Care Home: Stratton Road (20)

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What the care home does well People have key workers. This means they have someone especially for them, to make sure they get the support they need and that other staff members know about their needs. The staff at the home have a very good understanding of the people they support. People choose how they want to use their time. They can be on their own when they want, or join in with others. They can go out, or stay in. People enjoy lots of activities, in the home and outside. They have pub lunches. One person was going swimming without staff support. Some people had part time jobs.People have the things they want in their bedrooms. There is a safe garden. People were enjoying learning things, like how to use computers, at the activity suite in Marlborough. There were also games there, and opportunities to make music or try arts and crafts. People help keep the house clean and tidy. They go shopping. They choose what they want to eat and help to cook it. There is lots of fresh food in the home. The home is clean. It has good furniture and it is looked after. When people are not well they are helped to get the help they need from people like nurses and physiotherapists. Staff know how to give people their medicines. The staff have lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. When a new member of staff starts, managers and other staff help them understand what support the people living in the home need. The people that run Innovations visit the home often. They know the people that live there. When they visit they make sure things are being done how they have been agreed. They find out what people think about the home, so they can decide how to make it work even better for the people that live there. They make sure things are done safely, and people know what to do if there is an emergency. What has improved since the last inspection? They have better information to give to people, to tell them about the home. They have designed a better way of writing people`s support plans, using computers. This means people can be more involved in writing their own support plans, in a way that they like. People are encouraged to have goals to aim for, in their support plan, which we suggested last time we visited. All new members of staff have an induction time, when they learn important things before they start on their own to support people in the home. Staff and the people living in the home told us there was always at least one member of staff available. At our previous inspection, we said Innovations must make sure of this. This was because in 2007, lack of staff meant a person sometimes had to spend time at another Innovations home. This no longer happened. When the managers find something is not right, they make sure everyone knows who has to make it better, so they can check later. What the care home could do better: After this visit we have not made any requirements about things that have to be done. This is because we have seen that the home is run well, and people who livethere are happy with how it meets their needs. We found that the windows upstairs did not have a way to stop them opening too far. This does not mean they are dangerous, but we recommend they should be assessed, so they can be made safer if necessary. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stratton Road (20) 20 Stratton Road Pewsey Wiltshire SN9 5DY two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Roy Gregory Date: 0 4 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Stratton Road (20) 20 Stratton Road Pewsey Wiltshire SN9 5DY 01672564957 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) : Innovations Wiltshire Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection 1 1 0 9 2 0 0 7 A bit about the care home 20 Stratton Road accommodates three adults with a learning disability. It is one of four residential care homes owned by Innovations Wiltshire Ltd. Miss Bev Britten is the Registered Manager and Mrs Nan Lance is the responsible individual. Mrs Angie McGrorty, service manager, makes up the management team. The home is in a residential area of Pewsey, within walking distance of shops, doctors surgery and other amenities. The home is a semidetached house, furnished to a good standard. People have single rooms, one on the ground floor and two upstairs, with toilets and bathrooms on each floor. They share a living room, kitchen-diner and garden. The home has at least one member of staff on duty throughout the waking day and sleeping-in cover is provided at night. Fees for living in the home are based on individual need. 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 Good Excellent Excellent Good Good Excellent Good Good How we did our inspection: This is what the inspector did when they were at the care home We visited 20 Stratton Road on Wednesday 2nd September 2009 between 5:15 p.m. and 7:45 p.m. We then visited the Innovations office in Marlborough on Friday 3rd September. We met everyone that lives in the home. They showed us their bedrooms and the rooms they share. They invited us to share their evening meal. We chatted at the meal table, together with the member of staff that was working there. We were also able to talk with people on their own. They spoke about how they spent their time and what it meant to them to live at 20 Stratton Road. We looked at the papers in the home, that explain what support people need and how staff work with people to keep them safe. We could also read about activities people did. We saw how medicines were kept. The member of staff who was on duty spoke to us about the work they do, and how they are trained and supported. The senior support worker for the home came to join us for some of the time. We met Bev Britten, the registered manager, earlier in the day at another Innovations home that we visited. When we visited Innovations company office in Marlborough we looked at how staff training is organised. We checked how Innovations appointed new staff, to