Care Home: Rowans

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What the care home does well Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual preferences and lifestyles. Comments about the environment included "the home always looks clean" and "room is absolutely marvellous this did help in deciding to move to the home as it has an en suite. Very nice room standard of furniture of perfect". The home is effective at providing intensive individual packages of one to one support to residents who are assessed as having complex needs and whose behaviour is described as challenging. A sample of comments about experiences at the home included "---- is very settled and comfortable. It is an amazing home. Absolutely overwhelming, outstanding the care they lavish upon---" "positive client care. They have very good practises. Could not do anything better "specialist skills and knowledge are evident in the way they manage complex behaviour" and "the service has managed to provide a very person centred service to someone with complex needs". Staff are provided with clear up to date information about the needs and preferences of individual residents in order that they can provide consistent support. The home balances well the rights to residents to take reasonable risks as part of an enabling lifestyle. Residents lives are enriched by good practises in the promotion of independence, meaningful occupation, leisure pursuits, choice and being enabled to live chosen lifestyles. Personal and health care support is highly individualised and respects resident`s privacy and dignity. A relative commented "there is a timetable of things to do they give a choice of three activities and --- choices which one. Their timetable is geared towards the individual" Residents benefit by being actively supported to maintain relationships with their families and friends. Staff make a positive contribution in residents lives as staff are well supervised, enthusiastic and know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Comments about staff included "they are really positive and they are about the same age so -----feels they are more like friends, which -- can relate to. Staff communicate with --- really well" "the staff team appear confident and skillful with very good management support" and "when we go always a member of staff with --- watching and engaging in a DVD not just sitting there reading a magazine but interacting". The home is being managed effectively and openly in the absence of a registered manager. Comments about the management team included "very supportive" "always work in the best interest of service users" and "easily accessible extremely helpful approachable and can raise whatever issues without fuss". What has improved since the last inspection? As this is the homes first inspection since they registered with the Commission there were no areas in which the home has been previously required to improve upon. The home has only been admitting residents three months prior to inspection and many of the homes systems and practises are not yet fully bedded in or have been tested. However there are already mechanisms in place for residents, staff and other stakeholders involved in residents care to influence how the home is run with evidence that the home and organisation acts on any feedback it receives regarding the quality of its services and facilities. What the care home could do better: There are no shortfalls in practises noted at this inspection that have resulted in requirements being made. Instead consideration should be given to including capacity assessments as part of the homes pre admission assessment and support plans. This would help to underpin the homes good practises in the range and level of choices it provides to ensure this is consistently applied and to further promote resident`s rights to make decisions in their lives and The area manager was aware of the benefits of providing a more person centred approach to care planning documentation in order to actively engage residents in identifying their own plan of support. A training matrix has been developed which identifies the training that staff need to undertake and when this will be undertaken, this is to ensure that staff have all of training to work safely and effectively with residents. Key inspection report Care homes for adults (18-65 years) Name: Address: Rowans 27 Tadworth Street Tadworth Surrey KT20 5RJ     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: Jane Jewell     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 31 Information about the care home Name of care home: Address: Rowans 27 Tadworth Street Tadworth Surrey KT20 5RJ 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Modus Care Ltd Name of registered manager (if applicable) Mrs Louise Tracey Harrold Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category of service only: Care Home only (PC) to service users of the following gender: either Whose primary need on admission to the home are within the following category: Learning disability (LD) Date of last inspection Brief description of the care home The home is registered to provide residential care and accommodation for up to five people who have a learning disability. The home specialises in providing its services to people whose needs are within the autistic spectrum and behaviour which is described as challenging. The home provides long term care placements as well as day care for a none residing service user. The home was first registered with the Commission in August 2009. The home is managed by Modus Care Ltd who also manage four other residential care homes in the Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 Brief description of the care home Devon area and two in the Surrey area. The premises are leased with modus being responsible for the upkeep and maintenance of the property. The home is located in a residential area on the outskirts of the village of Tadworth in Surrey. There are bus and train networks nearby with the town of Epsom approx 4 miles away. The premises are a converted domestic property which have been updated and modernised for its current usage. The home is presented across two floors with stairs providing access to the first floor. All bedrooms are for single occupancy and provide en suite facilities. Communal space current consists of an art room, kitchen, dining area and lounge. There is a rear secure level garden, which is in the process of being developed. The home has its own transport The area manager reported that the fees for residential care currently range from £1200. to £2500. per week, depending on the services and facilities provided. Extras such as: newspapers, hairdressing, chiropody, some transport , toiletries are additional costs. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 is the homes first inspection since it was registered with the Commission in August 2009, with the first resident admitted in September followed by a second resident in December 2009. There are currently two residents residing at the home. The information contained in this report has been comprised from an announced inspection undertaken over five and half hours, between 11am to 4.30pm, and information gathered about the home before and after the inspection. The area manager had completed an Annual Quality Assurance Assessment (AQAA) within the date requested. Due to the service only having recently been opened this provided only information about the home but was used to inform the inspection process. The inspection was facilitated by the person appointed by the provider to oversee the management of the home in the registered managers absence. Hereafter referred to as the person appointed along with the area manager who is also based at the home. The Care Homes for Adults (18-65 years) Page 6 of 31 focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown the communal areas, and being invited to view residents and vacant bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff, during lunch time and over the morning and afternoon period. Five staff and two relatives were also consulted as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Four were returned in total from health care professionals. Their feedback is included in this report. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? As this is the homes first inspection since they registered with the Commission there were no areas in which the home has been previously required to improve upon. Care Homes for Adults (18-65 years) Page 8 of 31 The home has only been admitting residents three months prior to inspection and many of the homes systems and practises are not yet fully bedded in or have been tested. However there are already mechanisms in place for residents, staff and other stakeholders involved in residents care to influence how the home is run with evidence that the home and organisation acts on any feedback it receives regarding the quality of its services and facilities. 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may consider moving into the home are provided with a good range of information to help them decide if the home will be suitable for them. A comprehensive assessment process helps to ensure residents needs are understood and can be met prior to them living at the home. The home is able to identify and meet the range of needs of the people it supports who have complex challenging behaviour. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home and the services it provides. This includes an individualised service user guide provided to each resident. Relatives confirmed that they and their relative received lots of information about the home which helped them make informed decision about whether the home would be suitable. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Documents seen relating to the admissions process showed that comprehensive assessments are undertaken. Information about a prospective residents needs is gathered from a variety of sources including the resident, their representative and health care professionals. Copies of placement authoritys needs assessments are also obtained. The needs assessment then forms the basis of their initial care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. To further promote good practises the area manager agreed to also include capacity assessments. This would help inform staff of prospective residents levels of capacity to make decisions in their lives. Residents are aged in their twenties and are assessed as having a high level of need, and who have behaviour which is described as complex and challenging. One resident has resided at the home for several months and one resident for a month prior to the inspection. Through observation, discussion and examination of the homes documents the home is able to clearly evidence that it is meeting the needs of these residents. Although residents would not directly engage the inspector, residents showed many signs of positive body language and behaviour in their interactions with staff. Without exception all those consulted about the home spoke positively about their experiences. A sample of relatives comments included ---- is very settled and comfortable. It is an amazing home. Absolutely overwhelming, outstanding the care they lavish upon--- and the home provides one to one support day and night which suites --- we are delighted with the services to date. At night --- now gets the support as there is someone specifically assigned to assist, should --- wake at night. Health and social care professional fedback positive client care. They have very good practises. Could not do anything better the service has managed to provide a very person centred service to someone with complex needs and So far I can not fault them they have been proactive activation their specialist skills and knowledge as is evident in the way they manage complex behaviour. The area manager confirmed that each resident was provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit depended on the individuals needs and preferences. This included day and overnight stays, meals and meeting the staff. The first six weeks of residency is looked upon as a trial occupancy. Permanent residency is usually subject to a review of care needs with the residents their representatives and any care manager. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Copies of the homes terms and conditions are provided in each residents individual service users guide. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a care planning process, that provides clear, up to date and accurate information about their individual needs and the support needed to achieve them. The home balances well the rights to residents to take reasonable risks as part of an enabling lifestyle. Residents are actively involved in the running and in daily life at the home. Evidence: Each resident has a comprehensive support and risk assessment plan in place which is designed to enable personal, health, communication, social, behavioural, cultural and religious needs of to be addressed. Residents are involved in the development and review of their plans in accordance with their preferences, skills and strengths. Any changes in residents needs and preferences are identified promptly as the plans are constantly being updated as more information about each resident is realised. Staff Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: consulted with demonstrated a good understanding of the assessed needs of each residents and how they supported them to ensure they received continuity in their support. The area manager spoke of the plan to develop a more person centred care planning documentation in the near future, which will be designed to actively engage residents in identifying their own plan of support. Various communication systems and methods were observed to engage residents in discussions and decision making which helps them have control and make choices in their lives. In order to help underpin the good practises observed further consideration should be given in residents plans to include capacity assessments, in accordance with new legislation (Mental Capacity Act). This affects residents rights to make decisions in their lives and for staff to undergo training in this area. The home has a good system in place for enabling residents to take responsible risks as part of an enabling lifestyle. For example the risks faced and posed by residents are assessed and any measures to reduce or manage the risk are recorded for staff to follow. A range of ways was seen of how well residents are being actively involved in the day to day running of the home, this included deciding what activities, meals, shopping and participating in light domestic duties. Staff demonstrated an awareness of good practises about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Staff are also aware that residents have the right to ask that some information not be shared with family or others. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lives are enriched by good practises in the promotion of independence, meaningful occupation, leisure pursuits, choice and being enabled to live chosen lifestyles. Residents benefit by being actively supported to maintain relationships with their families and friends. Mealtimes and arrangements for eating are determined by residents and provide choice and variety. Evidence: Central to the ethos of the home is the promotion of residents personal development, by creating opportunities to develop social independence, communication and living skills. Examples were noted by relatives of the positive behavioural changes in the Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: short space of time since moving to the home of their relative. Relatives also commented they promote independence yet they support in an appropriate way eg in the kitchen but they are not on top of -- but support to do things by themselves and --- has real potential and they really bringing it out. The home has its own transport which is used to access a variety of social and leisure resources in the community such as local shops, clubs, leisure centres and restaurants. Each resident has a pictorial weekly plan which they have been involved in developing and includes a range of in house and external opportunities, including bowling, trampoline, picnics and meals out. A relative commented there is a timetable of things to do they give a choice of three activities and --- choices which one. Their timetable is geared towards the individual. Staff commented on how flexible each plan is depending upon the needs and preferences of the individual at the time and how there was opportunities to be spontaneous ie to go for a walk or to the local shop. Staff also spoke about how each plan has developed as they have got to know the residents preferences better and have introduced new opportunities for them to try different things. A relative commented when we go always a member of staff with --watching and engaging in a DVD not just sitting there reading a magazine but interacting. Relatives commented upon how welcomed they are made to feel when they visit, this included being offered beverages and staff being friendly and approachable. A relative also commented on the excellent levels of communication and of their involvement in developing support strategies for their relative. A resident has a mobile phone and IT equipment in order to keep in contact with family and friends. On the day of the inspection, it was observed that the routines of the home were reflective of residents individual needs and their lifestyle, for example what residents wanted to do, eat or if they wanted time by themselves. Staff spoke of the flexibility with regard to meal times, going to bed, rising and bathing. Residents are involved in menu planning, shopping for food and in some cases help prepare meals and snacks. Menus showed that a flexible and varied diet is offered. A resident has compiled a list of staff drink preferences so they are able to make drinks for staff. Meals are prepared in a well presented spacious kitchen. The kitchen currently remains locked when not in use. This decision has been based on the risks assessed based on a residents behaviour. The area manager confirmed that this decision will be regularly reviewed as their behaviour becomes more stable. The area Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: manager confirmed that recommendations made at the last environmental health visit have been actioned. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from personal and health care support that is individual, respects their privacy and dignity and promotes choice. The medication systems are well managed promoting good health Evidence: Staff said that none of the residents currently require much physical support instead they provide intensive one to one support in prompting and motivating residents to maintain their own personal appearance and change behavioural patterns. The organisation uses positive behaviour management strategies to support residents whose behaviour is described as challenging. This provides clear proactive strategies for staff to ensure that support is consistent. A chart shows residents who will be supporting them over the next week. Staff consulted with showed an understanding of good practises in preserving residents rights to privacy and dignity when providing support. Staff were able to give many examples of how they promote these rights in their every day care practises. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Where residents have expressed a gender preference of the staff to support them, then this is recorded and respected. Relatives commented the softly softly approach the home is adopting with --- is working as they are putting in the time and effort and it is having results, much calmer and they will do anything to support the clients, they bought a behavioural specialist in from their Devon homes when --- first moved to the home, to help guide staff. A social care professional fedback specialist skills and knowledge are evident in the way they manage complex behaviour. I have found them open and communicate we have a good working relationship and they have a very good relationship with the family. Residents are supported to access a range of health care services, to meet their individual needs. There was evidence of current involvement from General Practitioners, specialist nurses, opticians, chiropodists and dentists. Staff spoke of the innovative support being provided to a resident to help them become familiar with their a new health care provider. Another resident has been actively involved in deciding which Dr surgery they wish to become registered at. A relative commented on the thorough medical assessment and intervention that has occurred since their relative moved to the home. It was reported that none of the residents accommodated are assessed to administer their own medication. The medicine administration practises observed was seen to be safe and the records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Good practises were noted in the management of As prescribed medication which provided staff with guidance on when they should be administered. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure for residents, their representative and staff to follow should they be unhappy with any aspect of the home. Relatives consulted with said that they were aware of how to raise any concerns and felt comfortable to do so and that where they have raised minor issues these have been addressed promptly. There has been one formal complaint made by a neighbour since the home opened, this was managed effectively within the homes complaints procedure. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with confirmed that they have received formal training in safeguarding adults and prevention of abuse and showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual preferences and lifestyles. Evidence: The home is located approx 15 minute walk from local amenities, such as a bakery, bank, pub, restaurants and convenience store.. Prior to the home being registered the home underwent a refurbishment which has created a bright, modern and homely environment, decorated to a good standard. Work is ongoing to create a home reflective of the individuals residents needs living there, with plans to create a quiet/ sensory room on the first floor and hang more art work created by residents. A relative commented nice residential feel, home is a home, kept clean and tidy which is not too overwhelming. Communal space consists of an art room, dining area, kitchen and lounge. There is a secure rear garden which currently has a large trampoline in it, which a resident clearly enjoyed using. Although the garden is sparse at the moment there are plans in the spring to create a more vibrant inviting space. Residents have been actively involved in choosing their bedrooms and its decor. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Bedrooms were reflective of residents preferences and lifestyles. Residents are provided with keys for their bedrooms if they request, with one resident choosing to lock their bedroom when it is not in use. A relative commented room is absolutely marvellous this did help in deciding to move to the home as it has an en suite. Very nice room standard of furniture of perfect. There are sufficient number of toilets and bathrooms located around the home including all bedrooms providing bathing en suite facilities. All parts of the home visited were observed to be cleaned to a high standard. A relative fedback the home always looks clean. Systems are in place for the control of infection with some staff having undertaking hygiene and cross infection training. Staff confirmed that they have access to appropriate protective clothing to minimise the risk of cross infection. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff make a positive contribution in residents lives as residents benefit from a well supervised, enthusiastic staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Generally staff have the training to be able to work safely and effectively with residents and any training gaps, plans are in place to address. Evidence: It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. The tasks of the day appeared well organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who was available for support. Staff consulted with had a clear understanding of the aims of the home and how their individual role contributed towards achieving this. Staff and relatives felt that there was always sufficient staff on duty for residents to get the support they needed when they wanted it. A resident displayed many signs of positive relaxed body language in their interactions with staff. This included touching, smiling and laughing. Humour was observed to be used successfully in communicating with a resident, which promoted relaxed friendly interactions with staff. Staff Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: confirmed that there is some flexibility in the staffing hours should they need additional cover. There is a small stable staff team which includes a range of ages and experiences. All staff consulted with showed a good knowledge of residents individual needs. A relative commented about staff they are really positive and they are about the same age so -----feels they are more like friends, which -- can relate to. Staff communicate with --- really well. A social care professional fedback the staff team appear confident and skillful with very good management support. The personal files of two staff were inspected and these showed that a recruitment process is followed. This includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. This helps to ensure that only staff who are suitable to work with vulnerable people are employed. The area manager agreed to have evidence available within the home of all the necessary recruitment checks having been undertaken for bank staff who occasionally work at the home, as this is currently stored at the organisations other home. The organisation has its own training department. Not all staff have currently undertaken all of the mandatory areas of training recommended in order to work safely with residents. This had been identified by the home and a training matrix developed to highlight what training was outstanding and when it was to undertaken. The area manager agreed that all outstanding areas of training would be completed by the end of April 2010 and therefore no requirement is made. Staff spoke of the many areas of specialist training they have undertaken, this included positive behavioural management, autism and epilepsy. The area manager agreed that training in mental health awareness and mental capacity would be beneficial. A new staff member said that they had completed a local induction into the home including the industry recommended minimum induction standards. This helps to ensure that all new staff entering into the care industry have a minimum level of initial training. In information submitted to the Commission as part of the inspection process, stated that currently one staff member has completed National Vocational Qualifications to at least NVQ Level 2, with plans to increase this in the coming year. Staff confirmed that there is a formal programme of regular supervision being established and direct supervision with the person appointed to manage and area manager working along side support staff. All staff consulted with felt well supported by the management team to undertake their roles. A staff member commented can Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: ask anytime for guidance. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well motivated and knowledgeably interim management team who promote good practises, clear leadership and who run the home in the best interest of residents. The home regularly reviews aspects of its performance through an excellent program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The registered manager was involved in setting up the service prior to them going on leave in October 2009. Until their return the person appointed to manage and area manager are providing day to day managerial cover. They demonstrated much commitment and understanding of good practises in the care of people who have a learning disability and in the daily running of a care home. They provide a clear sense Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: of leadership and good practises which enables staff to then provide good individual support. A sample of comments about the management team included casual but efficient very supportive always work in the best interest of service users easily accessible extremely helpful approachable and can raise whatever issues without fuss and very engaging, communication is so open. Despite only recent opening there are already several mechanisms in place for the home to obtain feedback on the quality of the services and whether it is achieving its aims and objectives. These include, residents and staff meetings, informal discussions with residents and relatives and the required monthly audit of the homes services and facilities by a representative of the organisation and a written report provided. As a result of feedback changes to the environment and menus have been undertaken. Once the home becomes more established there are plans to develop feedback surveys. Staff spoke of the openness of the organisation and manager to new ideas and ways of working. Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. There are regular health and safety checks around the building. Information supplied by the home prior to inspection confirmed that thermostatic mixer values are fitted to hot water outlets, in order to regulate hot water within the recommended temperature range. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been undertaken. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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