Care Home: Sarsen House

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What the care home does well The home consistently maintains high standards in the delivery of health care. Where residents have significant needs, steps are taken to get them the most appropriate treatment. When necessary, additional care and support have been put in place, working with all relevant health care professionals. People benefit from the focus on promoting and maintaining the best health possible, enhancing their quality of life. The organisation has good management systems. The owners have close daily involvement with all aspects of the service, applying their own expertise in relevant areas. The registered manager has a nursing background as well as a management qualification. A senior carer also helps by taking on some management responsibilities. Residents benefit from a well run home. Care plans and risk assessments were clear and concise. Risk assessments were linked to care plans, and were in place for a number of issues including behavioural matters and anxiety. In discussion with the staff, it was clear that they were aware of the ways in which residents could be at risk, and were taking measures to avoid these. Staff we spoke to knew residents individually and were committed to meeting their needs. There is a comprehensive training programme for staff and training programmes are designed with residents needs in mind. All new staff are fully supported in their roles. One resident we spoke to said he was very happy living in Sarsen House amongst his friends. When we asked one healthcare professional what the home did well, she said: "It`s well organised, and provides a comfortable home for individuals". One staff member said: "For the most part, the service keeps the residents as well as they can be, in a happy environment". One family member was extremely complimentary about the home, and said: "Another year of care. My relative is so happy with you and her friends. I hope she is always with you". What has improved since the last inspection? At the last inspection, there were no requirements made. The two good practice recommendations had both been addressed. The statement of purpose and service users guide have been up-dated, and contained pictures to help some of the residents understand the documents. Pre-admission assessments had been revised and were clear, detailing all of a prospective residents` needs. There is a regular programme of household improvements, including painting and decorating. The fire officer`s visit highlighted a couple of recommendations, and these have either been completed or about to be. What the care home could do better: We saw that a good deal of care is taken by staff when they record details of the care which residents have. However, we noted that one person had, for a time, had their food and fluid intake measured, because they were having trouble eating and drinking. A chart had been kept to keep track of what they had each day. However, there was one occasion where the total fluid intake for the day had not been recorded. This means that it was difficult to evidence if the person had been drinking enough or not. We have asked the manager to make sure that where it is necessary to keep records of residents` fluid intake, the records are fully completed. We have also suggested that where fluid charts are used for residents, there should be instructions for care staff about what the daily total should be, and what to do if the total is under that amount. Key inspection report Care homes for adults (18-65 years) Name: Address: Sarsen House Sarsen House West Overton Marlborough Witshire SN8 4ER     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: Alyson Fairweather     Date: 2 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 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 28 Information about the care home Name of care home: Address: Sarsen House Sarsen House West Overton Marlborough Witshire SN8 4ER 01672861139 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: care@tullyboy.co.uk Tullyboy Homes care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Sarsen House provides personal care and accommodation for six people with a learning disability. The service is owned by Tullyboy Homes, a private sector organisation. They run another similar home in Wiltshire, and Sarsen House is in the village of West Overton. This is approximately three miles from the town of Marlborough, which offers a range of amenities. The service first opened in 1995. Most of the service user group have lived at Sarsen House from that time, and knew each other for many years beforehand. The property is a two storey house. A ground floor extension has been added since it became a care home. All service users have single bedrooms. Two of these have ensuite facilities. Others have access to bathroom and toilet facilities nearby. There is a range of communal space. The home also has a large garden. Information about the service is available within the home at all times. All of the material produced by Tullyboy Homes itself can be provided in pictorial format, and copies of our inspection Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 Brief description of the care home reports are also available in the home. Fees at the time of the inspection ranged from £966 to £1,470 per week. Care Homes for Adults (18-65 years) Page 5 of 28 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: The service was last inspected in November 2006. This unannounced inspection took place over one full day. We spoke to residents, and all were