Care Home: The Gatehouse

What the care home does well The home offers a service to young people who have reached, or nearly reached eighteen and are transferring from Children`s residential services (provided in the on site school) to adult residential services. Some of the young people attend the school on a daily basis and some have recently left school. The home make sure that any paperwork that is interesting to or about the people who live in the home is written in a way that they might understand. The young people know what is written down about the help that they need, these are called care plans.They get involved with making sure that they are up-to-date by being invited to meetings about themselves, called reviews. People are encouraged to decide on the things that they do everyday such as what they like to wear, where they want to go and what they like to eat. The staff make sure that if people have any special things they want or need, like having a female help you with your bath because you are female, they are helped to get them. The home make sure that people can continue to learn things by going to school or going to places with staff where they can do different things. They make sure that people can go to places, in the school holidays, evenings and at week-ends so that they can learn new things and enjoy their free time. People are helped to keep in contact with their families and friends. The home make sure that people are helped to look after themselves properly. They are good at trying to help people to change from being a young person to being a grown up. They try to make sure that people are treated in a grown up way and that they can live as they wish to. The home has lots of staff who are able to spend alot of time with people to make sure they are getting the care that they want and need. The manager is very good, he makes sure that staff and residents can always talk to him and that the home is run for the people who live there. What has improved since the last inspection? This is the first inspection of the service. What the care home could do better: The home could make sure that it helps people to grow up by letting them do some things that might be a bit dangerous, but that they make sure that they do them as safely as they can. The home could look at what information, about the young people, their families should get and what the young people think about it. The registered manager must look at how he makes sure that people keep fit and well. The home must make sure that the way it gets and gives people their medicine is as safely as possible. The home could help people to know how much money they have and how they are spending it. The home must make sure that having the washing machine in the kitchen will not mean that it is more likely that people will get germs. Key inspection report Care homes for adults (18-65 years) Name: Address: The Gatehouse Tadley Common Road Tadley Hampshire RG26 3TB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Kingston     Date: 0 2 0 2 2 0 1 0 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 Gatehouse Tadley Common Road Tadley Hampshire RG26 3TB 01189817720 011899821985 tadleyhorizon@priorygroup.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Priory Education Services Ltd Name of registered manager (if applicable) Mr Christopher Norman Ward Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is: 5 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 needs on admission to the home are within the following category: Learning Disability (LD) The service is registered for service users aged between 16-25 only. Date of last inspection Brief description of the care home The Gatehouse offers a service to five young people with learning and associated behavioural or emotional difficulties, aged between 16 and 25 years old. The purpose of the home is to support people with the transition to adulthood and to help them to develop as much indpendence, as they are able. The home is owned and run by Priory Education Sevices Limited. The house is in the grounds of Tadley Horizon School, run by the same providers as the care home. Care Homes for Adults (18-65 years) Page 4 of 31 5 Over 65 0 Brief description of the care home The house consists of a newly converted domestic building. It has a small ground floor and large first floor. The people who use the service have their own bedrrooms, two of which are en-suite. The home is situated in a semi-rural location, opposite a public park and common and within easy walking distance of the local town and ammenities. The home has two vehicles and easy access to the nearby large towns of Basingstoke and Reading. The fees are assessed according to the needs of the individuals and the service that is being offered. Care Homes for Adults (18-65 years) Page 5 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This service was registered in September 2009, this is a report for the first key inspection, which included a routine unannounced site visit to the service. This took place between 10.30 am and and 6.00 pm on the the 2nd February 2010. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Care Quality Commission and completed by the service manager. Discussions with the registered manager, two staff members and two people who use the service, took place. Limited observations of people who use the service and their interactions with staff took place during the visit to the home. Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since registration, about this service was Care Homes for Adults (18-65 years) Page 6 of 31 also taken into account when producing this inspection report. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home could make sure that it helps people to grow up by letting them do some things that might be a bit dangerous, but that they make sure that they do them as safely as they can. The home could look at what information, about the young people, their families should get and what the young people think about it. The registered manager must look at how he makes sure that people keep fit and well. Care Homes for Adults (18-65 years) Page 8 of 31 The home must make sure that the way it gets and gives people their medicine is as safely as possible. The home could help people to know how much money they have and how they are spending it. The home must make sure that having the washing machine in the kitchen will not mean that it is more likely that people will get germs. 