Care Home: Sharea

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What the care home does well People being supported at the home live in a sensory stimulating environment which is clean and homely with their personal accommodation furnished and decorated according to their individual needs and lifestyles. The home provides a relaxed and gentle atmosphere and is able to demonstrate that it meets the needs of the people whom it supports. This includes people who have complex needs and who have a visual impairment. A relative commented "he really seems to like living there and they seem very nice". A social care professional fedback "I think sheara is a very difficult house for staff, the staff do a wonderful job stimulating the clients and getting life into the house". Good person centred care planning provides staff with the guidance they need to provide individualised consistent supported which respects their privacy and dignity and encourages them to remain as independent as possible. The people being supported are enabled to make decisions in their lives and to actively participate in the daily events and running of the home and in planning the support they receive. People being supported are actively supported to maintain and develop further life skills and to exercise their choice over their daily routines with their lives enriched by the provision of a range of age appropriate and varied activities both at the home and in the local community. Family links remain an important part of the on going support provided. The staff team are well trained and showed a good awareness of the needs of the people they support. A sample of comments made about staff included "since the last inspection the staff seem to try harder although you see different staff they are all very nice" "staff they know their job ,they are always able to answer any question that I have they do a brilliant job" and "they are all very kind and helpful". The home regularly reviews aspects of its performance through a program of self review and feedback and acts on the information and feedback it receives in order to continue to improve the services and facilities it provides. What has improved since the last inspection? All of the shortfalls noted at the previous inspection have been addressed or are the process of being addressed. This has improved the standards of the environment with the redecoration of parts of the home and increased sensory stimulation around the building, through the use of textured wall and door coverings as well as orientation prompts designed for people who have a visual impairment. The unpleasant odour in the garden has been addressed with additional garden seating obtained to help create an attractive versatile outdoors space. Staff deployment has been reviewed with the evening shift slightly extended, in order to promote choice in the time at which people wish to be supported to go to bed. Stability in the management team and their improved insight in the good practises in the care of people who have a learning disability means that a clearer direction is provided which enables staff to provide good quality support. Comments about the management included "now a lot better as new senior appointed, much better support" and "manager so nice to talk to very understanding very approachable". The opportunity for occupation and stimulation has increased significantly with a range of activities now being undertaken which has helped to further enhance the lives of people living at the home. The provision of more suitable transport in the near future will help to ensure that all people living at the home are able to more easily access the community. The most significant improvement in practises has been through the development and introduction of person centred care planning and active support plans. This has seen more individualised care and support being provided and greater choices being available for the people who the home supports. Specialist equipment has been obtained to help aid the independence of people with a visual impairment. This includes talking microwaves and signs. What the care home could do better: Management cover over the weekend and holiday periods needs to be reviewed to ensure that staff are able to be appropriately supervised and that there are competent persons left in charge at all times. To further promote individuals privacy the person appointed to manage confirmed that they would develop guidance on the use of listening devises. This is to provide staff with the clear guidance on their use to ensure consistency To further promote an enabling lifestyle the person appointed to manage was aware of the need to now expand active support plans the include all the people living at the home and their key activities. Completing the ongoing improvements to the environment including the levelling of the patio area and the remaining redecoration will help to provide a pleasant safe environment in which to live. Key inspection report Care homes for adults (18-65 years) Name: Address: Sharea 69 Reigate Road Hookwood Surrey RH6 0HL     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: Jane Jewell     Date: 2 1 1 2 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: Sharea 69 Reigate Road Hookwood Surrey RH6 0HL 01293776248 F/P01293776248 info@avenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home Sheara is a care home registered to provide care and accommodate up to six people who have a learning disability and have a sensory impairment. Residents are aged over 40 years upwards. The home is managed by Avenues Trust Limited who are a large organisations specialising in caring for people who have a learning disability and also operate many other registered homes across the county. The premises are owned by a housing corporation who are contracted to maintain aspects of the premises. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 6 6 2 2 1 2 2 0 0 8 Brief description of the care home The premises consist of a converted domestic bungalow situated on a main road on the outskirts of Reigate. Local amenities are a car journey away. The premises are presented across two floors with access to the first floor via stairs. Residents accommodation consist of six single bedrooms with the use of communal toilets and bathing facilities. Communal space consists of a large combined lounge dining room, kitchen, laundrette. There is a large secure rear garden which has a large patio area. The front provides for off road parking. The manager reported that the current range of fees are from £1091.78 to £1223.10 per week, depending on room, the services and facilities provided which are based on an individuals level of need. Extras such as newspapers, hairdressing, chiropody, some transport , toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. Care Homes for Adults (18-65 years) Page 5 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and health care 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 this service is Two star. This means the people who use the service experience Good quality outcomes. The information contained in this report has been comprised from an announced inspection undertaken over five and half hours, from 11:00am to 4:30pm, and information gathered about the home before and after the inspection. The person appointed to manage the home had completed an Annual Quality Assurance Assessment (AQAA) within the date requested. This provided a good standard of information about the home which was used to inform the inspection process. People who live at the home, at the organisations request, are referred to as the people who are supported and hereafter referred to as this in this report. The home Care Homes for Adults (18-65 years) Page 6 of 33 remains without a registered manager and the person appointed by the provider to manage the home in the interim, hereafter referred to as the person appointed to manage, facilitated the inspection. This is the homes second key inspection within twelve months. The focus of the inspection was to look at the experiences of life at the home for people living there and the progress made towards addressing the shortfalls noted at the previous inspection. The inspection consisted of being shown the communal areas, and being invited to view the people who are supported bedrooms. People who are supported do not use verbally communication and therefore time was spend observing the daily practises at the home, activities and staff interaction. Four staff, a social care professional and two relatives were also consulted as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Eight were returned in total, four from people being supported by the home who were assisted to complete the form, one from staff, and three from health care professionals. Their feedback is included in this report. There were six residents living at the home at the time of the inspection. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? All of the shortfalls noted at the previous inspection have been addressed or are the process of being addressed. This has improved the standards of the environment with the redecoration of parts of the home and increased sensory stimulation around the building, through the use of textured wall and door coverings as well as orientation prompts designed for people who have a visual impairment. The unpleasant odour in the garden has been addressed with additional garden seating obtained to help create an attractive versatile outdoors space. Staff deployment has been reviewed with the evening shift slightly extended, in order Care Homes for Adults (18-65 years) Page 8 of 33 to promote choice in the time at which people wish to be supported to go to bed. Stability in the management team and their improved insight in the good practises in the care of people who have a learning disability means that a clearer direction is provided which enables staff to provide good quality support. Comments about the management included now a lot better as new senior appointed, much better support and manager so nice to talk to very understanding very approachable. The opportunity for occupation and stimulation has increased significantly with a range of activities now being undertaken which has helped to further enhance the lives of people living at the home. The provision of more suitable transport in the near future will help to ensure that all people living at the home are able to more easily access the community. The most significant improvement in practises has been through the development and introduction of person centred care planning and active support plans. This has seen more individualised care and support being provided and greater choices being available for the people who the home supports. Specialist equipment has been obtained to help aid the independence of people with a visual impairment. This includes talking microwaves and signs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 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 health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 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. There is a good range of accessible information available about the home and the services and facilities it provides, in order to help the people the home supports and their families make informed choices. The home is able to identify and meet the range of needs of the people it supports. The way in which prospective individuals would be assessed ensures that the home admits only those residents whose needs can be met by living at the home. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home and the services it provides. These documents have been reviewed and now provide information in a picture and audio format to make the information more accessible to the people for whom the service is intended. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: There have not been any new admissions to the home since 2000. Therefore, this standard continues to be assessed in respect of the admission procedure for any future admissions. The person appointed to manage continues to be aware of the admission criteria for the home and knowledgeable about admissions practises that would help ensure that a comprehensive range of information is gathered about prospective people. This would then inform their decision whether their needs could be met safely at the home. The people whom the home supports are assessed as having medium to high levels of needs and include people who have physical needs, learning disabilities, behaviour which can be described as challenging and all of whom have a visually impairment. Currently there are four male and two female people living at the home with ages ranging from 43 to 73 years old with most people having lived there for a significant number of years. The home continues to provide a relaxed and gently lifestyle and through observation, looking at records and speaking to relatives and staff it was clear that the home is meeting