make sure people could not start working until their background had been checked. We also saw the new activities suite, including the computers provided for people that use Innovations services. We sent out survey forms to the people supported by the home. We received these before our visit. Support workers had filled in forms with two of the people. One of the forms was filled in by a persons relative. We have received survey forms from Innovations staff, doctors and community nurses, about Innovations services, for other visits we have made in 2009. The service provided us with an Annual Quality Assurance Assessment [AQAA] when we asked for it. This told us what Innovations have planned, to make sure the home goes on providing support how people want them to. What the care home does well People have key workers. This means they have someone especially for them, to make sure they get the support they need and that other staff members know about their needs. The staff at the home have a very good understanding of the people they support. People choose how they want to use their time. They can be on their own when they want, or join in with others. They can go out, or stay in. People enjoy lots of activities, in the home and outside. They have pub lunches. One person was going swimming without staff support. Some people had part time jobs. People have the things they want in their bedrooms. There is a safe garden. People were enjoying learning things, like how to use computers, at the activity suite in Marlborough. There were also games there, and opportunities to make music or try arts and crafts. People help keep the house clean and tidy. They go shopping. They choose what they want to eat and help to cook it. There is lots of fresh food in the home. The home is clean. It has good furniture and it is looked after. When people are not well they are helped to get the help they need from people like nurses and physiotherapists. Staff know how to give people their medicines. The staff have lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. When a new member of staff starts, managers and other staff help them understand what support the people living in the home need. The people that run Innovations visit the home often. They know the people that live there. When they visit they make sure things are being done how they have been agreed. They find out what people think about the home, so they can decide how to make it work even better for the people that live there. They make sure things are done safely, and people know what to do if there is an emergency. What has got better from the last inspection What the care home could do better After this visit we have not made any requirements about things that have to be done. This is because we have seen that the home is run well, and people who live there are happy with how it meets their needs. We found that the windows upstairs did not have a way to stop them opening too far. This does not mean they are dangerous, but we recommend they should be assessed, so they can be made safer if necessary. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Roy Gregory CQC South West Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA Tel: 03000 616161 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 set out 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 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 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. Peoples aspirations and care needs are assessed prior to them being offered a service, taking into account the needs of people already supported by the home. Good information is made available. Evidence: The home had a pictorial combined service user guide and statement of purpose, produced in an easy read format, which contained the necessary information. There was evidence at the company office that there was ongoing review of how best to produce information of use to people living in the home, their relatives, and people considering placement. The people living at the home have done so for several years. Therefore no admissions have occurred for a long time, and none are in prospect. However, we have seen that an admission at a nearby home, also provided by Innovations, was based on a full assessment and was followed six months later by a full review, showing the company has sound procedures for assessment and admissions. We have also been advised by the company that people they support at 20 Stratton Road may be invited to consider alternative ways in which their needs may be met. A dialogue has been opened with the local authority and Innovations management have recognised that independent advocacy would play a large part in any decision-making process. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs and goals are assessed and reviewed through a planning system that promotes recognition of rights and abilities to make choices. People are actively involved in making decisions, individually and as a group. Risks are recognised and minimised to enable participation in every day life experiences. Evidence: Support plans for all three people in the home were very well written. All used standard headings. They gave concise but clear guidance to peoples own abilities, and to the areas in which some level of support was necessary to promote independence and enjoyment of life. People were clearly familiar with their plans, and said they took part in reviews. For a person with particular communication needs, their plan gave clear guidance on how to engage with them, based on experience and outside professional advice. We could see that this persons confidence in verbal communication had increased since our previous visit. Care plans emphasised a person-centred approach, to include respect for diverse needs. We saw at the providers office that work was in hand developing a support plan format on computer, which people being supported could directly input to. This allowed for inclusion of pictures. People living at 20 Stratton Road were already engaged in this and felt