Care Home: Sambourne Road (58)

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What the care home does well People and their families have different opportunities to talk to someone from the organisation about the plans to change from a care home to supported living. Mencap is supporting people throughout the changes. People are encouraged to pursue an independent lifestyle with support from members of staff when they need it. People benefit from being able to contribute to how the home runs from day to day. Risk management assessment does not mean that people are restricted from doing things they like to do. People are used to going out and about in the locality and doing their own shopping for food. This is because people have been encouraged to do things for themselves over a number of years. People have all their care and support needs set out in individual support plans. People`s health is monitored in their health action plans. They are supported to manage their own healthcare needs with making their own appointments and administering their own medicines. Information and documents are being put in formats that are accessible to each person, for example, on audio tape or CDs. People are confident in raising concerns and complaints with members of staff, management or directly to Mencap. The home takes these issues seriously. Systems are in place to make sure that people are safeguarded from abuse. Members of staff know how to recognise and report any allegations or observation of abuse to the local safeguarding process. A robust recruitment process means that people are protected from anyone who is unsuitable to work with them. Members of staff are experienced and well trained. Mencap provides training that is relevant to the needs of people who use the service. Members of staff are well supervised. People have built up good relationships with members of staff. People benefit from a home that is warm, clean, comfortable and well maintained. People decide how they allocate household tasks and safety checks. People and their families contribute to the home`s quality audit. Findings of the audit contribute to the continuous improvement plan which is monitored every month. Systems are in place to ensure everyone`s health and safety. The home is run in people`s best interests. Mrs Toye is experienced and qualified to run the home. What has improved since the last inspection? When people are funded to have one to one support time with a member of staff, this is now indicated on the staffing rota. Risk management assessments only contain information that is current. A number of reported medicine errors have been fully investigated and action taken to make sure people are properly supported to manage their own medicines. What the care home could do better: The care assessment document should not need review as this information is already in people`s support plans. People`s files should be rationalised to avoid duplication of information and recording. Key inspection report Care homes for adults (18-65 years) Name: Address: Sambourne Road (58) Sambourne Road (58) Warminster Wiltshire BA12 8LE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Walker     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Sambourne Road (58) Sambourne Road (58) Warminster Wiltshire BA12 8LE 01985217147 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): H5044@mencap.org www.mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Mrs Suzanne Toye Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Not more than 1 male service user in the age range 18 - 64 years with a physical disability may be accommodated at any time Only the one, named, female service user with a learning disability referred to in the application dated 9 March 2004 may be aged 65 years and over The maximum number of service users who may be accommodated at any one time is 6 Date of last inspection Brief description of the care home 58 Sambourne Road provides care and accommodation for up to six adults with a learning disability. The home is also registered to care for one person with physical disability. The service is operated by Mencap, a national voluntary organisation in the learning disability field. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 6 0 0 6 Brief description of the care home The property is a detached house in a residential area, within walking distance of Warminsters amenities. There are also good public transport links. The building dates originally from Victorian times, and has been extended at one side. People have single bedrooms, one of which is downstairs. Each bedroom has a hand basin, but there are no other en-suite facilities. There is a shower on the ground floor, and a bathroom upstairs. There is also another separate toilet, off the half landing on the staircase. Fees charged for care and accommodation vary widely, reflecting that some people have lived in the home for several years, and that others have additional funding for extra care hours. People pay a weekly rent contribution from their benefit income. The service has a Statement of Purpose and Service User Guide, which are key documents setting out information about the home and its facilities and services. A version of the Guide has also been produced on DVD, with the participation of people who use the service. People who are considering moving in and their representatives are also made aware of CQC inspection reports. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 14th April 2010 between 9:25am and 5.00pm. Mrs Suzanne Toye, registered manager, was present during the inspection. The area service manager was present for part of the inspection. We met with five people who use the service and two members of staff. We looked at care plans, risk assessments, medicines, menus, staff recruitment and training files and staffing rotas. We made a tour of the communal areas and three people showed us their bedrooms. We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. Care Homes for Adults (18-65 years) Page 6 of 31 Mencap has plans in place to change the service to supported living. People and their families are being consulted about how this is going to be achieved in peoples best interests. As part of the inspection process we sent survey forms to the home for people who use the service, staff, relatives and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. The last Key inspection was on 27th June 2007. The Judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 31 When people are funded to have one to one support time with a member of staff, this is now indicated on the staffing rota. Risk management assessments only contain information that is current. A number of reported medicine errors have been fully investigated and action taken to make sure people are properly supported to manage their own medicines. 