Care Home: Stratton Road (27)

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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. They go out for walks and to clubs and shows. They have pub lunches and play skittles. They are helped to keep in touch with their families and friends. They have the things they want in their bedrooms.People help keep the house clean and tidy. They go shopping. They choose what they want to eat. There is lots of fresh food in the home. When people are not well they are helped to get the help they need from people like nurses and doctors. When they are in hospital they get lots of help from the staff from the home, to make sure they are well looked after. In the home, staff know how to give people their medicines. They know how to look after people with epilepsy. The nurse who answered our survey said the staff were very good at looking after people with a learning disability. If people needed special furniture this was obtained for them. The home was clean and it was looked after. There was a safe garden. The staff have lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. 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 improved how they obtain information to decide if they can support someone who is interested in living at the home. They also have better information to give to people, to tell them about the home. All new members of staff have an induction time, when they learn important things before they start to support people in the home. There is now someone to come and look after the garden, so staff don`t have to do things like mow the grass instead of being with the people in the home. 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: People had different kinds of support plans. A new kind of plan that would suit everyone was being designed. We think this should be used as soon as possible so staff will know exactly how to support each person. Someone outside the home should sign a person`s plan, to show they agree with it. The staff have to spend some time working at night. This means they have less time to work in the day time. This makes it harder for them to have time for training or seeing their managers. The home may need to have some staff who only work at night, so the people living in the home can see more of their usual staff during the days. Some of the staff are not so good as others at signing. They should be given training to help in talking with and understanding people that use signing every day. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stratton Road (27) 27 Stratton Rd. Pewsey Wiltshire SN9 5DY The quality rating for this care home is: two star good service 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: 1 0 0 6 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 Inspection report CSCI Page 2 of 32 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Stratton Road (27) 27 Stratton Rd. Pewsey Wiltshire SN9 5DY 01672562691 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) : bill.innovations@googlemail.com Innovations Wiltshire Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Date of last inspection A bit about the care home 27 Stratton Road is a semi-detached house with single bedrooms for four people with learning disabilities. Two bedrooms are upstairs, with a bathroom and toilet nearby. The other two bedrooms are downstairs, close to a shower room with toilet. People share a living/dining room, kitchen and enclosed garden. Within walking distance is Pewsey village centre, with shops, doctors surgery, bus stops and a railway station. It is possible to park in the road outside the home. Care Homes for Adults (18-65 years) Page 4 of 32 The service is provided by Innovations (Wiltshire) Ltd. The company owns two similar care homes on the same residential estate as 27 Stratton Road, and a further care home, and domiciliary care agency, in Marlborough. Two company vehicles are available for use by the three homes in Pewsey, and there is some sharing of staff between them. Miss Bev Britten is the Registered Manager of 27 Stratton Road and her mother Mrs Nan Lance is the responsible individual. Mrs Lance, Miss Britten and the Innovations management team work closely together. Weekly fees are negotiated for individuals in accordance with the Wiltshire County Council fair pricing tool. A service users guide is provided to explain the nature of service people can expect. Care Homes for Adults (18-65 years) Page 5 of 32 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home We visited 27 Stratton Road on Wednesday 10th June 2009 between 1:25 p.m. and 8:15 p.m. We met everyone that lives in the home. They showed us their bedrooms and the rooms they share. We saw how people had their meals, and spent their time in the home. We looked at the written records kept by 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. Nan Lance spent time talking about how Innovations supports the home. The staff that were on duty also spoke to us about the work they do, and how they are trained and supported. During the afternoon we visited Innovations company office in Marlborough to see how staff training is organised. We also saw how a new form of support plan was being developed there. We sent out survey forms to the people supported by the home, to some staff and to local health professionals. One response we received was from a learning Care Homes for Adults (18-65 years) Page 7 of 32 disability nurse. She wrote about how the home worked with her, and with other people in the Community Team, to decide the best ways to support people who live in the home. We also heard from a doctor. Four members of staff returned surveys. Support workers had filled in forms for the people that live at the home. 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. They go out for walks and to clubs and shows. They have pub lunches and play skittles. They are helped to keep in touch with their families and friends. They have the things they want in their bedrooms. Care Homes for Adults (18-65 years) Page 8 of 32 People help keep the house clean and tidy. They go shopping. They choose what they want to eat. There is lots of fresh food in the home. When people are not well they are helped to get the help they need from people like nurses and doctors. When they are in hospital they get lots of help from the staff from the home, to make sure they are well looked after. In the home, staff know how to give people their medicines. They know how to look after people with epilepsy. The nurse who answered our survey said the staff were very good at looking after people with a learning disability. If people needed special furniture this was obtained for them. The home was clean and it was looked after. There was a safe garden. The staff have lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. 