Care Home: The Conifers

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What the care home does well People who use the service are able have their say about everything that happens in the home. They can choose how they spend their time and are helped to do the things they want. They are given lots of information in different ways so they know what to do if they are not happy about anything. Regular meetings are held to let people who use the service talk about what is important to them. They are helped to do the things they want to do safely, by meeting with staff to talk about any risks that might be involved. A plan is then made with them to help make the risk smaller and let them to do the activity safely. People who use the service tell us they like living there and think they are able to make choices about how they spend their time. Comments included: `I like my pink room and I chose the colour myself`. `I told Peter I wanted to go on a boat and I did`. `I like the staff`. `I did not like Kasia`. `I see my boyfriend and mum and dad and go home week-ends`. `I can do want I want during the day and at week-ends`. `There`s a menu in the kitchen and we choose the meals.` The speech and language therapist returned survey to CQC said: `I have worked in many care home and I feel that is a good relationship with visiting therapist and the management team. They keep me well informed of any changes with the residents before I see them`. People who use the service felt they had lots of opportunities to go out and to meet other people. What has improved since the last inspection? We did not say the home had to make any improvements following our last visit. What the care home could do better: There are no requirements made from this visit. Key inspection report Care homes for adults (18-65 years) Name: Address: The Conifers 228 Kempshott Lane Basingstoke Hampshire RG22 5LR     The quality rating for this care home is:   three star excellent 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: Janette Everitt     Date: 0 9 0 7 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 31 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 31 Information about the care home Name of care home: Address: The Conifers 228 Kempshott Lane Basingstoke Hampshire RG22 5LR 01256869949 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: roger@careopportunities.co.uk Care Opportunities Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category 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 category: Learning disability - LD Date of last inspection Brief description of the care home Conifers is a registered care home owned and managed by Care Opportunities a specialist independent provider who offer residential accommodation care and support to adults with learning disabilities. The home is located on the outskirts of the North Hampshire town of Basingstoke within a short walking distance of shops and other local amenities. A bus route passes near to the home making access to town centre facilities such as a modern shopping centre, cinemas, restaurants, theatres, and leisure centres etc easy and convenient. Accommodation is available in single rooms with ensuite facilities including a personal shower. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited 2 The Conifers on the 9th July 2009 to talk to the people who live there and find out if they were happy living there. We last visited the home on 13th July 2007. We got our information to write this report in lots of different ways. We checked to see if anyone had made a complaint to us about 2 The Conifers and found that they had not. We also looked at any information the home had given us about what might have happened since we last visited. We received information back from service users on the surveys we sent to them asking them about their lives and also from the speech and language therapist to tell us how she helps the service users to communicate with other people and to make choices in their lives. Care Homes for Adults (18-65 years) Page 5 of 31 We also got information from a big form the registered manager has to fill out to tell us what had happened in the home in the past year and set out what had changed since our last visit and what further changes the manager would like to make. It also told us what the staff are doing to make it a good place to live and if there is anything they want to do better. One of our inspectors visited the home and stayed for 5 hours. During the visit she was able to speak with five of the people who live in the home and ask them what it was like to live there. She was also able to see how the people who live there spend the day and what they do with staff. She was able to talk to the staff about what it was like to work at the home. Some time was spent looking at the records of three people who live in the home. This was to make sure everyone knew how the person liked to spend their time and what help they needed from staff to let them do these things. Other records were looked at to make sure the home was safe to live in. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 31 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 8 of 31 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. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met by the home. Evidence: The AQAA stated that the home has a thorough assessment process and that once a person has been referred to the home the home will then gather information from a community care needs assessment and any other relevant reports from psychiatric, psychological and other primary health professionals involved in the care of the person. Initial assessment is conducted from this information and a decision is made as to proceed to a full assessment. A full assessment is undertaken by the manager at the persons current residence at which time information is gathered from their key worker, files and other notes and they meet with the potential service user. The assessment covers all aspects of the service users life to identify their needs, Care Homes for Adults (18-65 years) Page 9 of 31 Evidence: goals and aspirations. A sample of three service users files were viewed. These demonstrated information gathered about the service user from various professionals together with a comprehensive assessment undertaken by the manager which fully involves the service user and their family. Four of the six service user surveys were returned and service users had been assisted by the speech and language therapist (SALT) to complete the answers. Comments made about their admission to the home indicated that people do have the opportunity to visit the home prior to going there to live and that there is period of time for thinking about this before a decision is made. Comments made on surveys said. I came to the home with my mum and she decided. I wanted to move here and I came and visited to see if I liked it. I visited with my sister and brother but cannot remember if we had information about the home. I visited the