the range of needs of the people for whom the home supports. People being supported by the home were observed showing signs of positive wellbeing through smiling, touching and relaxed body language. All persons consulted spoke positively about their experiences. A relative commented he really seems to like living there and they seem very nice. A social care professional fedback I think sheara is a very difficult house for staff, the staff do a wonderful job stimulating the clients and getting life into the house. The people whom the home supports are provided with a written contract of the terms and conditions of residency. There are further plans to develop contracts into an audio format to help aid the understanding of peoples rights and responsibilities while residing at the home. Care Homes for Adults (18-65 years) Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people being supported benefit from a person centred care planning process, which provides clear, up to date and accurate information about their needs, which helps staff to then provide consistent individual support. The people being supported are enabled to make decisions in their lives and to actively participate in the daily events and running of the home and in planning the support they receive. The home balances well the rights of people being supported to take reasonable risks as part of an enabling lifestyle. Evidence: Each person being supported has a person centred care plan in place which is designed to enable personal, health, communication, social, cultural and religious needs to be addressed. Four person centred plans were sampled which had been implemented in consultation with the people whom the home supports and their Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: relatives. Any changes in their needs and preferences are identified through the regular review of the plan. Annual placement reviews are also undertaken with each placement authority to help identify any changes in needs and to confirm that the home remains able to meet an individuals needs. These reviews are now undertaken in an audio format to aid the involvement of the people whom the home supports. Since the previous inspection the home have introduced active support plans. This involves breaking down an activity into steps, for example making lunch and identifying at each step how the individual is to be supported to aid their independence and involvement. Currently active support plans have been introduced for a few people whom the home supports. Observation of an active support plan being carried out clearly showed the positive participation and engagement of the person being supported and provided staff with very clear guidance on how the individual is to be supported to maximise their involvement. However where an active support plan was not in place for an activity observed by the inspector staff provided inconsistent support. The person appointed to manage agreed to ensure that active support plans were now put in place for the remaining individuals as a matter of priority, to ensure that staff had the clear guidance to provide consistently good active support. A staff member commented that improved person centred planning combined with active support plans has had a very positive impact for the people who the home supports as staff are much more familiar with the individual needs and strengths for each person. The home balances well the rights of residents to take reasonable risk as part of an enabling lifestyle against the risks faced and posed by themselves or others. This is supported through the written assessment of risks for example in areas such as challenging behaviour, mobility and environment. A range of ways was seen of how well residents are being actively involved in the day to day running of the home. Active support has had a significant impact in increasing individuals participation across a range of daily activities. This has included making their own meals, drinks and snacks. People who the home supports are now involved in making drinks for visitors as well as answering the front door. Staff consulted with consistently fedback that what the home does best is offering choice and were able to give many examples of how they provide choice to individuals through using a variety of communication tools and the use of opportunity sessions. These are used for individuals to experience new activities and food in order to increase the range of choices on offer. Consideration has also been given to new legislation (Mental Capacity Act) which affects people being supported rights to make Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: decisions in their lives. The person appointed to manage and staff have undertaken training in this area and showed an understanding of what to do should any restrictions be placed on individual lifestyle or affect their capacity to make decisions about their lives. Care Homes for Adults (18-65 years) Page 15 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 being supported are being actively supported to maintain and develop further life skills and to exercise their choice over their daily routines. Family links remain an important part of the on going support provided. People being supported by the home lives are enriched by the provision of a range of age appropriate and varied activities being provided both at the home and in the local community. Mealtimes and arrangements for eating are tailored to meet individual needs and preferences with people being supported actively involved in their own meal time preparations. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Consistent feedback was received that with the introduction of active support this has helped to further enhance or develop daily living skills for some individuals through the preparation of meals, laundering their clothes and light domestic cleaning. Each person being supported has a flexible weekly plan of events and activities. This includes undertaking line dancing, shopping, reflexology and music sessions. Staff spoke of undertaking a lot of in house activities including cooking and music. A staff member was observed reading a story with a person who the home supports, who was clearly engaged and enjoying the interaction. Staff spoke of the achievement of a person being supported having just completed a sailing course. On the day of the inspection the home was visited by a mobile sensory unit who provided one to one sessions each week. Staff consistently fedback that they felt that there were more opportunities for occupation and stimulation, since the previous inspection. Staff spoke of a recent Christmas meal that staff and people being supported went on which was enjoyed by all. A community mapping book has been developed to help aid awareness of the accessible activities and events in the area. Coffee mornings have also been arranged across the organisation to encourage contact with other services. A relative fedback that their relative is active and undertakes a wide range of activities and is encouraged to try new and different things and always seems to be doing something. The home is located in a semi rural location off a busy main road with access to local amenities only accessible by transport. Although the home has its own transport this is not easily accessible to people whose mobility is restricted. The person appointed to manage confirmed that in early 2010 the home will have its own mini bus with wheelchair access. Two staff fedback what the home could improve upon was to provide more outings for the people who it supports. This should be addressed through obtaining a more suitable vehicle. Relatives fedback that they are able to visit at any reasonable time, but phone in advance to establish a suitable time to visit due to their relatives going out a lot. Relatives confirmed that they are made to feel welcome when visiting and are offered refreshments. A relative spoke of being invited to attend reviews and their views sought on how well the home is meeting their relatives needs. The person appointed to manage confirmed that they have slightly extended the timings of the evening shift in order to improve the flexibility in the times that people who are supported can be assisted to bed. Staff spoke of the flexibility in the times that individuals wish to get out of bed, based on the activities or preferences that day. On the day of the inspection one person decided to have a lie in, which was respected Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: by staff. Although there is a formal menu plan each week staff spoke of this being flexible depending upon individual preferences at the time along with the timing of meals being based on the events of the day. Taster sessions continue to occur to help identify the food preferences of people being supported and increase the range of menu choices offered. There are plans to develop talking menus to further enhance choice. A staff member spoke of how the meal times have positively changed with the introduction of active support. Food is often served on dishes with people being supported, encouraged to then serve themselves. As previously noted not all people being supported had active support plans in place for preparing meals which led to inconsistent practises being observed by the inspector when a person was being assisted to eat. The person appointed to manage agreed to address this as a matter of priority. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and health care 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. People being supported benefit from the provision of flexible and respectful personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The medication systems are well managed promoting good health. Evidence: All persons supported by the home are assessed as requiring some level of personal support. Staff demonstrated a good awareness of the support needs of individuals with particular reference to communicate needs. Staff consistently feedback that the development of person centred planning and active support plans has positively changed the way they provide care to much more of an enabling role to encourage independence. Cultural assessments are undertaken for each individual to highlight what cultural or religious support is needed. Staff were mainly observed providing support in an engaging and sensitive manner. Staff showed much sensitivity to the privacy and dignity of people being supported and were able to give many examples of how they Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: promote this in their every day care practises. A health care professional fedback they always appear to treat the clients with respect and dignity. Good attention was given to the personal appearance of people being supported, which was age appropriate and afforded choice. The organisations policy is that only female staff are able to provide personal care. People being supported at the home are supported to access a range of health care services, to meet their individual health action plans. This included GPs, district and specialist nurses, dentists, psychologist, opticians, speech and language therapists. A health care professional fedback they are always welcoming to me they give correct accurate information. A listening devise is used to monitor for seizures during the night for one person being supported. Staff fedback that there is specific medical instructions why prompt intervention and monitoring is needed regarding this individual seizures, which was highlighted in risk assessments. However in order to ensure the person being supported rights to privacy the person appointed to manager confirmed that they would develop guidance on how and when the listening devises are used. No individuals are assessed as safe to administer their own medication. Care plans now record how each person being supported would like to be supported to have their medication. The medicine administration practises observed was seen to be safe and the records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Good practises were noted in the administration of (PRN ) medication which provided staff with instructions when these types of medication should be prescribed and records of when they were prescribed to ensure that there use can be effectively monitored. Care Homes for Adults (18-65 years) Page 20 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure in place for people being supported, their representative and staff to follow should they be unhappy with any aspects of the service. This includes the procedure also being available in an audio format. Although it is recognised by staff that the people they support would require full support to make a complaint and were knowledgeable on how they would support people living at the home to do this. The person appointed to manage reported that there have been no formal complaints made since the previous inspection. Relatives continue to confirm that they felt