Care Home: Smallwood

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What the care home does well People who are moving into the service have their needs assessed before a decision is made. People who use the service are supported to make decisions about their daily lives and people who know them well advocate for them. A multi disciplinary approach is taken to risk management with people who know the individuals well being involved. Early problems with providing a range of activities in the community is being addressed and people living in the service have a range of individual activities in their daily routines. People using the service are supported to access the local community and maintain relationships with the people who are important to them. Individual daily routines ensure that people`s rights and responsibilities are respected. People using the service are offered a healthy diet. Detailed personal support plans ensure that individual receive the personal support they need in the way they prefer and need. The homes policy and procedure on medication ensures that people are protected. There is a system in place to listen to people`s concerns and act on them. Staff and managers receive training on how to protect people from harm. People who use the service live in a homely and comfortable environment where steps are taken to address safety issues when they come up. Management are addressing training for staff who have less experience of supporting people who have autism. The service has a good recruitment procedure in place which means that people should be protected. Induction is structured for new staff and management have developed a plan to meet individual training needs. The manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. What has improved since the last inspection? This was the first key inspection of this new service which opened in January 2009. What the care home could do better: At the end of this inspection there are no requirements and four recommendations. it is important that information is the care and support plans uses information in the assessments consistently to ensure that staff have all the information they need to provide good support and care. To ensure that people in the home are protected all staff should complete mandatory training such as infection control with twelve weeks of starting work in the service. All staff should have the skills and knowledge to do their job well this means it is important that staff who are responsible for supervising others complete relevant training. To ensure the health, safety and welfare of people in the home are protected there should be a consistent approach to fire safety. Key inspection report Care homes for adults (18-65 years) Name: Address: Smallwoods Smallwoods Wards Drove Blandford St. Mary Dorset DT11 9LZ     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: Tracey Cockburn     Date: 1 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Smallwoods Smallwoods Wards Drove Blandford St. Mary Dorset DT11 9LZ 000000000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Voyage Ltd Name of registered manager (if applicable) Mr James Burnell Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Smallwoods is registered to provide care and support to eight young people with a learning disability. The service is owned by Voyage Limited a national provider with twenty years experience. Voyage operates around 250 services across the UK. The home has eight single bedrooms each with en-suites. The home is split into three properties, one has five single bedrooms, the cottage has three single bedrooms and there is a separate activity room and sensory room. There is a large garden. The home is close to the nearby town of Blandford forum and the amenities there. The weekly fees are dependant on individual needs and 1:1 support. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without giving them any warning. We completed a key inspection which looks at key standards looking at outcomes for people using the service. We visited the home over two days. We looked at the annual quality assurance assessment as part of the planning process, as well as the registration report on the service completed before it opened in January 2009. We looked at information sent to us about the service including concerns raised by social workers, notifications of incidents and information about staff changes. We sent out survey forms to people who use the service, people who work in the service and health care professionals. We received three surveys back from people who use the service and three from people who work in the service. People who use the service have complex needs and are not able let us know their views of the service directly. During the visit we observed life in the home. We spoke to managers and staff. Throughout the report the term we is used to demonstrate the information and Care Homes for Adults (18-65 years) Page 5 of 30 judgments are that of the Care Quality Commission. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are no requirements and four recommendations. it is important that information is the care and support plans uses information in the assessments consistently to ensure that staff have all the information they need to provide good support and care. To ensure that people in the home are protected all staff should complete mandatory training such as infection control with twelve weeks of starting work in the service. All staff should have the skills and knowledge to do their job well this means it is important that staff who are responsible for supervising others complete relevant training. To ensure the health, safety and welfare of people in the home are protected there should be a consistent approach to fire safety. Care Homes for Adults (18-65 years) Page 7 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service and their representatives have the information needed to choose a home that will meet their needs. The assessment process is detailed and person centred. Evidence: We looked at the care files for two people who have moved into the service since it opened in January 2009. The annual quality assurance assessment submitted to the commission states: *We accurately gather all information from families,social workers and previous providers to ascertain the exact needs to be met within