house with my sister and spoke to she and Roger about it. The service user guide and statement of purpose is produced for the service user in graphic format to enable the service users to understand information about the home before decisions are made whether they would like to live at The Conifers. Care Homes for Adults (18-65 years) Page 10 of 31 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. Comprehensive care plans and risk assessments are completed with the involvement of the people who use the service who are involved in planning how they wish to live their lives. People who use the service are consulted on decisions which affect their lives. Evidence: The AQAA states that the home has a thorough care planning process that fully involves service users in identifying their needs and exercising their choices, which is supported by a risk assessment process which facilitates risk taking by the service user within an appropriate support structure. Following a detailed pre-admission assessment and the decision is made for the service user to go to the home to live, a care plan is drawn up with the service user that identifies their wishes and aspirations for their future lives. The deputy told us that this can take time as information is gradually gained as the service user settles into the home life and becomes more familiar with the staff. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The AQAA states that the care plan includes the specialist requirements of the service user and includes general and mental health care. The care plans address the restrictions of choice and the appropriate best interest decisions process as required in the mental health capacity act. The sample of three care plan documentation was viewed by us. These evidenced person centered care plans that are produced with the service user and key worker and are in pictorial and other formats to enable service users to understand what they have participated in and agreed to. Care plans were observed to be signed by the service user and were reviewed monthly by the service user and key worker. The deputy manager, who was assisting with the inspection process, explained that until recently the care plan documentation has been divided into three sections. The first being a plan for care and support for ongoing daily living and communication, the second section for person centered planning that describes the dreams, aspirations and social activities for the service user and the third the health care needs of service users. The information contained in these documents was thorough but fragmented and staff would need to read through a great deal of information to know how each service user wished to undertake their daily activities. At the time of this visit the care plans were in the process of being condensed into one file for each service user to enable staff easy access to all the information they would need to know about the service users. At the time of this visit only one care plan had been produced in the new format. All care plans were very detailed and would allow staff to understand the service users wishes as how they wish to live their lives. A service users was spoken to, who told us that they understood what her care plans were and that she had helped the key worker to say how she wanted her life to be. A staff member spoken to said that the information in the care plans and the teamwork in the home ensures service users are supported appropriately. The home acknowledges that the service users have the right to take risks to assist them to achieve more independence. Any restrictions placed on service users are documented clearly in the care plans within a risk assessment framework. The home has the services of a speech and language therapist twice weekly and she works closely with the service users and staff in communication skills. We spoke to the speech and language therapist and she told us that she chairs the residents meeting Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: monthly and supports them to express their choices through symbols. Surveys returned from the service users told us that they are able to make decisions about what they do each day. The speech and language therapist was observed to be able to communicate with service users quite readily by signing and other non-verbal communication methods. The service users appeared relaxed and confident with her and she had a good rapport with them all. Care plans written by her describe how to effectively communicate with specific service users who have limited communication skills. The survey returned by the speech and language therapist told us that she supports service users to make choices that are appropriate to their needs and wants. They have regular multidisciplinary meetings with appropriate agencies to ensure that aims and objectives that have been set out for the service users, are carried out. The AQAA told us that service users are involved with decisions about the home and of choosing items to purchase for the home. The service user have recently had their bedrooms decorated and were able to choose the colour of the paint, one service user saying I chose the colour of my pink room. The AQAA told us that service users also participate in the selection of staff and will be involved in deciding if staff are retained after their probationary period of employment. This was discussed with the manager who told service users are consulted on and fully involved with the recruitment of staff. Care Homes for Adults (18-65 years) Page 13 of 31 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. The home provides good support for service users to take part in a wide range of activities and to maintain contact with families, friends and community activities. Service users are encouraged to follow a healthy diet when choosing their menus. Evidence: The AQAA stated that the staff support the service users to participate in useful and meaningful activities and are supported to maintain contact with families, friends and the community. Each service user has an individual programme of activities that is produced in a graphic format for them to refer to. The programmes are discussed at the monthly meeting with their key worker at which time they are asked if they wish to change any of the programme. The SALT also involves the service users at the monthly residents meeting where their social and activities programmes are discussed and service users Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: are encouraged to say what they wish to do. The discussions at these meetings are summarised in the review records. The speech and language therapist (SALT) has instigated an activities programme board in the dining room and each service user has a photograph of themselves on display and underneath this they attach symbols of what they are doing throughout the day. At the end of the day the service user removes these symbols and replaces them with appropriate symbols for the next days activities. One