Care Home: The Laurel

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What the care home does well There was clear information about the home that was easy to read.Each person had care plans and a person centred plan. These told staff how to meet people`s needs.People see the doctor, nurse, dentist and optician when they need to.Staff help people to take their medicines.People can go out and can do what they want when they are at home.People help to keep the home clean and do the cooking.They choose their own meals and take it in turns to do the shopping.The shared rooms and the bedrooms are nicely decorated. People like their rooms.People know how to make a complaint. Any complaints are looked into and if something is wrong it is put right.Proper checks are done so that new staff are suitable to support people. Some people help to interview new staff.Staff have the right training to support people.The manager and staff make sure the home is safe for people to live in. What has improved since the last inspection? People have easy to read information about the home in their rooms. Information is also available on video.People know what they have to pay for including meals out. More information is being included in people`s care plans to make sure all their needs are met.People are having more routine health checks.Many rooms in the home have been repainted and there are new carpets and furniture.The manager is getting more support from the owner so that he knows what he needs to do to make the service better.Staff have had more training so they know how to meet everyone`s needs.The owners are checking with people what they would like done to make the service better.The risk assessments, fire safety measures and checks are better so that people will be safe. What the care home could do better: Medicines need to be stored in a safer way. Medication records need to be made clearer so people have the right medicines.More painting needs to be done. The bathrooms need to be made better.There should always be enough staff so people can go out at weekends.The dates should be recorded when staff checks are received so you can tell when they are ready to start work. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Laurel 23 Park Lane Swindon Wiltshire SN1 5EL The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Barber Date: 2 1 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 41 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 41 Information about the care home Name of care home: Address: The Laurel 23 Park Lane Swindon Wiltshire SN1 5EL 01793496458 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wardsign Limited care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection 2 2 0 7 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 41 A bit about the care home The Laurel is a large semi-detached house in the Rodbourne area of Swindon. The house is in keeping with other houses in the street. It is close to local shops including the Designer Outlet Village on the site of the old railway works. The Laurel provides care and support to six adults who have learning disabilities. Care Homes for Adults (18-65 years) Page 5 of 41 There is a lounge, dining room, kitchen and two bedrooms on the ground floor. One of the downstairs bedrooms has an en-suite shower. There are two single bedrooms, and one double bedroom upstairs with a toilet and shower and bathroom and shower. There is a large garden and a garage, which is converted into a room for activities. There is at least one member of staff on duty in the home during the day and evening. One member of staff sleeps in at night. Care Homes for Adults (18-65 years) Page 6 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 41 How we did our inspection: This is what the inspector did when they were at the care home We asked the home to complete an Annual Quality Assurance Assessment. This told us about what has happened during the last year, and about their plans for the future. We sent out surveys and we had surveys back from 4 people who lived in the home and 2 staff members. Care Homes for Adults (18-65 years) Page 8 of 41 We visited the home on the 20th and 21st July 2009. We talked to the owner, the manager and two staff. We talked to five people who lived in the home. Care Homes for Adults (18-65 years) Page 9 of 41 We looked at some of the records. What the care home does well There was clear information about the home that was easy to read. Each person had care plans and a person centred plan. These told staff how to meet peoples needs. Care Homes for Adults (18-65 years) Page 10 of 41 People see the doctor, nurse, dentist and optician when they need to. Staff help people to take their medicines. People can go out and can do what they want when they are at home. People help to keep the home clean and do the cooking. Care Homes for Adults (18-65 years) Page 11 of 41 They choose their own meals and take it in turns to do the shopping. The shared rooms and the bedrooms are nicely decorated. People like their rooms. People know how to make a complaint. Any complaints are looked into and if something is wrong it is put right. Care Homes for Adults (18-65 years) Page 12 of 41 Proper checks are done so that new staff are suitable to support people. Some people help to interview new staff. Staff have the right training to support people. The manager and staff make sure the home is safe for people to live in. Care Homes for Adults (18-65 years) Page 13 of 41 What has got better from the last inspection People have easy to read information about the home in their rooms. Information is also available on video. People know what they have to pay for including meals out. More information is being included in peoples care plans to make sure all their needs are met. Care Homes for Adults (18-65 years) Page 14 of 41 People are having more routine health checks. Many rooms in the home have been repainted and there are new carpets and furniture. The manager is getting more support from the owner so that he knows what he needs to do to make the service better. Care Homes for Adults (18-65 years) Page 15 of 41 Staff have had more training so they know how to meet everyones needs. The owners are checking with people what they would like done to make the service better. The risk assessments, fire safety measures and checks are better so that people will be safe. Care Homes for Adults (18-65 years) Page 16 of 41 What the care home could do better Medicines need to be stored in a safer way. Medication records need to be made clearer so people have the right medicines. More painting needs to be done. The bathrooms need to be made better. There should always be enough staff so people can go out at weekends. Care Homes for Adults (18-65 years) Page 17 of 41 The dates should be recorded when staff checks are received so you can tell when they are ready to start work. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Elaine Barber Care Quality Commission CQC South West, Citygate, Newcastle upon Tyne, NE1 4PA. Care Homes for Adults (18-65 years) Page 18 of 41 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 19 of 41 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 20 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People had easy to understand information about the service so that they would know what to expect from the service. Peoples needs were assessed before they moved into the home so that their needs could be met. Each person had a contract with social services and the home. Evidence: We made a requirement at the last inspection that the statement of purpose must clearly detail what people are expected to pay for. Since the last inspection the provider has sent us a copy of the Statement of Purpose which has all the required information including what people are expected to pay for, in particular, meals taken outside the home. We also made a requirement that each person must have a copy of the service user guide. We saw that each person had their own copy of the service user guide in their room. We recommended that the guide should also state what the fees cover and extras people are expected to pay for. This information had been included in the guide. We recommended that the statement of purpose and service user guide should be available in alternative formats and the statement of purpose should be available to people in the home at all times. The service user guide was in simple words and pictures. The owner showed us a video of the home that they were Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: going to develop into a DVD to show to people. The owner told us that they were going to e-mail a copy of the service user guide to two people who had their own computers. A copy of the statement of purpose was available in the home. Four people completed surveys. They all said that they were asked if they wanted to move into the home and they got enough information to decide if it was the right place for them. We looked at the files of three people. Each of these people had had their needs assessed by a social worker before they moved into the home. Each person had a person centred plan, which contained assessment information about their needs. We saw that each of these three people had a contract with the home and the social services department. There have been no new admissions to the home since the change of ownership. Care Homes for Adults (18-65 years) Page 22 of 41 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 . Written information had been reviewed and changed to make sure that peoples needs were met and they could take risks as part of an independent lifestyle. People had opportunities to make choices and decisions and to be involved in all aspects of life in the home. Evidence: We looked at three peoples personal files. Each person had a person centred plan, which had been developed by the previous owners of the care home. The three people had new style plans called support guidance. When we looked at these we found that they contained sections about personal hygiene, activities and work, monies and finance, household, spirituality, communication, food and eating, drinks and drinking, sexuality, behavioural support and emotional support. The sections were completed from the point of view of the person and contained information about their abilities. They clearly showed how the person liked to be supported and how they were able to make choices. Following a recommendation at the last inspection the guidance provided information about the persons diversity needs and promoting their rights to be treated equally and fairly. A member of staff told us that they were producing Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: person centred plans for each person. We saw that two people had new person centred plans. There was information in the care plans about how people made choices, for example, choosing how to spend their money. During our visit we saw people choosing how to spend their time. Some people were chatting in the kitchen, one was listening to music in their room and another spent time sitting quietly in their room. Another person chose to watch television in the lounge then went to the dining room to talk with another person. One person told us that they helped with the shopping and liked to choose what food to eat. They also told us that they had many more opportunities to make choices that they had before the new owners took over the home. The manager told us that people were more involved in choosing the menus. We saw new style menus, which had pictures on them. One person and a member of staff told us that they had house meetings where they discussed issues relating to the house and made decisions. People told us that they had been involved in choosing the new carpets and colours for the decor. During our visit we saw the manager and a member of staff ask people what they wanted for their evening meal. People told us that they chose what food to buy when they went shopping. Four people told us in