the home. Geographical vicinity in relation to families has been considered to promote easy access and regular visits. Families have played a pivotal role in choosing bedrooms, colour schemes and designs from the outset. Accurate transitions have enabled Service user input into the environmental preferences and personalisation of appropriate areas. Prioritising identified Risk Assessments and ensuring staff are suitable trained in carrying out and recognising the need for vigilance. they also say in the AQAA that they can improve by: Ensure that support staff and Management are involved from the outset and all previous Care,Support plans and vital information Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: is given and evaluated accurately taking into account any changes to such needs that may be very recent, in preparation for a new service users transition to commence. Carry out a detailed assessment of service user abilities in current environment and how to implement a totally person centred progressive support plan for the future within the new environment. Establish further development programme for each individual so as to promote and enable a successful path of progression as soon as a service user moves into the service. Feasibility and compatibility studies of how service users will interact with each other, and what environmental factors need to be considered in order for service users to maximise their potential without being limited or dis-empowered due to needs of others. We found during our visit that people did have detailed assessments of their needs and a transition process, which included meetings with parents, the individuals themselves, other people who know them well such as staff at education establishments. One person told us in a survey forms that: some information that i fed back to the home was ignored Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive through individual communication systems. Evidence: We looked at the support plans for two people who use the service. We found the support plans contain detailed information on how people need and prefer to be supported. The annual quality assurance assessment states: * Further Risk Assessment for all staff * Improve Support plans in a more visual, person centred format using chosen communication tool. * Totally specific methods of providing detailed support to ensure a universal understanding by all support staff of how to provide the best possible support at all times. * Greater staff knowledge of local resources will then provide more choices available to individuals and therefore enable them to make more informed decisions. One person who uses the service wrote in the survey form that: It would be very Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: helpful to me if everybody saw the value of and used all of the time my communication system, I have speech and because of this it is sometimes not used The care plan for one person contained personal details,this included a description of me, preferred daily routine, likes and dislikes, communication, weekly plan, interests and hobbies. The plan of support covered physical health, communication, personal care, mobility, social skills, relationships, activities, behaviour, decision making. Each of these headings detailed the support the person needs and how to enable them. We looked at two peoples files and found both to be consistent in providing comprehensive information that staff would be able to follow. We found that both support plans were very individual and followed principles of person centred care. These plans are not in the accessible format we found with the weekly plan of activities. We found that the individuals representative had signed pages of the support plan but this was not consistent and some pages had not been signed. We found in one plan that some information which was in the assessment was not in the support plan. We looked at the weekly plan for one person which contained a variety of different activities many of which were based in the home. However the manager told us that as people settle in to the home activities will be expanded in line with what individuals can cope with. In one file we looked at there were short term and long term goals in relation to activities, one persons short term goal was to plan a holiday and their long term goal to participate in a holiday. There were also goals relating to daily living skills one person has a short term goal to change the bedclothes with prompting and the long term goal is to do it independently. Each person has risk management strategies in place and agreed with all the people involved in supporting the individual. The manager discussed a recent meeting when a potential hazard was identified for one person and actions were suggested as to how this could be minimised. Action has been taken previously when risks have been identified and there are risk assessments in place. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style and supported to develop their life skills. Social, educational, cultural and recreational activities are tailored to individual needs. Evidence: Some of the people living in the service are still in full time education, during the team meeting, staff were discussing activities for the summer holidays and seeking out places to go in the community and what some people would like to do. The staff and manager at the service have developed activity plans for people using the service. We observed activities taking place and listened to staff working with individuals. Activity boards are in place for each person currently living in the home, using their preferred method of communication for several people living in the service this system is PECS, Picture Exchange communication system. One person had a Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: board outside their bedroom with pictures on a board these are changed according to the day and the routine in place. The annual quality assurance assessment tells us that the home believe they do the following well: * 3 of 5 service users currently attending schools and we are in regular contact with these schools, to ensure that relationships are good. Communication books used between school and home, to keep up to date with Service user progress or any daily issues or concerns. *Service users actively