confident to raise any concerns that they had. A relative commenting that the person appointed to manage shows real concern when they have expressed some minor concerns in the past and addressed them promptly. There are written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff members consulted with all said that they had undertaken safeguarding adult training and demonstrated an understanding of their roles and responsibilities under Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: safeguarding adult guidance. Where safeguarding referrals have been made to social services since the previous inspection, the home have acted promptly and in accordance with safeguarding procedures and which have not resulted in any changes to practises being requested. Care Homes for Adults (18-65 years) Page 22 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 being supported live in a clean homely environment with their personal accommodation furnished and decorated according to their individual needs and lifestyles. Work has started to create a more sensory stimulating environment for the people living at the home with a visual impairment through the use of orientation prompts and specialist equipment Evidence: The home is located in a semi rural location and is a converted domestic bungalow. The premises are owned by a housing association that is also responsible for most aspects of maintenance and the external decoration. It was evident the considerable effort is made by the home to ensure that maintenance issues are reported promptly to the housing association with any outstanding issues being regularly chased up with them. In accordance with the previous requirements improvements to the environment have been undertaken which has seen the redecoration of some communal areas, a bathroom, new boiler, new dining room furniture and addressing the unpleasant odour Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: in the garden. In addition the home has started to create a more sensory stimulating environment through displaying textured wall and door coverings and objects of referenced as door plates to aid orientation. There are plans to fit new flooring in communal areas in early 2010 as well as continue with the redecoration of the rest of the home, new front door and improved the lighting throughout. There is a large rear secure garden which has a large crazy paved patio area which contains seating and plants. There are plans to level out the patio to address the concerns noted at the previous inspection of the suitability of this uneven flooring for people with a visual impairment. Ramps with hand rails have now been fitted to promote easy access to the patio area from the house. New garden furniture has been obtained and a person being supported purchased their own garden swing. Staff fedback that during the summer people being supported grew some vegetables and flowers which proved popular and enjoyable. A relative commented the garden looks nice, they seem to have sorted out the septic tank as it no longer seams to smell. People being supported bedrooms were individualised to reflect their lifestyles and preferences. One bedroom has recently been redecorated to a good standard and another was in the process of being redecorated with the occupant actively involved in the process. The home provides a range of individual aids and adaptations to assist mobility and independence, including ramps and grab rails. To address a previous requirement the person appointed to manage confirmed that individual assessments have been carried out, for some individuals, by an occupational therapist in relation to the suitability of the services and facilities. This highlighted some specialist equipment which was needed and some redecoration suggestions. Specialist equipment such as talking microwaves and information signs and boards have also been obtained to support the people living at the home with a visual impairment. All parts of the home visited were observed to be cleaned to a good standard. A relative fedback the home always looks clean. Systems are in place for the control of infection with staff undertaking hygiene and cross infection training. Staff were observed to be working in ways that minimised the risk of infection, by appropriate protective clothing when required. Care Homes for Adults (18-65 years) Page 24 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 being supported by the home benefit from a staff team who are well trained and that know them and who are employed in sufficient numbers as is necessary to meet their needs. However at weekends and over the festive holiday staff are not being appropriately supervised through the lack of suitable management cover. Evidence: The tasks of the day appeared well organised with staff aware of what their specific roles were and who they were supporting. Staff consulted with showed a good knowledge of the individual needs of the people they support and were generally observed interacting with individuals in a positive manner. Relatives and staff consulted with felt that generally there was sufficient staff on duty for people being supported to get the support they needed when they wanted it. Staff confirmed that there is some flexibility in the staffing hours should they need additional cover but generally there were three staff (sometimes with additional management cover) on duty throughout the waking day. A staff member fedback that the staff team is more stable now as more permanent staff have been employed. Some bank staff remain employed with the person appointed to manage confirming that they use the same bank staff to promote continuity. Relatives commented on the Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: number of different staff they see each time they visit but felt that this did not impact negatively on standards of care and that staff were always knowledgeable about their relatives needs. A sample of comments made about staff included since the last inspection the staff seem to try harder although you see different staff they are all very nice staff they know their job ,they are always able to answer any question that I have they do a brilliant job and they are all very kind and helpful. A staff member fedback wonderfully to work here the staff are happy to help and show you how to communicate with the residents. In line with the previous requirement staffing deployment had been reviewed. The shift times had been slightly extended to ensure that the people