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. Care Homes for Adults (18-65 years) Page 9 of 32 What has got better from the last inspection They have improved how they obtain information to decide if they can support someone who is interested in living at the home. They also have better information to give to people, to tell them about the home. All new members of staff have an induction time, when they learn important things before they start to support people in the home. There is now someone to come and look after the garden, so staff dont have to do things like mow the grass instead of being with the people in the home. When the managers find something is not right, they make sure everyone knows who has to make it better, so they can check later. Care Homes for Adults (18-65 years) Page 10 of 32 What the care home could do better People had different kinds of support plans. A new kind of plan that would suit everyone was being designed. We think this should be used as soon as possible so staff will know exactly how to support each person. Someone outside the home should sign a persons plan, to show they agree with it. The staff have to spend some time working at night. This means they have less time to work in the day time. This makes it harder for them to have time for training or seeing their managers. The home may need to have some staff who only work at night, so the people living in the home can see more of their usual staff during the days. Some of the staff are not so good as others at signing. They should be given training to help in talking with and understanding people that use signing every day. Care Homes for Adults (18-65 years) Page 11 of 32 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 33 Greycoat Street London SW1P 2QF 02079792000 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 Care Homes for Adults (18-65 years) Page 12 of 32 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 13 of 32 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. Good information is made available. Evidence: There had been one admission to the home since the previous inspection, in October 2007. The person previously resided in another care setting, but was in temporary accommodation at the time of referral. They stayed at Stratton Road initially for three months trial stay. The service obtained appropriate pre-admission information from the previous provider, from the persons care manager and family. The decision to make the placement permanent was thus based on a full assessment and was followed six months later by a full review. The persons community care assessment showed how living at 27 Stratton Road fitted with their long-term assessed needs. A close relative of the person admitted said they were pleased there had been a vacancy in an Innovations home, because they regarded the provider as having a strong local reputation for good care provision. Their relatives previous long-term placement had been marked by obvious unhappiness and frustration. There had been clear positive changes since the admission to 27 Stratton Road, with none of the issues Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: that had characterised the persons previous placement. The home had a pictorial combined service user guide and statement of purpose, produced in an easy read format, which contained the necessary information. This met the requirement made at the previous inspection, that the statement of purpose must contain all the information required. 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, and their relatives. Care Homes for Adults (18-65 years) Page 15 of 32 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 . Peoples individual needs and goals are assessed and reviewed through a planning system that promotes recognition of rights and abilities to make choices. Risks are recognised and minimised to enable participation in every day life experiences, but peoples opportunities could be extended by improving the communication abilities of some staff. Evidence: For each person living in the home there was written guidance on their preferred daily routines, which included recognition of how to promote making choices. In addition there was a variety of support plans and care plans. Some were written in the first person and projected a person-centred perspective, some were more prescriptive with an emphasis on direct care provision. We thought it important that there should be a uniform pattern of personal planning that combines meeting of care and support needs, clearly cross-referenced to assessed risks, and with an emphasis on how a persons quality of life is to be enhanced. We saw, on visiting Innovations company office, that there was active work in progress to produce such a personal planning system. This was based on PowerPoint, with a view to incorporating pictures and Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: possibly video clips. This will make it easier for staff to evaluate progress against plans and to take account of changing needs. It is important that external agreement to support plans, such as from a family member or social care professional, should be sought and recorded. We recommended this at the previous inspection but there was little evidence of signed agreement as a matter of course. There was a key worker assigned to each person living at the home. Their role was to take primary responsibility for the persons care planning, to ensure appointments were followed up, to identify and support personal shopping needs and to advocate for resource needs. Members of staff we spoke to said the key worker role was also effective as a means of gathering the viewpoints of all the staff group, regarding each person being supported. They saw the people in the home as having complex needs, which demanded a co-ordinated approach from the staff group to ensure individual choices were recognised and supported. Risk assessments seen were specific to individual needs. They were completed to a good standard. Some had been amended, showing they were working documents that were reviewed. They were checked as part of monthly management audits. A