Care Home: Pineapple Road (9-9a)

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What the care home does well The home has good arrangements for assessing the needs of people considering living there and deciding whether it can meet those needs. The arrangements include offering prospective users the opportunity to experience the service before accepting an offer of a permanent place. People using the service live a varied, interesting and stimulating lifestyle. This includes participation in a range of activities both within the home and in the wider community. People are supported in maintaining contact with their families and friends. Health and personal care needs of people living in the home are met to a good standard. The home supports people using the service to access a range of health and social care services in the community. Procedures are in place which support good standards of practice in dealing with complaints and in safeguarding adults. The home is located in a relatively quiet residential area and provides a pleasant home for people living there. People using the service benefit from the induction, training and development arrangements for staff which aims to ensure that care and support is provided by suitably trained and supervised staff. The home is developing a gardening project which offers service users skills in gardening, provides fresh and nutritious food for use in the home, and is planned to offer further opportunities for service users in 2010 when produce may be offered for sale in a local market. The home has made detailed representation to the owners of the building, Buckinghamshire County Council, with regard to the need for improvements in standards of decor in some parts of the building. Some improvements have been made but further work is necessary. What has improved since the last inspection? Staff recruitment and retention has improved which has greatly reduced the use of temporary staff. Service users benefit from improved continuity of care and support. People living in the home are making increased use of sports and leisure facilities in the community. This is reported to have led to a significant improvement in users wellbeing. The arrangements for the administration of medicines have been improved and individual lockable cabinets have been fitted in all rooms. This has led to improved standards of practice in the control and administration of medicines. The administrative systems in the home have improved which facilitates more efficient information storage and retrieval. What the care home could do better: Ensure that staff records contain all of the information required by the Regulations when appointing staff. For the protection of users. Keep the Commission informed of significant changes in management and staffing. To ensure that services to users are not adversely affected by such changes. The registered persons are advised to carry out a review of staffing levels in the home - using guidance from the Department of Health which is available through our website - in response to comments on staffing by respondents to the survey we carried out for this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Pineapple Road (9-9a) Amersham Bucks HP7 9JN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 2 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Pineapple Road (9-9a) Amersham Bucks HP7 9JN 01494765079 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): h3001@mencap.org.uk www.mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Mrs Deborah Bowden 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: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - LD Date of last inspection Brief description of the care home Pineapple Road is a home for adults with a learning disability and is managed by Mencap. The home is situated in a quiet part of Amersham not far from local shops and a walk to the town centre. There are good transport links with buses running past the end of the road and the town has a train station with main line trains and tube trains into London. The home is registered for six people, being accommodated on two floors. There are four bedrooms on the first floor and two on the ground floor. One room has en-suite facilities. The home has an attractive garden to the rear of the property which is accessible to residents. It also has a gardening project at an Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home allotment about ten minutes walk from the home. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by one inspector in October 2009. The inspection included a visit to the home on 27 October 2009. The inspection process included examination of support plans and other documents relating to the care of people living in the home (service users), discussion with the registered manager (the manager), service users and staff, observation of practice and inspection of some areas of the home. It also included consideration of information submitted in advance of the inspection by the manager and of the results of a survey we carried out for this inspection. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? Staff recruitment and retention has improved which has greatly reduced the use of temporary staff. Service users benefit from improved continuity of care and support. People living in the home are making increased use of sports and leisure facilities in the community. This is reported to have led to a significant improvement in users wellbeing. The arrangements for the administration of medicines have been improved and individual lockable cabinets have been fitted in all rooms. This has led to improved standards of practice in the control and administration of medicines. The administrative systems in the home have improved which facilitates more efficient Care Homes for Adults (18-65 years) Page 7 of 32 information storage and retrieval. 