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 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 10 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 produce enough accurate information, in appropriate formats, so that the young people can make a choice about whether they would like to live there or not. The home makes sure that young peoples needs are fully assessed, and that the home can meet the identified needs, some further development in this area may be beneficial. Evidence: The Statement of Purpose is up-to-date, the home has been operational for approximately five months, so the document is still being tweaked to ensure the information reflects the care being offered. The only admissions to the home, currently, are young people from the residential school which is run by the same provider. The home is in the school grounds, two of the people who live there still go to school, one has left. It is registered for five people, there are three people living there. The registered manager has made the decision that because of the diverse and special needs of the resident group, the ground floor communal living space of the home would be too small to accommodate Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: anybody else, comfortably,at this time. A Service user guide is in place, it is available to individuals in various formats such as pictures /symbols (widget) as appropriate for the individual. People who are admitted know the home as it is in the grounds of the school and they are introduced to it before admission. Numerous assessments are completed by the school in different areas of need and assessments are transferred to the home, with the individual. This assessment is developed into a residential plan of care which is a combined assessment and plan of care. It was discussed with the manager that assessments need to be reviewed and a separate home assessment developed, particularly for those people who have left school. The assessments include very detailed records of needs in all areas but need expanding to include peoples compatibility and ability to share accommodation with the other people who live in the home. The home is clear about what it wants to do, that is helping young people towards more independence. The service has not produced contracts or statements of terms and conditions, yet although the service user guide contains most of the information necessary. Care Homes for Adults (18-65 years) Page 12 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. The home make sure that the young people know their assessed and changing needs which are reflected in their plans of care. People are encouraged to make as many decisions as they are able about their life. Risk assessments are not designed to to support people to have new experiences and aid independence. Policies and procedures do not always reflect that that the young people who live in the home are adults. Evidence: The three plans of care were looked at, they include very detailed information about peoples needs and are very focused on the individual. Plans of care include long and short term goals and are organised under various headings such as social and leisure, sexuality, self harm, nutrition, personal care, racial harassment, financial,daily living skills and communication. How support is offered could be clearer, possibly by separating the assessment from the support plans. All specialist requirements are noted on plans of care, no-one has any physical disabilities but behavioural and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: mental health needs are clearly noted. The young peoples equality/ diversity and individual identity needs are well documented, understood and met. There are numerous risk assessments used, but they are based around the school assessments which are risk aversive, that is designed to be used to take as little risk as possible with other peoples children, for the adults in the home (the only person under 18 will be so within a month) the risk assessments need to be risk taking to aid development of independence and skills, albeit as safely as possible. The young people still at school have regular transitional reviews which they are involved in, as appropriate. Those people who are no longer at school have regular reviews organised by the registered manager, a minimum of 6 monthly. One person said that they would like to have more involvement with developing their care plan. The home work hard with people who use the service and their friends and families to develop an adult identity with and for them. They are legally adults and are in the home to work towards more independence and develop life skills. The young people have regular meetings and staff note the choices people make, they make as many decisions about their daily life as possible. Staff note many more negative decisions than positive ones, such as people choose not to, rather than people choose to. In some areas further work needs to be done to ensure people are recognised as adults for instance the young people who live in the Gatehouse, currently have no money of their own. The manager is currently trying to find out their financial position, it was discussed that as they are adults they must have access to at least their weekly personal allowance and have knowledge of their overall financial status, including any benefits so that they are able to make informed choices about expenditure, particularly as they are seeking to become more independent. Some peoples health needs are also dealt with by their families and this should also be reviewed (see outcome area 4.) Information in the home is held confidentially and staff are very aware of confidentiality issues, which they demonstrated whilst speaking with me. However there was a discussion about the practise of sending the daily contact notes to parents on a regular basis, particularly for those people over eighteen. It was suggested that the information that the home release to families should be something that the people themselves consent to. The home needs a clear generic and individual policy on confidentiality, particularly with regard to peoples parents. Care Homes for Adults (18-65 years) Page 14 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 enable the young people to be involved in a variety of interesting activities that include being part of the community, at all times of the day and at weekends. They are