persons relative commented that the person was able to make choices continuously about enjoyment of their personal space, being part of a group or engaging one-to-one with staff. The home ensured core routines and hygiene needs were met, in ways that were acceptable to the individual and did not impinge on their dignity or selfdetermination. However, the same person identified that abilities among the staff group to communicate with their relative using signing, varied from very good to poor. They thought one way in which the service could improve would be by training all staff to sign to a good standard. Care Homes for Adults (18-65 years) Page 17 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can take part in appropriate activities within the local community and wider area, whilst also being supported to enjoy resources available to them in the home. Significant relationships are supported. Menus are varied and service users can choose the food they prefer. Evidence: There was evidence of support to a variety of activity to meet individual interests and preferences, within the home and in the community. A persons relative spoke of the numerous opportunities for swimming, bowling, pub lunches and games, and walks. The same person had entertainments of their own in their bedroom, and also liked to watch television with other members of the household, or simply to be part of the group of people sharing the home. The relative was familiar with the home and thought it provided an experience like an inclusive family home. Their relative had formed a strong friendship with another person supported by the home. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: The home provided a car and also made use of public transport, although the need for wheelchair use in the community was a limiting factor with many buses. One person attended sometimes at a day resource centre, but this was soon to close. Staff we met were upbeat about the opportunities this would create in seeking resources in the community at large. However, two members of staff that responded to our survey thought that the number of staff limited the extent to which they could support people to make full use of community resources. People already attended the local sports centre, clubs and drama productions. One person belonged to a pony centre. All but one of the people in the home had a weekly meal together at a local pub, combined with a game of skittles. Some people preferred not to leave the home to any great extent, for differing reasons. They were well provided with activities that they enjoyed within the home and staff were able to respond to spontaneous wishes to go outside. Individual arrangements were made for people to maintain contact with their families. One person went most weekends to their family home, although a relative said sometimes the person chose not to do so because they preferred to join activities arranged within the home. For another person there had been recent discussions between their key worker and family members about how best to maintain contact. Arrangements had been made for one person to have Webcam conversations with a close relative who was unable to visit often. A persons relative who was accustomed to regular visiting said they were made to feel part of the home when they were there. Staff also helped them maintain telephone contact with their relative. Some people had holidays away with their families and the home arranged short holidays for people that wanted them. One person had chosen to go away with friends who lived at another nearby care home, and their key worker joined the holiday to support them. People in the home were included in conversations with staff members. They were invited to assist with meal preparation and to have drinks whenever they wanted. They were supported to make use of entertainments and hobbies within their bedrooms as they wanted to. Some people liked to help with tasks such as cleaning or laying tables, and were able to do so of their own volition. The menu was varied and the home was well supplied with fresh fruit and vegetables. There was daily consultation with people about what they would like to eat, using signing and pictorial aids as appropriate. All people in the home were involved in some way with shopping for food. For one person, concerns about their eating abilities had been referred for attention by a speech and language therapist. In the mean time staff were ensuring the person had a mainly soft diet, and were cutting harder foods into small pieces. Care Homes for Adults (18-65 years) Page 19 of 32 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 good liaison with health professionals as necessary. People are protected by the services policies and procedures for handling medicines. Evidence: Individual medical issues were effectively tracked, so it was possible to see the outcomes of previous appointments and arrangements for next appointments. Peoples weights were monitored. A learning disability nurse who is familiar with the home responded to our survey. She indicated that the home always properly monitors, reviews and meets the health needs of people who live there, and seeks advice to meet social and health needs. She added that the staff team very much have individuals needs in the forefront, and staff have improved considerably in all aspects of caring for people with a learning disability. We also received a reply from a doctor, who wrote, There is always a member of staff available who has full knowledge of the patient I am visiting as a GP. Two people had spent significant time in hospital within the previous year and in each case, the home had provided staff support within hospital. The close relative of one of the people said home staff never left his side during the hospital stay. The family Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: were kept informed of all developments during and after the hospitalisation. The relative considered the home very effective at securing additional resources when needed. For the other person who had spent time in hospital, after they were discharged home, additional funding had been procured in order to provide one-to-one care. The person had successfully come through what had been regarded initially as a period of terminal care. Recorded improvements in the persons wellbeing marked the success of how the staff cared for them, and the degree of liaison sustained with health professionals. There were written care