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 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a thorough pre-admission process which ensures that the needs of prospective users are assessed to a good standard, involve the person and those supporting them, and aim to ensure that the home can meet the needs of people admitted. Evidence: A copy of the homes current Statement of Purpose was provided for this inspection. The Statement of Purpose provides contact details for the home and for MENCAP, an overview of the services provides by the charity, MENCAPs mission statement, MENCAPSs vision and values, the purpose of Pineapple Road, the managers career background and qualifications, details of the accommodation and facilities, staffing, the arrangements for maintaing contacts with relatives and friends, and the objectives of the home (for a twelve month period). The Service Users Guide is written in easy read format with coloured and monochrome pictures. It includes reference to the Statement of Purpose, Mencaps Vision and Values, a summary of what it is like living at Pineapple Road, how to Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: complain, and the views of users of the service. The home also provides an easy read and picture summary of the ....contract between the service and the resident. The home has not had an admission since the last key inspection in July 2007. The manager told us that the last admission was three years ago. In terms of process, the home will only accept referrals from the local authority. At the time of this inspection in October 2009 the most likely source of referrals was the Community Learning Disability Team (CLDT) in Chesham. The time interval between the point of enquiry and the point of admission is adapted to meet the needs of the prospective service user. It is important that the prospective user feels that the home is right for him or her. It is also important for current users of the service that they and the new person have time to get to know each other. The process is usually initiated by an enquiry from a care manager acting on behalf of a prospective user. This may be followed up by a visit to the home from the care manager and members of the prospective users family. If the process moves forward from that point then arrangements are made for an assessment of the persons needs to be carried out by the manager of the home. The assessment is structured by MENCAPs assessment process and paperwork. The manager told us that the process is holistic and person-centred. The process includes consideration of assessment information provided by the care manager. If, at the end of the process, all parties agree to take the matter forward to the next stage then arrangements are made for the prospective to visit the home. If the person wishes the matter to continue then arrangements are made for the person to spend time in the home - initially during the day, then overnight, then extending as they wish. A key point stressed by the manager is that the pace of the proceess must match the needs and wishes of the prospective user. This will vary from person to person. The process aims to ensure that the home will be able to meet the persons needs and that the person will be happy to move in and live in the home. At the point of admission an initial Person Centred Plan (PCP) of support is drawn up. This is developed with the user in line with the persons needs. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support needs of people living in the home are recorded in their individual support plan and in their person centred plan. People living in the home are involved in developing and reviewing their own plan. Evidence: A service user support plan was in place for each person living in the home. This is coordinated by a key worker. The home was developing a person centred plan (PCP) with each person living there. These were in a format agreed with the person and included key aspects of the more detailed support plans which were maintained in the office. The example shown to us by one person included easy read and picture summaries of key aspects of their care and support and their activities and interests. It was retained by the person in their own room. The home is appropriately addressing the task of developing PCPs. The work includes staff training and supervision, user involvement, and the development of a PCP which Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: is appropriate and in a form acceptable to the user. Supprt plans include a photograph of the user, personal information, key contacts, a pen picture of the person, an assessment of needs, a plan of support aimed at meeting those needs, risk assessments, and correspondence. In broad terms support plans identify needs, state what the person can do, what current support is required, and what help they need to become more independent. Those examined included the support people needed with regard to diet, healthy lifestyle, medication, managing money, personal care, health matters, domestic activities (such as keeping their room tidy and doing their laundry), and specific matters (such as the action to take when a person reported feeling unwell). Support plans are reviewed regularly with people living in the home, and, at a minimum, annually with care managers. Staff work in collaboration with people and users are involved in decision making through a range of activities. These include day to day encounters in the home, shared activities, key worker and goal setting meetings, house meetings, through participating in staff recruitment, and in review meetings. The home is in contact with a local advocacy organisation based in Amersham. Risk management arrangements are well established in the home. Risk assessments in support plans included (among others) self-medication, gardening, going out of the home, travelling in vehicles, challenging behaviours, bathing, and activities in the kitchen. Some support plans included a copy of NHS risk assessments. The home conducted a Managing Risk with Individuals audit in January 2009. A summary of the outcome was provided for this inspection. Of 15 items assessed in the audit the home reported that it was achieving best practice in 11 and developing good practice in 4 items. Procedures for ensuring that information about people living in the home is managed in confidence are satisfactory. Records are maintained in an office which is locked when not in use. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home lead a varied and interesting lifestyle which has positive effects on the physical, psychological and social health of individuals. Meals are planned and prepared with people living in the home and are varied and nutritious. Evidence: The home has an active programme of activites. On our first visit for this inspection no one was at home. On the second visit only one person was at home with staff, the others were out until around 3:30 that afternoon. At the time of this inspection no one living in this home was in employment. The home had established links with a local service but the co-ordinator of that service had gone on leave and the service had not moved forward for the time being. However, the Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: manager was exploring alternative opportunities and was optimistic that the homes allotment would generate work, especially if it led to the establishment of a stall at the local market. The manager was also looking at opportunities for part-time employment for service users in a local charity shop. The home endeavours to maintain a varied and interesting range of activities for people living there. Some of these are structured and involve a commitment to regular attendance. These include attending a day centre, art classes, college, garden centre, and helping out in the allotment. Some people regularly go to a youth club and all are welcome to attend a local club - the Gateway club - once a week. Some users attend a local church. Staff support people in participating in local activities such as shopping, bowling (in High Wycombe and Hemel Hempstead), sports (such as football), an adult adventure project (near Taplow in Berkshire), boat trips on the canal (in Nash Mills near Apsley, Hemel Hempstead), cycling, swimming, and one person has made very good progress in martial arts. Neighbours have been invited to barbeques run by staff and users of the service. Staff and users go to cafes and pubs together on occasions and to an occasional concert. The home encourages people to live a healthy lifestyle and to pay attention to keeping active and eating a healthy diet. Holidays taken over the last year have included; a week in Great Yarmouth (with staff), in Wales (with family), a mediterrean cruise to celebrate a special birthday (with a member of staff), and in Poole, Dorset (with staff). The home has also organised days out using a staff car or pool car. Within the home people can pursue their own interests. The home has a TV, DVD/Video, music centres, board games, crafts or people can just experience time alone in their room or in the garden. People using the service are supported in maintaining contact with family and friends. In the survey carried out for this inspection people acknowledged the range of activities - but some wanted to go out more. Staff also indicated a wish to have more time to go out with people. Meals are planned with people living in the home and are cooked by staff with help from users. The manager endeavours to maintain a healthy bias to the diet. Breakfast is usually cereals, toast, fruit juice and hot drinks. Two people like to have a cooked breakfast at the weekend. Lunch consists of sandwiches - especially if out for the day Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: - or a light meal such as Salmon Salad, Pizza, Poached Eggs, Fish Fingers or Soup and a Bread Roll. Dessert is Yoghurt or fresh Fruit. The Evening Meal is the main meal of the day and consists of a two course meal main course with vegetables followed by dessert. Selections from menus around the time of this inspection included: Shepherds Pie with Mixed Vegetables followed by Fruit and Ice Cream, Lamb Leg Steaks with Potatoes and Peas followed by Fresh Fruit Salad, and, Fish Pie with Peas and Carrots followed by Frui Salad and Yoghurt. Battered fish is usually served on Fridays and a roast meat based dish on Sundays. As mentioned elsewhere in this report the manager expects the produce from the allotment to feature increasingly on the home menus, both for reasons of quality and taste but also so that people living in the home can benefit from the nutritional and educational aspect of their work there. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living in this home are met. Systems for the control and administration of medicines ensure that people receive medication as prescribed. Evidence: The personal support needs of people living in the home are recorded in their support plan. Aids and equipment are provided where required. At the time of this inspection these included a special bed (part funded by a charity), hoist, wheelchair, bath and wet room.The manager told us that they were liaising with occupational therapists and looking at further adaptations and equipment to meet individual needs. All of the people using the service were registered with a local GP practice - five with a practice in Chalfont and one with a practice in Amersham. The manager told us that the home has a good rapport with the GPs and the practice nurse. Specialist health services are accessed through the GP or the local Community Learning Disability Team (CLDT). These include physiotherapy, specialist community nurses, a psychiatrist, psychology, occupational therapy, and