Care Home: Saxby

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What the care home does well There is a good range of information available to help people make a decision about moving to Saxby. Procedures are in place to ensure that anyone being considered for a placement is thoroughly assessed and has opportunity to visit and meet people beforehand to see if it is the right place for them. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared to make sure that nutritional needs are met. The health and personal care needs of people living at the service are well met, promoting health and well-being. Procedures are in place to ensure that people receive their medicines in a safe and consistent manner. Procedures are in place to ensure that complaints and safeguarding issues are effectively managed, to listen to views of people who live at the service and reducing the risk of harm to them. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? A requirement to audit care plans periodically to make sure all documents are signed and to demonstrate that service users have involvement with their care plans, had been addressed. Medication administration records had been completed appropriately to show when medicines had been given or the reasons why not. What the care home could do better: The provider should make sure that monitoring visits take place at least once a month to assess the quality of care at Saxby. The appearance of the bathroom and shower room floors is poor due to staining and the marks should be removed or the floors replaced. Key inspection report Care homes for adults (18-65 years) Name: Address: Saxby Upton Road Upton Aylesbury Buckinghamshire HP17 8UA     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: Chris Schwarz     Date: 2 4 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 30 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 30 Information about the care home Name of care home: Address: Saxby Upton Road Upton Aylesbury Buckinghamshire HP17 8UA 01296749969 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: christine.barrett@radian.co.uk Turnstone Support Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home Saxby is registered to provide care to four people with learning and physical disabilities. The service is managed by Turnstone Support Limited. Saxby is situated in the village of Upton, which is a small village on the outskirts of Stone, near Aylesbury. There is access to amenities in nearby towns via the services own transport and a bus route operates to local villages and towns. Saxby is a single storey building which has been refurbished and adapted to meet the needs of the service user group. All of the bedrooms are single. There is a car park at the front of the property and an enclosed Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 4 4 Brief description of the care home rear garden. There is comprehensive information about the service in a service users guide and statement of purpose. Fees at the time of this visit were £1647.45 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day from 8.30 am until 3.15 pm and covered all of the key National Minimum Standards for younger adults. The last key inspection of the service took place on 22 August 2007. An Annual Service Review took place in August 2008 and concluded that good standards of care were continuing to be provided at the service. Prior to this inspection, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment (AQAA), was sent to the manager for completion. It provided a good standard of information about the service and statistical information needed to plan the visit and assess standards of care being provided. Surveys were sent out to the service but did not appear to have been received. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, Care Homes for Adults (18-65 years) Page 6 of 30 observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The provider should make sure that monitoring visits take place at least once a month to assess the quality of care at Saxby. The appearance of the bathroom and shower room floors is poor due to staining and Care Homes for Adults (18-65 years) Page 8 of 30 the marks should be removed or the floors replaced. 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 30 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 30 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. There is a good range of information available to help people make a decision about moving to Saxby. Procedures are in place to ensure that anyone being considered for a placement is thoroughly assessed and has opportunity to visit and meet people beforehand to see if it is the right place for them. Evidence: The AQAA described thorough processes for the admission of new service users. We were advised that only trained staff would undertake assessment of a prospective user. The views of the prospective user and their family would be taken into account and the service would liaise with their care manager from the local authority and doctor. The manager advised in the pre-inspection information that a transition plan would be set up where someone was being considered for a vacancy and this would involve overnight and weekend stays at the service. The views of the current service user group would be taken into account, we were told. From statistical information that was supplied we could see that there had not been any new admissions in the past year at Saxby. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The service had a statement of purpose in place which outlined the scope of the service and what it aims to provide to people. An easy read version was also available which people using the service may find more accessible in helping them understand this information. Service users had copies of the current service users guide in their rooms covering areas such as things you need to know about Saxby, the licence agreement, a copy of the complaints procedure and the last inspection report. A newer service user guide was also looked at, which had been produced using easy read text and colour symbols to explain information to current and prospective users. From the documentation that was available at the time of the inspection, there was enough information available to people to help people make a decision about moving in and to provide existing service users with a useful resource to refer to. No new admissions had taken place since the last inspection of Saxby. At that time the procedures used to admit existing users were found to be satisfactory. The procedures manual in the office contained a detailed admissions policy for the manager and other staff to refer to should they be asked to consider taking any new referrals. The needs of current service users were being met and no one had been admitted outside of the remit of the certificate of registration or the services statement of purpose. Care Homes for Adults (18-65 years) Page 12 of 30 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. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Evidence: Information supplied in the AQAA told us that care plans are in place for each person, which are reviewed when needed by the persons key worker, the manager and the service user. We were told that care plans have been improved since the last inspection to include more details about how people communicate and communication dictionaries were said to be in place. Yearly reviews were described involving outside agencies involved in peoples care. We were advised that people using the service have input with their care plans. Service users meetings were said to take place each month and an advocate has attended these in the past. It was possible to see that each person had a care plan in place, kept in their room. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Two care plan files were looked at. Each contained a photograph of the person and essential information such as religion, next of kin details, where they were born, doctor, care manager and physical characteristics. There were sections on supporting peoples privacy, opening their post, making choices, management of medication, what to wear, assistance with eating and drinking, dressing and undressing, using the toilet, bathing, night time needs, as examples. In both files there was evidence of information being reviewed on a regular basis and of service user involvement. One person who was able to had signed his care plan, the other file showed that staff had asked the user if the information was correct and noted the sign used to communicate agreement. Where one of the users required support in managing behaviour, there was a care plan to address this. Information on the signs that one of the users makes to indicate his needs had been recorded, as had likes and dislikes. Documents were seen which also supported information in the AQAA that annual reviews take place involving outside agencies, family members and the service user themselves. Risk assessments were seen in both files, covering a range of situations such as financial abuse, fire, hot water, showering and bathing, moving and handling, crossing the road, using keys, going to external activities and maintaining privacy. All assessments had been reviewed on a regular basis and included input from service users. Staff were helping service users manage their finances. There were procedures for them to refer to in the procedural manual. Files contained detailed information about each persons needs and a budget plan was seen in place for one person who wishes to save. Lockable cash tins and the record sheets were kept in peoples rooms in a lockable drawer. Two service users who were asked permitted access to their tins and records to see what procedures were being used. Staff were maintaining transaction sheets to show expenditure and receipts were being kept to verify spending. Balances of both tins tallied with the record sheets. One person was observed being supported by staff to take enough cash with him to go shopping for some DVDs and have lunch out. A carer involved him in the process of updating the record sheets and calculating the new balance after they returned home. Service users meetings were taking place at Saxby. External changes to advocacy input have meant that an advocate had not been attending recent meetings. Minutes were produced using easy read text and symbols or photographs and showed that there had been a meeting each month this year with people given opportunity to discuss and contribute to issues affecting them. People were being involved in decision making at the service. One person was seen Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: choosing what to have for breakfast, one said he had chosen the colour of the paint in his room and activity records showed that service users had been involved in the second interview process for prospective staff members. Service users were seen holding keys to their rooms and choosing whether they were kept open or closed. Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared to make sure that nutritional needs are met. Evidence: We were advised in the AQAA that one person accesses college, works two days a week and goes to day services one day a week. People using the service were said to make use of local clubs and community facilities and are encouraged to invite their families and friends to visit. Each person was described as having a key to their room and the front door and are supported by staff to answer the door and ask people for identification. We were informed that staff support service users with their mail and that they are supported to make choices about meals. We were informed that each person has a regular day with their key worker and that they choose what to do on these days, such as going to the theatre and bowling. The manager told us in the Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: AQAA that activities had improved since the last inspection such as two people attending sports sessions, walks around the local area and more events which families are invited to. Records of activities were being maintained by carers and there were photographs of service users in the hallway showing them involved with various activities and information leaflets on attractions in the area. People using the service take part in activities within the service and in the local community such as going to Wendover Woods, going to the garden centre and having coffee and cake, shopping, listening to music, dominoes, making bread and cakes, using the local pub, walks and attending Gateway Club. One person had been going out on his own but had lost confidence to do this although mechanisms were still in place to support him if he wanted to restart. Records also showed contact with family and friends. People were being supported to grow a range of fruit of vegetables such as plums, courgettes, potatoes and leeks and to keep the garden looking nice. One person described his week which involves attending day services, taking part in a recycling project for which he gets paid and having a home day at the service. All of the service users were at home on the day of this inspection and all went out with staff during the morning and had lunch out whilst they were away from the premises. People had been on holiday this year in groups of twos, one group to Center Parcs in Nottingham, the other to Pontins in Wales. Routines within the service were flexible. Two of the service users were already up and about when the inspection started, the other person was still in his room and got up a little later. People were