visit social places such as swimming pools, pubs and restaurants,parks and tourist attractions. * Close family relationships are maintained for all 5 service users with regular visits to both homes respectively. * Activities and social time is encouraged and supported between service users where appropriate. *Carefully structured daily activity schedules are in place in pictorial/symbol format. * Weekly Activity Schedules are used to compile daily plans. * All outcomes of activities recorded daily. * Service users actively choose with their meals and are supported to prepare and cook their own meals. A varied and nutritious menu is available each week, and amended accordingly. All likes and dislikes are recorded. * All meals are aimed at being a communal social activity in the dining room of each house. * Activity room in service is used as part of educational topics such as communication, art and crafts, music and movement and numeracy. * Support plans reflect a clear daily routine that is amended when required with service user participation throughout. * 2 Vehicles are on site solely for Service users to use. * Monies provided towards an annual holiday for each service user and daycare costs are covered to enable service users to enjoy a growing range of leisure facilities. * Medical exemption cards obtained and bus passes applied for. Timetables and brochures for many facilities are available. * Statement of purpose, Residency contract and service user guides all in service. We found that each person has an individual activity plan which is on their communication boards each day using the individuals preferred method of communication. One person who lives in the home returned a survey form which said: Mum would like me to have more opportunity to access things outside of home that I would like to do but this is improving. We also had staff surveys returned where several staff expressed views that there were not enough staff in the service to enable individual activities, however we also received comments that this was improving and further staff have recently been employed. We looked at the menus these are planned several weeks in advance. There was evidence of healthy food being offered and fresh fruit and vegetables were in the fridge. We spoke to the manager who told us that each person in the service has an amount Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: of money each month which they can spend on activities. Staff are being encouraged to use this money. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: We looked at documentation completed by staff on health care appointments. Each person has a health folder which contains their health action plan, symbols and pictures are used. We noted in one persons folder there was a medical appointment but we could not find any information on the outcome of that appointment. It is important that outcomes are recorded so staff are up to date with any changes. We spoke to a member of staff about an appointment for one person and how the emergency appointment came about. we were told that the person was indicating to staff through the use of PECS that he had pain in his mouth. Staff called the GP and paramedic who came out and advised on treatment. Staff supported the person to an emergency appointment the following day. We spoke to staff about this and looked at the way they had recorded the incident. The staff responded quickly to the persons needs and sought appropriate advice and treatment. Throughout the two days we were at the home we observed staff supporting people in a way which was conscious of their individual communication needs and mindful of their routines and need for Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: space. Medication is stored securely, there are no controlled drugs stored in the home at the time of the visit but they do have a CD cabinet which meets legal requirements. All staff are now being trained in safe handling of medication. Initially only senior staff were trained to administer medication. A monitored dosage system is used and they do not currently use covert medication for anyone. The annual quality assurance assessment tells us that they believe they do the following well: * Ensure that all service user appointments are made, attended and followed up, recording accurate outcomes and significant events. * Amend all support plans so they are current, showing the exact processes involved in support people with their individual personal care needs, ensuring that they are empowered and not de-skilled. Risk assessments are enabling and accessible to all staff. * Widget Symbols used effectively to prompt and guide service users to be as independent as possible. * Regular liaising with families especially if medical related questions are asked. * Medication audits are carried out and all MAR sheets are accurate and relevant. * Keyworkers assigned to ensure all toiletries are purchased and preferred. * Daily schedules include Personal care routines, allowing appropriate timescales for service users to be actively involved, in a relaxed and supported way. * All medical professionals are contacted accordingly and staffing levels are accurate when supporting to attend appointments. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service communicate their concerns and worries in a variety of different way, systems are in place to reflect this and ensure individuals are listened to. Staff receive training to understand abuse and how to protect people. Evidence: The complaints procedure is in an accessible format. We noted that for one person on their personal communication board there is the sign I want to make a complaint which he gives to staff if he is unhappy about something. Since the service opened there has been one safeguarding investigation which relates to the transition of people into the service and concerns about the level of support and activities provided. There was also concern about the experience and training of staff employed to work in the service. Since the service opened the manager has changed, as well as the operations manager. We found that lessons have been learned about the opening of the service and the new manager who is now registered has addressed concerns raised at this safeguarding meeting. The annual quality assurance assessment tells us that the service believe