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. No one new has moved in recently as the service is in the process of moving to supported living. People are contributing to assessments of their future care and support needs. Evidence: No one had moved in since the last key inspection and at that time we judged this standard to be good because we were able to assess how a new person moved in. Mencap had recently introduced a very detailed pre-admission assessment document. This had been filled out individually with everyone living at the home. The document was also regularly reviewed with people. We thought that this was duplication as the information from this document had already been captured in peoples care plans. In the AQAA Mrs Toye told us During the assessment if it is recognised that specialist training is required, this would be arranged prior to any service delivery. People were due to have a community care assessment from their funding authority Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: so they could review their future care and support needs for supported living. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are very well supported to make decisions about how they live. People have a say in how their support plans are recorded. Information is captured in ways that are accessible to people who use the service. Risk management assessment does not stop people from doing things they like to do. Evidence: In the AQAA Mrs Toye told us each tenant has an individual plan meeting their needs in a format they can understand, this is kept at present, with their consent, in the office. They are encouraged to look at their own plan and supported to understand what is written about them at any time. Tenants and families are encouraged to have input in the development of the support plan. Support plans were available in audio tape and pictorial format. Mencap had introduced what matters to me best practice standards. This reflected all the things considered to be important to people who use the service. In the AQAA Mrs Toye told us that this meant doing things in a way that is respectful, consistent, innovative, creative and thoughtful, directed towards carefully tailored and attentive support. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: One person showed us the agenda they had typed out to take to their review that afternoon with their keyworker and care manager. Action had been taken to address the good practice recommendation we made that hours which are funded for one to one work with specific people, should be clearly identified on the rota. Action had been taken to address the good practice recommendation we made that all risk assessments should be updated, to make clear which is the most recent information. Risk management plans were in place for self medicating, going out alone, being at home alone, safety in the kitchen, smoking, relationships with other people and getting angry or upset. There was clear guidance on what to do if anyone who went out alone did not return at the agreed time. In the AQAA Mrs Toye told us individual risk assessments for tenants identify the hazards associated with independence and maintaining their home environment (this includes community activities). Tenants are actively encouraged to be included in the agreed risk reductions identified. One of the relatives, in answer to the question: what the home could do better, told us A reduction in paperwork would help utilise their time and direction better. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People follow their own routines and are involved in different things to do locally. Much effort has gone into finding work, which has not been easy recently. People have good contact with friends and family. People decide how household tasks and responsibilities are divided amongst them. Efforts are being made to reduce the impact of planned changes in service delivery on peoples lifestyle. People are encouraged to eat healthily. Evidence: People got up and went to bed when they wanted to, depending on what they were doing the next day. Two people showed us their weekly programme which included, work, household tasks and leisure time. Two people told us they went line dancing and to local country and western events. There was a Gateway Club which some people went to. People used the local pub. People showed us the training certificates they had gained from different local colleges. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: One person told us they mowed the grass. Another person showed us the daffodils they had planted in pots. They had also weeded the garden. Another person showed us the area of the garden they could access from their bedroom which had tubs of flowers they had planted. One person told us they were hoping to find work in horticulture or with animals. People could spend some time at the home without staff. There were risk assessments in place which identified whether people could spend that time with other people who used the service. The home made sure that people knew what to do if there was an emergency during their time alone. People were supported to find employment and voluntary work. One person told us they worked at a local day service for older people. Another person worked in a local charity shop. They also had a part time cleaning job. Mrs Toye told us about the difficulties experienced in finding work locally. A local charity was supporting people