positive about it. People were encouraged to decide goals that they were aiming to meet, as recommended at our previous inspection. All plans included provisions for how to promote privacy. They showed how people liked to use their private rooms and how they wanted staff to make contact. People in the home said staff always knocked at their doors, and waited to be invited in. Evidence: Observations of staff interactions showed that people were consistently offered choices, and able to make decisions about everyday matters. We saw that people in the home chose how they spent their time, including making use of the shared rooms and their private rooms. They were supported to discuss things together, particularly at the meal table, and also had formal house meetings. Risk assessments seen were specific to individual needs, designed to facilitate participation. For example, we saw risk assessments about community access, bathing, making hot drinks, and cleaning in the house. The assessments were completed to a good standard, in an effective format. Some had been amended, showing they were working documents that were reviewed. They were checked as part of monthly management audits. 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. Varied activities give people access to the community and opportunities to develop skills and leisure interests within the home, local community and wider area. Significant relationships are supported. Menus are varied and service users can choose the food they prefer. Evidence: Two of the people supported by the home had part-time jobs for two days each per week. One person had been introduced to a local initiative to follow up a wish to go swimming, and was regularly going to the pool without staff support. They sometimes chose not to go swimming, and told us it was always up to them. One person showed some photos of when they had decided to dress in Scottish costume. A member of staff had assisted them to obtain and adapt various items. The fact that the photos were kept in the sideboard drawer in the dining room showed that people felt ownership of the whole of the home as theirs, and that they chose a significant degree of sharing. There was a cosy sitting room with television, and the garden provided another shared space. At the same time, they each also had a strong sense of attachment to their respective bedrooms, where they had things associated with their individual interests, audio-visual equipment and treasured possessions. Innovations had started up an activities suite within the company offices in Marlborough, which we saw. Here there were a number of computers for the use of people supported by all Innovations services. People were learning to use e-mail and webcams, and were involved in designing their own support plans. There were also Evidence: music and arts and crafts resources. There were plans to recruit an activities worker and to offer a service to people outside Innovations services. The people living at 20 Stratton Road were very enthusiastic about this development. They were making a lot of use of the computers. One of them was keen to progress to getting a laptop of their own, having identified how it could support a particular interest. Another of the people in the home was getting a lot from the arts and crafts provision, and a particular game had been provided at their request. The company had vehicles available to help get people where they need to be at different times, using staff from any of the homes to drive, as appropriate. People could plan to go out for shopping and other trips. Records showed they did so often. They also made use of public transport. People in the home had experienced holidays together, both in this country and abroad. Friendships among the group were very important to them. However, one of them had chosen to make holiday arrangements separate from the other two in 2008, and had been supported to achieve this. Sometimes the three people had a pub meal, using savings from the housekeeping budget. The evening meal that we were invited to join was a very pleasant, sociable occasion. The people in the home had chosen which vegetables to have, from a range of fresh vegetables in the house. Two of them had prepared the vegetables and assisted generally with the cooking of the meal, one of them making gravy. People confirmed they always made choices about meals, and were fully involved in shopping for food. The record of meals served showed good variety and healthy eating. There was evidence in support records of dietician advice having been sought an acted on for two of the people living in the home. After the evening meal, one person chose to go to their bedroom in order to watch the television news. The other two people chose to remain chatting at the table, with a hot drink. The member of staff showed an appreciation of peoples respective communication styles. People told us they got up, went to bed and had baths and showers as they chose. They were involved in household tasks, such as vacuum cleaning and using the laundry equipment, and expressed in pride in their home. A relative of one of the people living at the home told us, they have taught X to be more independent in looking after [them]self, also in cleaning [their] own room and helping within the care home. 