Care Home: Sandsground

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What the care home does well The home has a small and experienced staff team who have a good understanding of the individuals needs. They treat people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. People living in the home appear settled and confident in their surroundings and contribute fully to all aspects of daily life in the home. Interactions with staff on duty are friendly and relaxed. Care plans and associated documents are clear, informative and up to date. They describe the support to be given and explain the reasons for it. They show who has been involved in reaching these decisions. Where goals are set, there is evidence that these are met, making the process meaningful and beneficial for people. Effective systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. The manager, deputy and staff team are working hard to empower people and encouraging them to maintain independence, autonomy and choice. Health care is provided effectively, enabling people with some significant complex needs to receive the best possible advice and treatment for these. The home works diligently on behalf of the people living there to promote their rights to access appropriate support. Families and other relevant professionals are kept involved at all stages. Guidelines on key health issues are set out clearly to help ensure that the right support is given when necessary. The home promotes a good quality of life and focus` on maintaining and developing skills, enabling people to be as independent as possible. A range of experiences and opportunities are offered, including regular access to community activities, which is both enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. People receive a varied and wholesome diet that they are able to influence. There are policies and procedures in place to manage complaints and people should be confident that their concerns will be listened to and acted upon. The home promotes staffing levels and skill mix of staff in order to help ensure that people`s needs can be met. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The home encourages and supports staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people. In order to identify strengths and weaknesses the home has effective systems in place to audit the services they deliver. Any provisions required to improve the services are actioned immediately with clear audit trails of how these are met and constantly reviewed. People benefit from a well run home, under the leadership of an effective manager who has suitable knowledge, skills and competencies to ensure that the service continues to meet their changing needs. Staff commented positively on the atmosphere created in the home, and the direction in which it is being taken. The team demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people who use the service. What has improved since the last inspection? The home is well organised and managed by an effective, stable management team that promotes the views and interests of all people who use the service. The home has continued to improve following the last inspection and further examples are detailed throughout this report. What the care home could do better: All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection. We would like to thank everyone who took part in the inspection, their enthusiasm and support was greatly appreciated. Key inspection report Care homes for adults (18-65 years) Name: Address: Sandsground Swindon Road Highworth Swindon Wilts SN6 7SJ     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: Wendy Kirby     Date: 0 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Sandsground Swindon Road Highworth Swindon Wilts SN6 7SJ 01793764948 01793765181 barbara.pollard@choiceltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Choice Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users that can be accommodated is 3. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Sandsground is a large renovated three-bedroom bungalow on the edge of Highworth. The home is on one level allowing people access to all areas. Communal living space includes a large living room and separate dining room/conservatory. There is a small quiet room at the front of the property. To the rear of the property there is an enclosed garden and to the front a large stoned driveway and parking area sufficient for the needs of the home. The home provides care and accommodation for up to three adults. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 3 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 was an unannounced Key Inspection which included a visit to the home. The visit was completed by one inspector over one day and lasted approximately nine hours. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report in 2007 The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained information about what the home considers it does Care Homes for Adults (18-65 years) Page 5 of 32 well and what plans they have for further improvements in the coming year. During our visit we spoke with some of the people who live in the home, the area manager, the manager, deputy and other staff members who were on duty. Comments received will be referred to throughout this report. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at individual care files, which included pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and looked at the bedrooms. We finished the inspection with a feedback meeting to the manager and area manager. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: The home has a small and experienced staff team who have a good understanding of the individuals needs. They treat people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. People living in the home appear settled and confident in their surroundings and contribute fully to all aspects of daily life in the home. Interactions with staff on duty are friendly and relaxed. Care plans and associated documents are clear, informative and up to date. They describe the support to be given and explain the reasons for it. They show who has been involved in reaching these decisions. Where goals are set, there is evidence that these are met, making the process meaningful and beneficial for people. Effective systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. The manager, deputy and staff team are working hard to empower people and encouraging them to maintain independence, autonomy and choice. Health care is provided effectively, enabling people with some significant complex needs to receive the best possible advice and treatment for these. The home works diligently on behalf of the people living there to promote their rights to access appropriate support. Families and other relevant professionals are kept involved at all stages. Guidelines on key health issues are set out clearly to help ensure that the right support is given when necessary. The home promotes a good quality of life and focus on maintaining and developing skills, enabling people to be as independent as possible. A range of experiences and opportunities are offered, including regular access to community activities, which is both enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. People receive a varied and wholesome diet that they are able to influence. There are policies and procedures in place to manage complaints and people should be confident that their concerns will be listened to and acted upon. The home promotes staffing levels and skill mix of staff in order to help ensure that peoples needs can be met. