Care Home: Seymour House

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What the care home does well The service has an up to date Statement of Purpose and Service User Guide that includes information about the services provided by the care home. Prospective residents needs would be assessed before being offered a place at the home. Each resident has a care plan and risk assessment in place that ensures their needs are being met. Residents are encouraged to make decisions about their lives. Staff encourage residents to participate in a range of activities, and support residents to undertake their own activities. Staff promote contact with family, friends and the local community. A balanced diet is provided to residents. The health and personal care of people using the service is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Residents and their families have access to a satisfactory complaints system that enables them to raise concerns. Residents are protected from abuse through the home`s provision of staff training and policies and procedures in regard to Safeguarding Adults. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of the residents. People who use the service are protected by the organisation`s recruitment policy and procedures. The care home is owned by a family and two qualified managers ensure that home is run in the best interests of people who use the service. What has improved since the last inspection? The manager has consulted with the Fire Authority for advice with regard to the fire safety arrangements in the home. This was undertaken on the 26th February 2009 when the fire and rescue team visited the home and undertook an inspection of the premises. What the care home could do better: Whilst each house was very clean, tidy and free from malodours, the following identified issues must be addressed by the registered provider. In house number 23, the door of the bedroom on the ground floor did not close properly, and did not fit into the door frame, there was a gap between the top of the door and the frame. The shower room and hallway had exposed water pipes that must be boxed in to ensure residents are protected from harm of touching the hot water pipes. The shelf in the shower room was broken and must be removed or repaired. The bathroom had the overflow filled with a sealant, and the sink was stained and requires attention. Although there is a frosted window in the bathroom, there was not a curtain/blind that would ensure full privacy for residents when using this room in the winter nights. The plug for the electric toaster must be checked to ensure it is safe for purpose, as it was warm to touch. House number 25 requires attention to the electric wires outside the entrance porch of the front door as they could easily be pulled or damaged. The corner of the inside of the front door has plaster coming away, and the window by the telephone has putty missing. The radiator covers are loose and worn. The shower room has a bolt lock on the inside of the door, however, this room could not be accessed from the outside should an emergency happen to a resident whilst using the shower room. The laundry room has a damp stain on the ceiling above the window and a large crack in the wall. The flooring was cracked and rippled and not impermeable as required. The door handle was very loose. In the garden, the patio had an old washing machine that requires removing. There is a brick storage room in the garden, however, there was a whole window missing, and this could be easily accessed by climbing the groups of breeze blocks stored outside this window. A water cistern in the garden requires moving, and the old furniture and pipes outside the garage door require moving. Key inspection report Care homes for adults (18-65 years) Name: Address: Seymour House 21, 23, 25 Seymour Road Slough Berkshire SL1 2NS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joseph Croft     Date: 0 4 0 6 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: Seymour House 21, 23, 25 Seymour Road Slough Berkshire SL1 2NS 01753820731 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: seymourhouses@hotmail.com Committed Care Services Limited care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 9 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability (LD) Date of last inspection Brief description of the care home 21, 23 and 25 Seymour Road comprise three properties in Chalvey, Berkshire. Each property can accommodate up to three adults with learning disabilities in small groups. All bedrooms are single and have been personalised by the occupants. The houses are near to the centre of Chalvey and a short drive to Slough where there are good shopping, leisure and transport links. The responsible individual for the provider and the manager and several staff are part of the same family unit. Fees for the service range from #664.02 per week up to #1478.33. The home has a statement of purpose and service users guide to inform prospective service users about the provision and scope of the home. 9 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for the service is Two stars. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) (us, we) undertook an unannounced site visit to the service on the 4th June 2009 using the Inspecting for Better Lives (IBL) process. The site visit was undertaken by Regulation Inspector Mr Joe Croft and took over six hours, commencing at 10:45 and concluding at 17:10. The manager assisted throughout the site visit. The inspection process included a tour of the two houses currently being used. The following were sampled during the site visit. The Statement of Purpose, Service User Guide, menu, medication records, care plans, risk assessments, records of health care appointments, duty rota, staff recruitment and staff training files. Discussions took place with the manager, two members of staff, four residents and one relative who visited the home on the day of the site visit. Residents told us that they like living at the home, the activities they do and the food they eat. They always choose what they want to do during the day and evenings. They stated that they like the staff who are always at the home for them, Care Homes for Adults (18-65 years) Page 5 of 30 and they know how to make a complaint if they wish to. Staff were observed interacting with residents in an appropriate manner and calling them by their preferred names. Surveys were received from six residents, four members of staff and one health care professional. All surveys were complimentary about the care home and have been used as a source of evidence throughout this report. The manager returned the Annual Quality Assurance Assessment when we asked for it. This document contained the information we asked for and has also been used as a source of evidence in this report. The inspector would like to thank the manager, staff and residents for their cooperation during the site visit. Weekly fees charged range from 950 pounds to 1100 pounds. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Whilst each house was very clean, tidy and free from malodours, the following identified issues must be addressed by the registered provider. In house number 23, the door of the bedroom on the ground floor did not close properly, and did not fit into the door frame, there was a gap between the top of the door and the frame. The shower room and hallway had exposed water pipes that must be boxed in to ensure residents are protected from harm of touching the hot water pipes. The shelf in the shower room was broken and must be removed or repaired. The bathroom had the overflow filled with a sealant, and the sink was stained and requires attention. Although there is a frosted window in the bathroom, there was not a curtain/blind that would ensure full privacy for residents when using this room in the winter nights. The plug for the electric toaster must be checked to ensure it is safe for purpose, as it was warm to touch. House number 25 requires attention to the electric wires outside the entrance porch of the front door as they could easily be pulled or damaged. The corner of the inside of the front door has plaster coming away, and the window by the telephone has putty missing. The radiator covers are loose and worn. The shower room has a bolt lock on the inside of the door, however, this room could not be accessed from the outside should an emergency happen to a resident whilst using the shower room. The laundry room has a damp stain on the ceiling above the window and a large crack in the wall. The flooring was cracked and rippled and not impermeable as required. The door handle was very loose. Care Homes for Adults (18-65 years) Page 7 of 30 In the garden, the patio had an old washing machine that requires removing. There is a brick storage room in the garden, however, there was a whole window missing, and this could be easily accessed by climbing the groups of breeze blocks stored outside this window. A water cistern in the garden requires moving, and the old furniture and pipes outside the garage door require moving. 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 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 9 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. People who may use the service, and their representatives, are provided with the information needed to enable them to make a choice in regard to the ability of the home meeting their needs. Prospective residents needs would be assessed before being offered a place at the home. Evidence: The home has a Statement of Purpose that included information in regard to the aims of the home, principles of care, the service user group catered for, the manager and staff qualifications, the weekly fees, insurance, confidentiality and complaints. This document was last reviewed on the 1st September 2008. The Service User Guide includes a summary of the Statement of Purpose, and information in regard to activities, the sizes of the bedrooms and a copy of the complaints procedure. This document uses pictures to help the people using the service understand the text that has been written. The Service User Guide was last reviewed on the 23rd December 2008. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: The manager told us that the current six residents have been living at the home for many years. The last admission was in 2004. The manager told us that they had undertaken pre-admission assessments but had not retained this information. However, they would now save all assessments. The home has a simple admission procedure that was dated 23rd December 2008, however, this would benefit from the inclusion of specific information in regard to the whole pre-admission process. This was discussed with the manager who told that this would be done. The manager told us that when a referral is received they would obtain a copy of the care plan, health care needs and risk assessments from the placing care manager. The manager would visit the prospective resident at their current placement to undertake an assessment of their needs to ensure these could met at the home. Prospective residents would be invited to visit the home with their relatives, and offered overnight stays. The moving in process would be at a pace to suit the resident. The manager told us that they would not admit any resident whose assessed needs could not be met. Reviews of the placement would take place after six weeks, six months and annually. We had a discussion with one relative on the day of the site visit. They told us that they did receive a copy of the Statement of Purpose and their relative visited the home before deciding to accept a place. All the completed surveys returned by residents informed that they received enough information about the home, and they were asked if they wanted to move into the home. The Annual Quality Assurance Assessment (AQAA) informs that the home has a Statement of Purpose and Service User Guide, and that a care plan would be obtained from care managers, and a full needs assessment would be undertaken by the home. Regular reviews would be held after admitting a new resident. Evidence found during the site visit supported the information provided. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans and risk assessments in place that ensure their needs can be met. Residents are encouraged to make decisions about their lives. Evidence: Two care files were sampled during the site visit. Care plans included information in regard to personal hygiene, dressing, eating and drinking, social behaviour, medical needs, communication, socialisation, special relationships and hobbies and interests. Both care plans viewed had an annual review undertaken, and one had been reviewed in-House in March 2009. The other care plan was last reviewed in-house in July 2008. This was discussed with the manager who told us that their understanding was that care plans had to be reviewed on an annual basis. The National Minimum Standard in regard to the reviewing of care plans was shown to the manager, who then told us that she would ensure all care plans are reviewed on the minimum of a six month basis. Each care plan sampled included objectives and was signed by staff and residents who were able to. The manager told us that the reason why some residents who were not able to sign their care plan was recorded. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Daily notes were viewed for the two residents. These had two entries each day, and included records of night times. Each care file viewed had risk assessments that included risks in regard to use of the kitchen, bathing, community use, crossing roads, emotional state, using iron and falls. Evidence was viewed that these had been reviewed in March 2009. The care files also included a personal information sheet that included the residents next of kin, GP details and other personal information pertaining to the resident. During discussions, the manager and staff told us that staff support residents to make decisions for themselves such as the choice of menu, clothes they wish to wear and activities they want to partake in. This was evidenced during the site visit, in particular one resident conveyed they wanted to go for a walk. We had discussions with four residents who told us that they make decisions for themselves, they can choose what they want to do and where they want to go. Surveys received from residents all informed that they always make decisions about what they do each day. The AQAA informs that care plans and individual risk assessments are in place and are reviewed on a regular basis. Staff have received training in regard to risk assessments. Staff encourage residents to make choices and they are involved in the daily running of the home. Care Homes for Adults (18-65 years) Page 13 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. People who use the service are encouraged by staff to participate in a range of activities. Staff promote contact with family, friends and the local community. A balanced diet is provided to residents. Evidence: Residents living at the home are from a multi-cultural background, and they are supported by a multi - cultural staff team. The manager told us that one resident was undertaking paid employment, however, this had now ceased. Another source of employment is being sought for this resident who had also undertaken some voluntary work, and had a certificate on their bedroom wall celebrating their achievement with this work. Two residents attend day centres where they take part in a variety of activities. Each resident has a daily record of the activities they have undertaken in their care plans. During discussions the manager Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: and staff told us that most residents are able to go out of the home independently, and they take part in activities that include going for walks, shopping, cinema, restaurants and pubs. This was confirmed during discussions with four residents. All surveys received from residents informed that they can do what they want to during the day, evenings and weekends. On the day of the site visit one resident had decided to go for a walk on their own, and told the manager they were doing this. Another resident proudly told us that they had cleaned and tidied their bedroom. The manager told us that they are experiencing difficulty accessing local evening clubs for their residents, therefore they are looking to provide this for residents from all their care homes. During discussions one parent told us that their relative had attended a day centre, but decided not to continue with this as they did not like it. This was their relatives choice and that was respected by staff working at the home. Staff were observed to be friendly and interacted well with the residents who were at the home on the day of the site visit. Residents living at the home are supported by staff to attend places of worship as and when they wish to. During discussions staff told us that there are no restrictions on visitors to the home. This was confirmed during discussions with one relative who told us that they can visit the home and make telephone calls to their relative with no restrictions. The manager told us that all residents have visiting relatives, and therefore do not use advocates. The manager also told us that they do have the contact details of advocates should this be required. Residents have annual holidays that are provided by the home. Photographs were displayed in the homes of holidays undertaken during the last three years. Residents told us that they like going on holiday. Staff are currently planning to take the residents on a self catering holiday to Wales this year. The manager and staff told us that residents have the opportunity to meet other people at the day centres and when going out into the community. During discussions staff told us that residents are supported to undertake simple household chores such as laundry and cleaning their