Care Home: Shaftesbury Court

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What the care home does well Comprehensive pre-admission assessments are carried out so that all care and support needs are known before people move in. People can stay at the home to see if it is suitable for them before they move in. The home provides good information to new people. Care plans and arrangements for health services are in place before people move in. People contribute to writing their individual care plans which are regularly reviewed. People make their own decisions about how they want to live. Risk management does not unnecessarily prevent people from doing the things they want to. People`s healthcare needs are being met and monitored. Systems are in place for safe management of people`s medication. People have access to lots of different things that they are interested in; at the home, at college and in the locality. People benefit from a healthy diet. People are supported to prepare some meals and the central kitchen provides a choice of main meal each day. Systems are in place for anyone to make complaints about the service. Complaints are taken seriously and fully investigated. Staff and management are confident about using the local safeguarding procedure when concerns are raised. Sufficient staff are available at the different times that people need them. Staff are experienced and well qualified. A robust recruitment process means that people are protected from anyone who is unsuitable to work with them. The manager is experienced, qualified and competent to run the home. He makes sure that the home is run in people`s best interests. What has improved since the last inspection? The main kitchen has been repainted and re-furbished. All of the kitchens on each of the units have been replaced and the flooring upgraded. The gardens have been remodelled, with people being involved in the design. What the care home could do better: Body maps should record size, colour of any wounds and whether the skin is broken. Care plans should identify when medication that is prescribed to be taken only when needed should be given. If different types of pain-relieving medication are prescribed, the person`s care plan should identify when each one should be given. Key inspection report Care homes for adults (18-65 years) Name: Address: Shaftesbury Court Manor Close Trowbridge Wiltshire BA14 9HN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Walker     Date: 0 9 1 0 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 33 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 33 Information about the care home Name of care home: Address: Shaftesbury Court Manor Close Trowbridge Wiltshire BA14 9HN 01225760228 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.sanctuary-care.co.uk Sanctuary Care Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Shaftesbury Court is registered for 18 younger people with a physical disability. The focus of the home is to support people to lead an independent life style. Shaftesbury Court is situated in the town of Trowbridge, at a reasonable distance of all local amenities. Sanctuary Care owns the home and the registered manager is Mr Steve Coare. The home was purpose built in the 1980s to support people who use wheelchairs. All the bedrooms are single. The home is divided into four wings with four bedrooms on each wing. Each wing has an assisted bathroom and a kitchen/dining room. There is also a registered bungalow with space for two people. The main communal area is situated in the centre of the home linking the three units. 1 17 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 8th October 2009 between 9.25am and 5.50pm and on 9th October 2009 between 9.20am and 1.35pm. Mr Steve Coare, registered manager, was present during the inspection. We spoke with people who use the service and staff. We looked at care plans, risk assessments, health plans, daily reports, medication, activities, staff training and recruitment records and menus. We made a tour of the communal areas and two people showed us their bedrooms. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We asked the home to complete an Annual Quality Assurance Assessment (known as Care Homes for Adults (18-65 years) Page 5 of 33 the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. The last key inspection was on 3rd October 2006. We looked at all the information we received since the last inspection so that we could decide what to focus on during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 33 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 33 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 33 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 have a comprehensive assessment of all their care and support needs before they move in. People who are considering using the service can stay at the home, to see if it is suitable. People have good information about the home before they move in. Evidence: We saw that people who were considering using the service had the opportunity to stay at the home for at least two weeks to see if it was suitable for them. We saw that they had a daily programme of things they could do during their trial period. In the AQAA Mr Coare told us ideally a four week trial period will be arranged before any final decisions are made. We are good at supporting friends and family with this process. We could still do with better information such as audio, DVD, Braille. People were provided with a service users guide which included their contract and tenancy agreement, as well as information about the services which the home could provide. The service users guide had been updated in January 2009. It also had information about advocacy services, how to contact senior management in the Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: organisation and previous inspection reports. We looked at the care plan of one person who had recently moved in. There was a detailed pre-admission assessment filled out with the person and the carers at their other care home. Information had been obtained from