to find work. People told us about the different places they went to using local trains and buses. People had started to look at where they were going on holiday later in the year. Two people were going to Weymouth to stay in a hotel for a week. Another person was going to Torquay. Some people were saving up for their holidays. People paid for their holidays but the home paid for some of the activities and day trips whilst on holiday. Members of staff supported people on holiday. One person told us about the homes cat and that everyone looked after it. Another person introduced us to their own cat. People told us they met once a month to discuss different things about living at Sambourne Road. People also met with their keyworker to discuss and record their goals and aspirations. They met regularly to see how they were achieving those goals. In the AQAA Mrs Toye told us Diversity is one of Mencaps key strategic priorities. On our internet site we have a dedicated diversity section; this is accessible to all staff. Mencap has a dedicated diversity officer and there is a steering group of staff from across the organisation who meet to share good practice and oversee the implementation of our diversity policy. The area service manager told us about the plans to change the service from a care home to a supported living service. Mencap had produced a consultation pack and this Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: was to be discussed with members of staff, so that they could support people with decisions about their future lives. The pack gave information about some of the things that everyone may worry about. There were also planned meetings with peoples families and representatives, so that the issues could be discussed in more detail. The area service manager told us that people and their families would be given the opportunity to discuss the issues with families of people from other services who had been through a similar change. The deputy manager was in the process of putting information about the changes onto a CD, so that people had more time to digest the information. People also had the opportunity to move to their own flat or house. In a survey form one person told us I feel that my home is always clean and tidy and I get the right support for myself. [Do better] to be able to do more cooking. Another person told us always nice and clean, makes me feel happy. A third person told us Treats me well. Nice tenants. Do what I like to do. In a survey form one of the relatives told us It gives my X the help and support needed to have a reasonably independent and self sufficient life. Encouraging Xs hobbies and ensuring Xs physical and mental wellbeing. Each person decided what they were going to eat during the week and compiled their individual menus. People were supported to write a shopping list. One person told us they went to a local supermarket to buy their ingredients for meals. They said they each had a weekly allowance specifically for food. They also shopped for communal items such as toilet roll and cleaning materials. Another person showed us the separate areas in the fridge and freezer where people stored their food. People had a cupboard each in the kitchen for dry goods. One person told us they often had a snack lunch at a cafe in Warminster with their friends, or brought fish and chips to eat at home. Another person told us they preferred to have their main meal at lunch time; other people had their main meal in the evening. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and specialist care needs are well documented in individual health action plans. People have good access to healthcare professionals. People are encouraged to manage their healthcare needs and records are made easy to understand. People are independent in managing their own medicines. Evidence: Everyone had a health action plan some of which had photographs for better explanation. The plan set out how people were supported to manage their own healthcare, visits to dentists, GPs, the chiropodist and specialists or other healthcare professionals. The Specialist Behavioural Nurse and Psychologist had been consulted for expertise on managing aspects of peoples emotional wellbeing. If people could not always tell members of staff what was happening to them, the health plan gave guidance: if I am in pain I will...when I am happy I...when I am sad I will.... The care plans identified peoples communication needs and how people expressed themselves, verbally and physically. There was detailed information about the different medicines people were prescribed. The plans recorded support with healthy eating, exercise and support with personal cleanliness and looking nice. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: People were supported to administer their own medicines. Some people collected their monitored dosage pack from the pharmacy. Each person had a lockable medicine cabinet in their bedroom. One person showed us their medicine administration record. They signed the record when their medicines were taken. Staff supported people if needed with administering ear drops. One person told us they had reduced their medicines to the point where they didnt need them anymore and felt much better. If members of staff administered peoples medicines, the person signed a form giving their consent to this. If people were prescribed medicine to be taken only when needed, the details of why it was taken was in their care plan, health action plan and some people had pictorial guidance in their bedrooms. Peoples care plans had very good information about the different medicines that people were prescribed, the reasons they were taking it, any side effects and the time it was taken. Peoples GPs had been asked to agree a list of homely remedies, so that they were safe to take with prescribed medicines. All staff had received internal and external training in managing peoples medicines. We were recently notified of a number of medication errors. These had been investigated by Mrs Toye and those members of staff involved interviewed. Records were kept of the incidents and no one had any ill effects. The