Care Home: Orchard View Care Services

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What the care home does well People are provided with helpful information about Orchard View to help them make a decision about whether it is the right place for them. Visits to the home are encouraged and facilitated by the home`s management, and the standard of assessment by the home is high. Orchard View provides a very individualised service, which focuses on person centred care to ensure that people are able to choose how they wish to spend their day in a safe and a caring environment. Orchard View provides a wide range of opportunities and activities. People have the choice of attending an on site day centre where they can mix with their peers or they can choose activities outside of this group. The home has been pro-active in seeking new activities and resources for people to access, including a range of exercise. Choice is promoted, and people living at the home can influence the range of meals. People are involved in the local community, and are members of local groups. During our inspection, we saw how people are supported to keep in contact with Friends and families. People living at the home have roles within it, and can attend residents` meetings, which ensure that their voices are heard , recorded and acted upon. Medication is well managed, and the quality of recording for people`s physical and mental well-being is excellent. Staff receive regular training in this area of care, and records show that the home works well with health professionals, as well as advocating for people`s individual needs to be met. Staff are trained in a range of relevant skills and receive good quality support from the management at the home, including staff meetings and supervision. They are well informed and stable staff group. They are managed by a committed owner, who acts as a positive role model. The home is maintained to a high standard, with individualised bedrooms and an attractive spacious garden. What has improved since the last inspection? There were no requirements made from the last inspection. The home has acted on two good practice recommendations relating to recruitment. The owner continues to invest in the home, and the home`s AQQA shows how the home continues to improve its service. What the care home could do better: As a result of this inspection, we have made three requirements relating to recruitment. These have timescales attached to them and the concerns must addressed by the service to help ensure the safety of people living at the home. We have had confirmation from the home that they have already began to address these concerns and adopted new procedures to make their recruitment process more robust. We have also made five good practice recommendations around strengthening the recruitment system and registering the home`s manager. Key inspection report Care homes for adults (18-65 years) Name: Address: Orchard View Care Services Station Road Southview Bow Crediton Devon EX17 6HX     The quality rating for this care home is:   one star adequate 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: Louise Delacroix     Date: 2 2 0 4 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: Orchard View Care Services Station Road Southview Bow Crediton Devon EX17 6HX 01363881093 01363881093 lynmatthews@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Orchard View Care Services Ltd Name of registered manager (if applicable) Mrs Lynda Ann Matthews Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Bedroom six will be registered on the condition that any fire authority recommendations which may be made in the future following consultation between the Building Control Department and the Fire Authority are met. Date of last inspection Brief description of the care home South View is a large detached bungalow situated on the outskirts of the village of Bow, which is about seven miles from Crediton. There are six single bedrooms, one on the first floor. There is a large and well kept garden to the rear of the bungalow with beautiful rural views and an outbuilding, which is equipped as an activities and day centre room. There is a separate secure office building for administration. The manager has also started to create a sensory garden and safe walk leading to a seating area with a willow backdrop. Access to the property is level and easily located Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 Brief description of the care home with parking spaces to the rear of the activity centre. The Home have their own minibus. The cost of care is variable. Additional costs, not covered in the fees, include private chiropody, holidays, mileage contributions, personal clothing, hairdressing and personal items such as toiletries and magazines. Previous inspection reports are available in the Home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. The home s previous rating was excellent. The reason for this change of rating is solely linked to the management of the homes recruitment process which is not robust, and relates to the staffing and management sections of the report. All other outcome groups within the report have been rated as either excellent or good. This key inspection was unannounced and was a schedule visit as part of our routine inspection programme. The home last key inspection was on 18th April 2007. We have also carried out two annual service reviews since 2007. None of the information we received to complete these reviews caused us concern. Prior to this inspection, the home completed an Annual Quality Assurance Assessment (AQQA). This is a self assessment document completed by the home and provides CQC with information about how the service is run and the people they care for. We check Care Homes for Adults (18-65 years) Page 6 of 31 the quality of this information during our inspection. We also received seven staff surveys and five surveys from people living at the home. For this key inspection we (CQC) spent six and a half hours at the home. We met people living at the home, and observed their care and support. We looked in detail at the care records relating to two people living at the home, as well looking at the file for someone who had moved in since our last inspection. Staff that we met during the day were welcoming and proud of the achievements of the home. They showed us around, and we were able to talk to staff about their understanding of peoples care needs and their role to support them. We also looked at records relating to the running of the home, such as recruitment and quality assurance documents. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection, we have made three requirements relating to recruitment. These have timescales attached to them and the concerns must addressed by the service to help ensure the safety of people living at the home. We have had confirmation from the home that they have already began to address these concerns and adopted new procedures to make their recruitment process more robust. We have also made five good practice recommendations around strengthening the recruitment system and registering the homes manager. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes assessment process ensures that peoples needs are throughly assessed to a high standard to ensure that peoples individuality is recognised and catered for. Evidence: The home states in their AQQA that they have always catered for each individual, by arranging visits to the home prior to placements being agreed, communicating thoroughly with both the service user, their family and care manager and then follow up with excellent care planning. People living at the home were supported by staff members to complete CQC surveys about the home, and in these they told us they had received enough information about the home to help them make a decision about whether it was the right place for them. We were told by staff that it is important for people to spend time at Orchard View to get to know the people that they will share a home with, and meet the people who work at the home. Throughout the inspection, we saw and heard examples of the home working closely with families and other agencies to ensure that they provide an individual service for each person living at the home. We saw this individualised Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: approach demonstrated during the day by the interactions between staff and people living at the home. During our inspection, we saw that the home is committed to ensuring that service users have access to information in a format that is accessible to them. Staff told us that one person had moved to the home since the last inspection, and they told us how the person had visited several times and settled in well. We looked at the persons care file and saw that a comprehensive assessment was in place, which included information from the local authority. We also saw that the home keeps assessments up to date to reflect the changing needs of people living at the home. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ethos of the home promotes peoples needs, interests and aspirations by ensuring that staff are provided with excellent quality information to enable people to develop their independence and support choice. Evidence: The homes AQQA states that we constantly monitor our service users needs through visual observations, daily report records and by analysing incident forms. This enables us to make sure that all risk assessments, guidelines and care plans are continually kept up to date. The paperwork we looked at reflected this statement, as did our own observations in communal areas. People living at the home were given the choice of showing us their rooms, which some people agreed to, and during this time we able to see that they had copies of their care plans in a format suitable to their communication needs. When we spoke to staff and the owner, they emphasised that the ethos of the home is Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: to make the people living there central to making decisions about their lives. This is reflected in peoples care plans, and was demonstrated during the inspection. For example, one person was experiencing an unsettled period in their life, and we saw staff subtly monitoring when to intervene in their actions and decision-making to help keep them and other people safe. This approach enabled the person to have space and a level of autonomy about how they spent their time. We saw that people living at the home have a range of communication skills, which staff were able to tell us about, and which we saw demonstrated in their interactions. For example, we saw staff picking up on peoples body language and tone of voice, as well as for some people the verbal content of their speech. We saw staff helping people make informed choices, and we also observed how staff following guidance to make that choice meaningful for individuals. We saw from minutes that house meetings take place, which enable people living there to make known their thoughts and decisions, as well as being able to participate in different aspects of the homes life. The care plans that we looked at included risk assessments relating to health and life choices. For example, staff explained how some people at the home have privacy key cards for their individual rooms. We saw people approach staff for these keys so that they could access their rooms. This means that each room is kept secure for each individual. Staff told us that most people prefer to spent time in communal areas, apart from one person, who has one to one support from a staff member. However, during the inspection another person requested their key and spent time alone in their room. We saw that staff monitored this situation discretely and respected the persons need for space and time away from group living. We saw other people moving around the home and the garden looking relaxed and at ease in their surroundings. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from excellent links to the local community, while being supported to maintain contact with people who are important to them. Evidence: The homes AQQA states that they have improved in the last 12 months by continuing with more personalized activities, and introducing additional ones e.g. rambling walks, reiki etc. We have improved on communication by introducing more communication boards and providing more Makaton training for staff, this is turn has helped the staff to further promote service users independence where possible. During our inspection, we spent time in the communal areas of the home and heard people living at the home planning activities with the support of staff. We saw that the majority of people living at the home chose to spend time with people using the day care centre. The atmosphere was busy, lively and well managed. Later in the day, with less people the atmosphere was quieter and calmer. On both occasions, people living at the home Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: looked relaxed and happy in their surroundings, which we judged by their body language and their interactions with others. We saw how staff adapted their communication styles to suit the individual needs of people. During our visit, art work relating to the summer was underway, while a model of a volcano was also being constructed to reflect current events. One person we met chose to