encouraged to keep in contact with family and friends. The home is trying to encourage the young people and others to accept their adult status. The home provide an adequate diet and people are encouraged to be as involved as possible in choosing and producing the food they eat. Evidence: The activity programmes are very individually focused, two people go to school five days per week. They also go out to the cinema, shopping and have access to the community on a very regular basis. Another person who lives in the home has 2:1 support to go into the community and access various activities. People are encouraged to choose their activities and staff work hard to motivate those people who often Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: prefer to stay in the home. Religious/cultural and social diversity needs are clearly detailed in the plans of care. There are plenty of staff to ensure activities can take place out of hours. The home have two vehicles, a large people transporter and a car. The home is in a semi rural area with a common opposite and the town and shops within a short walking distance . The young people have entertainment systems of their choice in their rooms such as Cds, DVDs and televisions.They also have a computer for their use, in the communal area and have access to computer games and other entertainment and communication technology. Two people spoken to said they have loads to do, they are always busy and staff are always available to help them and take them out. On the day of the visit a staff member had come to play the guitar and sing for the young people. All the young people have good contact with their families, generally visiting them on a regular basis and/or families visiting the home. People are in contact with friends at school and these are sometimes invited over for meals or activities. The staff are careful to balance visits of school friends as the young people are still in a transitional period from school to home. Two people said that they wanted to go home and live with their mum but understood that this was not likely. The manager is trying to find ways of people thinking of the service as their home, and the family home as somewhere they visit. The home is looking at ways of promoting Independence, in the early stages of the transition to adulthood, this is made more difficult because the home is in the school grounds. It is still working closely with the school with two of the young people who live in the home. The manager is very aware of the issues and is developing strategies to continue with the positive work with the school but develop an individual identity for the home and minimise the negative aspects of the closeness to the school. Plans of care include personal development, sexuality, self image and relationships, these are addressed as appropriate, dependant on the age, safety and maturity level of the individual young person. The home is aware of any specific nutritional needs of an individual and these are noted on plans of care. Most people have their main meal at school and a smaller meal in the evening (late afternoon). Menus seen were adequate but need some attention to ensure a good variety of food is offered. Food records are kept for each individual on a daily basis even though no one has a specific nutritional condition or issue. The food records showed that peoples diets are reasonable but they could be improved on. One person is very involved in designing menus and shopping for food, they also have some firm ideas on the equipment Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: needed to provide a more varied diet. The manager is, currently, developing the menu and is in the process of gaining finances to add extra equipment to the kitchen. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the young people who use the service are met in the way they prefer, with great importance being attached to their equality and diversity needs. Peoples emotional and physical needs are effectively met but where the responsibility lies is not clear. Medication is, generally, administered safely but long distance prescribing and dispensing of medication may not be the safest and most effective method. Evidence: Plans of care include very detailed personal support guidelines. Staff are very aware of equality and diversity issues, such as same gender personal care, respecting peoples sexuality and their self-image.The young people are supported with their personal issues and their adult development in a very sensitive and respectful way. The home is trying to ensure that they have a gender and experience balanced staff team. Staff spoken to were able to describe, in detail, how they support the young people in ways that respect their privacy and dignity. The plans of care include any needs that require specialist health input such as psychology, behaviour specialists or any medical specialists. The home do not have Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: health care plans and records.The people who are at school are still checked according to Childrens looked after standards, the school nurse holds records, she also holds records for the other young person even though they have left school. Consideration needs to be given to health care plans being kept in the care home when the young person reaches 18 or at least records of any GP, specialist visits, so that the staff team can make sure that all checks are completed as necessary and they have an overall understanding of peoples health needs. The person who is not at school should be assisted with health care needs from his home, particularly as the homes focus is to help people to become more independent. One person is temporarily registered with the local GP, but their permanent GP is based in their families home area. This should be reviewed and the individual should be encouraged to be a permanent patient of a local GP surgery. The individuals medication is prescribed from the surgery in the familys home area which means that it is sent through the post to the home, these include a controlled drug. The home cannot be sure what the prescription is, as it is sent in dossset packs via the parents. This could be problematic if there are any medication issues that need to be resolved swiftly. The home have some copies of communications from specialists for the individual, the one seen noted that the person had been prescribed a different dosage of the controlled