arrangements for people to be supported to have their medicines at the proper time had been looked at and changed to reduce further risk of errors. Action had been taken to address the good practice recommendation we made that care should be taken to ensure that an accurate audit trail was maintained in medicine records. There was a monthly audit of medicines. This meant that members of staff could monitor whether people needed more support with managing their own medicines. People told us they made their own appointments with their GPs. Some people told us they liked to have a member of staff with them if they went to their doctor so they could help them remember or understand what the doctor said. The area service manager told us that Mencap was developing health passports. People would take these to health appointments and show the GP what they wanted and ask the GP to write what they said in the passport. Members of staff had received training in end of life care from a local hospice. They had joined other local providers of services for people with learning disability to look, with the hospice, at discussing death and bereavement with people. Some people had already decided on what they wanted to happen at their funeral. Parents and families would also be involved in these discussions. One person told us about the benefits of Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: the regular bereavement counselling support they were receiving. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that the home or the organisation will listen and act on things that they are not happy with, or take action if they complain about the service. Systems are in place so that people are safeguarded from abuse. Staff are confident in recognising and reporting abuse to the local safeguarding process. Evidence: We asked people what they would do if there was anything that they didnt like or wanted to make a complaint. They all told us they would talk to Mrs Toye, the staff or the area service manager. They told us they had a pre-printed letter that they could send to Mencap. They all said they were confident that things would be sorted out if they did complain. The complaints procedure was recorded on a CD and in pictorial format. We looked at the complaints file. Records were kept of investigations, action plans if complaints were upheld, together with responses to complainants. Responses to people who used the service were in pictorial and large print format. People were supported to manage their own money. They had lockable storage in their rooms or could keep money, bank cards and savings books in the safe. One person showed us their pictorial reminder for allocating money for things such as bus fares, meals out or entrance fees. The deputy manager was compiling another pictorial format for an event later in the week where the person had to pay and get change. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Each person had a financial risk management assessment. The area service manager regularly reviewed peoples record of expenditures, transactions and money held in the safe. Advocates were available to people, particularly with supporting them with the changes to supported living. We asked members of staff about the local safeguarding process. They were quick to tell us how they would report any allegations or observations of abuse. Two staff told us that they had experience of adult protection investigations elsewhere. There was a pictorial abuse policy and procedure on one of the notice boards. The relief staff file had details of the safeguarding referral telephone numbers. All new members of staff were trained in adult protection and Mencaps whistle blowing policy during their induction. This training was updated yearly. Care Homes for Adults (18-65 years) Page 22 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. People benefit from living in a warm, clean, comfortable environment that is well maintained. Evidence: People had keys to the front door and to their bedrooms. Staff had to ring the bell to gain access. All the bedrooms were single accommodation. There was a large sitting and dining room downstairs. There was a small quiet room upstairs where private meetings were held. One person showed us the bathroom and shower facilities. They told us that everyone took baths and showers at different times and they fitted in with each other. Both the rooms were lockable for privacy. In the AQAA Mrs Toye told us that as a result of listening to people who used the service the sitting room, bathrooms and kitchen had been redecorated. There were plans to remove the tree from the front garden to give more light, provide a patio in the back garden and to provide raised beds to grow vegetables. People told us about how they had helped to choose the furniture in the dining room. They recalled overcoming the difficulties in assembling the solid wood dining table. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: People were involved with cleaning different areas of the home as part of their weekly programmes. People decided how cleaning tasks were shared when they met at the house meetings. We saw cleaning schedules for staff to complete each day for the other areas of the home. People also liked to make sure the garden looked nice; cutting the grass and planting flowers. There was a pictorial fire evacuation procedure at all of the exit doors. One person showed us the laundry room. They said everyone had a rota to do their washing. Members of staff had access to protective clothing and disposable vinyl gloves. The bathrooms and toilets had soap dispensers and single use disposable towels. Care Homes for Adults (18-65 years) Page 24 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. Staffing levels mean that people have staff available when they need them. Staff are experienced and have good access to training. A robust recruitment process means that people are protected from anyone who is unsuitable to work with people who may be vulnerable. Members of staff are well supervised. Evidence: The staffing rota showed that a minimum of two staff worked during the day throughout the