spend time in their own room, and another person spent time on their own, in the group and took part in a trip with a staff member. Staff were clear in their discussions with us about the individuality of each person and their right to follow a lifestyle that suited them. People living at the home were supported by staff to complete CQC surveys, and told us they were able to make decisions about what they do on a day to day basis. Staff were positive in their CQC surveys about the range of activities and the promotion of peoples independence. In the morning, some people had taken part in a social group in Crediton, and in the afternoon some people spent the afternoon at a garden centre, while others chose to stay behind. We heard a trip to the local swimming pool being arranged, and saw from records that people have access to a range of activities and exercise, as well as complimentary therapies. We saw from records and heard from discussions that people can participate in group outings but that there is also time provided where they have one to one support. Activities are not just restricted to the day time and also take place in the evening, including discos and trips to the pub. Our observations confirmed that the staff group work around the wishes of people living at the home. Staff told us that an annual holiday takes place, and we were told about the different venues that have been tried and considered. We were told that some people living at the home enjoy taking part in preparing food and staff showed us how a recipe book had been translated by the home into appropriate pictures and brief text to support peoples independence during these sessions. For example, one person with support can now bake cakes using an adapted recipe. A person living at the home showed us photographs of people who were special to them, and throughout the day we heard staff acknowledging family and friends as important elements of peoples social networks. We saw examples in care plans and through our discussions with staff of how people were enabled to keep in touch with their friends and family; and overheard phone calls which demonstrated the homes commitment to this area of support for the people living at the home. The staff also told us about their relationship with peoples care managers and how they are involved and updated about the needs and wishes of people living at the home. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: We spent time with some of the people living at the home while they ate their lunch, and saw how staff supported them with making choices. Generally, people looked relaxed and at ease and appeared to be enjoying their lunch. The home shows a strong commitment to ensuring that the people living at the home have input in compiling the menu. For example, by translating food choices into appropriate pictures and through group meetings which are minuted. We met with staff who could tell us about peoples individual likes and dislikes, and how these were catered for. We heard that people living at the home take part in the day to day running of the home, for example we saw one person setting out the cutlery and we heard that another person likes to dry the dishes. We saw that there is clear guidance for a person who needs their food and fluid intake to be monitored. For example, they told us how they had liaised with the hospital regarding this monitoring need when a person living at the home had needed treatment. Staff that we spoke to were well-informed and understood their responsibilities. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from an excellent standard of personal and healthcare support provided by a well informed team of staff. Evidence: Care records clearly show how people like to receive personal care, and during our visit we saw that most staff supported people discretely to visit the toilet, whether this was through a verbal reminder or physical assistance. We visited the rooms belonging to people with incontinence needs, and found the rooms odour free and clean. For example, we saw how staff respected peoples privacy and helped people to maintain their dignity. Staff could give us examples of how people were supported with bathing in a way which maintained their dignity. One person showed us their selection of toiletries and a staff member talked with them about the enjoyment they gained from looking after their appearance. We saw that people looked well cared for, and that their belongings and clothes were respected by staff, which was demonstrated during our visits to peoples individual rooms. The homes AQQA states we constantly monitor our service users and make sure that all their health care needs are met and that where necessary the home contacts an Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: external professional to make sure that the decisions made are in the right interest of the service user. We saw that regular dentist and optician appointments are made and a private chiropodist visits our service users every six weeks. In the AQQA, it states we provide aromatherapy for all our service users who wish to partake in it, on a weekly basis. From our discussions with staff, from the recordings in peoples individual care plans and the homes diary, we could see examples of all the above during our visit. We also saw from records how people living at the home regularly have their health monitored by a visiting health care worker. Care plans provided a high level of detail about peoples health care needs. The home has been pro-active in creating a hospital passport, which includes vital information about the individual, which not only promotes their safety but also their well-being. In our discussion with staff, they showed a clear commitment to ensuring that other professionals involved in the care of people living at the home were provided with a high level of individualised information to promote a successful health intervention. For example, work with the hospital anesthetist. According to the AQQA in the last 12 months, the home has installed a new medication storage system, although they are still waiting for the controlled drugs storage to be supplied, which was chased during our inspection. Staff told us about the training they had received and how this was updated, and we saw records of this training. Medication records were up to date and complete. We shared some examples of how to further good practice, such as double signing by two staff members when hand written alterations are made to the records to ensure that transferred information is accurate and keeping a list of staff initials to help provide an audit trail. The latter was in place before we left. We looked at the care records for someone who has experienced a bereavement in their life, and saw how this loss was recognised by the owners and staff group through the guidance in place, discussion with staff and through correspondence with health professionals. We saw from the persons care plan that they now have access to specialist support. We saw staff follow the guidance in the persons care plan to address the persons changed behaviour as a result of their grief. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from a good system to ensure that people living at the home are enabled to raise concerns to staff who know how to respond, and are protected by a robust financial system. Evidence: The homes AQAA states that there have been no complaints received in the last twelve months. CQC have also not received any complaints or concerns in the last twelve months. Records show that the home has in the past sought advice when there have been concerns. Surveys showed that people living at the home knew how to express unhappiness and that staff know what to do if someone has concerns about the home. We saw that the staff group as a whole picked up on peoples body language, and we observed some staff being particularly skilled at intervening and responding to peoples anxieties or frustrations. We also saw from the minutes of staff meetings that staff can express concerns and have these discussed. We saw that people living at the home are provided with information about complaints in accessible formats. Training records show that staff have access to safeguarding training. There is a clear audit trail that shows how people have spent their personal allowances with accurate records kept. However, we have advised the owner that in the future they should not be an appointee for people moving to the home as there are systems run by County councils to take on this role. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from excellent surroundings, which gives them space to make choices about where they spend their time and promotes their independence. Evidence: The building has the appearance of a home and not an institution. Decoration and cleanliness is maintained to a high standard within the home. Peoples rooms are personalized and reflect their individual interests. Staff told us that the home supplies furniture but there are occasions when people living at the home may be invoiced for replacements if furniture has become damaged. Currently, there is no moving and handling equipment as staff told us that people do not have significant moving and handling needs. One person uses a frame to move around the home, and staff told us how they are able to access areas of the garden. The bedrooms we visited had ensuite facilities, and the communal bathroom has a bath and a separate shower. The garden is an attractive space, with different areas to provide space and privacy for people using it. We saw people using it throughout the day. A sensory garden has been started but not yet completed. In the grounds, people living at the home have access to a separate building, which is also used for day care. Steps have been taken to try and make the grounds secure, particularly the front area which faces onto the road, and we also heard staff discreetly checking throughout the day for the Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: whereabouts of people living at the home. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are up to date with training and provide care in an individualised and informed manner. However, the homes recruitment process is not robust and therefore potentially puts people living at the home at risk. Evidence: There is a manager and deputy manager, senior carers, carers and a team of bank staff. The AQQA states there are 16 permanent care staff. The home also has a staff member who works as an office administrator. We saw from minutes of a staff meeting that there has been a recent change in roles and responsibilities for some workers, and records show that the staff team are able to voice their queries and views on this change, which the home home acknowledged in their AQQA. We were shown that new staff are issued with a planned induction worksheet and new staff are provided with codes of conduct and practice. The owner told us that there was a relatively low turnover of staff and that recruitment had not proved problematic for the home. The home stated in their AQQA that NVQ training is promoted, which includes a range of levels, and staff were positive in their surveys about the relevancy of their training and their ability to carry out their job. One person said that staff are trained well and we saw from a selection of staff training records that they have regular access to Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: mandatory training, as well as more specialist training, which reflects the needs of the people they are working with. Staff interaction with the people living at the home confirmed this level of training. We were told that the home usually books external trainers, which we saw from certificates, and that the home also belongs to a training body. Care homes need to be able to show that their recruitment processes protect the people who live there. There is set information that need to be kept to evidence good and safe practice.The homes AQQA states that the home have a thorough recruiting and induction process for all new staff. We checked with the owner and staff about who were the newest members of staff working at the home, and looked at the recruitment files for three people. The three files showed that the homes recruitment process was not robust. For example, for two staff members there was no police check (CRB) in place prior to commencement of employment. In exceptional circumstances this is acceptable, if a POVA First check is in place and there are two written references dated and addressed to the prospective employer (including the persons last position in care, if applicable), identification, a photo and a full employment history without gaps, plus additional information. However, this was not the case. We also saw that there was no recording of decision-making linked to risk for a negative work reference and information on a subsequent CRB. References were not automatically sought from the last employer for two people, which is not safe practice. For a third staff member, there was no identification recorded on file. We have also talked to the home about making their induction process more robust. The owner said they were clear that people undergoing their induction should not be left alone with people living at the home following a recommendation in their last report. We heard a person under going their induction acknowledging