Care Home: Overton House

What the care home does well Students who wish to consider living at Overton House are provided with information about the residence and have the opportunity to visit before they indicate that they wish to be considered for residency. Students are supported by nursing and care teams and have a dedicated key worker. Their care plans provide an overview of their physical and emotional needs and staff have a good understanding of the support required. Students said, "Overton is very good." Students also agreed that the catering at the home was excellent encouraging them to eat nutritionally and healthy meals whilst also appealing to their tastes. Staff had access to a robust training programme providing them with the knowledge and skills they need to meet student`s needs. A comprehensive quality assurance programme is in place which involves feedback from students. Students attend house meetings, have a representative on the student parliament and meet with senior management. The AQAA stated, "Independence and informed choice is promoted and students are consulted and involved in all aspects of life in the home." What has improved since the last inspection? One requirement was issued at the last inspection and this had been complied with. Wardrobe doors had been removed to make them more accessible to students. What the care home could do better: No requirements and a few recommendations were made during this visit. The home has a robust quality assurance system in place which addresses issues as they arise and is maintaining the high standards of care provided. Key inspection report Care homes for adults (18-65 years) Name: Address: Overton House Overton Road Cheltenham Gloucestershire GL50 3BN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lynne Bennett     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Overton House Overton Road Cheltenham Gloucestershire GL50 3BN 01242234635 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: National Star College care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Physical Disability (Code PD) Date of last inspection Brief description of the care home Overton House is one of two homes providing off site accommodation for students attending the National Star College. The building is owned by Barnwood Trust and is leased to the College. Overton House is a large Georgian property, which has been adapted and extended to provide residential accommodation for up to 31 students who have physical disabilities. The house is situated in a residential area very close to the centre of Cheltenham. Student accommodation is provided on three floors, accessed by shaft lifts. This consists of a mixture of single and double rooms and a flat. A recent garage conversion creates an additional two independent living flats. Overseas volunteers who work at Overton are housed on the top floor. Students have access to a range of communal spaces, including a large recreation room, a quiet lounge and a dining room. A Care Homes for Adults (18-65 years) Page 4 of 30 31 Over 65 0 Brief description of the care home domestic size kitchen is also provided in addition to the main kitchen. An enclosed inner garden is accessible to all students. During the daytime, local people with disabilities use parts of the building such as the computer room and recreation room for adult education courses. The provider supplies information about the service, including the most recent CSCI report, to students and their advocates on request. The current scale of charges is maintained within the Learning and Skills Council matrix. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place in December 2009 by one inspector over two days. The registered manager was absent but the Director of Residential Services was present along with the deputy manager of Overton House. As part of the inspection we (the Care Quality Commission) request an AQAA (Annual Quality Assurance Assessment), providing considerable information about the service and plans for further improvement. It also provides numerical information about the service (DataSet). This inspection was completed before the deadline for the return of the AQAA so we agreed with the management that we would refer to the comprehensive AQAA returned by the registered manager to us in February 2009. We updated information supplied in the DataSet during our visit. We talked to 4 students using the service, and asked staff about those students needs. We also looked at the care plans, medical records and daily notes for these 4 students. This is called case tracking. We also sampled records for other students. Care Homes for Adults (18-65 years) Page 6 of 30 We distributed surveys to students and staff during our first visit and these were returned to us by the end of the inspection. In addition to this we walked around the environment and several students showed us their rooms. We looked at staff files and training records, quality assurance and health and safety systems. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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. Students visit the home and have access to a range of information about Overton before they decide whether they would like to live there. The home has access to comprehensive assessments and records to assess whether they are able to meet the students needs. Evidence: The Statement of Purpose and Student Handbook could not be accessed at the time of our visits. Copies were locked in the registered managers desk. Copies were forwarded to us the next day. The Director of Residential Services stated they are reviewed annually and that all students would receive copies of these at the start of the new term in September. The Student Handbook states that We start working on the next accommodation list at Easter, and you will be asked where you would like to live. Twenty new students had moved into Overton House at the start of term. Those spoken with said it had been a smooth process and that other students and staff had been very supportive. Staff said that new students arrived at Overton a few days earlier than other students Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: so they could settle in and staff could develop care plans and risk assessments. Students also visited Overton House