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. People receive personal care in ways they prefer. Peoples health needs are assessed and monitored, with close liaison with health professionals as necessary. People are protected by the services policies and procedures for handling medicines. Evidence: Peoples support plans gave detailed guidance on what support, if any, people needed with personal care, and the people had indicated their agreement to their plan contents. There was good attention to maintaining routine medical appointments, and these were always well recorded. People were weighed monthly and there was evidence that significant changes were acted on, for example, two people were being supported to follow dietary advice obtained, and one of them was also being encouraged to exercise. Another person had a routine exercise programme, which staff followed under physiotherapist guidance, related to mobility needs. The physiotherapist had recommended a further hospital assessment for this person, that had resulted in a course of medical treatment that staff were supporting. A psychology assessment had been requested for one person, on the basis of observations made by staff over time. In the light of the outcome, the senior support worker intended there would be some specialist training made available to staff. All staff already had annual updating training about epilepsy, delivered by a communitybased nurse specialist in learning disabilities. There was evidence of good liaison between Innovations and both the community team for people with learning disabilities, and local health resources, including the GP surgery. There was not a great deal of use of medications in the home. Peoples medicines were Evidence: kept in cabinets in their own rooms. There were agreements signed by a GP about homely medicines that people could take. People had given their signed consent to receipt of medicines from staff. There were plans to support one person towards selfadministration of medicines. Members of staff undertook training in medicines administration. The supplying pharmacy provided workbooks for staff to complete. Senior support workers oversaw the process, and revisited assessment of competency within routine staff supervision. It was planned by Innovations to enrol at least one of the senior support workers in the company on a more advanced distance learning course in medications practice. Medicines Administration Records [MARs] were routinely checked by management. We found good record keeping, including records of the use of prescribed topical creams. The companys protocol for the use of medicines was prominent in the front of the MAR folder. 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. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. Evidence: The home had not received any complaints since the previous inspection. The service had worked on improving the accessibility of the complaints procedure and explaining it to people living in the home. By holding regular house meetings and with the nature of staff interactions, and peoples access to external professionals, people in fact had many opportunities to voice any dissatisfaction. This meant that potential complaints by people receiving a service were likely to be recognised and resolved at an early stage. All staff received annual updating training about abuse awareness and safeguarding. There was provision for newly recruited staff to receive this quickly as part of induction. A recently recruited member of staff, who was on duty when we visited, confirmed this. They had received a copy of the No Secrets guidance to the local agreed inter-agency safeguarding procedures. A copy of this was also readily available in the home. Innovations have demonstrated to us that any issues of concern are taken seriously and there is co-operation with local safeguarding procedures. Internal incident forms, and notifications to us, demonstrate that staff are observant and keep objective records. Some people in the home were active in a self-advocacy group, whilst Innovations has a good record of arranging advocacy support to people as needed. Senior staff in the organisation had received training from Wiltshire Council about the Mental Capacity Act, including deprivation of liberties safeguards. A related information pack had been placed in each Innovations service, and it was intended that training opportunities would be extended to more staff. People living in the home had signed agreement to receive support with how they managed money. They received monies from appointees and staff supported them, as Evidence: they wished, to ensure they had cash as they needed it and for longer-term needs such as holidays. There were routine management checks of money records for accuracy. There was a protocol to follow if a person should go missing. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 20 Stratton Road provides a homely, safe environment, suited to the needs of the people who live there. It is maintained and kept clean to a good standard. Evidence: All of the home presented as clean and homely. The three bedrooms reflected peoples differing personalities and interests. They confirmed they had chosen their colour schemes. The shared rooms reflected that the home was lived in. Furnishings and decor were of a good standard. Cleaning schedules were used as a guide to ensure standards were upheld, rather than as a rigid framework. There was a utility room with washing machine and drier, and washing was dried outside when the weather allowed. An environmental health officer had visited the home since our previous inspection, and identified no areas for attention. There were good arrangements within Innovations for attending quickly to maintenance issues as they arose. The company employed a gardener to cover all the homes in the group. This meant the enclosed garden provided further shared space for socialising and relaxation. 