health liaison nurses. The care managers are also based with the CLDT (five users are with one care manager and one with Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: another). Medicines are prescribed by the persons GP and are dispensed by the Amersham branch of Boots Chemists. Most medicines are dispensed in the Boots monitored dosage system (MDS). The administration of medicines is governed by MENCAP policy. Staff are trained in the administration through an in-house E-learning programme combined with observation of practice by approved staff. A pharmacist was scheduled to talk to staff on the MDS system. Staff competence is assessed by the manager and staff are required to complete an annual training update on the subject of medicines administration. Medicines are stored in a locked cabinet in each persons room. Medication records are held in the staff office Records include a photograpgh of each person for whom medicines have been prescribed, a medicines administration record (MAR sheet), staff signatures, a pen picture of the person, and a handover procedure which identifies the member of staff responsible for the administration of medicines on each shift. The homes arrangements are checked during the managers proprietors visits and periodically by a pharmacist from Boots. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have access to an effective complaints procedure if they are dissatisfied with any aspect of the service. The home has systems in place which protect the interests and well-being of people using the service. Evidence: The service is required to conform to the complaints policy and procedures of MENCAP copies of which are available in the home. A summary of the process is on display in the home. We were informed that copies are also available in CD format. The service users guide includes guidance on how to complain: to the manager, to the area manager, and to the commission. The manager told us that she intends to produce a more simple pictorial guide to the complaints procedure which is separate from that in the service users guide. The home has not received any complaints during the twelve months preceding this inspection. The home has a comprehensive policy governing the safeguarding of vulnerable adults. Policy and guidance documents available to staff include the MENCAP policy, the current version of Buckinghamshire Joint Agency guidance, the Department of Health guidance No Secrets, and guidance booklets on the Mental Capacity Act 2005 Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: and Deprivation of Liberty safeguards (DOLS). All staff are required to attend training on the subject of Safeguarding Adults. There have not been any safeguarding referrals from this service during the twelve months preceding this inspection. All staff are trained through Team Teach on positive ways of responding to aggression. The manager provides guidance to staff on the management of particular instances where challenging behaviour in the form of aggression may feature. People living in the home require support in managing their money and the home has systems in place to provide this. The procedures are subject to the policies of MENCAP. They involve a financial risk assessment, systems for recording transactions and retaining receipts, weekly budget planners, arrangements for safe keeping of monies in a secure safe operated by a coded key pad, and checks on the arrangements by the manager and by the manager carrying our monthly proprietors visits (reg 26 visits). Each person living in the home has an account with a bank. Cash may be drawn out using a card or pass book. A mini statement is taken at each withdrawal. Records of all transactions are mainted and regular checks carried out by managers. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a pleasant, comfortable and safe home which has been adapted to meet their needs. However, the standard of the accommodation in the communal areas on the ground floor could be improved by redecoration and one item on the first floor requires more immediate attention. Evidence: The home is a detached property, comprised of two semi-detached houses, which has been adapted for current use. It is located in a residential area in Amersham Common, within walking distance of the main A404 road between Little Chalfont and Amersham. Parking is available in Pineapple Road. The area is served by buses. The nearest rail station is Amersham on the Hill. Local shops are within walking distance. The home is well established in its area and we were informed enjoys a good relationship with neighbours. Entry is controlled by staff. The ground floor accommodation is comprised of the entrance hall, kitchen, dining room, lounge, laundry, freezer store, and two bedrooms (one of which has en-suite accommodation comprising wc, hand basin and shower). Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: The ground floor is accessible to a wheelchair user. Stairs lead to the first floor. The first floor accommodation is comprised of four bedrooms (none of which have en-suite facilities), bathroom, shower and WC, office and staff sleep-in room. Bedrooms vary in size. All of those seen on this inspection were comfortably furnished and had been personalised in accordance with the wishes, interests and tastes of the person living there. There is a garden to the rear of the property which comprises a patio with seating, lawn, flower beds, shed and a summer house. The garden is reasonably well secluded with fencing and a hedge on the boundary. The home has an allotment which is about a ten minute walk away. Since its establishment in April 2009 the home has grown cabbages, carrots, strawberries, onions and flowers on its allotment. In 2010 it is planning to rent a stall in Amersham market to sell produce and raise funds for the home. The home has a pleasant domestic feel and staff