the persons care manager and family. We saw that specialist medical care had been put in place beforehand so that the persons healthcare was continuous. The persons care plan had been ready for them on the day when they moved in. Care Homes for Adults (18-65 years) Page 11 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from individual care plans in which they set out their own goals and aspirations. People are well supported to make their own choices and decisions about their lives. Risk assessment does not unnecessarily prevent people from doing the things they want to. Evidence: Peoples care and support needs were set out in their care planning files. People had signed up to their care plans. One of the people we spoke with showed us their life plan that they had recently completed. The person told us about how the process of writing their life plan had helped them to think about their future and what they were going to do next. They went on to tell us about the positive outcomes they had achieved in writing their life plan. Mr Coare told us that staff were working with everyone to support them with writing their life plans. In the AQAA he told us we want to ensure that those with higher care needs do not miss out on opportunities. Service users are fully involved in the process Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: of planning their care and decision making, on how their care and support is delivered. Our aim is for service users to live as independently as possible within a safe environment and for each person to reach their potential, making their own choices. Mr Coare gave us an example of how one person had been supported by an IMCA (Independent Mental Capacity Advocate) to make their own decisions. Care plans identified whether peoples parents were involved in parts of peoples support, for example, with finances. We saw that peoples risks for different things that they did had been assessed and were regularly reviewed. Risk assessments included statements about whether people had awareness of risks to their wellbeing in different situations; going out alone; use of wheelchairs; going in the vehicles; swallowing; bathing; falls; vulnerability in different situations; managing finances; use of equipment; moving and handling and use of a hoist. We saw records of how staff had supported people when they wanted to go out on their own. A missing persons procedure was in place. Behaviour management strategies were in place, with advice from the clinical psychologist. We saw no evidence that peoples liberty was being restricted. Care plans identified any emotional support they wanted. There was information about promoting peoples self esteem, decision making and choice, and motivation. One person told us that staff know that they must knock on their bedroom door and wait to be invited in. Another person told us that they had two keyworkers. One staff member told us that people could choose their keyworkers and who provided their personal care. Care plans identified peoples different communication needs. Mr Coare told us he was looking to provide more communication aids. One person showed us their aid to use all of the electrical equipment in their bedroom. They also had a remote control device fitted to their wheelchair to operate the automatic doors. Care Homes for Adults (18-65 years) Page 13 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to have an independent lifestyle. Shaftesbury Court has established itself as part of the local community. There are lots of opportunities for people to do different things both at the home, at college and in the locality. People choose different things to eat from a healthy menu. Evidence: People had secured funding for more one to one time with staff. They chose what they wanted to do. One person told us that they planned to go to the cinema that week during one to one time. Keyworkers kept records of what people had been involved in during one to one time. Some of the people we spoke with told us about what they did at college. One person told us they did personal presentation; about make up, hair and looking nice. Another person told us they did woodwork. One person went to work at a local community Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: farm. Another person told us that they had been to Swanage and to a bird sanctuary during the summer. Another person told us they liked to go shopping either in Trowbridge or Bath. They said they did cooking in their one to one time. They also went bowling or out for meals. They said they liked to watch television. They told us they went to a church club and went to church on Sundays. A member of the care staff had the responsibility to plan and arrange activities. They told us about how they looked at providing different things for people to do depending on what they were interested in. They told us they had trained in providing activities to people and used many ideas from the course. People had filled out a survey about their interests. The activities person told us that one person was doing a pottery course at a different college and it was hoped that other people would access this course. A newsletter was published with different activities planned for the coming months. The Christmas party was being planned. On the second day that we visited people were joining in with a drumming workshop. Mr Coare told us that this workshop took place four times a year and told us about how much people enjoyed it. We saw that staff also joined in with the drumming. The activities person told us they ran a regular helpdesk so that people could talk to them about what they wanted to do, or bring other issues to them. The activities person told us that they were the staff council representative for Sanctuary Care and the representative at the local college. This meant they could liaise with the different bodies about issues that people had raised either in person or through the helpdesk. We saw photographs of a visit by Bath Rugby Club earlier in the year. There were also art workshops, different board games, a quiz