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 are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. Evidence: Two of the three people that lived in the home had relatively low support needs. During the day, there were many times when one or more of the people were out. Therefore, the standard for staffing the home was one support worker, but with additional staffing at regular times to ensure people got one-to-one time. This in turn meant that when more than one person was in, a pair of staff could offer support together, or could divide themselves between support within the home and outside, thereby increasing choices available to the people living in the home. Staff and the people supported confirmed to us that staff availability was much improved after our previous inspection, when we made a recommendation to keep staffing under review. This was because at that time, it was sometimes necessary for a person to spend time at another Innovations home due to lack of staff to support them otherwise. This practice had ceased. People enjoyed consistency of staff. A senior support worker was the anchor point for the home, working shifts there and providing supervision to other staff who regularly worked there. She told us that any shortfalls in staff availability were always covered by existing staff offering overtime to cover, or by use of Innovations bank staff members. Therefore there was no need to use external agency staff at any time, and continuity for the people supported was preserved. A recently recruited member of staff was on duty when we arrived at the home, later joined by the supervisor. The new member of staff told us her induction included a great deal of shadowing of experienced staff in all the Innovations homes, and reading of support plans, risk assessments and other guidance. She had frequent opportunities Evidence: for probationary meetings. We saw her induction pack. She was due to undertake two days formal induction training. Her personnel file at Innovations office showed she had been subject of a detailed interview. On the interview panel was a person that receives a service from Innovations. It has been identified that two of the people supported at 20 Stratton Road would like to be involved in interviewing prospective staff. There was evidence at the office of recent efforts to secure training to enable them to do this. We saw that staff were appointed only after receipt of references, and confirmation that there was no evidence that they were unsuitable to work with vulnerable people. Across the whole company, staff were expected to enrol for National Vocational Qualifications [NVQ] in care, and there was a high level of achievement to level 2 and above. The senior support worker at 20 Stratton Road was working towards NVQ level 4. A training matrix at the company office showed that training was planned in advance and different training providers were considered, to ensure training met the particular needs of people being supported. One member of the administrative team at the company office had particular responsibility for identifying and booking training resources. Individual staff files held good evidence of training received. Bank staff were fully included in training events. Supervision records kept at the company offices in Marlborough showed staff received regular one-to-one supervision from a senior carer, approximately six-weekly. This included reference to direct observation of peoples working practices. The company had introduced annual appraisals for all staff. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team provides leadership and direction so people benefit from a well run home. There are systems for monitoring and improving the service provided, based on direct feedback from people that have a stake in the service. There are a number of measures in place to promote and protect the health and safety of people that live and work in the home. Evidence: Whilst Innovations has a manager registered to each of its homes, in this case Bev Britten, there is very much a management team approach towards all the services provided by the company. Everyday oversight of individual services is maintained by senior support workers, who are qualified to NVQ level 3, and all managers share in management monitoring and strategic development of all services, together with Nan Lance and the operations director. Bev Britten is completing her Registered Managers Award, having been held up by a significant period of sick leave. She works a regular weekly support shift at the home. The company undertook a staff team building exercise during 2008, which had led to an action plan for the companys development. There was a record of monthly whole staff team meetings. Members of staff were expected to attend at least one in three of these. Therefore staff were in touch with the companys development aspirations, and new procedures were adopted across all services at the same time. The home received a monthly management monitoring visit. An extensive checklist ensured all areas of provision were looked at in some detail and showed how matters for action were delegated and followed up. The company operated a quality assurance system based on questionnaires sent to Evidence: people using the service and their supporters. There was evidence that responses were acted upon in order to tailor the service to peoples wishes and expectations, or to ensure people were aware of the reasons for certain decisions or practices. Key worker meeting forms included an action section so staff could demonstrate how feedback obtained directly from the people supported was used to make changes. All staff received regular training in food hygiene, first aid and manual handling. The senior support worker in the home gave wheelchair training to staff across all Innovations services. This was of particular relevance to a person living at 20 Stratton Road. There were a number of environmental risk assessments, which staff had signed. Risk assessments were reviewed through routine management monitoring. We observed that upstairs windows did not have restrictors that would prevent them being opened wide enough to constitute a hazard. We said the risk should be assessed, so that protective measures could be taken depending on the degree of assessed risk. There was safe storage of substances that could be harmful to health. There was evidence of regular testing of all fire equipment and of clear procedures to follow in the event of fire. Water, fridge and food temperatures were monitored consistently. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 42 The risks posed by unrestricted upstairs windows should be assessed, and addressed as appropriate. Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). 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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