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The home encourages and supports staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people. In order to identify strengths and weaknesses the home has effective systems in place to audit the services they deliver. Any provisions required to improve the services are actioned immediately with clear audit trails of how these are met and constantly reviewed. People benefit from a well run home, under the leadership of an effective manager who Care Homes for Adults (18-65 years) Page 7 of 32 has suitable knowledge, skills and competencies to ensure that the service continues to meet their changing needs. Staff commented positively on the atmosphere created in the home, and the direction in which it is being taken. The team demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people who use the service. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed to ensure the home is suitable to meet individual requirements. Evidence: Although the manager has not had first hand experience of the admissions process she was was able to describe the process that is undertaken to ensure that a full assessment and transition period is conducted for people wishing to live in the home. We looked at the pre admission assessments, which were comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre admission should provide a sound benchmark of each persons ability, state of health prior to admission and subsequent needs when they move into the home. We were told that people wishing to live in the home, family and carers are involved in the pre admission assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the home also obtains comprehensive assessments, care plans and support from other health and social care Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: professionals involved, for example, social workers and hospital staff. We were told that people who were considering moving into the home have an opportunity to meet with people already living in the home and staff. Visits, sleepovers and outings are tailored to the individual. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that the service provided to each individual takes into account their personal preferences, supported by both written information in care plans and risk assessments which are subject to ongoing review. Staff have a good awareness of individuals needs and treat people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. People living in the home are consulted on, and given opportunities to participate in, all aspects of life in the home. People are supported to take risks in their daily lives within their home and out in the community. Evidence: From the initial pre admission assessments staff had identified needs enabling them to Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: form written care plans. The plans that we looked at were very detailed and person centered, including personal preferences and likes and dislikes. Plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that people are involved in deciding how they wish to receive care. Each person has a portfolio with person centered assessments, which means that staff put the views, wishes, likes and dislikes of each person at the center of all care provided. The information was informative and useful enabling staff members to provide the appropriate care to support health and social needs. Our surveys ask health and social care professionals, Does the service support people to live the life they choose wherever possible?. Both surveys agreed and one person stated, The team have built excellent relationships with each of the people living in the home and they make every effort to help them communicate their wishes and choices in order for them to carry these out. The plans showed consistency in assessing, planning and evaluating care as required. Regular care reviews take place for people living in the home, which can include family members and Key Workers wherever possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. Both health and social care professionals stated in the surveys that social and health care needs are properly monitored, reviewed and met by the home. Staff also agreed in their surveys that they are given up to date information about the needs of the people they support and care for. Staff demonstrated a clear understanding of peoples individual needs. Through observation and discussions with the staff we saw skills of sensitivity and warmth when communicating and delivering care to people living in the home. The health and social care professional surveys also agreed that accurate information is gathered and that the right service is planned for each individual. Some people have complex needs with varying impairments and learning disabilities. We were told about individual communication requirements and through patience and time the staff had identified effective methods of communication with individuals. More staff have accessed Intensive Interaction Training in the last twelve months and continue to build on this communication method in order to support the people living in the home so that they can develop their communication skills. Risk assessments were examined and showed us that staff were mindful of keeping people safe within their home and out in the community. Individual risk assessments were detailed and well written for example, how much supervision was required when visiting the GP, what risks were involved with regards to road safety and preparing meals and drinks in the kitchen. The manager told us that the staff were vigilant in Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: empowering people to promote as much independence as possible but at the same time making sure that they do this as safely as possible. Each persons care records are stored appropriately and confidentiality is respected. At no time during our visit were any records left unattended by staff. Each time records were completed they were returned immediately to their normal place of storage. Staff members are also required to sign a Confidentiality Statement, which explains their responsibilities in relation to confidential information, when they start working in the home. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a range of activities and are supported to live a fulfilling life in and out of the home. People are supported and encouraged to maintain firm connections with families and friends. People take an active role in promoting and maintaining a healthy well balanced diet. Evidence: Care files and discussions with staff demonstrated that the home was providing people with opportunities to develop social, emotional, communication and independent living skills. There was information on levels of independence and the level of support that was required by staff to support the people both in and outside of the home. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Weekly activities and plans are reviewed with people, staff and families to ensure that they remain relevant to the individual. All individual tastes and preferences are taken into account. One family invited staff to their home to see where a prospective admission had lived and the assessment was completed with various family members including siblings. The information shared is produced in a Lifestyle Plan and provides staff with extremely useful information including, peoples personalities, essential things that are important to individuals, how people express emotions, things that people enjoy and how to support people successfully and keep them safe. Daily routines and activity plans were discussed which included attending various day centers and clubs in the local community. People regularly go out and enjoy the local community amenities by visiting pubs, clubs/discos, restaurants, swimming baths, shops, ice skating rink, trampolining and cinemas. The home has its own transport and also supports people to feel confident using public service transport. People often enjoy walking and one person has their own bike. People enjoy two holidays per year and are fully involved with choosing the type of break they would prefer. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms or they can use the communal areas and garden when weather permits. People living in the home often visit friends and family and communicate by writing letters, sending cards on special occasions and by using the telephone. Friends and families are invited to the home for coffee mornings, parties and other special events. People living in the home are supported to express their sexuality and develop relationships of their choice, one person said in their care file I just want to be trendy and smell nice. The size and layout of the dining room makes it possible for everyone. including staff to enjoy the social advantages of dining together, however people can choose to receive their meals in their rooms if they prefer. People make their own choices at mealtimes with the support from staff. The menus, which they have produced, offer a varied healthy diet plan. Alternatives were also made available and flexibility in meals was evident. People are encouraged to help prepare the meals. Staff in the home are mindful of educating and assisting people in maintaining a healthy balanced diet. We saw that staff monitor peoples weight closely and the care files give very specific information about maintaining adequate nutrition. This includes peoples likes, dislikes and how much support they require from staff. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The kitchen was clean, tidy and well equipped. The stores, fridge and freezer had a good supply of food. People living in the home are involved in the shopping and use local amenities for their food supplies. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service had good systems for meeting and monitoring individuals physical, emotional and health care needs, whilst maximising their choice, privacy, dignity and independence. There are safe systems of practice in receiving, storing, administering, and disposing of drugs. Evidence: There does not appear to be any unnecessary rules in the home and it was clear that the manager and staff are working towards empowering people and encouraging them to maintain independence, autonomy and choice. Daily routines are flexible within the home, people can get up and go to bed when they like, have their meals in their bedrooms, they can go out when they wish and participate in activities they have a particular interest in. This was confirmed through documentation in care files, in discussion with individuals and through observation during our visit. Staff support and encourage people to express their preferences when purchasing clothes, toiletries and having their hair done. Plans also tell staff whether people Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: prefer male or female carers when receiving personal care and what they like to be called. All personal care is provided in private and bedrooms and bathrooms can be locked from the inside. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred. The care plans we looked at gave clear information about individual needs both physically and emotionally. Health Care needs are detailed in the Care Files. Records of visits to the General Practitioner and the outcomes are recorded. Specialist referrals and visits to other health professionals including, Consultants, Chiropractors and Dentists were seen; to help ensure that peoples identified needs are being monitored and met. The manager explained that peoples health care needs are closely monitored in consultation with primary health care services and that access to health screening is undertaken. The home has various recording methods so that they have a quick reference guide and background history for individuals. Information can include a daily account, fluid and nutritional intake and a record of any illness. Short term care is also documented for example when a person is on antibiotics for a chest infection. All staff have had first aid training. Policies and procedures for receiving, storing, administering and disposing of medications are in place. There were photographs of each person on their medication charts to help ensure that medication was dispensed to the correct person. Medication fact sheets are available and tell staff how people like to take their medicine and why they need the medication. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Up to date records evidenced that medication received in the home and medication being returned to the local pharmacy was being followed correctly. Staff training records evidenced that staff had received in house competency training, which is updated six monthly, they also access external courses on medication awareness. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to manage complaints and people should be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: The complaints policy and procedure is detailed and contains all the relevant information, this can be found in the service user guide and welcome pack, which is given to people and families on admission. People living in the home told us in our surveys that they knew how to make a complaint and who to speak to if they were unhappy. All staff surveys told us that they know what to do if anyone using the service has a concern. Staff demonstrated an awareness of individuals and that they would be able to recognise if a person was sad or concerned about something, either through facial and vocal expression or changes in their behavior. We receive details from the home about any internal complaints investigations and safeguarding referrals, the outcomes have shown us that these have been dealt with openly and effectively. The manager told us that she is committed to encourage an open culture within the home so that people feel comfortable and able to make a Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: complaint or a suggestion without fear of reprisals. The manager makes every effort to see people living in the home Monday to Friday, her office is by the main reception area which means that visitors can see and talk to her on a regular basis. Being available has meant that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Holding meetings for people living in the home, relatives, and staff has meant that communication and sharing information has improved. People are also able to express any concerns they may have on a one to one basis during their monthly care plan reviews. This further promotes people becoming less frustrated thus relieving anxieties and any potential complaint referrals. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. Policies and procedures given to staff include, Whistlblowing, How to make a grievance and Harassment in the workplace. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. We spoke with staff who confirmed that they had received this training and they were able to demonstrate its effectiveness when discussing the content of the training. A number of staff have either completed or are enrolled on the National Vocational Qualification (NVQ) in care award and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable, it provides a safe, peaceful and well maintained environment for the people living there. The bedrooms, communal rooms and facilities are suitable for their purpose and meet the peoples needs. Evidence: The home provides accommodation for up to three people. We walked around the inside and outside of the home and viewed the bedrooms and the communal areas including the dining room/conservatory and lounge. Room sizes are fairly spacious for their stated purpose. All areas of the home were decorated to peoples taste, clean and well maintained. Some attention has been given to ensure that areas are homely, including photographs of the people living there. People had been supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. Rooms are lockable so that they can maintain their privacy and keep their personal possessions secure. The lounge area allows for people to be seated together enjoying the entertainment systems on offer. We were told that a new flat screen television had been recently ordered. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The laundry room and sluice is well equipped. Supplies of gloves and aprons were seen throughout the home. COSHH (Control of Substances Hazardous to Health) substances are kept in a locked cupboard and risk assessments and safe systems of work are in place to protect people living, working and visiting the home. All staff are aware of the infection control policies in the home. The outside provides a safe, private area for people to relax in, there is plenty of seating, a water feature and sensory area. At the front on the property there is a new grassed area following a request from the people living in the home that they would like a swing. This has been purchased and provided a lot of enjoyment. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The relationships between staff and people living in the home are good and create a warm positive environment to live in. People are supported and protected by the homes recruitment policy. The people are cared for by skilled staff that are trained, supported and supervised by management. Evidence: The manager ensures that staffing levels are indicative of the needs and levels of care required and confirmed that levels of staff rise should dependency levels increase. All staff surveys agreed that there are enough staff to meet peoples needs. Most of the team are experienced members of staff who have a good knowledge of the people living in the home. We spent time throughout the day observing staff carrying out their duties and assisting individuals. Staff were respectful, warm in manner, good humoured and sensitive towards the people within a relaxed homely environment. Morale in the home appeared good with the staff working well together. All three people living in the home told us in their surveys that the staff treat them well and listen and act on what they say. One health care professional told us, Sandsground Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: is a lovely home with a relaxed atmosphere and a very dedicated staff team. There are staff meetings held bi monthly. All meetings are recorded and appropriate subjects are discussed in order to guide and direct staff practice. Records of meetings show that attendance levels are generally high. Staff are required to sign to confirm they have read the minutes of each meeting. The home follows a good recruitment procedure. This will help ensure that the right people are employed to work at the home, and people living in the home will be further protected. People living in the home are encouraged and supported to be involved in the recruitment of new staff. Records contain completed application forms with a full employment history, at least two written references and Criminal