whilst living on college campus so that they could make an informed decision about whether they wished to live there. One student said they had very little choice about their move having previously lived in other accommodation in Gloucester but that they had settled in well and were enjoying living at Overton. Minutes of a house meeting held with students in September indicated that students had discussed house rules and their responsibilities whilst living there. Assessments plus care plans and other records were forwarded to Overton House prior to the start of term from students previous residential accommodation. Nursing staff and management had access to this information when deciding whether they were able to meet students needs during the assessment process. Care Homes for Adults (18-65 years) Page 11 of 30 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. Students are being involved in developing their care plans that reflect their aspirations and needs. Approaches to communication provides information in alternative formats promoting a positive approach to communication. Risks are being managed safeguarding them from possible harm. Evidence: Students had a plan of care which provided an overview of their physical, personal care and medical needs and they also had a personal development file which concentrated on their social and emotional needs. Care plans identified peoples religious or spiritual beliefs and their cultural needs. The AQAA stated, We strive to meet student requests for same gender carers and we run sexual awareness workshops within our personal development and citizenship programs. We case tracked four people and sampled other plans. We also had access to Nursing care plans and Individual Living Skills folders. Some additional information was also made available to us. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Care plans were being reviewed each term with students, who had signed the plans we sampled. A survey from staff stated, we keep up to date with documents such as personal care plans. It was also evident that where incidents or accidents had occurred changes were being made to these care plans if needed. Plans were written in plain English, provided clear and succinct guidance and also highlighted other records which should be read in conjunction with them such as Behaviour Management Plans or Moving and Handling Risk Assessments. Some daily notes referred to students assessed needs and how staff had supported them to meet these. Records of meetings between students and key workers were examined confirming discussion about issues affecting students or any changes in their identified need. Care plans were in place for people at risk of self harm or who needed to be supported when angry or upset. They had access to a Psychiatrist or Psychologist who had been involved in the preparation of guidelines. Students spoken with said that staff supported them well with their personal care needs and several showed us their care plans which they had agreed could be displayed in their rooms. They also said they had been assessed to use transport or go into the community without support and that risk assessments reflected these personal development goals. There were no restrictions in place. Some people used lap belts on their wheelchairs or had bedsides. Consent forms were in place indicating where students had agreed to the use of these. The risk assessment for one student stated that they had consented to the use of bedsides to prevent falls. This is good practice. Another risk assessment stating that a lap belt was in place to prevent falls did not refer to whether the student had consented to this but could be cross referenced with the separate consent form. There was good evidence around the home of how alternative methods of communication were being used such as makaton symbols and sign language, photographs and pictures to illustrate staff rotas, menus and moving and handling guidance. Staff and students were able to take part in weekly makaton sign language sessions. The AQAA stated, Students are encouraged to work towards personal development targets which are realistic yet challenging, whilst staying safe. We talked with students about the hazards they face and they said they completed assessments as part of their personal development targets for instance to access the community independently. They appreciated the duty of care of the organisation to make sure they were safe and the need for risk assessments to be in place. On the files case Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: tracked there were a number of risk assessments with an analysis of how these should be minimised. Care Homes for Adults (18-65 years) Page 14 of 30 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. Students who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. Students have a nutritional diet and their diverse needs are catered for. Evidence: We spoke to students individually, in a small group and joined them for lunch. All spoke highly of Overton House and their experiences of life there. Students said they were able to access town either independently or with support, using local transport such as buses or trains and the homes transport. We sampled daily records for one week in November and a week in December. One person was supported to go to church. Others had been bowling, to the cinema, to a pantomime, shopping, to clubs and to local pubs or cafes. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Students also have the option of staying on the college campus for evening activities or to go the Star Bar. They said they can access three bus services back to Overton during the evening. They said that they usually spend a day a week at Overton when they work with college tutors on their personal development targets such as using public transport or cooking. Concerns were expressed by students and staff that occasionally staffing levels can impact on lifestyles but that staff usually go that extra mile to make sure they can go out. A student survey said, staff help me get out and about in the community. Daily notes indicated that students were encouraged to take responsibility for their laundry. Domestic machines were provided in the laundry. Staff surveys commented, the staff encourage students to develop their independence, and our home maximises the students independence. The AQAA stated, We support students to gain and practice a wide range of skills. We promote independence and support students to make informed choices in personal development and transition. Students spoke to us about opportunities to live independently in the flat at Overton. They arrange staff to provide the support at times they wish and cook their own meals. The student handbook states that visitors are welcome at the home between 9.00 am and 10.00 pm. One student told us their mother was visiting on the evening of our visit to the home. Students also had access to broadband in their rooms as well as an IT suite where they made good use of keeping in touch with friends and relatives. For some students key workers kept in touch with relatives, with their permission, either by email or by telephone. Key workers also said they kept in touch with students via the college email system. Students were being involved in house meetings where they could discuss issues or social events. Minutes for two meetings were examined during our visits. The deputy manager said these were normally displayed on a student notice board but could not be located during our first visit. One student said they were the residential representative for the home meeting with other representatives and senior management as part of the student parliament. They said each term meetings with the management of Overton were usually held but they not had one this term. Students were heard being offered choices by staff about what they wanted to do, what they wanted to eat or drink or where they wanted to be. Staff gave students time to express themselves and responded in a timely fashion to their responses. Staff said that students can access advocates if they wish and there was information in the home about local organisations. Students were being referred to Connexions for support with their transition when leaving college and personal action plans were in Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: place. A new counselling service had been set up for students at the college, called Speak, which is co-ordinated by an ex student of the college. Comments about the provision of food at Overton ranged from excellent to nice variety/balanced diet, and healthy fat reduced options whilst still meeting the needs of teenagers. The cook said that students were offered choices about their meals and these were respected. There were no special diets this term. She prepared an evening meal which was reheated by staff. They had training in basic food hygiene and temperatures were being recorded for reheated food. Good hygiene practice was seen to be in place, with prepared food being labelled with date of preparation and personal protective equipment being worn by the cook. Students meal choice was recorded in the diary in the kitchen and their daily notes indicated whether they had eaten their meal. Additional meal records were being kept for students for whom their were concerns about their diet. Fresh fruit and drinks were accessible at all times. Students said they also liked to eat out or order take-away meals. There were also opportunities for students to prepare their own meals in the independent living kitchen or to do baking. Care Homes for Adults (18-65 years) Page 17 of 30 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. Personal care support is offered in a way that responds to students needs and preferences, promoting their dignity. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication and training of staff in specialised techniques. Evidence: Each students care plan indicated the support they needed with their personal care providing clear information and guidance about their washing, showering, mouth/nail care, dressing, toileting needs and night support. Staff surveys commented, we deliver a high standard of care, and provide personal growth opportunities for a range of individuals some with complex problems. The AQAA had indicated that where-ever possible they would respect students choice about their preference for the gender of staff providing this. It also stated, We promote independence and student choice in all aspects of care. Nursing care plans and medical care plans were also in place for those students who needed them. The nurses were keeping individual notes alongside entries in daily notes to indicate where treatment, monitoring or support was being provided. Staff Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: said there was good communication between the residential staff and nurses, who also provided training to residential staff. Care staff said they had received training in the care of students who had a percutaneous endoscopic gastronomy tube (PEG). Full and detailed records were being kept of health care appointments. Most students retain the support of health care professionals from home but are registered with the college General Practitioner. They were also being supported to access outpatient appointments locally. A Psychologist was employed to provided 1 to 1 support for some students and worked closely with the behaviour management team. People also had access to a Psychiatrist and to the local Community Learning Disability Team. Records indicated that where staff had concerns about the wellbeing of students they responded to this quickly and reported to the appropriate staff whether nurses, GP or senior management. Monitoring records were in place such as body maps for concerns about tissue viability. Comprehensive plans were in place reflecting the support provided to people with pressure sores or at risk from these. Systems for the administration of medication were examined and found to be satisfactory. Each student had a medical care plan identifying their medication and any other treatments. A nurse explained the way in which medication was administered to students, encouraging them to come to the nurses based in the dining room. Medication was labelled with date of opening and stock control was kept on the medication administration record. The nurses stated that people had given their consent to have their medication administered by them and for other specialised techniques. Records were seen. At the time of our visit 9 students