and users seemed comfortable in activities together on the day of our visit. The quality of the accommodation is variable. The property is owned by Buckinghamshire County Council and the manager has raised a number of matters with the landlords which require attention. The manager is rightly energetically pursuing these on behalf of people living in the home. Some of the communal areas of the home would benefit from decoration. It was noted that in one bathroom the vinyl flooring had not been finished to the base of the WC. This requires attention because it does not maintain an impermeable surface and could compromise standards of hygiene in that room. Since the last inspection the kitchen has been partly refurbished with new worktops and tiling, wood effect laminate flooring has been laid in the ground floor, some bedrooms have been redecorated (by staff), and new carpets have been laid in some rooms. All areas were clean and tidy and no untoward odours were noted. Standards of housekeeping were good. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home are supported by staff who have undergone a good recruitment process, have had training and maintain ongoing professional development to ensure they have the skills to meets the needs of people using the service, and are well supported and supervised by their manager. Evidence: The staffing of the home at the time of this inspection maintained two staff from 7:00 am to 2:00 pm, two staff from 2:00 pm to 9:00 pm, and one sleep-in member of staff at night. These figures exclude the manager who works flexible hours over seven days of the week. The work does involve some lone working and we were made aware of concerns about this. Staff responses to our survey included a need for More Support hours, Provide more care hours to support residents in the community, Stop lone working (in case of emergency), and More opportunities to take residents out, i.e. greater levels of staffing. These comments would fit with some of those received from people living in the home (as summarised elsewhere in this report). While we did not receive any serious concerns about staffing levels there were indications of pressure on staffing at times. The registered persons would be advised to review staffing levels taking account of current guidance from the Department of Health and guidance for Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: professionals on our website. The personnel records of three staff appointed since the last inspection were examined during the course of our inspection visit. All applicants for posts in the home have to complete an application form. The structure of the form allows for any gaps in an applicants employment to be explored at interview where necessary. The form requires applicants to provide their reasons for leaving previous employment. This is particularly important where the person has been employed in a position which involves working with vulnerable people. Health status is self declared. References had been obtained on all applicants. The home does not appoint staff on a POVA First basis. An enhanced CRB certificate had been received for all staff before taking up their position in the home. It is noted that some files did not include a recent photograph of the member of staff (required as proof of identity). People living in the home have participated in local staff recruitment initiatives and the manager wishes to extend this involvement. All new staff undertake an induction programme which entails completion of a workbook over a 12 week period. The induction programme meets Skills for Care requirements. Staff are provided with a copy of the General Social Care Council codes of conduct as part of their Welcome Pack on appointment. All staff are required to complete a six month probation period. The organisation has good arrangements in place for post induction training and professional development of staff. This consists of a combination of in-house, distance learning, and external training by an independent training agency. Training includes First Aid, Moving and Handling, Infection Control, Mental Capacity Act, Health and Safety, Administration of Medication (distance learning with assessment by the manager), Safeguarding, Team Teach (an approach to responding to challenging behaviours), Working with Families, Diversity, Lone Working, and, Autism Awareness. Staff are supported in acquiring NVQ qualifications at level 3. Three staff had acquired NVQ3 at the time of this inspection. Two staff had recently started such training. All staff have personal supervision. The manager told us that the home is aiming for this to take place monthly. At the time of this inspection the frequency varied between monthly and two monthly. Supervision includes a discussion on staff continuing professional development (CPD). One member of staff told us that (the) Manager supports staff through supervision, regular staff meetings and reflective practice and has ensured that staff acquire their skills through training. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Staff were positive about the home - both when seen during our visit and in their responses to our survey. Staff communicated a positive commitment to the people living in the home, a supportive and motivating manager, an interesting job in an organisation which iinvests in their training and development, and a very clear view of the key focus of their work, namely helping people living in the home to enjoy a good quality of life and be involved in mainstream community activities. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home strives to improve the quality of the service for users and to maintain a safe environment for people living there. Evidence: The registered manager has extensive experience of working in health and social care services for adults and younger people and has been manager of this service since January 2008. The managers current position does not involve formal responsibility for any other service. However, the manager had been supporting another MENCAP service in Oxford over the latter part of 2009 and we had not been notified of this. The arrangement involved one or two days away from Pineapple Road. Registered persons are required to consult us on such changes which may have implications for the users of a care service. On this occasion the people living in the home do not appear to have been disadvantaged by the development. This omission is unusual because the manager normally maintains good communications with us. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The manager has qualifications in catering, in Foundation Management of Care, NVQ Level 4 in Care, and holds the Registered Managers award (RMA). The manager is also trained and experienced in person centred counselling. The manager maintains her continuing professional development through the development programme run by MENCAP. The home has a positive and open atmosphere. Staff and people living there seemed very comfortable with each other. One respondent to our survey wrote that the home Understand (s) each of the people who live in the home as an individual, with differing personalities, needs, (and) preferences. Users of the service were supported in being involved with it. The service had carried out an Annual Quality Service Review in March 2009. It is noted that its rating had improved from 3 to 4 (on a scale of 1 to 5). The review forms part of the services continuous improvement plan. This looks at a range of aspects of a service - including (among others); Choice and Respect, Staffing, Interests and Relationships, Food and Nutrition, Support Plans, Risk assessments, Environment and Safety and General Administration. It is noted that the Executive Summary includes the comment The situation at Pineapple Road has improved dramatically and The opportunities available to the people who use the service have dramatically increased and it is clear that people who live at Pineapple Road are much happier and more confident. Their personal achievements in 2008 have been incredible. We received six completed survey forms from people living in the home and four completed staff survey forms in response to our survey. The form for people living in the home was an easy read/picture version and all respondents had received assistance in completing it. All of the people living in the home said that the staff treat them well, all said that they can do what they want to during the day, in the evening and at weekends, five of six said that the home was always fresh and clean, and all said that they knew who to speak to if unhappy. Four of six said that they did not know how to make a complaint - one person did not answer that question. In response to the question What does the home do well?, answers included: Activities. Help me; Food - Good Choice. Very yummy. I get to listen to music and watch TV. More or less everything is great - same as being home; Cooking - we get a variety of meals which we get to choose each week. Activities - I am always busy and able to go out to do fun things; Looks after me; Look after me; and, Fun. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: In response to the question What could the home do better?, answers included: Not sure; Take me out more; More outings; I wish I was able to be taken out more often, and Nothing. Proprietors visits (Reg 26 visits) are regularly made to the home. They are well structured and records are maintained on computer. Records of recent visits were viewed during our visit to the home. A copy of a recent visit was also provided. The arrangements for maintaining a safe environment in the home are good. There is a health and safety policy and staff attend a two day training course on the subject. The training programme includes training on moving and handling, first aid, infection control, fire safety, food hygiene, and responding to aggression (Team Teach). Details of the most recent checks on the homes electrical circuits, portable electrical equipment, hoists, heating and gas appliances were provided by the manager in the pre-inspection papers. Some of these matters are the responsibility of Buckinghamshire County Council who own the building. Health and safety matters are included in the managers monthly compliance reports to senior managers and are included in the monthly proprietors visits. The home was inspected by the local fire authority in January 2009 and its arrangements for fire safety found to be satisfactory. A fire risk assessment was carried out by an external person in October 2009. Fire training was last carried out in July 2009. Fire training is carried out fortnightly and is based on an interactive CD. Fire drills are carried out monthly. Contracts are in place for the maintenance of fire safety equipment. Systems are in place for recording accidents and inclidents. Records examined were seen and found to be satisfactory. Overall this is a well managed service. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 13 The registered persons must 31/12/2009 ensure that all parts of the home to which users have access are so far as practically reasonable free from hazards to their safety. The registered persons must ensure that the flooring in all WCs and bathrooms is impermeable to water and can be cleaned to maintained good standards of hygiene. 2 34 18 The registered persons must 06/12/2009 ensure that staff records include proof of the persons identity including a recent photograph To ensure that practice in the recruitment of new staff is rigorous and protects users of the service from the appointments of staff unsuited to working with vulnerable adults. Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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