night once a month and cooking. We saw photographs of the trips that people had been on during the summer. People had chosen which trips to go on. People told us that they did not necessarily want to go out all together. The home had two accessible buses to go out in. There were fund raising events for a third bus which was needed, so that people would have more options to go out in small groups or on their own. People also used buses and trains. People had been on two different seaside trips, to a monkey park, to Bristol, Longleat, a farm and to a hawk conservancy. People had been involved in Trowbridge carnival. One person told us they helped out at a local shop on a voluntary basis. Most people had their own computers with internet access. One staff member told us that people could also access computers at a local community resource centre. Most people had mobile phones. Mr Coare told us that one of the portable office phones Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: could be made available if people wanted. One person told us that they regularly gave talks to social work students at the local college. They were also involved in the interviewing process for prospective staff for the home. One person told us they regularly went to their parents for the weekend. The activities person told us about the facilities that people used at the local community resource centre. As well as social events, people used their lending library and were involved in community projects. A Halloween party was planned at the community centre. People were also involved in community arts projects. People had made a mosaic with a professional artist. In a survey form one person told us about what they thought the home did well: the food. Good care. Thumbs up to the staff. [Do better] More activities I like. Another person to the same question said: Food. Staff. Going out. A third person said: look after me well, especially if I have problems. Just like the way things are. People decided what was on the menus and could make suggestions about meals either in their own meetings, or via a suggestions form. People had decided to vary the time of day that the main meal was served. People made their own breakfast with staff support if needed. Everyone we spoke with said they really enjoyed the meals. One person told us I eat my breakfast when I want it. I have my meals when I want them. If Im out they will save a meal for me. They told us they liked the different things on the menu. They went on to say we have a set day to do our food shopping at [a local supermarket]. They explained that people had one meal prepared by the central kitchen each day. They told us that people made their other meals themselves in the kitchens on each of the units. People showed us the fridges and cupboards that everyone had, to store their food. They told us that the amount of money they had been given for buying food had been recently reduced. We asked Mr Coare about this. He told us that this had happened because the organisation had found that since taking over different homes across the country, that food allowances were not always equal. We saw that this issue had been discussed at a residents meeting earlier in the year. People had been given three options to consider and adopt, about how meals were paid for. The money for buying foodstuffs was returned to people so that they could be more independent in meal planning. Some people went out regularly with the Pub Club for meals. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: We saw that people had a choice of lunch including a vegetarian option or salad. The meal was either cheese and potato pie with two vegetables or chicken korma with rice. Staff sat with everyone to have lunch with them. The local Environmental Health department had awarded the homes kitchen five stars. Care Homes for Adults (18-65 years) Page 17 of 33 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. People determine how their health and personal care is provided. People have good access to healthcare professionals. All health and complex care needs are set out in peoples care plans. Safe systems are in place to manage peoples medication. Evidence: Care plans set out peoples individual preferred routines for care and support at night and during the day. Peoples medical history and healthcare needs were set out in a medical information file. Some people told us that they could make decisions about who provided their intimate personal care. One persons care plan recorded their preference. We asked whether there was information about people being able to choose to have staff of the same gender to provide their intimate personal care, as we could not find a policy in the guidance. Mr Coare told us after the inspection that Sanctuary Care did not have a specific policy but he would discuss this with the policy group. He sent us information contained in the service users guide and contracts. We saw guidance to staff about not providing personal care alone. Peoples terms and conditions also stated that people could choose whether to be supported by male and female staff. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Care plans identified key healthcare professionals involved in peoples care. It was clear from the files that people had prompt referrals to healthcare specialists when needed. Named staff had been trained by a nutritionist from a local hospital to give special meals via a PEG (percutaneous endoscopic gastronomy) tube. The speech therapist had also given advice about gradually introducing food and drinks to stimulate swallowing reflexes with a view to eventually taking a regular diet at some point in the future. The organisation had a policy on artificial feeding and there was a twenty four hour helpline if needed. Some people had an epilepsy profile compiled by the learning disabilities nurse which was regularly reviewed. Their care plans identified how they experienced the condition and guidance to staff on how to support them. Records were kept of any seizures. Body maps were kept of any wounds or marks. We