of the service users demonstrated how this board works and was happy to show us how she attaches the symbols. Examples of activities include swimming, horse riding, bowling, the pub and clubs, cinema, craft clubs, an advocacy club and service users can also attend local events such as fetes, the balloon festival and the local shopping centre on a regular basis to do their shopping. Four of the people who live in the home were spoken with during the visit and they said they enjoyed their lives and the activities they participated in. Two of the service users participate in a local gardening project and attend their allotments twice weekly. One of the service users was keen to show us the vegetables he had picked from his allotment that morning. Throughout this visit is was observed that service users were taking part in various activities in the lower ground floor room. One was playing crib with the therapist, another was colouring and a carer and service user were playing bingo. The home has their own transport that is used to support people to travel to their activities. At the time of this visit one service user was taken to town to hire a costume for the summer show and another was transported and escorted on a hospital appointment. People are supported to maintain contact with family and friends and transport is provided to transport people to relatives homes if necessary. One lady service user told us she visits her parents every week-end. Other service users have relatives visit them at the home. Surveys returned by the six service users said I can choose from the activities in the home or go out into the community if I wish. I see my boyfriend, my mum, dad and Suzanne and go home week-ends. The other four said that every day they can choose what they want to do. The speech and language therapists told us that service users with communication difficulties are encourage to choose their activities from the time table of symbols. The home is planning a summer party at the home and all families and friends have Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: been invited to watch the service users performing a musical show. There is an atmosphere of excitement about this and several of the service users were keen to talk to us about their roles in the show. The deputy manager told us that there is always a large Christmas party but this will be the first summer party and they are anticipating it to be a success. Holidays for service users are also discussed and planned. One of the service users was willing to show us photographs of their holiday cruise and told us in a survey that I told Peter I wanted to go on a boat and I did. There were photographs displayed of all of the six residents who had been on holiday together in the spring and those spoken to said that they had thoroughly enjoyed the experience and wished to go again. Funding for holidays is shared between the organisation and the service user. The deputy manager told us that at the present time there are no service users attending further education as the funding for this has stopped in Basingstoke. Service users help in the routines of cleaning the house and are responsible for their own rooms and clothes washing. All service users have keys to their bedroom doors and most choose to keep them locked when not in them. Staff were observed to be interacting and speaking with service users in a respectful manner and deferring to their opinions about certain things. One service user was in charge of preparing the lunch that day and as part of his life skills plan he had decided on the menu, shopped and cooked the meal. Another service user was observed to be helping clear up the kitchen following lunch. The home has a four week menu that the service users are supported to plan and is discussed at the residents meetings. The menu plan was observed to be displayed in the dining room. People make choices about the food they eat each day, with staff providing support to maintain a balanced diet. Mealtimes are flexible to fit around activities and snacks are available at any time within limitations if a service users weight and eating habits are being monitored. We were invited to join the service users for lunch and this was prepared and presented well. The service users appeared to enjoy the meal. They told us that they like the food and that they get to choose what they would like to eat at each meal time. Care Homes for Adults (18-65 years) Page 16 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place, ensuring that the service users personal, emotional, health care and medication needs are met. Evidence: The AQAA told us that staff provide personal care in a sensitive and supportive manner that maintains the service users dignity and privacy in a manner they prefer. All service users have an en-suite facility in their room. The care plans viewed described to what extent service users need support with their personal care and how they wished this support to be given. The manager told us that support is given in a way that will develop service users skills and independence. Six people who live in the home completed a survey for us. All six residents told us that staff always treat them well, and said that staff always listen to them and act on what they say. People are supported to attend a range of health services including GP, dentist, audiologist, psychologist and psychiatrist. All service users see a podiatrist 8 weekly for foot care. One service user told us that he has a problem with his toe nail and is being seen by the podiatrist every six weeks. Other services observed to be Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: available were the dentist, and optician. Detailed information is recorded in service users care plans about medical consultations and appointments. The health care needs are fully documented. The speech and language therapist (SALT) attends the home twice weekly to work with service users on their communication skills and works with the service users and advices them on how to express their choices and to use visual symbols for communicating this. SALT also works with and trains staff on how to communicate with people who have communication difficulties. A psychologist attends the home weekly to work with the service users and monitor any challenging behaviours. Care plans were seen to be written for managing the different behaviours that may occur and record the trigger factors that may initiate certain behaviours. Medication is stored in a locked cabinet in the general office. None of the people living in the home were currently prescribed any controlled drugs however the home has in place a specific controlled drugs cabinet and recording systems if this is needed in the future. The home uses a monitored dosage system (MDS) for the storage and administration of medication. The medication administration records (MAR) were viewed and these had been recorded appropriately. For medication that is prescribed on a PRN (as needed basis only) a