guidelines for each person that specified how people preferred to receive personal care. Staff we spoke with were well aware of the detail of these guidelines, which were kept readily available for any staff who might not be so familiar. Personal care was provided by staff of the same gender as the person supported. For a person who needed occasional use of oxygen, there was a written protocol for safe administration. This was signed by a health professional, who had also recorded establishing the competency of individual members of staff to undertake this aspect of care. The same person had an epilepsy emergency intervention plan, which included a protocol for use of a specific rescue medication. This was of recent date and staff had been trained accordingly. All staff received training about epilepsy annually. For one person, staff were monitoring epileptic episodes in a specific and timed way, at the request of the epilepsy specialist nurse, to aid her in refining the treatment plan. There were arrrangements for some people in the home to receive home visits for dental check-ups. Where a person was assessed as at risk of pressure damage, there was a risk assessment in place. There was scope for this to be more wide-ranging, to show for example how concerns around incontinence and nutritional needs, identified elsewhere in the care record, linked to pressure area risk and how the risk could be lowered. Each bedroom had a medicine cabinet, so peoples medicines were kept individually and administered to them in the privacy of their own rooms, although the MARs [medicines administration records] were kept centrally. Following an error in administration in 2008, there had been a temporary policy of requiring two staff to be involved in all medication administration, until management were satisfied that the risk of repeated error had been fully addressed. There were agreements signed by a GP about homely medicines that people could take. We found good recording of all aspects of medicine administration, except for a person whose close relative had supplied some over-the-counter medicines. These had been written up as needed on a MAR, but not checked by a second member of staff, and greater clarity was necessary. Care Homes for Adults (18-65 years) Page 21 of 32 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: There is a culture of ongoing dialogue between people that live in the home and the staff that support them. Additionally, managers from the company, including the provider Nan Lance, are frequent visitors. The home is receptive to visiting relatives, friends and professionals at any time. Therefore indicators of unhappiness or discontent are likely to be recognised and communicated at an early stage. Relatives we spoke to said they were fully aware of the channels open to them to complain formally, to Innovations or to outside agencies, although they were confident any issues would be addressed without such recourse. The home had received no formal complaints in the previous year. The homes Annual Quality Assurance Assessment stated that all people in the home had received guidance suited to them about how to raise any concern, and this was revisited in one-to-one key worker meetings. Training records showed all staff had received refresher training in safeguarding children and adults during 2009. Innovations have demonstrated to us that any issues of concern are taken seriously and there is co-operation with local safeguarding procedures, although this has not been relevant to 27 Stratton Road within the past year. Training opportunities in respect of the Mental Capacity Act and deprivation of liberty safeguards were being researched. All injuries found on people living at the home were recorded by way of body map, whether the cause was known or not. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Incidents arising were well recorded and shared with appropriate people. There was clear liaison with local health and social care professionals about behaviours that could indicate or cause distress, and how to manage them. Staff were trained annually in managing difficult behaviours, with an emphasis on recognising triggers and deescalation. There had been no use of physical interventions in the previous year. The learning disability nurse that responded to our survey wrote that the home staff will always keep team members [i.e. the community team] informed of injuries, incidents, health issues etc. There was a risk assessment for each person in the home regarding their vulnerability in respect of money. As a result, personal monies were held in safe keeping by the home, with individual records kept of receipts and expenditure. Nan Lance checked these records at every monitoring visit, and the system was further audited externally each year. Care Homes for Adults (18-65 years) Page 23 of 32 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 . 27 Stratton Road provides a homely, safe and clean environment, suited to the needs of the people who live there. Evidence: People displayed pride in their bedrooms, each of which reflected occupants age, gender and interests. People had their treasured possessions around them, as they wanted. There were no restrictions on how people used the communal rooms, including the kitchen, or the garden, as staffing levels allowed for support to be available. We saw that people made choices about where they wanted to go, and which furniture they wanted to use. Some specialist furniture had been obtained, for example, anti-tip dining chairs and individual armchairs. One person had been provided with a hospital bed following referral to occupational therapy. Another person had the benefit of pressure-relieving mattress and cushion until pressure area concerns had been resolved. The home had been visited by the environmental health officer during 2008 and the kitchen had been awarded four stars [out of five]. We found the home was clean in all parts. There were weekly and daily cleaning schedules, which were monitored to ensure standards were maintained. Aprons and gloves were readily available, and people living in the home were supported to use these when assisting in the kitchen. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The laundry room had plenty of space and was well organised. The garden was plain but provided a safe outside space. The company employed a gardener to cover all the homes in the group. This addressed our recommendation from the previous inspection that support staff should not be expected to undertake tasks such as mowing lawns. We identified a loose water tap. We were able to confirm this had already been identified by staff that day, and referred to the companys maintenance person to be fixed. Care Homes for Adults (18-65 years) Page 25 of 32 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: The home had a core staff group of five, so they were reliant on inputs from other Innovations support staff who also worked in other homes provided by the company. This was not a drawback, as a strong team ethos is fostered across the company, and the three homes in Pewsey are very close to each other. The staffing rota provided for three staff on duty during most of the day, and a waking member of staff at night. This meant a total of five staff were used in a 24-hour period. Staff we spoke to felt confident in this level of provision, which allowed them to give a lot of one-to-one attention to people and to feel supported by each other. A persons relative spoke of consistency of staffing. However, the change to waking night staffing [as opposed to sleeping-in cover], in response to increased needs at night, was impacting on the hours staff members could work by day. This will need ongoing monitoring, to determine whether at some point, specialist night workers may be necessary to relieve pressure on the day duties. All the core staff group had obtained NVQ [National Vocational Qualification] in care to at least level two and we saw that for staff across the whole company, NVQ acquisition Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: was expected and was the norm. A training matrix at the company office showed that training was planned in advance and different training providers were used for different courses, 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. 28 members of staff were about to attend accredited food hygiene training, in four groups. Sampled recruitment records showed new staff were appointed only after the necessary checks about their backgrounds were completed. We saw that for one person, issues raised in a reference from a former employer had been pursued, and followed up by requiring an extended probationary period, with frequent initial individual supervision. In line with our recommendation from the previous inspection, all new staff underwent a structured induction. There were arrangements to ensure a chain of regular staff supervision. Senior support workers were supervised by the management team, and in turn gave one-to-one supervision to support workers. One of the negative consequences of night working was that the senior support worker for the home was finding fewer opportunities to provide supervision time. This had been identified within his own supervision and appraisal. We saw that some supervision was provided by other senior personnel, including in one instance the development director. Records of supervision were kept in a consistent way and showed that they covered a wide agenda, in depth. Generally, support staff were being supervised two-monthly. In the Annual Quality Assurance Assessment, there was acknowledgement of some shortfalls and the reasons behind them. Care Homes for Adults (18-65 years) Page 27 of 32 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 . Arrangements have been made for the good management of the 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 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 development director. The latter was appointed in 2008, on a part time basis, to help identify ways of developing person-centred care, and to put them into action. For example, he was leading on development of the new support plan format. The company undertook staff team-building exercises during 2008. 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 Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: development aspirations and new procedures were adopted across all services at the same time. There were also management-only meetings. The home received a monthly management monitoring visit. An extensive checklist ensured all areas of provision were looked at in some detail. In line with our recommendation, it was clear how matters for action were delegated and followed up. A member of staff said she appreciated the openness with which management performed its role. Bev Britten was completing NVQ level 4 in management. She had been set back by a long period of ill health since the previous inspection. The company operated a quality assurance system based on questionnaires sent to 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. Feedback from people being supported by the service was obtained by key worker meetings. The company had an annual development plan. All staff received regular training in food hygiene, first aid and manual handling. There were a number of environmental risk assessments, which staff had signed. There was safe storage of substances that could be harmful to health. The home was fitted with automatic closing fire doors. There was evidence of regular testing of all fire equipment and of clear procedures to follow in the event of fire. Correct procedures were in place for the use of oxygen. Care Homes for Adults (18-65 years) Page 29 of 32 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 1 2 14 (1) (c,d) The home?s admissions policy and assessment tool must enable the registered person to confirm in writing whether the home can meet the person?s needs in respect of their health and welfare. 01/08/2007 Care Homes for Adults (18-65 years) Page 30 of 32 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 6 The current work on a unified person-centred support planning system should be progressed as a priority task, to ensure consistency of provision and of evaluation. The format adopted should include provision for obtaining supporters signed agreement. All staff should be trained in communication methods appropriate to the people supported by the home. Pressure area risk assessments should incorporate a wider range of factors that may add to a persons vulnerability to developing pressure ulceration. For the identified person, seek greater clarity about the need for homely medicines and terms for their use. Continue to monitor the impact of night-time working on the staffing rota, and consider ways to reduce this impact if necessary. 2 3 7 19 4 5 20 33 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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