medication than the latest dosset pack, which had been sent through the post. The manager was addressing this anomaly on the day of the inspection. It was discussed that the manager should seek the advice of a qualified pharmacist with regard to the safety of sending medication through the post, especially controlled drugs and clarify where the responsibility for peoples health lies, considering that the young people are over 18, are adults and are living in their own home. Medication administration records completed by the home were accurate, on the day of the visit. They are administered via a monitored dosage system and staff are trained before they are able administer medication. Two people administer the medication. The home has a controlled drugs system but it is not clear whether the cupboard meets the required safety standards, a qualified pharmacist should be asked for advice regarding this matter. Care Homes for Adults (18-65 years) Page 19 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 ensures that peoples views are listened to and acted upon, as is appropriate. The young people who live in the home are are protected from all forms of abuse but they have no knowledge of their financial situation. Evidence: The home has a comprehensive complaints procedure which is produced in a simple format to give people who use the service the opportunity to understand it. The AQAA noted that no complaints had been received by the home, the manager confirmed this. Two people spoken to said they know who to complain to or talk to if they have a problem. One person said they have plenty of people to talk to and they usually listen. People can also make their feelings known by displaying certain behaviours which staff and the manager were able to describe and identify as people showing that they were not happy. Staff are trained in Child protection and safeguarding adults procedures. Safeguarding is part of the induction programme but the manager is in the process of accessing the local authorities course in adult protection. Staff spoken to were very clear about their legal and moral obligations to protect people in their care and knew who to go to, external to the organisation, if necessary. They were very confident that the registered manager/ organisation would listen and take the necessary steps to protect people. The home has a comprehensive safeguarding procedure but needs to access Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Hampshires adult procedure, aswell as their Child protection procedures. Two people,who live there, indicated that they feel safe and were observed to be very confident when communicating with staff. The Commission has received no information with regard to complaints or safeguarding matters about this service. The home has detailed behaviour plans for individuals, as necessary, the manager was advised to evidence how the behavioural guidelines had been developed by whom and if they are still relevant. Staff are trained in the use of Team TEACCH, a system used to deal with physically aggressive behaviours and includes physical restraint. The home use physical restraint, on occasion, these incidents are recorded and cross referenced with other records but could contain more detail about the method used and any changes made to behaviour guidelines as a result of the incident. The home does not deal with any personal finances for the people who use the service. Currently, they have no knowledge of benefits, financial resources or personal allowances for the individuals. The manager was advised that as two people are already over 18 and one is almost 18 he needs to gain knowledge of peoples individual financial situation. They need to be helped to understand what benefits they receive, income and expenditure and receive a weekly personal allowance, as a minimum. Knowledge of their overall financial situation also enables people to have informed choices about expenditure and allows the registered manager to protect people from any form of financial abuse. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The downstairs of the home is quite small but it provides a pleasant environment that has good quality furniture and fittings and is comfortable. The home was seen to be kept very clean and hygienic, but having the washing machine sited in the kitchen could be a hygiene issue. Evidence: The Gatehouse has a lounge/diner, and a small kitchen downstairs, it is of a good standard and offers appropriate communal space for the three people who live there. There is little room downstairs for trying to deal with anybody who may display a behaviour that can endanger themselves or others. The home is registered for five people, with the current high staffing ratios the downstairs space may not be adequate for five. There are five single bedrooms, two en-suite, one is currently being used as an office. The registered manager has made the decision to admit a maximum of four people, currently, because of space constraints, especially downstairs. Private (bed) rooms are spacious and very much peoples personal space, reflecting their tastes and personality. The house has a large garden, which is still being developed. It is within easy walking distance of the local supermarket and town centre. The house is opposite common land which provide a good public space to walk and exercise. People also have access Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: to some of the school facilities, when it is appropriate. There is no downstairs space for people to entertain friends or family/privately so they use their rooms for this purpose, which is not always ideal. The washing machine is situated in the kitchen, this needs risk assessing to ensure possible cross infection/hygiene issues are minimised as far as possible. The home has access to two vehicles and is a few miles away from the large towns of Reading and Basingstoke and the the smaller town of Newbury. Care Homes for Adults (18-65 years) Page 23 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. The home have an appropriately trained staff team who are able to meet the complex and diverse needs of the people who live there. Staff are developing into an effective and efficient team, with the guidance and support of a skilled and experienced manager. The home has a robust recruitment policy to ensure that staff are safe to work with the people who use the service. Evidence: All staff have comprehensive job