bedrooms Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Staff knock on bedroom doors and call residents by their preferred names. Evidence was seen that residents had keys to their bedrooms, and some had chosen to use these. Residents were observed to have access to all communal parts of the home. The menu was viewed during the site visit. Meals prepared include meat, fish, pasta, fresh vegetables and fruit. The manager told us that the weekly menu is planned every Sunday with the residents. Healthy eating is promoted at the home, and the manager is currently undertaking Food Management training. We were told that dietitians had offered advice on individual residents meals. The manager told us that all staff had attended training in regard to food hygiene and handling. The sampling of four staff training files provided evidence that staff had received this training in 2008 and 2009. Religious and special dietary needs are catered for at the home. The AQAA informs that residents have access to the local community that includes church and the town centre. Residents maintain regular contact with their family and friends, and are supported to go out in public places where they are able to meet other people who do not have a disability. Under Our plans for improvement in the next twelve months the manager has written that they are looking to introduce activities in the home for residents such as gardening, pottery, dancing and cooking. Care Homes for Adults (18-65 years) Page 16 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 good 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 of people using the service is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The two care plans viewed provided information in regard to the level of support each resident required with their personal care needs. During discussions the manager and staff told us that most of the residents are able to attend to their own personal care needs independently, some only requiring prompts from staff. On the occasions when staff do attend to the personal care needs, this is undertaken in the privacy of bedrooms and bathrooms. Residents spoken to told us that they choose what time they go to bed and get up in the mornings, one resident told us that they choose to get up early in the mornings. From discussions with the manager, staff, residents and the viewing of care plans for two residents, it was clear that residents have access to all health care professionals as required. Each of the two care plans viewed maintained information of all health care appointments that included the GP, Dentist, Psychiatrist, Opticians and other Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: specialist health care professionals. This information was clearly recorded and easy to access. Staff at the home follow the organisations Medication Policy and Procedure that was last reviewed in December 2008. The manager told us that no current resident is taking a controlled drug or are self medicating. The home obtains medication and printed Medication Administration Record sheets (MARS) from the local pharmacy. Medication was viewed in one of the houses, and the administration records for two residents. Medication was appropriately stored in a locked metal cabinet. The MARs sheets included the quantity of medication received, and were accurately maintained. No omissions were noted in the records viewed. The home has a book for recording medication that has been returned, and this had been signed by the pharmacist. The manager told us that they had not had a visit from the local pharmacist to check their records, as they had been told this only happens for larger care homes. The manager told us that they would contact the pharmacist to try and arrange a visit. Care plans included detailed information about the specific medication residents were prescribed, including known side effects to be aware of. The home also has guidelines for staff in regard to the administering of over the counter medication (PRN) for each resident as required. The manager and staff told us that the staff who administer medication had received the necessary training. The viewing of four staff training files provided evidence that they had received this training in June, October and December 2008. The AQAA informs that the personal and health care needs are attended to in a person centred way, all residents have check ups with health care professionals, accurate medication records are maintained and all staff receive training in regard to administering medication. Evidence found during the site visit supported the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 18 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. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are protected from abuse through the homes provision of staff training and policies and procedures in regard to Safeguarding Adults. Evidence: The Commission has not received any concerns, complaints or allegations in regard to the home since the last inspection. The home follows the organisations Policy and Procedure in regard to complaints, which was last reviewed in December 2008. This document informed that complainants would be provided with a timescale for responding to complainants and included the contact details of the Commission. The manager told us that they have not received a complaint since the last inspection. The home maintains a complaints and a compliments book. During discussions staff told us that they can tell by the body language, moods and behaviour if residents are unhappy. One relative told us that they were provided with a copy of the complaints procedure and know how to make a complaint. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Surveys returned from residents informed that they all know how to make a complaint. Residents told us during the site visit that they would talk to staff if they were unhappy. Staff surveys informed that they know what to do if if some-one has concerns about the care home. The home follows the organisations Safeguarding policy that was last reviewed in December 2008. This provides information in regard to the different types of abuse, who to report allegations of abuse to and the procedures to be followed by the manager that include making referrals to the local Safeguarding Team. The home has a copy of recent local Safeguarding procedures. Scenarios in regard to abusive situations were discussed with the manager and two members of staff. Each knew of the procedures to be followed, were knowledgeable of the different types of abuse, and aware that all allegations must be reported to the local Safeguarding Team. The manager told us that all staff had attended training in regard to Safeguarding Adults, and that she and the other manager had attended the Train the Trainer courses delivered by Slough Borough Council in regard to Safeguarding training. The sampling of four staff training files provided evidence that staff had received training in September 2008. The home has dealt with two Safeguarding issues during the last twelve months, both of which have been concluded. The AQAA informs that the complaints procedure is service user friendly, staff have received Safeguarding training from their internal trainer and they have an Adult Protection policy in place. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a comfortable, clean and fresh environment, however, the identified issues raised in this report must be addressed to ensure that residents live in a safe, well maintained environment. Evidence: The registered service consists of three house, numbers 21, 23 and 25 Seymour Road. Number 21 is currently not in use and therefore was not viewed during this site visit. A tour of the other two homes was undertaken. Each property can accommodate up to three adults with learning disabilities in small groups. All have single bedrooms that have been personalised by residents. During discussions one resident told us that they had chosen the colours for their bedroom. Each home had a kitchen/dining room, lounge, laundry room, shower room and a bathroom with a toilet. Whilst each house was very clean, tidy and free from malodours, the following identified issues must be addressed by the registered provider. In house number 23, the door of the bedroom on the ground floor did not close properly, and did not fit into the door frame. There was a gap between the top of the Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: door and the frame. The shower room and hallway had exposed water pipes that must be boxed in to ensure residents are protected from harm of touching the hot water pipes. The shelf in the shower room was broken and must be removed or repaired. The bathroom had the overflow filled with a sealant, and the sink was stained and requires attention. Although there is a frosted window in the bathroom, there was not a curtain/blind that would ensure full privacy for residents when using this room in the winter nights. The plug for the electric toaster must be checked to ensure it is safe for purpose, as it was warm to touch. House number 25 requires attention to the electric wires outside the entrance porch of the front door as they could easily be pulled or damaged. The corner of the inside of the front door has plaster coming away, and the window by the telephone has putty missing. The radiator covers are loose and worn. The shower room has a bolt lock on the inside of the door, however, this room could not be accessed from the outside should an emergency happen to a resident whilst using the shower room. The laundry room has a damp stain on the ceiling above the window and a large crack in the wall. The flooring was cracked and rippled and not impermeable as required. The door handle was very loose. In the garden, the patio had an old washing machine that requires removing. There is a brick storage room in the garden, however, there was a whole window missing, and this could be easily accessed by climbing the groups of breeze blocks stored outside this window. A water cistern in the garden requires moving, and the old furniture and pipes outside the garage door require moving. Surveys received from residents informed that home is always fresh and clean. The requirement made during the last key inspection in regard to consulting with the fire authority in regard to the fire safety arrangements in the home has been complied with. The AQAA informs that residents choose the colour and decor of their bedrooms, the home is always fresh and clean, and that all staff have received training in regard to infection control These issues were discussed with manager and a requirement has been made that the registered person must ensure that the identified issues in regard to the environment raised in this report are attended to. Care Homes for Adults (18-65 years) Page 22 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 arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of the residents. People who use the service are protected by the organisations recruitment policy and procedures. Evidence: The manager told us that residents living in the two homes are independent and can attend to their own personal care needs. Therefore there is one member of staff on duty each shift in each house, with a second member on duty during the morning and weekends. However, it was not possible to evidence this on the duty rota, as this document included staff who also worked at a third care home that is owned by the organisation. This was discussed with the manager who told us that she will attend to this, and would probably use a colour coding to identify which member of staff is working in which house. The manager told us that they are working towards having a fully trained senior member of staff who would be able to undertake additional management duties as part of their role. The Annual Quality Assurance Assessment forwarded to us informs that of the twelve members of staff employed by the organisation, six hold the minimum of an NVQ level 2 and above. This was confirmed during discussions with the manager on the day of the site visit. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: The recruitment files of the two most recent staff to be employed at the home were viewed. These included an application form, two written references, a full employment history, health declarations, proof of identity and Criminal Record Bureau checks. One file did not include the reason for a gap in employment. This was discussed with the manager who told us that they would attend to this straight away. The manager told us that new staff shadow work another member of staff during their first week, and all staff undergo induction training that is in line with the Skills for Care Council common induction standards. All staff attend the mandatory training as required. Evidence of this was viewed in the four staff training files that were sampled. Other training staff had undertaken included The Mental Capacity Act, risk assessment, Learning Disability Awareness, Parkinsons disease, challenging behaviour, communication and Equality and Diversity. Staff surveys inform that their induction covered everything they needed to know about the job, they receive training that is relevant to their role, helps them to understand and meet the individual needs of people , keeps them up to date with new ways of working and provides staff with enough knowledge about health care and medication. These surveys also informed that there are always enough staff on duty to meet the needs of residents. Residents told us that the staff are nice and always help them. Comments in residents surveys include Staff do help me when ever I need it. I can talk to staff. Staff are good to me. The AQAA informs that the home has competent staff who work in the care homes, they recognise the needs of residents and are able to meet them appropriately. They have sufficient numbers of staff on duty at any one time and do not use agency staff. Care Homes for Adults (18-65 years) Page 24 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 arrangements for management and administration ensure that the home is run in the best interests of people who use the service. Evidence: The home continues to be managed on a daily basis by individuals who are qualified, each holding the NVQ level 4 and the Registered Managers Award (RMA). One manager is currently undertaking a degree in the Learning Disability Studies. Both managers are qualified as Train the Trainer for all mandatory. The Safeguarding training that was provided by Slough Borough Council. The home is a family organisation and have two registered managers, one is registered for Seymor House, the second is registered for the other care home on the same road. However, both managers are involved in each of the care homes. Both managers are hands-on and work in the care home on a daily basis. The manager must ensure that the identified issues in regard to the environment are attended to. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Quality assurance is undertaken through two monthly meetings with residents, minutes of these meetings were sampled during the site visit. Evidence was viewed that the home had undertaken a survey to ascertain the views of how well the home was meeting the needs of residents. These surveys had been sent to residents, relatives, health care and other associated professionals. The date of this was 20th August 2008. Although comments received were complimentary about the home, the manager had not produced a summary of the findings. The manager told us that this would be undertaken. The Annual Quality Assurance Assessment was returned to us when we asked for it. This document was comprehensive and provided all the information we asked for. The sampling of four staff training files provided evidence that staff had received all the mandatory training as required. The AQAA informs that all the policies and procedures had been reviewed in December 2008. Information provided in the AQAA informs that all the Health and Safety maintenance checks of equipment used at the care home have been serviced in accordance with the manufacturers recommendations. However, the following were evidenced during the site visit. Portable Electric Appliance Testing (PAT), 30th September 2008, fire extinguishers, 6th May 2009, gas appliances, 7th May 2009 and the electric circuits, 8th April 2009. The home had an inspection from the Fire Officer on the 26th February 2009, the manager told us that they had attended to the recommendations made in the report. The last visit by the Environmental Health Office (EHO) was dated the 9th August 2006. The manager told us that she would contact the EHO to ascertain if the home is due to have another visit from them. The home has generic risk assessments and a fire risk assessment that were reviewed in 2008. The AQAA informs that the home is managed by managers who are NVQ level 4 qualified, and are registered with the Commission, they ensure all health and safety checks are in place and an annual quality assurance is undertaken. Plans for improvement during the next twelve months are to have a fully trained senior member of staff so that management can delegate more work to them to allow the managers to concentrate on other areas that require attention. Care Homes for Adults (18-65 years) Page 26 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 27 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 1 24 23 The registered person shall 04/09/2009 having regard to the number and needs of the service users ensure that the physical layout of the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order; all parts of the care home are kept clean and reasonable decorated. The registered person must ensure that the identified issues in regard to the environment raised in this report are attended to. Care Homes for Adults (18-65 years) Page 28 of 30 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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