discussed further enhancing the records with descriptions of size, colour and whether the skin was broken for monitoring purposes. One person told us that staff made appointments with their GP at the surgery. They said they preferred their keyworker to accompany them to remember what the GP had said. They also said they had regular appointments with the neurologist to monitor epilepsy. The person told us about the exercises they did everyday to help with flexibility and walking. They said they preferred staff to keep and manage their medication. They told us they were deciding whether to have the injection for flu this winter. During our conversation staff came to discuss an appointment to have their medication reviewed with their GP. We saw that the organisation had developed a policy in response to the possibility of an outbreak of swine flu during the winter. Mr Coare told us that he had received further guidance that morning from the organisation. We spoke with two visiting district nurses. One told us that people who use the service and staff were always very welcoming. They said that staff would refer any concerns and act on advice given. They told us they had no concerns about the care and support offered to people. The other district nurse told us that they visited during the afternoons, so that any treatments did not interfere with people going to college or other activities. They said they had good working relationships with staff at the home. People had their risk of developing pressure damage regularly assessed. Pressure relieving equipment and profiling beds were in place where identified. One of the Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: visiting district nurses told us that the home was good at managing any risk of pressure damage and that no one had any pressure sores. Medication was administered from a monitored dosage system put up by the supplying pharmacist. A daily check was carried out on the administration process. Staff were required to check and sign each time they administered medication, to make sure they knew about any changes. We saw that medication was given at the prescribed times, for example, before or after food. New peoples medication was checked with their GP when they moved in, so that an accurate record was kept of what they should be taking. Some people came to the office to receive their medication. Mr Coare told us that he planned to move the medication cabinets to another room which was no longer used. This would free up office space and enable more privacy for people taking medication. It would also mean that the medication trolley, currently secured to one of the handrails in the central area, would be more safely stored. No controlled medication was being administered. However the home had a controlled medication cabinet which met the standards for safekeeping controlled medication. One person told us that they preferred to take their medication in yoghurt rather than swallowing it with water. We saw agreement from one persons GP for a medication capsule to be split, so that the contents could be put in food or drink and taken more easily. We saw that care plans did not identify when medication was to be given that was prescribed to be taken only when needed. We saw that the medical part of the care plans referred the reader to the medication administration record. There was written information from a community psychiatric nurse about when to use one of these medications. It was clear from talking to staff that they knew what symptoms they should look for if the medication was needed. We said that where some people took two different pain-relieving medications, the care plan must identify when each one was to be given. We saw one person ask for pain relieving tablets and staff discussed with the person as to where they were experiencing pain. Mr Coare told us that the McMillan Nursing Service was available to people and would be involved in supporting people to write end of life care plans when needed. There was also support available from a local hospice. Consideration was given to the ageing process and staff were trained in dementia. In a survey form one healthcare professional told us what they thought the home did well: Excellent communication with outside agencies. Good at identifying specific needs i.e. religious, cultural. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: Another healthcare professional told us: Approachable. Open to discussion and dialogue. There are no specific nor significant issues I would like to raise. Pleased with resource. Care Homes for Adults (18-65 years) Page 21 of 33 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. Systems are in place so that anyone can complain about the service. People are used to having their concerns dealt with. Management and staff are confident in using the local safeguarding procedure when concerns are raised. Evidence: The complaints procedure was displayed on notice boards around the home. There were also details about how to make a complaint in the service users guide, which had been given to everyone. We asked people about making complaints. One person told us they would talk to staff. The activities person had told us about the helpdesk they ran each week, where people could bring issues to discuss. They gave us examples of how different things had been changed in response to peoples comments and suggestions. The home kept a complaints log with information about any investigations and outcomes. We saw that Mr Coare wrote to complainants telling them about how he had addressed their complaint. Mr Coare told us that the organisation monitored all complaints centrally. We saw that the organisation would also respond directly to any complainants. Mr Coare told us about how some people had used IMCAs (Independent Mental Capacity Advocates) to support them make decisions about different things they were Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: dealing with. People paid part of their Disability Living Allowance towards trips out in the vehicles. There was a list of the charges to