week, depending on peoples needs. One member of staff slept on the premises at night. Relief staff were employed to cover for sickness and annual leave. There was a file containing brief descriptions of peoples care and support needs and routines at different times of the day. This was for agency staff to sign up to each time they worked. This file contained emergency contact numbers. There was a pictorial rota on the notice board, so that everyone could see who was on duty each day and night. Members of staff introduced themselves to each person as they came on duty and when their shift finished. They made a point of telling people that they were going home and when they would see them next. Members of staff also introduced us to everyone and said why we were in the home. There had been changes to the staff team with some new staff appointed. People were involved in part of the interview process. They spent time with applicants and asked Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: questions. All the information and documents required by regulation were on file. No one started work without a check on their suitability to work with people who may be vulnerable. New staff were given the opportunity to declare any convictions or cautions. Criminal Records Bureau certificates were obtained for each member of staff every three years. Members of staff were expected to declare any cautions or convictions as they occurred. Members of staff were provided with ID cards. Mencap had introduced a career development programme for each member of staff. Letters to new staff confirmed when they were booked to start the mandatory training. All new staff followed Mencaps induction programme. Mencap provided a learning programme for all members of staff. Training was planned for the year and included a monthly programme for each member of staff. Mrs Toye also monitored when training was completed and when updates were needed. Training included handling medicines, risk assessment, personalisation and person centred working, epilepsy, moving and handling, first aid, fire safety, personal safety, food hygiene, safeguarding vulnerable people, autism, working with families and death, dying and bereavement. Mencap also provided e-learning. Regular staff meetings were held and all staff had monthly supervision. In a survey form one person, in answer to the question, what the home does well, told us Staff listen. In a survey form one of the relatives told us I have always found the staff at Sambourne Road to be helpful, caring and understanding. In a survey form one of the staff told us Concentrate more on listening to individuals need, emotions and feeling. Getting the level of support right and not prioritise paper work to the extent where the above takes a poor 2nd place. Another member of staff wanted to be more informed about the changes and move to supported living. 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. Mrs Toye is experienced and competent in running the home. She keeps herself up to date with current good practice with regular training. The home is run in peoples best interests. People contribute to the homes continuous improvement plan which is regularly monitored. Systems are in place to ensure everyones health and safety are protected. Evidence: Mrs Toye took up the post of manager in January 2009 and was registered with us in July 2009. She had worked at different homes run by Mencap, including in supported living. Mrs Toye told us she had been inducted into the role of manager. During that time she had received training in employment, the disciplinary and grievance procedure, performance management, coaching, health and safety, mental health and financial management. Mrs Toye told us she was nearing completion of the Leadership in Management Award. She had completed NVQ Level 4 in care and management. Mrs Toye was supported by a full time deputy manager. Mencap had an on call system for members of staff to contact a manager outside office hours. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: The area service manager told us that Mrs Toye would be provided with a copy of our guidance about compliance with the essential standards of quality and safety and our judgement framework for registration under the Health and Social Care Act 2008. Mencap carried out the annual quality audit of the home, with surveys sent to people and their families. The results of the audit were fed into the continuous improvement plan. This plan was updated each month and considered other issues as they arose throughout the year. The action plan identified who was dealing with the issue, what they had done and when the matter had been resolved. The area service manager monitored the continuous improvement plan as part of the monthly unannounced visits required by regulation. People told us they could talk to the area service manager whenever she visited. People also discussed things with the manager when they needed to. In the AQAA Mrs Toye told us we held regular tenant forums and monthly quality reviews completed by the area service manager. People also met with their keyworker and had one to one days. Much of the paperwork had been made more accessible with the inclusion of pictures and information put on CD. People who used the service had some things that they checked, such as hot water temperature, some electrical equipment, fire alarms, filling the first aid box and emptying the rubbish bins. Members of staff carried out regular daily, weekly and monthly health and safety check of systems and equipment. The manager and the area service manager had meetings planned with people who use the service and their families to discuss the changes to provide supported living rather than continue to be registered as a care home. 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 1 2 2 7 The care assessment document should not need review as this information is already in people support plans. Consideration should be given to rationalising peoples files so that information is not duplicated. 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). 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