present during at least part of the day. We met with various staff members, including care staff and senior carers, as well as the registered manager and her husband, who performs the quality audits for the home. We received an Annual Quality Assurance Assessment (known as the AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the AQAA and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during our visit. We looked at various files and documents, including care plans, risk assessments, healthcare and health and safety procedures, staff training files, and the staff recruitment procedures. Care Homes for Adults (18-65 years) Page 6 of 28 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 28 What the care home does well: What has improved since the last inspection? What they could do better: We saw that a good deal of care is taken by staff when they record details of the care which residents have. However, we noted that one person had, for a time, had their food and fluid intake measured, because they were having trouble eating and drinking. A chart had been kept to keep track of what they had each day. However, there was Care Homes for Adults (18-65 years) Page 8 of 28 one occasion where the total fluid intake for the day had not been recorded. This means that it was difficult to evidence if the person had been drinking enough or not. We have asked the manager to make sure that where it is necessary to keep records of residents fluid intake, the records are fully completed. We have also suggested that where fluid charts are used for residents, there should be instructions for care staff about what the daily total should be, and what to do if the total is under that amount. 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 28 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 28 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. Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. All residents have their individual needs assessed before they arrive, so that staff know how best to support them. Evidence: The home has a comprehensive Statement of Purpose and Service User Guide which give an overview of the service which will be provided. This is also available in pictorial format, and has recently been updated. It gives details of the organisations complaints procedure. Most residents have been at Sarsen House for some time, although there was one vacancy when we visited. A structured assessment form was in place, which looked at potential residents physical and mental health needs, their communication, their hearing, vision, social contacts and any pressure care needs. The home then decides if they can meet the persons needs, whilst taking into account the needs of the people who already live in the home. Care Homes for Adults (18-65 years) Page 11 of 28 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. Care plans are in place and reflect the assessed needs of the person using the service. Residents are encouraged to make decisions about their life as much as possible, and supported to take risks where appropriate. Evidence: We examined two care plans in detail. Evidence shows that care plans are kept under review and that the person using the service is involved in the care plan development, where possible. One member of staff told us: We discuss any changes to support plans at hand-overs and team meetings. Peoples care plans reflect their assessment. Where an activity or task indicates that there may be a potential risk, this is indexed and clearly linked to the accompanying risk assessment. Care plans also have pictures for residents. Two staff have been trained in Person Centre Planning, and the others are due to do so. Care plans are regularly reviewed with dates of the reviews recorded. However, some were not, although they had been signed. It is recommended that this is done as a matter of routine, in order to evidence when the review took place. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: All of the staff members we spoke to had a good understanding of peoples needs and how best to support them. One member of staff told us that it had been nice to see how one person they support had achieved so much while living at Sarsen House. People are able to go to bed when they choose and get up when they want, subject to attending plans for their day. One person told us they often stay up late watching DVDs. A Users Charter sets out their entitlements. People are encouraged by staff to take an exploratory approach, and to try things out to see if they want or like to do them. The input of the homes staff team, and other relevant parties, ensures that responsible decisions are reached by a process of assessment. Guidelines for the approach taken to particular needs are drawn up with help from other professionals. Risk assessments are kept on file where necessary. Some are lifestyle assessments, including riding in the vehicle; (eg behind the driver, left leg in first, etc) There are also risk assessments in place where it has been necessary for someone to use bed rails. There are generic risk assessments in place for general household tasks, including the use of chemicals and electricity. Care Homes for Adults (18-65 years) Page 13 of 28 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. Residents are encouraged and supported to participate in appropriate activities, within the local and wider community. If a person living at the home wishes to maintain links with family and friends, staff support and encourage them to so. Peoples rights are respected and responsibilities recognised in their daily lives. They have the opportunity to choose what they eat, and the menu is varied and healthy. Evidence: All residents have access to a wide range of activities both at home and outside. At home, people have entertainment equipment in their own rooms, as well as in communal areas. There is also a range of games, puzzles, and books available. People attend various educational and occupational activities during the week, and staff from the home may support some of these sessions. Some service users are not able to attend every time, depending upon how their health varies, but staff then spend time with them on a 1:1 basis. Some people also receive support on an outreach basis. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: This enables them to have opportunities at home, or in the community. Some of the activities which people said they enjoyed included going to the local sport centre to play football, skittles and cricket. One resident said he enjoyed the steam trains at Minehead and the local trains at Swanich. People go to the Gateway club as well as the local Mencap. Other visits have included the London Eye, and the pantomime. A local farm attracts others, with its pot bellied pigs, horses and chickens. Other regular outings include shopping and trips to the local pub, as well as swimming, cinema, music and movement and computer activities. All residents have the opportunity of an annual holiday, escorted by staff. These are done in small groups. Some people may only go for short breaks, if they find it difficult to cope with longer periods of absence from familiar surroundings. Holiday destinations have included Foxs hotel in Minehead (one resident told us that he had a lovely time, with great food. People have been to the Isle of Wight and Bournemouth, as well as Centre Parcs. There are no restrictions on visiting times. Residents can see visitors in their own room, the small sitting room, or in the garden. Some residents have friends visit them at the home if they want them to, and some go visiting in return. Sarsen House supports all its residents in maintaining contact with friends and family. As well as visits, this may be done by letters and phone calls. Relatives are seen as a valuable resource, as they can provide knowledge about the needs and life history of individuals. Interaction between residents and staff is positive and relaxed. People are able to choose how they spend their time when at home. Staff are knowledgeable about individuals, and sensitive in respecting their wishes. There is generally unrestricted freedom of movement for residents. They are expected to respect the privacy of each others bedrooms. Some areas are kept locked for particular health and safety reasons. External access is also made secure. One person told us how he liked to polish the furniture and help in the house. He helps to cook lunch, and goes to the market shop for fruit and vegetables, and likes to sweep the drive. All meals are prepared by staff of the home, who receive training in food safety, and the home has achieved a Five Star accreditation for Food Hygiene from the local Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Environmental Health officer. Menus are based on the known likes and dislikes of residents. Input and advice has also been obtained from a dietician regarding the particular needs of some individuals. Special dietary supplements are used if required. The home has had success both in encouraging weight gain for service users in poor health, and in promoting weight loss for people who could benefit from this. Some residents use adapted cutlery and crockery, and an occupational therapist has advised on the most suitable items for them. Most of the household usually dine together, with staff giving support as necessary. One persons preference to eat separately is respected. On the day we visited, he had a late lunch in the kitchen, and had soup and a sandwich, and was able to eat on his own as he wanted. The food is always cooked from scratch, and fresh fruit and vegetables are grown in the garden. Fresh meat is bought from the local butcher. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to address their personal and health care needs effectively. They are protected by the homes policies and procedures for dealing with medicines. Evidence: All the service users at Sarsen House have assistance with personal care. This is tailored individually, depending on their abilities, and any safety concerns. For instance, some may require observation when bathing, due to their health needs. Attention is given to ensuring that residents maintain a positive image at all times. Apart from Learning Disabilities, a number of residents have other mental and physical conditions which need monitoring. There were good records of communication with GPs, Occupational Therapists (OT), orthotics, psychiatrists and the local Community Team for People with Learning Disabilities (CTPLD). Appointments with health professionals were well documented, and gave details of any changes in peoples treatment. One person has a very unusual syndrome, and the manager has joined the society and has collected lots of information which might be helpful for the resident. The home had secured extra funding in order to have 1:1 support when they were ill. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: There was evidence of multidisciplinary meetings to support the decision to use bed rails for one resident. There were records of x-rays, well woman and man check ups, hearing and sight checks, foot care and medication. Continence advisors were contacted as required. People had health needs plans in place, and all epilepsy profiles were current. People also had mobility assessments done. When we visited, one person was quite ill and had some complex health needs. There was clear evidence of the wide range of input they have received. This has involved all relevant professionals in carrying out appropriate assessments, and the process is continuing in response to the ongoing changes in the residents needs. One person had a food and fluid chart in place, as they had not been eating or drinking very well. However, the fluid chart had not always been totalled up, making it difficult to see how much had been taken. We have advised the owners that these must be fully completed each day in order to establish how much fluid has been taken. It would be useful for care staff to have instructions about what the daily total should be and what they should do if it is not reached. None of the residents are self-medicating. Staff are involved in storage, administration and recording of any prescribed drugs. They receive training after they have been in post for six months. Training also includes instruction from a community nurse in the specific technique for administration of a drug to help manage epilepsy. We watched one staff member deal with peoples medication in a safe manner. Arrangements for the management of medication are appropriate, and there is secure storage. Administration is carried out in line with relevant guidance. Records relating to administration of medication were maintained appropriately. Care Homes for Adults (18-65 years) Page 18 of 28 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. Residents are safeguarded by the services policies and procedures for complaints and protection. Evidence: Sarsen House has a detailed complaints procedure in place, and there is a version with symbols and photographs, intended to be more comprehensible for residents. There have been no complaints made either to the home, or to us at CQC since the last inspection. One person was extremely complimentary about the home, and said: Another year of care. My relative is so happy with you and her friends. I hope she is always with you. The home operates in accordance with local multi-agency arrangements for adult protection, and a copy of the relevant procedure is kept in the home. A whistle blowing policy is in place, and the home has appropriate staff conduct and disciplinary procedures in place should they need to use them. All staff are aware of the No Secrets guidance and all have had safeguarding training. Care Homes for Adults (18-65 years) Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, comfortable and safe environment, which is appropriate to their needs. It is clean and hygienic. Evidence: Sarsen House is an attractive property, set in its own garden, in a pleasant village location. Accommodation for service users is provided on two floors. It is well decorated and maintained. Periodic audits of the building are carried out. These identify any tasks to be addressed. A few years ago the whole building was rewired, and new oil tanks were installed. There is also an ongoing programme of redecoration. Most major work is carried out when residents are away on holiday, to minimise disruption to them. Each service user has their own bedroom. Four of these are on the ground floor. All rooms are decorated and furnished to reflect the taste of their occupant. Two of the bedrooms have en-suite facilities, and the others have bathroom and toilet facilities nearby. Areas of communal space are all on the ground floor. There is a large lounge and a separate dining room. The kitchen also has a seating area, which is often used by one Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: of the homes residents. Externally there is an enclosed garden with a vegetable plot. Appropriate equipment has been obtained to help meet the needs of service users with impaired health and mobility, such as a specialist bed. This has been done with support and advice from the relevant professionals, who have also given instruction in appropriate usage. Records are kept of cleaning schedules, and audited as part of the overall quality assurance process. Care staff carry out all cleaning and household tasks. Many of these are carried out during the week, leaving weekends more free to undertake activities with service users. Laundry facilities are situated in the garage, away from those parts of the building regularly accessed by service users. These have good wall and floor coverings, which means that these areas can be kept hygienically clean, minimising any infection risks. Staff have also had infection control training. Care Homes for Adults (18-65 years) Page 21 of 28 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. Residents are supported by staff who have achieved at least NVQ Level 2, who have had appropriate training, and have regular supervision with their line manager. They are protected by the homes recruitment policy and practices. Evidence: A minimum of two staff per shift is maintained during daytime cover, and whenever possible this is increased to three. Additional staff are provided when this is required, to facilitate particular activities. Rotas mostly show that three staff have been on duty during the dayuntil 1pm. Once a fortnight three staff work until ten so that residents can attend the Gateway Club. Overnight cover consists of one person, on waking duty. They have access to senior staff, via an on-call rota. Extra funding has been made available for more staffing for one resident whose needs have escalated recently New staff are overseen by a senior carer during their initial induction and orientation. After a couple of months, once they have settled in, they begin working on a nationally recognised set of induction standards: the Learning Disability Qualification (LDQ). Several staff have achieved NVQ Level 2 and NVQ Level 3. One member of staff was working with her assessor during the time we were in the home, and had just completed her NVQ that day. Many staff have worked in the home for a number of years, and are very well known by residents. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Staff training has included intensive interaction, medication handling, food hygiene, health and safety, safeguarding, emergency rescue medication, epilepsy, fire training and infection control. The managerand a senior staff member have also had training in the mental Capacity Act and the Deprivation Of Liberty Safeguards. Planned training includes: Use of the Boots Monitored Dose System (MDS), Equality and Diversity, Care of the Dying, First Aid and Drug Awareness. The provider uses a training matrix to inform him of when peoples training is due. We discussed the frequency of training in manual handling with the providers, and they are going to seek advice from one of their training providers. There is a checklist for all stages of recruitment, selection, and joining the organisation. This is closely linked to the homes quality assurance system. Two sets of staff files were viewed. These showed that all required checks are carried out, at the appropriate times. New staff do not commence working until satisfactory references and CRB checks have been obtained. Residents have informal involvement in the recruitment and selection of staff, as candidates visit the home. All new staff are subject to an initial probationary period of six months. This may be extended, if it is felt that an employee has not yet demonstrated the necessary competence or conduct. Additional supervision arrangements are then put in place. Staff members spoken to confirmed that they receive regular one to one supervision, with their line manager. Records confirmed that this took place 6-8 weekly. The manager supervises the senior member of staff, who has had training in supervisory management, and who in turn supervises the others. The manager plans to have one more person trained to do this. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is suitably qualified, competent and experienced, so that residents benefit from a well run home. Quality assurance measures underpin service developments, and include actions based on knowledge of the residents, and the views of relatives and other professionals. Residents health and safety are protected by the systems in place. Evidence: Sarsen House is managed by Mrs Catherine Howie, who has a professional background in learning disability nursing. Although not practising in this setting, she has maintained her registration through regularly updating her knowledge. She attends a range of courses and conferences and is always looking for further learning opportunities to continue to extend her own professional development. Tullyboy Homes, the provider organisation, is also a member of social care organisations which include other care providers, bringing opportunities to share best practice ideas. An extensive quality assurance system has been devised and implemented. It is built around the homes statement of purpose and is tailored specifically to the service. The Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: system enables a comprehensive audit of all areas of performance. Frequencies of review are set at varying intervals. Staff are allocated different areas to check. Annual review is tied in with the services end of financial year. This enables findings to be incorporated into the next years business plan. Mrs Howie acknowledges the difficulty in getting feedback from the residents, but has made efforts to get their views via a pictorial questionnaire. They continually seek comments from families in order to get their views about how the home functions and what could be improved. There is evidence of regular checks and maintenance on key equipment and systems. electrical testing is done on each item and is due again in June 2010. Various health and safety checks are done daily, weekly, monthly quarterly or annually, and there is a risk assessment for each room, including electrical goods. The Fire Risk Assessment was done in June 09 and is currently being updated. The providers are working with the fire officer on an individual evacuation plan for each resident. At the recent fire inspection one or two items were suggested for improvement, and the provider has either completed or about to complete these. Staff receive training in a range of health and safety topics, including food safety and manual handling. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 17 Where it is necessary to keep records of residents fluid intake, these records must be fully completed. So that there is evidence of people getting enough fluids. 10/03/2010 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 6 19 All care plan reviews should be dated, in order to evidence when the review took place. Where fluid charts are used for residents, there should be instructions for care staff about what the daily total should be, and what to do if the total is under that amount. The providers should seek advice regarding the frequency of manual handling training. 3 35 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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