what was in the final plan. One person said Im not interested in that, that is what the staff do. Plans were seen for six people currently living at the home in depth, and other plans were sampled for specific areas. The plans seen were generally a reasonable reflection of the day-to-day needs of the people living at home, but would benefit from additional information being made available on peoples social and personal history, and goals and aspirations, with action plans on how to achieve these. Plans are Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: currently not very person centred, and discussions with the manager and care manager indicated they were keen to progress this. Following the second site visit additional discussion was held concerning the development of person centred plans, and sample plans were supplied by the home for comment. During the second visit we spoke to a number of staff about care they were delivering to individuals and also their understanding of the role of the key worker. The care outlined was as indicated in the plan, and people were clear of the individuals rights and wishes to make alterations to the plan as they wished each day. This demonstrated some element of flexibility. We discussed the importance of information sharing in relation to reviewing of the plans and the manager and care manager have plans to ensure that these are regularly updated and staff contribute to this process. At the front of each care plan there is a sheet for staff to sign to say that they have read and understood the plan. In one of the files seen a number of staff had not completed the sheet. The home said they regularly consult with people living at the home about the way in which it is run. We could see minutes of regular residents meetings being held, and there is also a suggestion box. The manager told us that she regularly visits people individually to see if they have any comments or suggestions to improve the home as she acknowledges some people do not feel comfortable in a group setting. A relative who we spoke to on one of the visits told us that they felt their relative needed more purpose and would benefit from developmental plans being made for their return to the community. They also felt able to be involved in their care at the home which was positive for them. Risk assessments are available in each persons file. Risk assessments are a way of identifying and wherever possible reducing the potential harm from activities which may present risks. It is important that staff are clear about the content of all risk assessments, and that they are kept updated to reflect changes in the level of risk. Most staff have received training in the Mental Capacity Act, and some assessments are now being undertaken as part of the care planning process. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to follow lifestyle choices. Further work could be undertaken to promote communication and lifestyle options for people. Evidence: On the second site visit we spent time with a number of the people living at the home. We spoke to them about how they spent their time and the opportunities they had to follow their chosen lifestyles. We then looked at the activities available or planned for people. Care plans did not contain lifestyle plans or enough information about peoples lifestyle preferences. Some additional information would also be useful on peoples communication needs, and we had some discussions with the manager about ways of organising this information. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: People who completed questionnaires for us told us that they could choose what they wished to do each day. The home has an activities organiser, who offers people opportunities for both 1:1 and group activities each day. As a result of comments from people living at the home the manager has plans to provide activities and outings 7 days a week, rather than as currently only Monday to Friday in general. One person we spoke to said they would enjoy more culturally based activities, such as visiting Museums or National Trust properties. People living at the home had in the last week been on a trip to the Plymouth Aquarium, and have also had opportunities in the last year to go wheelchair iceskating, sailing, ballooning, wheelchair dancing and have been to see a staff member jump from a plane. They plan to introduce ski-ing and horse riding in the coming year. On the afternoon of the second visit people had gathered to watch a film in the activities room. The home has a computer for peoples use, but several people also have their own in their rooms. On the second visit some people were in their rooms, others out, in the garden or in communal areas. The people in their rooms were engaged in art activities, pet care, watching television or reading. People told us: Most of the time my needs are met I like this home, its friendly and the staff are really nice. Foods good. very good staff - go out of their way to help wherever possible Staff are very helpful and friendly. Meals have improved Provides shelter for those who need it Whatever I need is always available. The staff treat me well I think the caring is excellent. The staff are very polite and very attentive and I have no complaints. Some people told us they would like more variety in their meals. The manager plans to update the 4 weekly rotating menu. Each day there is a choice of a vegetarian option. Some people chose to eat their main meal in the evening and this is saved for Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: them. People can choose to buy other food of their choice which can be cooked for them if they wish. We discussed the respecting of peoples religious beliefs. People are enabled to attend services of their choice. Not all areas of the home are decorated at Christmas to ensure people of faiths other than Christian or people of no faith do not have to participate if they do not want to. The home are trying to access holidays for the people who live there but this is problematic due to the differences in benefits people can claim. Fees paid do not provide funds to pay for additional holidays. The home raises money to fund some activities. Care Homes for Adults (18-65 years) Page 16 of 29 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 home may benefit from ensuring the new care planning systems take a systematic proactive approach to meeting health care needs. Evidence: On the first visit to the home we looked at they way in which the home manages peoples health care and medication. Care files seen showed evidence of the home having contact with local community services both to support peoples physical and mental health needs. People are supported to attend hospital appointments and specialist moving and handling equipment is available as needed in peoples rooms. The home also has specialised baths and two passenger lifts to access the first floor. Files did not contain much information about a pro-active approach to peoples health care, which the home may wish to consider when developing the new plans. The home manager told us about the ways in which several peoples health had improved since coming to the home. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: On the first visit we looked at the way the home administers medication. We spoke to a member of staff checking incoming medication about how the system works and looked at the records the home keeps for the receipt, storage, administration and or disposal of medication. Some people manage their own medication for which a risk assessment is undertaken. The home uses a monitored dosage blister pack system, which means that medication is prepared in a series of blister packs which are colour coded. These help to ensure staff can easily see that medication has been given out and helps to reduce the risks of errors. When we went round the building one persons room had a bottle of antacid medication left out. All medication must be kept safely locked away to ensure people for whom it is not intended do not have access to it. The homes controlled drugs book was seen and was replaced by the second visit as requested. During the Inspection we took part in a handover between shifts, where we could see how staff were allocated their duties during the day. People told us that they felt their needs were taken care of. One person also said that although the home had people living there with a wide variety of needs people rubbed along well enough. Care Homes for Adults (18-65 years) Page 18 of 29 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. Policies and procedures are in place for the management of complaints and to help protect people living at the home from abuse. Evidence: In the AQAA completed by the home they told us they had received 5 complaints in the last year. These were all resolved appropriately according to the manager. People we spoke to or who completed questionnaires for us said that they knew what to do to make a complaint and felt confident to do so. The home has a complaints procedure which is on display in the home. This would benefit from being made available in other formats to support peoples communication. There is also a whistleblowing policy and procedure for staff who wish to raise any concerns about the home. Staff have all received or are about to receive training in safeguarding, which helps them identify abuse and what they must do about it to protect people in their care. Since the last Key Inspection there has been a safeguarding issue at the home which is still being resolved with the local safeguarding team. Comment will be included in the next report. The home has policies and procedures for protecting people who live there. Care Homes for Adults (18-65 years) Page 19 of 29 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 environment for people, which is accessible and being refurbished. Evidence: During the course of the two visits we looked around the building, including at peoples rooms and service areas. We did not look in all the rooms as some were occupied and some locked. Those we saw were clean, warm and comfortable. Rooms vary in size, with some having an outlook over Torbay. Several windows have been replaced and double glazed recently, as a part of the ongoing refurbishment of the home. Some areas of the home are looking tired and have considerable wall and door damage from wheelchairs. This undergoes constant repair. In the last year the home has completed an extension at first floor level. This has joined two previously separated areas of the home and with the benefit of a second shaft lift, means that people have better access around the home, as well as there being additional en suite rooms available. The home has equipment available to support people, with ramped or level access throughout. There are adapted bathing facilities with hoists and wide access corridors and doors. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: People who completed questionnaires told us that the dining room became congested at mealtimes due to the number of wheelchairs . There is a small lounge/dining room on the first floor but this is not often used by people, and the congestion in the main dining room can be compounded sometimes by people coming to the home for day care. The manager may wish to consider making the first floor lounge more attractive for people to use. The home has an activities room, which was being used during the Inspection visits for computing activities and a film show. Peoples rooms seen were personalised and many were individual with personal belongings, artwork and pets. Several people had their own IT equipment, and some had moving and handling equipment or specialist beds. The home has a garden area to the rear, and some parking, although this is limited. There is on street parking nearby. Oldway Heights is situated in a residential area of Preston, Paignton. The home is in an elevated position, but is near to local shops and facilities including a GP Surgery. Bus and train services run locally, and the sea front is close by. Risk assessments are carried out for the environment for example for the risk of fire. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are suitable. Some additional training needs were identified. Evidence: On the first visit we looked at the ways in which the home recruits, trains and supports staff. On the second visit we spoke to staff about their job role and the care they deliver. We looked at staff files for some recently recruited staff. These showed that the home carries out a full recruitment process, including standardised interviews and references. The home also takes up criminal reference bureau checks on the people appointed. This should help to ensure that people who live at the home are being cared for by people who are suitable to be working with people who may be vulnerable. The manager tries to ensure that equality and diversity are represented throughout the recruitment processes. As an example age is not required on application forms. A number of staff completed questionnaires for us about the home. They told us they were given up to date information about the people that they cared for and that full checks were carried out when they were employed. They also told us that their Induction gave them the information they needed to help them do their job and that Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: they received ongoing training, including national Vocational qualifications. These are a national award reflecting the competency of a person in their job role. Some felt that at times they were short of staff, and that more activities could be provided. The home has a training matrix detailing the qualifications or courses staff have attended and those due or due for refresher training. We discussed accessing additional training in Mental health, person centred planning and de-escalation training for staff. Some staff were due to attend training in working with people with personality disorders in the week following the Inspection. Some training is provided internally via a system of professional DVDs. Staff receive an initial Induction which the home aims to complete within their first three weeks of commencing working at the home, and then an extended 13 week plan. A file seen showed this being carried out for a person who had been recently appointed. Staff we spoke to on the visit told us that they were happy in their job role and that the staff worked well as a team. They were clear about the needs of the people they were working for and could identify the training they have undertaken and additional training they wished to take. Staff receive supervision from the Care manager. Supervision is a system ensuring staff receive support in their working role, and are working consistently to their full potential. People living at the home told us I think the caring is excellent, the staff are very polite and very attentive. The staff treat me well, Staff are very helpful and friendly, I like this home. Its friendly and the staff are really nice Very good staff go out of their way to help wherever possible. One person said the home needed more staff as sometimes we have to wait a long time. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well managed. Evidence: The manager of the home Mrs Jane Bastafield has just been registered, which means she has been found to be a fit person to be in day to day control of the home. She has previously been a registered manager elsewhere and has many years experience of working with people in care settings. The owners Mr and Mrs Privett have owned care homes in Torbay for over 25 years. A recent safeguarding investigation remains on going, so comment will be included in the next inspection report. People living at the home have opportunities to have their say about the way the home is run. There are regular meetings for people to comment formally on the home; a suggestions box; a key worker system and the manager regularly sees people living there individually to discuss any suggestions they may have. The home also has a quality assurance system in place which takes information from a number of sources Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: to develop an action plan for the coming year. This also involves surveys sent to people who live at the home and their supporters. Discussion was held on expanding and formalising some areas of this to include internal audits and case tracking. This should help to develop a sense of how the homes policies and procedures impact on the individuals who live there. On the second visit we looked at the Health and safety practices at the home. Environmental and safe working practices risk assessments were being undertaken. These are a way of managing and reducing risks to people who live and work at the home. No assessment has taken place however about legionella or asbestos in the home, and there is no first aid risk assessment. The manager told us that all hot water outlets are regulated to ensure people cannot be scalded and all hot surfaces are protected , such as radiators. Window openings were also said to be restricted. The home has policies for the lone working of staff and provides a mobile phone for their support when out with people. The home has a health and safety policy, the statement of intent of which needs signing and some areas needed updating. The manager confirmed that all policies and procedures are currently under review and revision. The home has policies and contracts for the management of clinical waste. Discussion was held on the policy for staff vaccinations, which the manager confirmed are recommended but several staff have not had this as they have to pay for the vaccination. However the homes policy says this will be paid for. The manager agreed to clarify the policy. Other staff welfare policies include risk assessments for pregnancy and health checks offered to night staff. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 6 Risk assessments must be kept updated This is to ensure they reflect risks presented and can help to minimise the potential for harm. 08/03/2010 2 35 18 Staff must receive training in Mental Health, person centred planning and deescalation techniques. This is to ensure staff have the skills to support people living at the home safely. 03/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans need some reworking to take into account a more person centred approach, history and social history, and proper goals/action plans for each individual. The manager should make sure that all staff are aware of risk assessments and care plans in files. 2 6 Care Homes for Adults (18-65 years) Page 27 of 29 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 3 11 Care plans would benefit from additional information being available on peoples lifestyle choice and communication needs. People may benefit from a more systematic and proactive plan for the assessment and management of their health care needs. All medication, including medication kept by Individuals must be kept safely. The homes complaints procedure may benefit from being made available in other formats to make it more accessible to people with communication difficulties or visual impairments. A first aid risk assessment should be provided and assessments undertaken for Legionella and Asbestos. 4 18 5 6 20 22 7 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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