they do the following well: * All staff , service users and families are aware of the complaints procedure and process and the company policy is robust and current. * All service users have symbols format Complaint cards easily accessible * All staff are NCI trained (Non-Violent Crisis Intervention) * Daily NCI drills carried out and recorded. * Staff are vigilant with who visits the service and all security measures are adhered to as per protocols in place. *Mandatory Induction training for all staff Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: covers POVA and on going refresher training attended by staff and management. * The Letting us know what you think Policy is easily accessible for Service users/families. * Whistleblowing Policy is covered on staff induction. * MSR carried out by Operations Manager and covers different areas each month. * Service user monies are accurately recorded and staff trained to follow correct procedures. Both the manager and the deputy manager are book on safeguarding training with a local authority in July 2009. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes to the environment have minimised risks and ensured the home is a safe place to live. It is comfortable and well maintained. To ensure the home is hygienic staff have to understand the principles of infection control. Evidence: The home provides accommodation for eight people, five people living in the main house and three in the cottage. Each person has their own bedroom which they choose with the support of people who know them well. All bedrooms have an en-suite bathroom. There is a large lounge and a separate dining room. Most of the communal rooms are accessible to all the people living in the home. The kitchen is accessible with support. The service is not a secure unit for young people, however due to the vulnerability of the people living there, precautions have been put in place to ensure that it is secure and protocols are in place for staff on what they have to do. There is a sensory room for people to use which staff said provides a good space for people who use the service. The manager told us that staff are going to have sensory training to they can help people get the full benefit of the room. The annual quality assurance assessment says: *New Service - January 2009. As of late, the service has undergone various improvements to ensure that it remains, safe, presentable, clean Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: and hygienic, such as baths being fitted, new flooring, additional security measures, and increased equipment and leisure activities. A sensory room has been installed. Plants have been planted and areas have been effectively identified for their full potential such as activity room, dining room, bedrooms and outside areas. Staff training is on-going to ensure that all areas of the site, are compliant and kept to an extremely high standard. They also tell us that: * Service users can personalise or de-personalise their private space, and all parts of the service clearly shows whos house it is, who lives there, and how they are involved in activities, cooking, leisure time and generally enjoying living in the home. During the site visit we walked round the home, we found there was good storage for linens and the home was clean. We found the home to be clean and free from offensive odours at the time of the visit. However two of the survey forms returned from people who use the service said that the home does not always smell clean and fresh. We were concerned that a large number of staff have not yet completed their infection control training this could have a detrimental effect on the cleanliness and hygiene in the home. We discussed this with the deputy manager who is responsible for all mandatory training and ensuring staff complete this urgently. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to training mean that staff are encouraged to learn the skills they need to support the people living in the service. Evidence: Health and social care professionals have expressed concerns about the training staff receive,specifically around specialist training and lack of experience. We found that all new staff have to work through an on line induction and foundation course covering all mandatory training, they have 12 weeks in which to complete the course which they have to complete in order to complete their probation. Once they complete the on line training they are automatically put onto the National vocational qualification (NVQ) training and learning disability qualification (LDQ) training. We also found that while some staff have been recruited with little previous experience of working with younger adults all the senior staff in post do have experience. The annual quality assurance assessment sent by the service states: * General Social Care Council Standards booklets provided to ensure that staff are adhering to these regulations, and supporting all service users to maximise their potential. * Personnel files contain previous experience information and all training certificates are copied, to be kept on site. * EL BOX is the internal mandatory electronic training provision that all staff must complete over a 12 week period, prior to successfully completing their 6 Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: month probationary period of employment. * LDQ, NVQ 2,3 and 4, and RMA are all part of an extensive training programme that Voyage offer, based from the training department. As soon as staff complete the common induction standards on the EL BOX, they are enrolled onto the LDQ , and as their 6 month probation is signed off, they are enrolled on the NVQ2. * The Deputy Home Manager has key responsibilities in ensuring that all staff carry out this training and is vigilant in monitoring progress made, and provides time on the rota, for staff to actively carry out this training when on shift. * Staff Team photo board show the whole team. Notice board is regularly updated with all current memos, protocols, Voyage magazine and amendments to procedures. One member of staff wrote on a survey form: we have some very passionate, motivated and dedicated staff in this team Some one who lives in the home wrote in the survey form under the question;Do the staff treat you well All staff are very kind and although staff have had to learn very much as things have evolved everyone is very kind. further autism specific training would be very helpful We looked at the staffing rota and found that on the two days we inspected the rota had the following staff on duty: On the 18th both the deputy manager and the registered manager were on duty all day There was a senior support worker on duty from 7:30am to 3pm and three support workers with the same in the afternoon. There are thee night staff one asleep and two awake. The night shift runs from 10pm to 8am which is 10 hours. There is a 30 minute handover at the start of each shift. The rota has the full name and job title of each person working in the home and their contracted hours. We spoke to senior support workers who are responsible for supervising support workers, they have not had any specific training in supervision. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed by people who understand the needs of the people living there and are working together as a team to ensure that system are robust and protect the individual. Evidence: The manager has successfully become registered with the commission and has demonstrated over the two days of the inspection that the service is being managed by someone who has put management processes into place and has developed a staff team which work well together. We observed a staff meeting and listened to staff discussing the support of the people who live there are working together to find solutions to situations. We found that the deputy manager who is in charge of training has good process in place for ensuring that staff complete their training in a timely manner. We found that some staff who started working in the service when it opened were not up to date with mandatory training but the deputy was aware of the problem and addressing it. The annual quality assurance assessment stated the following about what they need Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: to do to continue to improve: *More Localised Training courses could be sourced. * More Clear and structured action plans in most effective format to implement for the future development of : Menu Planning Health and Safety Checks and Maintenance/Repairs Service User Holidays and activities Staff training and recruitment Service user progress, development and long term goals. The annual quality assurance assessment tells us: * Of paramount importance, is that the Management of the service, ensures that the main objective is to create and maintain a service that truly lives up to its promise and commitment to the people that we support, in providing a place of safety, security, comfort, support and guidance for the entire duration of the individuals time living in the service. * Ensure that the service has a well trained, experienced Registered Manager, Deputy and 3 Senior Support Workers. *Manager in post has been working in this field for the last 4 years, has an NVQ 3 in Health and Social Care, a BTEC HND in Catering and Institutional Management and experience in Managing many types of establishment, gaining a lot of experience in Autism , Learning disability and Complex Needs. * Senior Support Workers have been assigned support staff to supervise, and the Deputy Manager supervises them. The Home Manager then supervises the Deputy, and attends all Senior Support worker, team and Service user meetings. Probation and appraisal meetings conducted by the Home Manager. Operations Manager makes monthly visits to carry out Monthly service reports. * 2 keyworkers per service user have been assigned to cascade any requirements to the rest of the team. * Ensure that all policies and procedures, manuals and updates are read and signed by all staff. * Involvement of whole team with new ideas and viewpoints. * Put the Service users needs first, and all support staff have regular guidance on how to implement new plans and practices to ensure consistent approaches. * Carry out all required checks and reports maximising individuals skills and experience so as to give a fair and productive distribution of responsibilities across the staff team. We received one survey form from a member of staff which said: we have a good management and seniors do their job well giving structured shared workload they also said feel management supports me well The service has corporate quality assurance systems in place and parts of this are working well such as the regulation 26 visits whereby the operations manager visits monthly and completes a report on how the service is doing. Each month a different area is audited such as conduct and management, health and personal care. The registered manager submitted regulation 37 notifications when an incident occurs in the home and send the commission weekly updates. We looked at health and safety systems within the home and found that staff are receiving training in safe working practices and where there are gaps the deputy manager who is responsible for training is aware of them and has taken steps to Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: address them. We found that hazardous substances are safely locked away. As the service is new all the servicing of heating and electrical and plumbing is up to date. We looked at the fire records and found that each person living in the home has a personal emergency evacuation plan. the fire risk assessment had been updated on 29/05/09 and a fire safety audit completed on 3/05/09. Junes fire audit had been completed on 10/06/09 and mays fire audit had been completed on 31/05/09. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The registered manager should ensure that care and support plans are consistent with the information in the assessments. The registered manager should ensure that all staff undertake infection control training with 12 weeks of starting work. This will ensure they understand the principles of infection control and maintain the well being of people using the service. The registered manager should ensure that any staff who are supervising others have training in this aspect of their job. The registered manager should make sure that the monthly fire audits are consistently spaced out as there was a gap of only ten days between the May fire audit and the June fire audit. 2 30 3 36 4 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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