care plan has been written to identify when staff should be aware of certain behaviours that may be caused by discomfort or pain which may not be able to be expressed but would indicate that pain killing medication should be offered. Staff administering medication have received training and training records support this. The AQAA stated that the home wishes to improve this training by developing a tool to periodically evaluate the competence of the staff in medication administration and continue to update staff training. The deputy manager completes regular medication audits to assess whether the procedures are being consistently followed. The community pharmacist also visits the home annually to audit medication. At the time of this visit there were no service users choosing to manage their own medication but the deputy manager told us that this would be possible if a service user was assessed as being safe and able to do so. The home does not administer medication without the permission of the service users. Care Homes for Adults (18-65 years) Page 18 of 31 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. The home has clear policies, procedures and methods in place to ensure service users are able to complain and are protected from abuse. Evidence: There is a complaints procedure which is provided to all people living in the home in a pictorial format to make it more accessible and it is discussed with each of the service users. Service users are encouraged to express their views about the service via the complaints procedure, service users meetings and the monthly visits by the senior management, at which times service users are spoken with and asked about any issues or suggestions they may have to improve the service. Six service user surveys were returned and told us that service users know who to speak to if they are not happy and how to make a complaint. Comments said I can speak to all the staff. I speak to my key worker and the manager. I go to my room and my key worker or the manager will speak to me. I might go to Cathy. I would go to my key worker. The surveys returned to us and completed with the support of the therapist told us that if service user, with poor communication skills, were unhappy with anything they would show this through non-verbal communication and behaviours and that staff would recognise this and act upon it. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: The home does keep a complaints log but no complaints have been received by the home is the past year. CQC have not received any complaints in the last year. The home has a policy and procedure on safeguarding adults and the prevention of abuse. Staff spoken with demonstrated a good understanding of the action they should take if abuse is witnessed, reported or suspected. All new staff receive a two day induction to the home of which the protection of vulnerable adults (POVA) training is a module. Staff then attend further training on POVA and the Mental Capacity Act through outside trainers and the manager, who is a qualified trainer in adult protection. The development for the coming year states that service users will be involved with this training to enable them to have more awareness of what is abuse. The home has reported incidents involving one person who lives in the home, to the local adult services department under the safeguarding procedures. These have been reported to CQC via notifications and there is now a protocol in place to manage this persons behaviours, a copy of which, the safeguarding team have received for consultation and agreement. The home has records of all the appointments and meetings regarding this person and the manager is working with adult services to resolve this situation. The home holds money for most of the people who live in the home for safekeeping. There was clear information about the money held in the home, with records of expenditure, receipts and regular checks of the money. The money is individually stored in a locked cupboard. There was evidence of a monthly audit which is done by a qualified accountant. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users live in a well maintained home that provides a clean, comfortable and safe environment for them. Evidence: The home is a large detached property in a residential area. The service users each have spacious rooms with en-suite facilities. The rooms have been decorated in the colours of their choice and some service users have chosen to bring with them person furniture and electrical equipment. We were invited to look around three bedrooms. These were decorated in bright colours and were observed to be very individual and reflected their hobbies and various collections of items of their choice. The deputy manager told us that there are new curtains on order for some rooms and this was demonstrated in one room where the curtains were hanging off of the rail. The home has a refurbishment plan that runs over an 18 month cycle and the communal areas were decorated in May 2009 and were observed to be bright and well furnished. There are three communal areas in the home, one being a very spacious lower ground floor room that looks out onto the garden and is used as a lounge and for service users activities. The home is very comfortable and service users told us Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: they liked living at the home and particularly liked their own rooms. Surveys returned from the six service users said They painted down the stairs and my room in yellow and I chose that. I like my pink room and my garden. We had a barbecue. We help to clean the house. The other surveys indicated that the house is always fresh and clean. The home was very clean and tidy and we were told that there are cleaning schedules for all areas. The home has infection control policy and procedures in place and training. Cleaning materials, protective clothing and appropriate hand washing facilities are provided for all staff to use as necessary to prevent spread of infection. The home employs a part time gardener to maintain the large front garden and the garden at the back whilst service users are involved with certain aspects of the garden such as cutting the grass. Care Homes for Adults (18-65 years) Page 22 of 31 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. Staff are well trained and there are good systems to check staff before they work in the home. This helps to keep people safe and ensure staff can meet their needs. Evidence: Staff rotas rotas and the deputy manager told us that there are 4 care staff on throughout the day from 07:45 until 20:00. From 20:00 until 21:15 there are two care staff on duty and the one awake care staff come on duty from that time until 08:00 in the morning. The deputy manager is in the home from Monday to Friday for eight hours but is also on call if needed. The registered manager also attends the home most days but is involved with more operational management of the care group. The speech and language therapist attends