were self administering their medication and others were being assessed. Robust assessment procedures were in place to assess students ability to manage their medication and they were awarded certificates at Level 1 to Level 4 indicating they needed verbal prompting or could manage their medication systems independently. The nurses said they regularly audited students who were self administering medication and if needed support would be re-introduced. Students had facilities to store medication securely in their rooms. Care Homes for Adults (18-65 years) Page 19 of 30 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. Systems are in place to enable students to express their concerns and they are confident that they will be listened to. Students should be safeguarded from possible harm or abuse. Evidence: All students were given a copy of the complaints procedure in their student handbook and the Statement of Purpose. This provided information about our contact details. They also had a copy displayed in their rooms. Students spoken with said they would talk to the management team, their key workers or express concerns at house meetings or the student parliament. The complaints folder indicated that the home had received one complaint in 2009 expressing concerns about staffing levels. There was evidence of an investigation into the concerns and the response to the complainant. There was also evidence that the complainant was satisfied with the outcome. Students said they had expressed concerns at their house meeting about the aid call system which disturbs some students during the night. They said they were told that students in other years had expressed similar concerns but that nothing had been done about it. Management said they were aware of the problem and had looked at the possibility of using other systems but the layout and size of the building had not made this possible. The complaints folder also contained copies of concerns about possible safeguarding issues. There had been four recorded in 2009 leading to one safeguarding meeting Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: with the local adult protection team. Staff surveys indicated, we support students with safeguarding isses, helping them to sort their lives out. The AQAA stated, Concerns and issues are investigated and responded to promptly. Staff are trained in protection issues and performance monitored. Staff spoken with had a good understanding of the procedures in place to report safeguarding concerns. Their training records indicated that they had completed internal safeguarding training and also attended alerters guide training with Gloucestershire County Council. The Director of Residential Services confirmed that training in the Mental Capacity Act and Deprivation of Liberty Safeguards was being cascaded out to residences. Information about this legislation was available in the home. Staff had completed training in the managment of challenging behaviour and had support from the behaviour management team. Guidelines were in place to support students in distress or experiencing anxieties. Staff spoken with had a clear understanding of how to support students. Robust record keeping was in place to record incidents. Records confirmed the appropriate action was being taken in response to these. Students had financial assessments in place and personal financial records indicating when they had access to their money. These were being audited and signed to indicate money transfers. Students had secure facilities in their rooms in which to keep their valuables if they wish. Inventories were in place for students personal possessions with evidence that these were being updated when needed. Care Homes for Adults (18-65 years) Page 21 of 30 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. Students live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Evidence: Overton House is leased from a housing association and this has caused considerable problems over the years. During our visits the home was pleasantly decorated, well maintained and clean. Communal areas were bright and light and students had been encouraged to decorate these areas to reflect their interests and lifestyle choice. A maintenance system was in place to deal with day to day issues. Students and staff spoke positively about the maintenance team for their efforts in resolving issues promptly. Longer term refurbishment plans were in place including dealing with problems with the boiler and refitting a lower ground floor shower/toilet. Several students showed us their rooms which they had decorated with posters and pictures. Some students share rooms and they had expressed concerns that the privacy screens/curtains provided did not provide sufficient privacy. Wardrobe doors had been removed to enable easier access. Students were observed using keys to their rooms. The deputy manager confirmed that these were being replaced. The home and grounds are accessible to people who use wheelchairs. There were also two shaft lifts providing access to other floors. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Surveys from students and staff indicated concerns with Overton House, for instance, the building is old and some facilities do not always operate properly, and Overton building is ok but it is not really meeting the students needs. The college has worked hard over the years to upgrade facilities in the home including refurbishing bathrooms/wet rooms/toilets/ communal areas and replacing worn carpets. This work is ongoing. Specialist adaptations were in place throughout the home. An assisted bath on the lower ground floor also had access to overhead tracking. Mobile hoists, bath and shower chairs were provided. Records indicated that when a new student moved into the home, an assessment had been completed by the Occupational Therapist and additional hand rails had been placed in their room. A listening device for a person with epilepsy had been replaced with a sensor mat to provide greater privacy whilst ensuring their safety. A toilet on the upper floor had an automatic door and push buttons providing greater accessibility for people. Staff said they were completing infection control training at the end of term. The laundry was used by students and provided a mix of industrial and domestic