seen to choose whether to be in communal areas or their own room and were invited to open the door when visitors rang the doorbell. Two people were seen in possession of keys to their rooms and lockable drawers. One person was seen during the afternoon being supported to clean his room. Records were being kept of meals and showed that people are supported to eat a balanced diet with a good range of meals such as vegetable casserole, lasagne, roast dinners, quiche and jacket potatoes, sausage casserole and breaded chicken with vegetables. Takeaway menus were also available and staff said service users have a takeaway meal about once a fortnight. One service user makes bread a couple of times a week and the manager advised that some of the relatives make cakes for everyone to enjoy. There was a pleasant dining area for people to use. Care Homes for Adults (18-65 years) Page 17 of 30 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 health and personal care needs of people living at the service are well met, promoting health and well-being. Procedures are in place to ensure that people receive their medicines in a safe and consistent manner. Evidence: The AQAA showed that people are supported to access health care facilities and that permanent staff members who know peoples needs go with them. Records of appointments and health care interventions were said to be well maintained and food dairies and seizure charts are kept as necessary with service users permission. Peoples medication was being kept in lockable drawers in their rooms and we were advised that one person is being supported to move towards self medicating. Peoples care plans outlined the type of support they need with personal care and in keeping healthy. These reflected individual approaches to each person, in line with their unique care requirements, and were being reviewed and updated regularly, with service users involvement. Adaptations and disability equipment were in place to support people with their daily living tasks. All of the service users were male and the staff team comprised mostly male workers. Staff on duty had a good understanding of Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: peoples needs and were respectful towards them. They reported positive changes to service users behaviour and overall well being which was reflected in monthly summaries written for each person and kept up to date. There was a policy on managing medication in the procedural manual. Medicines were being administered using a monitored dose system and each persons current monthly supply was being stored in a lockable drawer in their room, alongside the record sheets. Record sheets had been maintained apart from on two recent occasions for one service user where the member of staff had forgotten to give morning medication. The manager advised that changes have now been made to how staff assist this service user to get up in the morning, to make sure that medication does not get missed. An incident form was completed at the time. Staff training records showed that they undertake at least three observed competency assessments before they are permitted to handle medicines. Care Homes for Adults (18-65 years) Page 19 of 30 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. Procedures are in place to ensure that complaints and safeguarding issues are effectively managed, to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: We were informed in the AQAA that concerns and complaints are recorded at the service and at its headquarters in Aylesbury. We were advised that there is a clear complaints procedure in place and that complaints are responded to within agreed timescales. The manager advised us in the pre-inspection information that the service has improved its recording and response times and keeping other relevant people informed. In the statistical information, the manager recorded that there had been one complaint about the service over the past year and no safeguarding incidents or referrals. A copy of the complaints procedure was contained in the procedural manual and easy read versions were in service users files in their rooms. A compliments and complaints log was being maintained, with more compliments noted. The one complaint mentioned in the AQAA referred to an issue with drains which was dealt with. There were procedures for responding to safeguarding concerns and a copy of the local authority inter agency guidance was available. In service users files there were Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: risk assessments to protect them from financial and other types of abuse and an easy read abuse policy was contained within the service users guide. Staff training records showed that carers receive training in this area of practice. Recruitment records also showed thoroughness in carrying out pre-employment checks. There was also guidance for staff on supporting people who challenge. Care Homes for Adults (18-65 years) Page 21 of 30 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 premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. Evidence: We were told in the AQAA that the service is clean, tidy and very homely. Redecoration was said to have taken place over the past year and new carpets fitted. A new maintenance contract had been put in place which was more effective at getting jobs done. We were advised that people using the service are involved in selecting colour schemes for their rooms and communal areas of the building. Information told us that the garden is well kept and that people enjoy using it. All parts of the service were described as being accessible to service users and people have the equipment they need for daily living tasks. We were told that equipment was being serviced and safety checks carried out. Saxby is a detached bungalow located just outside of the centre of Aylesbury in Upton. It blends in with other properties in the road and has a few parking spaces at the front of the building. Accommodation is well presented with four single bedrooms, two of which have ceiling tracking fitted to enable easy access into an adjoining bathroom. People have been supported to personalise their bedrooms and profiling beds have Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: been obtained where needed. The laundry and kitchen are of a good size and had all necessary equipment. Service users have a lounge/dining room overlooking the garden and open farmland. The garden was being well maintained and had a seating area on the patio for people to enjoy some fresh air. The bathroom and shower room, both with toilets, were stocked with necessary supplies including hand wash and alcohol gel. Locks were in place to safeguard privacy. Suitable arrangements were in place for the disposal of clinical waste, in bins which prevent service users gaining access to the contents. There were no unpleasant odours around the building and the standard of cleanliness was good. Discussion did, however, take place with the manager about staining on the bathroom and shower room floors which detracts from an overall well maintained home. The manager advised that these floors have been steam cleaned and scrubbed in the past although the staining remains. One floor had been replaced but the marks had returned. It would be advisable for the provider to look into this and consider replacing the current flooring if cleaning will not remove the stains. Floor levels are flat throughout the building to enable wheelchair access and doorways are wide enough to permit access. The bathroom and shower room have been fitted with equipment suitable for the disabilities that people have. Cleaning products were being stored safely out of peoples way. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. Evidence: We were informed in the AQAA that the staff team had 9 permanent care workers, 8 of whom have undertaken a Skills for Care level of induction. Five people were described as having obtained National Vocational Qualification at level 2 or above. One person had left the service in the past year. All staff were indicated as having undertaken training in food handling, none had received input on infection control. The manager told us in the AQAA that all staff access a good training programme. We were told that people using the service are involved in second interviews for prospective staff and are asked for their feedback with peoples probationary assessments. The manager told us in the pre-inspection information that use of agency and sessional staff had been needed to cover gaps on the rota. Since the AQAA was completed, another person has started working at the service. Rotas showed that there had been reliance on agency and sessional workers up until recently to help cover the rota. Individual proformas were in place to show that agency workers had been thoroughly recruited by the supplying agencies. Levels of Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: staffing were typically at least two carers on each shift during the waking day and at night a waking night carer plus another person sleeping in. This seemed sufficient for peoples current care needs and enabled people to go out to activities and maintain contact with the community. Interaction between carers and service users was respectful and supportive, with staff involving people in what was going on in the service. There were two staff working towards a National Vocational Qualification in addition to the five people who have already completed theirs. The team leader has achieved the Registered Managers Award. Training records of three new staff showed that they are promptly put onto mandatory training. Recruitment files for the same staff were also looked at and showed that thorough processes had been used before carers started working at the service, including uptake of written references and Criminal Records Bureau disclosures. Staff do not start working at Saxby until their full Criminal Records Bureau disclosure has been returned is satisfactory. There was evidence on service users activity records that they had participated in the second interviews of prospective staff members. Regular staff meetings were taking place at the service. Minutes showed that nine had taken place in the past year. An effective handover checklist had been produced at Saxby to make sure that information and tasks are handled well, including a check of each persons cash tin balance and the petty cash, completion of charts and daily records, passing on telephone messages and information about any visitors and checking medication administration records. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. Evidence: We were advised in the AQAA that there is a good manager induction and that managers attend training specific to their services. We were told that the provider has quality assurance systems in place such as service user and staff questionnaires and that monitoring visits are undertaken. Information from these tools was said to be fed into a continuous improvement plan for the service. We were told that health and safety was being monitored by the manager with records kept of when checks have been carried out. Statistical information showed us that hoists, electrical hardwiring, fire fighting equipment and gas appliances had been serviced appropriately. The manager is registered with the Commission and has achieved National Vocational Qualification level 4 in management. She is working towards level 4 in care. The registration certificate for the service was displayed by the front door and was Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: accurate. Monitoring visits have been taking place by the provider although reports showed that there had only been three so far this year instead of one per month. The provider is advised to improve this to make sure that there is proper oversight of the quality of care. Stakeholder questionnaires had been sent out recently, with two returned by care managers from the local authority. Both considered there were good outcomes for service users in relation to communication, meeting needs, approach by staff and support. One thought the communal space needed to be bigger. One commented a very friendly, homely atmosphere with very professional staff. A lovely home. The manager was maintaining a continuous improvement plan to address any areas that need attention. Health and safety was being well managed. There was a certificate on the office wall to show that the district council awarded the service a 5 star/excellent award for food hygiene in November 2008. The most recent visit by a fire safety officer took place in December 2008 when all safety matters were found to be satisfactory, with advice given to keep the fire risk assessment under review, which the manager was doing. There were certificates to show recent gas safety checks and servicing of the fire alarm system. Portable electrical appliances had been serviced towards the end of last year and hardwiring was found satisfactory when inspected in 2007. There were certificates to show that disability equipment such as hoists and profiling beds had been serviced in May this year. A generic risk assessment was in place, as well as individual ones on service users files. Six health and safety checks had taken place so far this year according to records, to identify any hazards around the premises. Call bells were being checked regularly to make sure they remain in good working order. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 29 of 30 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. 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