the home twice a week and is involved with the communication, activities and training staff. The clinical psychologist also attends the home one day a week to monitor behaviors and work with the service users and staff. The records of three of the most recently employed staff members were checked and all contained evidence that the home had obtained an enhanced Criminal Records Bureau (CRB) disclosure in respect of them, had confirmation that the person was not on the protection of vulnerable adults list (POVA), the home had obtained two written Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: references for the person and had a full employment history and interview notes. The home has its own two day induction programme that is followed by an an induction programme based on the Skills for Care Induction standards and this is undertaken over a period of six months which is classed as a probationary period for the staff member. A copy of a completed induction programme was seen in one personnel file. Following the probationary period and induction training the successful staff member then continues the training for the national vocational qualification (NVQ) level 2 or 3. The AQAA states that three of the ten care staff have achieved their NVQ level 2 and above and three are currently undertaking the training. The deputy manager is in the process of undertaking her leadership and management course in Social Care which she anticipates completing within the next year. The home has a comprehensive training programme in place and staff reported they have received good training that enables them to meet service users needs. The training programme demonstrates a mixture of training both in house and by external trainers. The speech and language therapist and clinical psychologist supplies most of the training in working with people with poor or no communication abilities and other methods and ways of communication, challenging behaviours, autism and the psychiatry of learning disabilities. Mandatory training which is moving and handling, infection control, health and safety, abuse, food handling and hygiene and first aid is undertaken yearly and is delivered by in-house trainers who have been trained to deliver the training. If necessary the staff will attend outside training for mandatory training. The training for the mental capacity act and deprivation of liberty is undertaken by the manager in the home as an introduction but staff undertake further training through Hampshire County Council training scheme. The deputy manager showed us the training matrix which recorded all training undertaken by staff and any future training needs identified or planned. Training certificates were also viewed and demonstrated that staff have undertaken a variety of training that is appropriate to the service users that live in the home. Training needs are identified through staff appraisal and supervision. There is a structures system for supervision to take place 6 times a year and is undertaken by the manager and deputy manager who have received training in the principles of Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: appraisal and supervision. The deputy manager told us that staff will discuss a variety of issues and training needs at the time of supervision. A sample of supervision records were seen by us. All staff training is fully funded by the company. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home ensures the health, safety and welfare of service users and staff are promoted and the home is run in the best interests of the service users whose views about living in the home are sought. Evidence: The registered manager is a very experienced learning disability manager and is a qualified learning disability nurse who has achieved the Registered Managers Award. The registered manager informed us that he is currently relinquishing his management role in the home to his deputy manager who is undertaking her management and leadership training currently and will be applying to CQC for registration. He agreed that CQC will be informed of these new management arrangements in writing imminently but he continues to attend the home daily and takes more of an operational overview of the service. The deputy manager did assist us throughout the day but the registered manager and Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: a director also attended the home during this visit. Staff spoken with said they thought the management was supportive and observing the interaction of the staff would suggest that they have good working relationships and are working as a team. One of the partners in the organisation visits the home each month and assesses the quality of the service that is being provided against the standards. Reports of these visits are made and sent to the manager and contain a list of actions that may be needed. The reports were viewed and evidenced that these are thorough and demonstrated that staff and service users have been spoken to and that the report covers all quality aspects of the service. There are regular service user meetings that are headed by the speech and language therapist at which time people living in the home can say how things are going and what changes they feel are necessary. These views and suggestions can also be discussed with the key worker at personal reviews. Records of these meetings are kept. The manager completed the annual quality assurance assessment for us before the visit and highlighted his plans for what improvements the organisation wish to make over the next year. The home has a thorough quality audit system that produces an action plan. The records of the audits were viewed by us and evidenced that an audit is done monthly for care plans, medication, health and safety, personal files, vehicle check, food hygiene, incidents and accidents. The results of these are analysed and are a measurable tool for gauging the success of the home and any improvements that are necessary. A health and safety policy and procedure designed to protect and keep both residents and staff safe was in place. Records of the servicing and testing of the fire alarm system, emergency lighting and portable electrical appliances, gas appliance systems, were inspected and were up to date. Control of substances hazardous to health (COSHH) assessments, equipment servicing and accident records were all available. There were records to confirm that all staff have receive training in the techniques of moving and handling, first aid, food hygiene, health and safety and the procedures to follow in the event of fire, including evacuation. There was an environmental workplace risk assessment in place, which was evidenced as being audited monthly. A Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: fire risk assessment was also in place and had been reviewed appropriately. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 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). 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