washing machines. Personal protective equipment was provided. Communal hand wash basins were provided with liquid soap and paper towels. There was a policy and procedure in place should students have swine flu. Care Homes for Adults (18-65 years) Page 23 of 30 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. Students needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of students living at the home. Robust recruitment and selection procedures should protect people from possible harm. Evidence: Staff said that they had access to an induction programme when they started working at the home. The AQAA confirmed that this was equivalent to the Skills for Care Common Induction standards and that all staff completed this. The Director of Residential Services said that staff also had access to the Learning Disability Qualification. The college runs a National Vocational Qualification (NVQ) programme and 94 per cent of staff at Overton House had completed their Health and Social Care Awards. The remaining 6 per cent of staff had been registered for their awards. This is excellent practice. Staff spoken with appeared to be knowledgeable and have the skills necessary to support students. As mentioned concerns had been expressed about the impact of 4 staff vacancies and staff absence on staffing levels. Staff said that the team had pulled together to make sure shifts were covered and that there were 9 staff on duty in the morning and 8 in the evening. Surveys indicated, very occasionally staffing levels are stretched. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Students had also expressed their concerns to us that staff were working long hours. They stressed that the team were excellent, good fun and everyone does what they can do. Management had recruited additional staff but unfortunately they had not taken up the posts. Further recruitment was planned for the new year. Staff files are kept in the Human Resources Department on campus. Five files were brought to Overton for inspection. A high standard of record keeping and collation was seen to be in place. Each file had a front sheet providing evidence when information had been requested and when it had been returned. All staff had completed an application form and where there were gaps in employment history these had been investigated and evidence provided of a full employment history. At least two references had been received before staff were appointed and some had evidence that they had been verified verbally with the employer. Reason for leaving former employment working with adults and children had been provided. Copies of certificates had been provided to evidence previous training. Staff are not appointed before a satisfactory Criminal Records Bureau check is returned. These can now be destroyed for Overton House. Evidence of identity had been provided on each file with a current photograph. Copies of birth certificates should not be kept in line with the recommendations of the Data Protection Act. The AQAA stated, Students are actively involved in the selection process for appointing new staff. The National Star College has its own staff training department offering a comprehensive training programme to staff including mandatory training, specialist training such as epilepsy, learning disability awareness, makaton and challenging behaviour. All staff complete equality and diversity training, boundaries and safeguarding. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place involving people who live at the home. Systems are in place to maintain and monitor the health, safety and welfare of people. Evidence: The registered manager is very experienced in the care field and has the Registered Managers Award and a NVQ Level 4 in Care. At the time of our inspection she was absent due to illness. She had supplied a comprehensive AQAA to us in February 2009 providing considerable information about plans for improvement. We were able to evidence that these improvements were being put in place such as introducing a new daily recording system, environmental improvements and providing safeguarding training for staff. At this inspection there has been continued improvement of the service with more outcome areas achieving the excellent rating. Staff and management will be receiving training in the Mental Capacity Act and Deprivation of Liberty Safeguards. No one in the home was subject to a Deprivation of Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: Liberty Safeguard at the time of the inspection. The National Star College has a robust quality assurance system in place which involves feedback from students. We were able to read comments from students in their Student Perception Survey which contributed toward the 2008/2009 Quality Improvement Plan. These included, Overton was like my second home, and Overton is very good. The Director of Residential Services confirmed that the self assessment was currently taking place and the Quality Improvement Plan would be produced from this. Regulation 26 visits as required by us were taking place. A copy of these was forwarded to us after the visits. Robust systems were in place to monitor health and safety in the home. We sampled fire records confirming checks on equipment were carried out within the appropriate timescales. A current fire risk assessment was in place. Fire drills and training were also being done. Fridge, freezer and water temperatures were being recorded. Servicing of equipment and adaptations were also in place. Environmental risk assessments were in place. An annual health and safety audit had been completed in 2009 and it was clear that actions identified were being dealt with. Care Homes for Adults (18-65 years) Page 27 of 30 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 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Any restrictions (such as use of bedsides or lap belts) as agreed with people should be fully noted in records such as risk assessments which describe the rationale for the use of these. Copies of birth certificates should not be kept on staff file. These can be evidenced as checked on the front sheet on staff files. 2 34 Care Homes for Adults (18-65 years) Page 29 of 30 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). 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