being supported choices of what time they went to bed was not restricted by the staffing hours. The home has been proactive in ensuring that the recommended number of staff have completed National Vocational Qualifications (NVQ) in care. Staff consulted with confirmed that they had undergone all of the mandatory training in fire, food safety, first aid, safeguarding adults and manual handling needed to help them work safely with the people they support. Some areas of specialist training have also been completed, in visual impairment and mental capacity. Staff spoke of the training in active support being particularly beneficial. Newly appointed staff confirmed that they had undertaken a comprehensive induction into the home, which included the organisations induction course and the industry, recommended minimum induction standards workbook. Staff consulted with who did not have any formal training in learning disability spoke of undertaking this in the near future. Over a five week staff roster viewed only two shifts at the weekend had been covered by a manager or senior carer. Over key dates during the festive period very little management or senior care cover had been allocated. The roster indicated the person in charge at weekends which were support workers. Staff confirmed that they were able to contact the manager or the organisations duty manager if they needed advice or support. Staff spoke of receiving some formal supervision from the management team and generally felt supported to carry out their roles. The person appointed to manage agreed to review the management cover to ensure that staff were being suitable supervised during the weekend and festive period and that there was always suitable competent persons left in charge of the home in their absence. The person appointed to manage confirmed that a spot check has been undertaken since the previous inspection, during the night, to assess the quality of the services being provided. They were aware of the need to ensure that these were undertaken Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: more frequently in order to ensure the regular supervision of staff and further promote people being supported safety and wellbeing. Care Homes for Adults (18-65 years) Page 27 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. People being supported at the home benefit from a management team that continues to develop their knowledge of good practises and who ensures a clear ethos of the home enabling staff to provide good quality support. A range of regular health and safety checks helps to promote the health and safety of residents and staff. The home regularly reviews aspects of its performance through a program of self review and feedback and acts on the information and feedback it receives. Evidence: The home has been without a registered manager since October 2007. Since the previous inspection there has been much more stability in the management and senior management at the home as bore out by the significant improvements to practises noted in this report. The person appointed to manage the home was again in the process of applying to the Commission to become the registered manager, as they Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: had withdrawn their previous application in order to undergo further personal development. The person appointed to manage demonstrated much clearer understanding of the day to day running of home and of good practises in the care of people who have a learning disability. They have continued to undergo training to keep themselves updated in changes in legislation and good practise guidance. Consistent feedback was received regarding how easily accessible the person appointed is. A sample of comments about the management of the home included fantastic very supportive management communication can be a problem sometimes nothing written down to pass onto staff can phone her anytime chatty nice person now a lot better as new senior appointed, much better support and manager so nice to talk to very understanding very approachable. There are several mechanisms in place for the home to assess the quality of its services and facilities. This includes the implementation of a development plan completed with senior management. This highlighted the key areas for service development at the home and the action they would take to address the shortfalls noted at the last inspection. This was near completion and has involved the introduction of more personalised active support and the ongoing improvements to the environment. The area manager undertakes the required monthly audit of the home, on behalf of the organisation, to monitor the services and facilities and completes a comprehensive written report on their visit. Feedback surveys are also used to obtain feedback on the services provided and the performance of the home which are sent to relatives and other stakeholders annually. The results being sent to the organisation who in tern forward on this feedback back to the home to address. Changes to the environment and activities have been undertaken as a result of this feedback. Written guidance is available on issues related to health and safety. Records submitted by the person appointed to manage stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. This includes monthly health and safety checks undertaken by staff and annual audits by the organisation. The person appointed to manage confirmed that mixer values are fitted to hot water outlets in order to regulate hot water within a safe temperature range and temperatures monitored regularly. Systems were in place to support fire safety, which included regular fire alarms and emergency lighting checks, staff training, maintenance of fire equipment and fire drills were reported to have been undertaken. The person appointed to manage reported Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: that they have undertaken a fire risk assessment which recorded significant findings and the actions taken to ensure adequate fire safety precautions in the home. 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 1 33 18 That at all times suitably competent persons are left in charge in the Managers absence. To ensure that service users are in safe hands and their wellbeing is promoted. 15/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 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. 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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