different destinations in the service user guide, so that people knew what they would have to pay for. People could keep small amounts of cash in the homes safe. Records were kept of all transactions. Mr Coare told us that most people managed their own finances and had lockable storage for valuables in their bedrooms. People were encouraged to save and had their own bank accounts. We saw two staff support one person to access their money, decide what they were going to spend it on and talk about how much they had left in the safe. We saw that issues about changing the way how people had money returned to them from their fee to pay for food shopping and arrangements for collecting petrol money had been discussed at the residents meetings. Staff members had received training in the local safeguarding adults procedure, both as part of their induction and regularly thereafter. Each member of staff had been given a copy of the booklet entitled No Secrets in Swindon and Wiltshire. There were blank copies of the local safeguarding referral form on the training room notice board. We asked staff about how they would report any observations or allegations of abuse. They were quick to tell us about both the organisations and the local reporting procedure. Mr Coare told us about different referrals which had been made to the process for peoples protection. The service users guide provided people with the local authoritys booklet on keeping people safe, which outlined the safeguarding procedures. Mr Coare told us that Criminal Records Bureau certificates had been obtained for the visiting aromatherapist and hairdresser as they provided these services privately in peoples rooms. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and spacious environment which is well maintained. Evidence: The home was purpose built in the 1980s. The accommodation was arranged in three units with a central sitting room, office and kitchen. All of the bedrooms were singles with a bathroom or shower and toilets on each unit. All of the bedrooms were decorated and furnished according to peoples own tastes. People had put different photographs and objects on their bedroom doors. Some people had overhead hoists to help them transfer to and from their wheelchairs if they needed. Each unit had its own kitchen and dining area. One person showed us their nearest bathroom. They told us they had their bath on another unit as they could not get into their nearest bath. Another person showed us how some of the exit doors opened automatically when they activated a switch on their wheelchair. Action had been taken to address the requirement we made at the last inspection that the kitchen was painted. Action had also been taken to address the requirement we made at the last inspection that all flooring is maintained to a standard that could be kept clean and safe. Mr Coare told us that since we last visited, all the kitchens on each of the units had been replaced and flooring changed. A budget had been made Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: available to refurbish one of the bathrooms to make it more accessible. In the AQAA Mr Coare told us about plans for the next twelve months: carpets will be replaced in the dining areas. New tables will be purchased. Patio doors onto the garden will be changed to provide better access to wheelchair users. The gardens had been re-modelled since we last visited. People who use the service had been involved in the designs. Mr Coare told us that he planned to move the medication cabinets from the main office to a room which had a payphone which was not used. He said this would free up vital space in the office and enable people to receive their medication with more privacy. Mr Coare told us that people had been asked by the council to assess the wheelchair accessibility of roadside kerbs in the locality. He said that changes had been made following this assessment. During the inspection the fire alarms went off. This was not a test. The houses and flats in the grounds were linked into the homes fire panel and the false alarm was identified as coming from one of these facilities. We saw that everyone followed the procedure and responded quickly. The local Fire and Rescue Service attended and checked the homes fire risk assessment and fire safety records. We saw that staff explained to people what was happening. One person told us that everyone exited the building and met at the central point if the fire alarms sounded. Mr Coare told us that people who use the service had attended the homes fire safety training. We saw that the home was cleaned to a high standard. We spoke with the housekeeper who showed us their stores and explained their routines. They worked Monday to Friday in the mornings. At other times staff would do the cleaning. We saw that disposable protective clothing and gloves were available. The laundry was clean and ordered with facilities for managing different types of laundry. People were supported to do their own laundry if needed. Care Homes for Adults (18-65 years) Page 25 of 33 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. People benefit from having sufficient staff around when they need them. A robust recruitment process is in place to protect people from anyone who is unsuitable to work with people who may be vulnerable. Staff are experienced and well trained. Evidence: The care staffing rota showed that during the weekday mornings there was a minimum seven care staff with a senior or designated responsible person (DRP) leading the shift. Senior staff with this designated role had undergone a process of assessment to ensure that they were clear about this role and its responsibilities. During the evenings there were five care staff and a senior or DRP until 10.30pm. This was reduced at weekends to five care staff and a senior or DRP during the mornings and four care staff and a shift leader or DRP during the afternoons and evenings. When we asked about this, Mr Coare told us that many of the people who used the service went to their parents at the weekends. He went on to say that the