this fact, and we saw they remained with staff members. However, the home had not gathered enough information about the person, such as proof of identity, to help make a judgement about their suitability to meet people living at the home, although they had begun to gather references; one had been returned and was positive. The home told us that they had received a second positive reference the day after our inspection. The home have acted promptly to the above concerns and provided further information from their own subsequent audit within a short timescale. They sent us an action plan and showed through this documentation that they have taken rapid action to address the gaps in their recruitment process, including updating their employment/employee systems, and they told us they have already implemented these changes for a new employee. Staffing levels appeared appropriate on the day of the inspection based on the fact that people living at the home had the option of Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: different trips out, could spend their time in different parts of the home and did not seem to be restricted in their choices by staffing levels. Throughout the inspection, one staff member was based in the house to provide, one to one support for one person. Seven staff told us in their surveys that there was always enough staff on duty and one staff member said this was usually the case. The homes AQQA states as a positive that they have been able to recruit several more male members of staff, which reflects the mix of client group at the home. We saw from records that staff meetings are held and that staff have access to supervision; one such session was taking place as we arrived. Staff told us in their surveys that they regularly meet with their manager and are given enough support. One staff member told us in their surveys that the staff are always updated in changes in the home/policies. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people can feel confident that the home is well managed and safe, and their opinions will be valued and acted upon. However, during this inspection we found that management practices in staff recruitment potentially put people at risk. Evidence: The home does not currently have a registered manager. The owner, who has been the registered manager in the past, has taken on the role of manager but has not yet submitted an application to register. The staff surveys we received showed that staff felt proud to work at the home and felt that the home provides an excellent service to the people living there. Through our discussion with staff and the owner we could see that people are very committed to ensuring that the needs of people living at the home are met and that they have access to the services that they require. The owner provides a positive role model to her staff and the AQQA shows the commitment of the home for staff to reach their true potential in their work. It recognises where the service has progressed and what they could do better, and how they will achieve this. Our visit confirmed the homes statements within their AQQA Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: that they are person-centred in their approach and ethos. However, the homes management of the recruitment practice prior to the inspection is the only area that does not reflect this value as it has the potential to put people at risk by not ensuring the suitability of new workers. We use two documents to help us make judgement about homes ratings. One is called the Key Lines of Regulatory Assessment (KLORA) and the other is a guidance document, which describes how to interpret KLORA. This guidance states that if the recruitment process is not robust that the rating for the management section must reflect this concern. We looked at the homes quality assurance system, and looked at the last annual surveys, which provided positive feedback from people using and visiting the service. The minutes from staff meetings are detailed and comprehensive and show the owners stated commitment to being open about the way the home operates. We saw that residents meetings take place and include topics such as the homes menu and types of holidays, with a summary being provided in an appropriate format. Staff have access to supervision and benefit from clear leadership. The AQQA states that the maintenance of equipment is up to date, and a staff member confirmed that a current fire risk assessment is in place and has been completed by an external contractor. The home is well maintained. All the records we looked at were up to date and we saw that risk assessments are reviewed and updated, where necessary. Staff told us that there was nobody with moving and handling needs, and that no specialist equipment was needed. We saw from records that staff have access to training to help keep them safe and other people safe, such as breakaway training. Throughout the day, we saw that staff monitored the whereabouts of people living at the home, and took appropriate action to diffuse situations, which were becoming tense, to promote the safety and well-being of the people living at the home. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Staff must not commence work at the home until two written references have been received. One reference should be from the last employer and include detail of why the person left their employment. 18/05/2010 This is to ensure the suitability of the applicant to work in a care environment. 2 34 19 Staff cannot start working at 18/05/2010 the home until proof of identity has been obtained. This is to protect people from the risk of harm. 3 34 19 Staff cannot start working until the provider has received confirmation that the staff applicants names are not included on a list of 18/05/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 people unsuitable to work with vulnerable people. This is to protect people from the risk of harm. 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 34 The home should ensure that the induction process is more robust by ensuring that they have gathered pertinent information about the applicant, such as proof of identity. Risks identified in peoples applications must be identified and a record kept of decisions made. The home should ensure that any gaps in peoples application forms are accounted for and the reason recorded. The home should submit an application for a registered manager to CQC. The home should review all of its policies relating to recruitment to ensure that they follow current guidance and good practice in this area of care. 2 3 34 34 4 5 37 41 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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