descriptions, codes of conduct and work contracts. The home has a total staff team of 11, the manager tries to balance the genders and experience of the staff team according to the needs of the people who live in the service. The staff team are mainly quite new as it took a while to appoint suitable staff and ensure the receipt of all the necessary safety checks. The home has a shift system, that is, 7.30 am to 3 pm and 2.30 pm to 10 pm, there is one waking night staff on duty. The minimum staff per shift is two, but usually there are three staff if the three people who use the service are at home. One person has 2:1 support to enable them to access the community and participate in activities. Staff will work later in the evening if the young people want to access after hours activities. One person said that they would like to go to a nightclub for their birthday and was confident that staff would take them if they asked. People who live in the home said that they liked Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: most of the staff, especially the manager. They said that staff generally listened to what they say but did not always do what they wanted them to. Two of the 11 staff have an NVQ 2 or above, two are enrolled on NVQ 3 and seven staff are to be enrolled on NVQ training as soon as possible, the seven are new staff and complete a probationary period before professional training commences. Recruitment records are held in the school administrative offices, two were seen, they were comprehensive and included all the necessary information, one person seemed not to have a professional reference but the registered manager had advised that he had personally spoken to the referee and saw the written one. The induction covers all the necessary health and safety training, autism, communication methods and Team TEACCH. People are then offered training opportunities, as they arise. Two staff confirmed that they have good training opportunities. It was discussed that a home and individual training record may be an effective way of identifying training needed and recording training completed. Staff said that the after some teething difficulties things are now better organised and staff are working as an effective team. They said that the management was very good, supportive and motivating. Staff receive regular supervision and regular staff meetings are held. 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 home is well run by a competent manager, it focuses on the needs of the young people who live there. People are kept as safe as possible by adherence to Health and Safety Policy and procedures. Evidence: Chris Ward is the registered manager for the service, he has 4 years experience in a managerial role, a Health and Social Care degree and NVQ 4 in management. He manages the Gatehouse on a day to day basis, joining the care rota regularly. He also has the responsibility for being the schools Child protection co-ordinator. He is confident that he can accept both responsibilities and manage effectively. The young people who use the service, said that they really like Chris, he will always listen to you. Staff described management as supportive and motivating. One said that he was comfortable to call him for advise even when he wasnt on duty another described the management style as encouraging. The registered manager said that he has really good support from his line manager. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The home has regular visits from the organisations quality assurance monitoring officer, notes seen for November were very detailed and thorough setting goals and timescales for the manager to complete any necessary work. As the home has only been open for approximately five months no formal Quality Assurance monitoring, other than regulation 26 visits, has taken place. It was clear that the people who use the service put forward their ideas and views and it is listened to. People spoken to, did say that they would prefer to live with their parents than in the Gatehouse and one said if that is not possible they prefer to live in school. Staff are aware of these thoughts and are helping people with their maturity, development and acceptance of growing up. The records kept are of a good standard, records of health needs and some Health and Safety records should be kept in the home (see outcome 4). The AQAA noted that all necessary policies and procedures are in place. Health and safety is very efficiently overseen by a designated individual who works from the school. He completes maintenance checks and records and ensures everything is health and safety compliant. The safe working practise risk assessments should be available in the home for staff to refer to whenever necessary. The home keeps detailed accident and incident forms although they could include more detail about what action has been taken to minimise the risk of recurrence. The home receives all necessary resources to meet the needs of the people who use the service. Care Homes for Adults (18-65 years) Page 27 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 28 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 1 10 12 To ensure that the care home is conducted in a manner which respects the privacy and dignity of the people who live there. So that people know that they can keep most of the things that they want to private and confidential. 01/04/2010 2 19 13 To look at how the registered person can ensure that individuals arrangements to meet their health care needs are as efficient and effective, as possible. So that the home is able to support people to receive the best medical care in as timely a way as is possible 01/04/2010 3 20 13 To review the safety of 08/03/2010 administering medication prescribed by a G.P not local to the home and sent Care Homes for Adults (18-65 years) Page 29 of 31 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 through the post by the individuals family. So that the registered manager can be assured that staff are administering medication as safely as possible. 4 30 16 To look at the hygiene issues of having a washing machine in the kitchen and minimise the risk of any cross infection or other hygiene problems. So that people who live in the home are as safe as possible from illness. 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 01/04/2010 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). 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!