staffing rota would be increased when needed. There were two waking night staff. One of the staff members told us Its a lovely place to work. We are like a big family. They said they had had an induction into their role. They also told us about the training they had recently undertaken including: infection control and health and Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: safety. They said they were hoping to do an NVQ Level 2. Mr Coare had a training matrix which showed when each staff member had undertaken essential training. It also showed when this training needed updating. Copies of training certificates were on staff members individual files. Staff members had recently undertaken training in mental health awareness, medication, moving and handling, artificial feeding with a PEG, Control of Substances Hazardous to Health, health and safety, fire prevention, first aid, tissue viability and the local safeguarding procedures. Training was provided as either DVDs and questionnaires or courses in house or with external providers. The home had a designated room for meetings, training and supervision. Two members of staff were qualified moving and handling trainers and four staff members were qualified training facilitators. The training matrix showed that sixteen staff members held NVQ Level 2, eleven members of staff had NVQ Level 3 and three staff members had NVQ Level 4. Staff members were given supervision every two months. They also had annual appraisals. We looked at the staff recruitment files. All the documents and information required by regulation were on file. We saw that no one commenced working until checks on their suitability to work with people who may be vulnerable had been done. Some people who use the service were involved in the recruitment process. We saw that most staff members had had previous experience of working in care homes. New members of staff had completed a period of induction into their role. Training had been given about the organisation and principles of care. Induction files contained information about epilepsy, cerebral palsy, spina bifida, hydrocephalus and information from the clinical psychologist about managing different behaviours. There was information about respecting peoples privacy and dignity and proper boundaries in physical contact with people who use the service. Staff members had also undertaken training in dementia in people with a learning disability. In a survey form one of the staff members told us: I find Shaftesbury Court very efficient. I am a new starter to the role here at Shaftesbury but I have been given all the necessary information to do my job well. Although we have a lot of contract/bank staff, it seems illness can still really affect the smooth running of the team. I feel perhaps a couple more contract staff could be appointed to avoid the breakdown. Another staff member told us: The home is supportive of new staff. Training is relevant to the service users. The individual has their own care plans that are person Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: centred. Care Homes for Adults (18-65 years) Page 28 of 33 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 manager is experienced, qualified and competent to run the home. The home is run in peoples best interests. People have different opportunities to make comments about the service. Systems are in place to ensure that everyones health and safety is monitored and maintained. Evidence: Mr Coare had managed the home for thirteen years. He had NVQ Level 5 and the Registered Managers Award. He kept himself up to date with current good practice with regular training provided by the organisation. He told us about future training he had booked on. This included updates in: managing challenging behaviour, health and safety, mentoring, supervision and appraisal, infection control and moving and handling. He had recently updated his training in leadership development, coaching, undertaking an investigation, grievance procedure, fire safety, food hygiene, Control of Substances Hazardous to Health, safeguarding vulnerable, recruitment and selection, people and artificial feeding. In the AQAA Mr Coare told us: the management structure has changed over the past Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: 12 months. A deputy manger is now in post. This has strengthened the leadership of the home providing consistency in the managers absence. A system of designated responsible staff has been introduced. We saw that any significant changes in policy or guidance were sent personally to individual staff member in a memo. Copies of the minutes of the residents meetings, in large print, were displayed on notice boards. People also met with people who lived in the organisations other homes called Shire meetings. People who use the service had been involved in designing the organisations quality assurance survey at these meetings. They had also decided that staff should not wear uniforms. Mr Coare told us that the surveys had been recently distributed. He told us that the returned surveys would be sent to the organisation for their annual quality review. He also said that the home asks people to comment on different quality issues every month. Mr Coare told us that people met with the operations manager when they made the unannounced visits each month. Monthly checks were carried out on the internal and external environment. Any maintenance or servicing was carried out by the organisations own approved contractors. Environmental risk assessments were in place and were regularly reviewed and revised if needed. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 19 20 Body maps should record size of any wounds or marks, the colour and whether the skin was broken. Care plans should identify when medication that is prescribed to be taken only when needed is given. If different types of pain relieving medication are prescribed, the persons care plan should identify when each one should be given. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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