Records Bureau (CRB) disclosures. Staff receive a job description, terms and conditions of employment, and GSCC code of conduct. There is an induction programme, which covers all mandatory training, including a Learning Disability Qualification, Fire, Manual Handling, Health and Safety, First Aid and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. All five staff surveys agreed that the induction covered everything they needed to know in order to fulfill their roles and responsibilities. The home provides the staff at the home with training and development opportunities tailored to individual needs. The manager and staff are conscientious in attending training relevant to the needs of the people they are caring for. Courses are relevant to the roles they perform in order to understand the needs of individuals and to keep them up to date with current practice. Training this year includes,Autism awareness, Managing Epilepsy, Crisis Intervention and Prevention and Person Centered planning. Staff have also received training on the Mental Capacity Act and the Deputy Manager is in the process of training staff in Deprivation of Liberty Safeguards. Health and social care professional surveys agreed that the manager and staff have the right skills and experience to support peoples social and health care needs. Staff surveys told us that all training provided was relevant to their role, helped them understand and meet the needs of individuals, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. We also spoke with staff about the training provided by Choice and they said, We are given lots of opportunities for training and development, Training is effective and always Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: on time, and The manager and senior team have supported us to professionally develop and six of us have nearly completed NVQ3. In addition to this staff have a minimum of eight one to one supervisions a year. The management have established a formal recorded supervision procedure for all staff. A plan is devised for discussion relating to the people that live there, work issues, staff issues, personal development and training. Senior staff have received training in how to give effective supervision to help ensure that the sessions are valued. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and best interests are central to the management approach in the home. The home continues to improve its quality assurance by introducing continuous monitoring of polices, procedures and practices in order to ensure that the home is run in the best interests of the people who use the service. People benefit from a well managed and safe environment. There are good systems in place to protect and safeguard the people living in the home Evidence: We spent all day in the company of the registered manager Mrs Pollard who consistently demonstrated effective leadership skills within her role. Her vast knowledge and enthusiasm of the home, the people living there and all staff who work at the home was second to none. We received very positive comments about the manager from staff including, The manager is so easy to communicate with and She is open, approachable and works hands on with us and the people living here. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Through observation and discussions it was evident that she is a team invigorator, engendering a productive positive atmosphere throughout the home. Throughout our visit the manager demonstrated good, effective leadership and management skills that relate to the aims and purposes of the home. It was evident the manager and staff are a stable team that supports a commitment to providing quality of care for the benefit of the people living in the home. The management team encourages innovation within the staff team and ideas that are generated are respected and actioned, which demonstrates an open and inclusive atmosphere. The staff were positive about Choice as a company and one person told us in their survey, I just want to say that Im really happy to get the chance from Choice to be part of their company. The home supports people with complex needs and the ethos is to encourage independent living within the scope and abilities of each person. Both the manager and staff spoken with remain clear on these points and it is evident that people living in the home, have made significant progress including improved mobility, social skills, confidence and self awareness and all staff should be commended for their continued efforts. The home continues to monitor and assess the quality of services provided, by giving people questionnaires to complete and holding meetings for people living in the home and their relatives, families and friends. Regular audits are also carried out in the home with regards to care documentation, environment, activities, medication, and other procedures in the home. As mentioned previously in the report the home also completes an AQAA for us which provides us with information about where the home feels it has improved and their plans to improve in the next twelve months. The AQAA we received was fairly detailed but did not include everything that the home has improved in over the last twelve months. The manager agreed that it was easy to forget what good practice had happened in the previous twelve months. It is recommended that it would be good practice to keep the AQAA as an ongoing working document so that important information is not missed. Another way of continuous self monitoring of the services and quality provided by the home are through Regulation 26 visits. A responsible individual appointed by the Registered Provider conducts monthly visits, which must be unannounced. They include looking at such things like care documentation, procedures and practices in Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: the home and talking to staff and people living in the home. By following this legal requirement the home have been be able to make judgements of the care and services provided and address any evident concerns and issues that may have been identified at this inspection. The organisation has comprehensive policies and procedures to support the home, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Details of the policies were provided by the acting manager as part of the AQAA. The policy and procedure for holding peoples personal money was looked at. We looked at the statements of individual accounts and saw that good accounting methods are maintained and receipts for sundries were available. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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