Care Home: Sun House

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What the care home does well People thinking of moving into the home are provided with sufficient information to enable them to decide if the home is likely to be able to meet their needs. The home provides a pleasant and supportive environment for the people living there. Although none of the bedrooms have en-suite accommodation the overall standard of the environment is good and the managers have plans to continue to improve the quality of the home. The home has a pleasant garden. The home is well located for the amenities of Aylesbury including shops, cafes, pubs, a cinema, specialist drop-in and support services, and local healthcare facilities. Support is provided by trained and supervised staff. Staff providing support to users have received appropriate training, have access to further opportunities for training and development, and are well supervised. People who live in the home benefit from a range of opportunities for social and leisure activities. Where possible the home supports people in training and employment schemes. Users are supported in leading fulfilling lives in line with their choices and abilities. The healthcare needs of people are addressed by staff in liaison with health and social care services in the community. In particular the home liaises with users GPs and the local community mental health services. What has improved since the last inspection? Staff have developed craft sessions which have proved popular with users. These involve planning, acquiring and using a range of materials, making craft objects, and displaying the finished product in the home. These contribute to the quality of the home`s environment. Users have been invited to be involved in the recruitment process for new staff. just under half have participated to date. A number of improvements have been made in the garden including new lighting and in particular lightin in the arbour for users who like to smoke in the garden. New flooring has been laid in some rooms, new TVs and DVD/video players have been acquired for the lounges. Users and staff have taken short breaks in Bognor Regis in Sussex and Bere Regis in Dorset and regular day trips are planned using a `People Carrier` which is hired for the occasion. There have been significant changes in staffing since the last inspection. The manager is confident that staffing has now settled and that the current staff team will make further improvements to the service with consequent benefits for users. What the care home could do better: The home must ensure that its arrangements for dealing with complaints are included in the statement of purpose and the service user`s guide and that users are informed of those arrangements. The home must give notice to the Commission of events which may have an adverse effect on the care of users living there. The home must ensure that it can provide evidence that all of the pre-employment checks on staff have been carried out before they start work in the home. Information on individual users which is potentially confidential should not be displayed on notice boards on view to other users and visitors. Handwritten entries on medicine administration records (`MAR` sheets) should be signed by two members of staff. Both signatures should be of staff approved to administer medicines in the home. The home should again review its practice of using communal towels in WCs and bathrooms. Such a practice can increase the risk of cross infection. Key inspection report Care homes for adults (18-65 years) Name: Address: Sun House 127 Tring Road Aylesbury Bucks HP20 1LQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 2 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Sun House 127 Tring Road Aylesbury Bucks HP20 1LQ 01296338103 01296338103 sunhouse@nildram.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hightown Praetorian & Churches Housing Association care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Sun House is a care home providing personal care and accommodation for eight people with mental health problems. It is owned and managed by Hightown Praetorian and Churches Housing Association. The home is located about one mile from the centre of Aylesbury on the main road to Tring and is conveniently situated for buses, shops, education, social and recreational facilities in the town. The home is established in the area. It is a converted property and its style is in keeping with other properties in the neighbourhood. The home is on two floors and does not have a lift. All bedrooms are single. The home is a medium to long-term service and urgent or emergency Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 8 Brief description of the care home admissions are not accepted. Referrals are only accepted through the mental health care programme approach (CPA). The residents are supported by an established staff team supported by the Community Mental Health Team. Fees for living at Sun House can be obtained on application to the provider. Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in September 2009 by one inspector. The inspection included an unannounced visit to the home on Monday 28 September 2009. The visit took place between 9.45 am and 7.30 pm. The manager sent us the services annual quality assurance assessment (AQAA) in advance of the inspection. The AQAA was clear and and comprehensive and gave us most of the information we asked for. The inspection included consideration of the information in the AQAA. It also included discussion with the manager, staff and users. We looked at the homes Statement of Purpose. We observed activity in the home - especially how staff and users got on together. We inspected records. The records included individual support plans, medicines Care Homes for Adults (18-65 years) Page 6 of 34 administration records, and staff records. We looked around the house and garden.We looked at the arrangements for administering medicines. We looked at things users and staff told us about the home in a survey carried out for this inspection. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 34 The home must ensure that its arrangements for dealing with complaints are included in the statement of purpose and the service users guide and that users are informed of those arrangements. The home must give notice to the Commission of events which may have an adverse effect on the care of users living there. The home must ensure that it can provide evidence that all of the pre-employment checks on staff have been carried out before they start work in the home. Information on individual users which is potentially confidential should not be displayed on notice boards on view to other users and visitors. Handwritten entries on medicine administration records (MAR sheets) should be signed by two members of staff. Both signatures should be of staff approved to administer medicines in the home. The home should again review its practice of using communal towels in WCs and bathrooms. Such a practice can increase the risk of cross infection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving to this home can be assured that they will be given sufficient information and an opportunity to visit the home before deciding whether they wish to move there. Most prospective users can have confidence that the homes procedures for assessing needs will enable it to consider whether it can meet those needs. This process may be compromised however, where the home is given insufficient time to give full consideration to a referral. Evidence: The statement of purpose outlines the aims of the home (Service Provided), a detailed description of the accommodation (including the dimensions of each bedroom), an outline of the homes arrangements for involving residents in running the home, its support for residents in social activities, a summary of its philosophy, admission criteria, details of staffing, staff induction and training, a confidentiality statement, and finally, a note on changes to the document. The document does not include reference to the complaints procedure. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: The home has thorough and well established systems for assessing the needs of prospective users. The home works closely with the community mental health team (CMHT) and only accepts referrals from that source. The admission criteria are set out in its statement of purpose. Before referral the prospective user will have been involved in an assessment carried out by a member of the CMHT under the care programme approach (CPA). This includes an assessment of needs and an assessment of risk. The referral is then routed through a Placement Panel whose remit is to find accommodation which might best suit the person. With the prospective users consent relevant information is shared with the home. The information is taken account of as part of the homes own assessment of the persons needs and its consideration of whether it can meet those needs. The home provides information to the person as required. The process includes pre-admission visits to the home. Should all parties agree to admission then an initial admission of one month is agreed. Progress is reviewed with the user and their Care Programme Approach (CPA) key worker as required but a formal multi-agency review meeting is held at the end of the first month. The home expects support from the Community Mental Health Team during the transition period. Evidence of this support was noted during our visit to the service when a social visited to arrange a consultation with a users GP. On occasions the home has found that pressures elsewhere in community health services can lead to efforts by professionals to circumvent the process outlined above. The manager has found that agreeing to admission in such circumstances, particularly where the CPA care plan has not been fully thought through, can increase the likelihood of an unsuccessful admission and consequent disruption for the new resident, current users of the service, and staff. A small home such as this has limited capacity to deal with such problems. Care Homes for Adults (18-65 years) Page 12 of 34 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. People living in this home can be confident that their needs are understood and that staff will provide support appropriate to meeting those needs. This will include liaising with local community health and specialist mental services as required. Evidence: A support plan is drawn up for each service user. Support plans are based on a structured Person Centred Plan format. The format covers the range of support planning from preparation, through to the formulationation of a plan, progress records and summaries, monthly, six monthly and annual reviews. Each service user has a key worker who is responsible for co-ordinating the process and for involving the user in their own plan. The plans seen on this inspection were of a good standard. Plans included an assessment of needs and a plan to meet those needs. Plans took account of the care programme approach (CPA) care plan drawn up by the community mental health team (CMHT). Plans included a photograph of the person, basic personal information, a pen Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: picture of the person, summaries of key assessed needs, plans to meet needs, and risk assessments. Assessments included notes on the persons social needs, self-care, physical needs, social needs, domestic skills, and healthcare needs. Risk assessments included vulnerability (to exploitation for example), decline in mental health, smoking in own room, risks associated with self-medication, non-coperation with treatment programme, risks associated with other people in the community, and risk related to cooking in the kitchen. Plans included evidence of liaison with community mental health services (two teams the adult team and specialist mental health services for older people) and, where required, the persons GP. Liaison with the CMHT included a copy of the persons care programme approach (drawn up at a level appropriate to the needs of the person) and evidence of communication with the CMHT (for example a visit by a social worker on the afternoon of the inspection visit). Plans also included the activities in which users participated or required support. Daily notes are recorded at the end of each staff shift - twice a day. Progress is reviewed monthly by the user and key worker. A more comprehensive review, timed perhaps to inform the review of the persons CPA with the CMHT, takes place six monthly. One detail noted on this inspection was a display on a notice board of tasks to be carried out or appointments for the day for each user - identified by room number. In such a small home the display of such information could inadvertently breach an individuals confidentiality. Such information, which staff and users find useful for planning their day, would be better kept in a diary out of sight of those who have no need to know what others are doing for the day. Users are involved in decision making through day to day encounters with staff, involvement in their support plans, tea break meetings, and house meetings. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home benefit from support in accessing a range of activities, both in the house and in the wider community. This maintains contact with family and friends and the maintenance of social, intellectual and practical skills by participating in activities with others. Evidence: The home supports users to lead varied and fulfilled lives. Users are supported in drawing up plans for the day, the week and the month. Within the home users are encouraged to look after their own room, do a share of domestic tasks and prepare a meal for themselves once a week. Some like to help out in the garden occasionally. The type and range of activities is agreed with each user and people are not put under undue pressure. On Friday evenings users and staff arrange a social event in the home around a meal and DVD. Barbeques have been held in the garden over the summer and people living in the home have invited family and friends to such events. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Users are free to go into Aylesbury and make use of the shopping, cafes, pubs, cinema and leisure facilities as they wish. Many users go to drop-in and day centres in Aylesbury. One person used to go to a Richmond Fellowship work based project in the town until it recently closed. Arrangements were being made for a referral to an alternative service around the time of this inspection. One user was currently a student on an Open University course. Another had participated in a weekly dog walking scheme. One person had a long standing interest in ballooning, bungee jumping and chess and frequently participated in such events. Many service users were in contact with their family and friends. Some are in regular contact with their church. Staff and users have had short breaks in Bognor Regis and Dorset. They have also arranged day trips out, hiring a people carrier for a trip to Brighton for example. Over the summer one person has had a day trip on a canal. The manager told us that staff are keen to increase the range of activities on offer to users. Residents are involved in the day to day running of the home. A set of house rules is on display in the home. These set out house rules on such matters as smoking, illicit drugs, alcohol, keeping the house clean and tidy, that everyone is expected to participate in running the house, fire, noise, privacy, bullying, visitors, and use of cookers at night. They are designed to maintain harmony and co-operation in communal living. Meals are planned with users and both staff and users share in meal preparation. Menus are reviewed with users. The advice of a dietician is obtained through community health services when required. Users are weighed monthly. User whom we met during our visit seemed quite satisfied living in the home. One person expressed dissatisfaction with regard to transport for trips away from the home. This matter was discussed with the manager at the time. Other than that users seemed to find the pace of life in the home suited their needs. In our survey, in answer to the question What does the home do well? users responded: Domestic duties. Food prep. Looks after me; Feed me, do my washing. Let me go hot air ballooning; The home keeps me off the street; Cooking the meal for residents. Good activities in the home; and, Keep place clean. In answer to the question What could the home do better? users responded: Support me with getting my shopping and getting out and about; Nothing; I would like more Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: menu planning; and, Nothing for now. Care Homes for Adults (18-65 years) Page 17 of 34 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. Peoples health and personal care needs are met in a way which protects them from harm - in liaison with healthcare agencies in the community where require. The homes arrangements for the control, storage and administration of medicines are good and aim to ensure that services users receive their medicines as prescribed. Evidence: Users preferences with regard to their support needs are recorded in their support plan and are reviewed with staff as circumstances change. All users are registered with a local GP and with specialist mental health services either the local CMHT or specialist mental health services for older people. Access to some community health services - such as district nurses - is through the persons GP. Podiatry where required is provided through a local health centre. The services of an optician are obtained either through a high street provider or, where required, a visiting optician. Service users may use their own dentist or access an NHS dental practice through Manor House hospital in Aylesbury. Service users on depot injections attend a depot clinic at the Tindall Centre in Aylesbury. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The home has limited capacity in terms of material and staff resources and skills to meet significant general health care needs in the longer term. The CMHT or mental health services for older people provide specialist mental health support to service users. All users are registered with the local specialist mental health services. Access to psychiatrists, community mental health nurses (CPNs), social workers, and psychologists is through the specialist teams. Medicines are prescribed by the persons GP or by medical staff at the CMHT. Medicines are dispensed by Boots Chemists - most using the Boots monitored dosage system (MDS). Some medicines such as Clozapine are supplied separately. All medicines are checked by two staff on receipt in the home. Medicines are stored in two locked metal cabinets in the office. The interior temperature of the medicines storage cabinets are recorded three times a day. Medicines requiring storage in cool conditions i.e. below 8 degrees are stored in a lockable container in the refrigerator. The homes arrangements are subjected to an audit check by a pharmacist twice a year. The reports of such checks carried out in March and September 2009 were seen on inspection. It was noted that the arrangements were found to be in order. At the time of this inspection no service user was self-administering all of their medication. One user was managing their own insulin. Staff receive training on the administration of medicines as part of their induction to their job. Staff competence is assessed by a senior support worker and the manager. All staff with responsibilities for medicines administration are required to attend refresher training annually. Sample signatures of staff approved to administer medicines are available in the medicines cupboard. Examination of the homes procedures on this inspection showed generally good standards of practice in the home. Arrangements for storage appeared satisfactory and records of administration were in order. One point noted was that handwritten entries for Clozapine on MAR charts were not signed by two members of staff. Clozapine is subject to additional safeguards and is prescribed only after the results of a blood test are notified to the prescriber. Service users collect their supply from the hospital pharmacy. The details of administration are transcribed by home staff on to the persons MAR chart. It would be a good practice and safeguard for two staff to check and sign such entries. Reference texts available to staff and users in the home included a 2009 British Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: National Formularly (BNF) and a general textbook on medicines published by the BMA, 2005 edition. The home would be advised to obtain a more recent edition of of the BMA text and copies of the guidance of the Royal Pharmaceutical Society of Great Britain guideline for medicines in social care and of our guidelines on the administration of medicines in care homes. Overall, based on the evidence seen on this inspection the homes arrangements for control, storage and administration of medicines and for meeting users healthcare needs are good. Care Homes for Adults (18-65 years) Page 20 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home benefit from living in a safe environment where they are listened to and their interests and well-being are safeguarded. However, these otherwise good standards may be compromised by weaknesses in not informing people of the complaints procedure, not ensuring ready access to statutory guidance on safeguarding and not reporting safeguarding events as required. Evidence: The home has a pleasant and open atmosphere which is conducive to good communication between service users and staff. Staff and users seemed to have a comfortable relationship and during our inspection staff were noted to respond to any concerns raised by users. The home is required to conform to the complaints and safeguarding policies and procedures of Hightown Praetorian and Churches Housing Association. As stated earlier the complaints procedure was not included in the copy of the statement of purpose supplied for this inspection. The complaints process must be summarised for users in both the statement of purpose and the service users guide. The manager is required to report on complaints in the managers report which is submitted to senior managers monthly. Complaints are also looked at during the monthly proprietors visits. In answers to our survey question Do you know how to make a complaint?; of five service user forms returned three ticked Yes, one No, Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: and one wrote Not Sure. Good systems are in place for recording complaints. Five complaints have been recorded since 2008. All appeared to have been dealt with appropriately by managers. However, it is noted that two of those complaints were from staff. Staff usually have other means of communicating dissatisfaction - reporting to their supervisors or managers, formal supervision, meeting with their manager, handover meetings, and staff meetings for example. One person complained to us about a matter during the course of our visit. This was discussed with the manager later in the day. The complaint appeared to express disagreement with some aspects of the multi-agency care package and the implementation of those aspects in the home. Because of this it was agreed that this particular matter should be referred to the CMHT and the professionals with statutory responsibilty for the care package. The home was not in contact with a local independent advocacy service at the time of this inspection. The organisation has a policy governing procedures with regard to safeguarding vulnerable adults. It also provides training through its training department at head office. The home did not have a copy of the current Buckinghamshire joint agency policy on safeguaring. The manager undertook to obtain a copy the day after our inspection. The home has made one safeguarding referral since the last inspection. This was being dealt with by local statutory (health and social services) services at the time of our visit. Although this fact was communicated to us in the paperwork which preceded this inspection (the AQAA) we were not notified of it as required (under Regulation 37) at the time. This inspection finds weaknesses in some aspects of the homes arrangements for complaints and safeguarding. The ethos of the home facilitates openess in communication and appropriate reporting of complaints and concerns. The actions of managers with regard to complaints and safeguarding reflected appropriate concern for the welfare of users living in the home. The quality of the reports of monthly proprietors visits are excellent and confirm that managers treat these matters seriously. However, there is a need to update the statement of purpose and service users guide, perhaps to review the arrangements for recording complaints by staff, and to review the homes threshold for reporting to the Commission under the Regulations. The rating of these two key standards on this occasion reflect the findings of this inspection. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: The organisation provides training to staff on responding to aggression and violence. The home does not manage monies on behalf of users but the manager said that where possible it does maintain an overview of residents finances. There are facilities for safe keeping of cash and valuables if required. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home benefit from living in a well located, homely and well maintained environment. The home needs to be aware of the need to adapt practice to meet the changing needs of users and prospective users. Evidence: The home is located in a residential area on the main road between Aylesbury and Tring. It is conveniently situated for local buses and the amenities of Aylesbury town centre.The nearest rail station is at Aylesbury. There is limited car parking to the side of the house and further car parking in nearby roads. The home is a two-storey detached building which has been adapted for current use. Entry for non-residents is controlled by staff. The accommodation on the ground floor comprises, staff office and facilities, lounge, quiet room, laundry, kitchen, bedroom, shower and wc, separate wc, dining room, kitchen, and exit to garden. Stairs lead to the first floor. The home does not have a lift therefore the first floor is not accessible to a wheelchair user. The accommodation on the first floor comprises, seven bedrooms, two bathrooms (one with wc) separate wc, and store cupboard. All Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: bedrooms are single but none have en-suite facilities. The garden is a very pleasant area which has been improved in recent years. There is a small garden to the front of the home and a larger garden to the side and rear. The rear garden includes areas for seating, lawn, flower beds, and an arbour with seating. The garden is reasonably secluded through wooden fencing on its boundary. New lighting has been installed since the last inspection. The manager intends to continue to improve the garden over the next couple of years by replacing garden furniture and by growing vegetables and herbs in one area. The home has a pleasant ambience. Samples of users and staff craft work were on display on the ground floor. Users resident at the time of our visit expressed satisfaction with the accommodation. All areas of the home were tidy and clean on the day of our inspection visit. No untoward odours were noted. The overall standard of the accommodation good. The front lounge was in use for most of the day. Smoking is permitted in this room. We were informed that at the time of this inspection seven of eight users resident smoked. The furniture in the lounge is showing damage from the level and nature of use and should be considered for replacement. Since the last inspection a new television and DVD/Video player have been acquired for this room. The quiet room is a non-smoking room. This room was also used by users wishing to have a change from the activity in the lounge. It is also used for meetings with individual residents. The manager informed us that since the last inspection new furniture has been acquired for the quiet room. The kitchen and dining room was in good order, tidy and clean on the day of our visit. The kitchen units were scheduled for refurbishment. The kitchen is adequately equipped for current use. The home has not had a recent inspection from the local environmental health department but when inspected in 2007 it was awarded five starts for standards of practice. A new machine machine and tumble dryer have been purchased for the laundry. Five of eight bedrooms have been redecorated and had new flooring laid since the last inspection. The home uses the Workskills group, a mental health workskills project based in Amersham, to redecorate the house and garden. This is a commendable practice. The manager informs us that new bedding has been purchased for all rooms. The manager has plans for further improvements over the coming year. The report of the last inspection in October 2007 included a requirement that the Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: home seek the advice of the environmental health department on the use of communal towels and bath mats. The manager told us that they had sought such advice and had been informed that as long as the towels and mats are properly laundered every day then the risk of cross infection in such a service was minimal. The home needs to keep this matter under review. Communal towels are still in use and remain a potential source of cross infection - particularly in light of the changing needs of users and prospective users. One person living in the home expressed their concern about this during our visit. Care Homes for Adults (18-65 years) Page 26 of 34 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 living in this home benefit from the support of well trained and supported staff. This may be undermined however by delays in confirming that all checks have been completed before staff take up post in the home. Evidence: Staffing at the home at the time of this inspection consisted of one manager, one senior project worker and five project workers. This provides for one staff member between 07:00 and 08:00, two staff between 08:00 and 21:00, one staff member between 21:30 and 23:00, and one sleep-in member of staff at night. The turnover of staff during the year preceding this inspection was relatively high for this small home. However, matters had stabilised by the time of our visit and the manager told us that the new staff team had settled in well and that she now expected matters to remain stable for the foreseeable future. Permanent staff are supported by bank staff who have knowledge of the organisation and the home. Bank staff cover for absences due to sickness, vacancies, and planned and unplanned leave. At the time of our visit the home had some funded hours unfilled but which were held to cover unplanned events. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Users seem to have coped well with the changes and as stated earlier in this report there appeared to be a good relationship between users and staff. The home is supported in appointing new staff by the organisations Human Resources (HR) department at head office. HR staff process applications and provide advice on recruitment. The home holds a summary of the information held on each personnel file in the HR department. The summary forms were examined in the presence of the manager. Three of three forms did not have a recent photograph of the person (to meet part of proof of identity requirement). One form did not include evidence that health status had been checked. In one case the letter from the HR department confirming that appropriate checks had been carried out was dated late July 2009 when the person had started work in the home in mid June 2009. Such information should be available in the registered service from the time the person takes up their position. Staff have access to a comprehensive programme of training. This includes induction, update, specialist, and NVQ training. Computer based E-learning for update training is being rolled out across the organisation. Each member of staff maintains a personal portfolio which includes a schedule of training and certificates of attendance or attainment. New staff undertake induction training which includes completion of a workbook and attendance at some sessions at head ofice. Reviews are held at three and six months - the latter usually noting the end of the persons probationary period. The home is doing well with NVQ with five of seven staff holding NVQs at level 2 and above. Supervision is well established in the organisation and in the home. Sessions are planned and notes are maintained. Staff seen during our visit described an open culture and a supportive manager. They had a clear view of the aims of the home. Staff confirmed the positive approach to learning and development in the organisation. Staff comments on survey forms included (among others): At Sun House, all the staff team are looking forward to increasing the independency of residents, that is involving them in cooking their own meals, helping with house chores; We are constantly working towards improving our residents living skills and to promote their independence;and, the home supports the residents, involving them to be more independent, to carry out tasks and achieve their goals. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be confident that the home is well run and managed in the best interests of users of the service. Evidence: The manager has been in post since May 2008 and has worked in the home for seven years. At the time of this inspection the manager was close to completing the registered managers award (RMA) and was in the process of applying to the commission as registered manager for the home. On completing the RMA the manager was intending to start an NVQ4 in Social Care. The homes development plan was displayed on the notice board in the office. This covered the period march 2009 to April 2010. The manager was expecting to begin formulating a plan for the year 2010/2011 with her manager before the end of the year. The manager told us that the organisation had carried out a stakeholder survey in July 2009. This included users (with an incentive to participate of winning vouchers - two Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: of which had been won by users in the home), members of the CMHT and of the Assertive Outreach team. The survey did not include families. the manager told us that this is carried out as a separate exercise. The results of the survey were expected in October 2009. The arrangements for safe working practices are generally satisfactory but there appears to be a need for more attention to detail in providing evidence of this. It is noted that the dates of last review or of issue of a certificate were not given by the manager in the dataset section of the AQAA. The manager told us that a generic risk assessment was carried out in September 2009. A check by external consultants for Legionella carried out in August 2008 was negative. Testing of portable electrical appliances (PAT) testing was carried out in September 2009. The manager told us that a fire risk assessment was carried out in July 2009 but had not yet been printed off from the computer. Systems are in place for checking fire points weekly. Staff training on fire safety is carried out at head office on induction and through E-learning updates thereafter. According to the manager a fire drill was carried out in June 2009. Contracts are placed by head office for the maintenance of fire safety equipment and electric lighting. Procedures are in place for recording accidents to users, staff and visitors. Proprietors visits are carried out monthly. These are comprehensive in scope and involve talking to staff and residents. The reports of the visits carried out in June and July 2009 were seen during our visit and were of an excellent standard. The reports of visits in August and September were still to be printed off from the computer. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered persons must 30/11/2009 ensure that the statement of purpose includes the homes arrangements for dealing with complaints So that prospective users of the service and their representative are aware of the homes procedures for dealing with complaints 2 22 4 The registered persons must 30/11/2009 ensure that users of the service have information on the homes arrangements for dealing with complaints So that users of the service and their representatives are informed of the homes procedures for dealing with complaints 3 23 37 The registerd persons must 30/10/2009 give notice to the Commission without delay in the event of an occurrence Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action of the matters listed in this Regulation. To ensure that the Commission is notified of events which may have an adverse effect on the care of users living in the home. 4 34 19 The registered persons must 30/10/2009 ensure that evidence that the organisation has acquired the information listed under Schedule 2 is available from the time a member of staff starts work in the home. To ensure that users living in the home are not placed at risk due to the appointment of staff unsuited to such work. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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