their surveys that they always made decisions about what to do each day, and could do what they wanted during the day, evenings and weekends. There were examples in the person centred plans of how people were involved in the routines of the home such as meal preparation, washing and making drinks. A member of staff told us that people were supported with the cleaning, meal preparation and hanging out the washing. The manager said that people were being encouraged to be involved in the running of the home and doing more things for themselves. We recommended at the last inspection that the risk assessments should be reviewed and developed further to include the individual risks to each person, the reasons why people are taking risks and the benefits of risk taking. We suggested that particular attention should be paid to the risk to one person of uncovered radiators so that they are kept safe. We saw that two people had new style risk assessments which showed the advantage of participating in activities, for example making a cup of tea and showering. One person who had had a fall had assessments of the risks associated with slipping on the stairs and slipping in the bath or shower, with action to be taken to reduce these risks. A third person had risk assessments produced by the previous owner. A member of staff told us that they were updating these and copies were available on the computer. All the radiators in the house had been covered. Care Homes for Adults (18-65 years) Page 24 of 41 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People had opportunities to be part of the community and to take part in appropriate day time and leisure activities. People maintained relationships with their family and friends. Peoples rights were respected and their responsibilities were recognised in their every day lives. People were offered a healthy diet and enjoyed their food. Evidence: When we looked at the personal support plans we saw that there was information about peoples day time activities. Two people went to a resource centre and two people were retired and had activities at home. Another person went to a drop-in centre and had voluntary work. Two people told us that they were retired. One person told us about their voluntary work, the meetings they went to and being involved in an advocacy group. One person returned from the resource centre and told us that they had enjoyed their day. We looked at three peoples personal notes for the past month. These showed that Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: people had opportunities to go out into the community. One persons notes showed that they visited the pub and cafes and went to work. They showed that this person went out twice a day. This person told us that they went out regularly and used taxis. They took a taxi to a meeting during one of our visits. The second persons notes showed that they went to the resource centre most weekdays. They also went into town and out for meals. This persons support plan stated that they often chose not to go out. The third persons notes showed that they went to the cinema, the recycling centre, for pub lunches, shopping at the supermarket and personal shopping. One person told us that they had all been on holiday to Bognor Regis and the notes confirmed this. During one of our visits two people went out shopping to the supermarket with the manager to do the food shopping. One person told us that there were not enough staff on duty on a Saturday for people to go out. The daily notes showed that people also had varied leisure activities. They watched TV, listened to music, watched DVDs, had music sessions with the manager, read the paper with staff and went out for meals. One person had a laptop computer and internet access. During our visit when people came home form the resource centre four people sat in the dining room and chatted together. They were joined by a member of staff. There was a relaxed atmosphere. One person told us that they had been to Wembley to watch a football match. The owner had bought a games console and people told us that they enjoyed playing games. A record was made in the daily notes when people had contact with their family and friends. These showed that one person had contact with their sister. One person had letters from their sister and staff said that they were going to arrange to take the person to visit their sister but there had been staff shortages. One person told us that they had contact with their mother. We saw information in the support guidelines about how people were supported to be involved in household tasks such as cleaning, washing, food shopping and meal preparation. One person told us that they were involved in meal preparation, making drinks and cleaning. A member of staff told us that people were involved in preparing meals, clearing away and washing up. We saw one person helping to tidy and wash up after lunch. The daily records showed that each person was involved in the daily routines every day including meal preparation, shopping, cooking, clearing away, washing up and washing. Staff did most of the ironing but one person told us that they had ironed their trousers with support. Information in the support plans showed that people got up and went to bed at different times. As already stated people were involved in food preparation and shopping. One person, the manager and a member of staff told us that people chose the meals that they had. During our visit one person chose baked potatoes for tea and a member of staff asked each person what they wanted for the fillings. Two people and staff then went shopping for the ingredients. One person chose their meals using pictures rather than words. There was a varied menu which showed that a balanced diet was served. We saw a fruit bowl with fresh fruit provided. Peoples likes and dislikes were recorded in Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: their support plans. People told us that they liked the food. Care Homes for Adults (18-65 years) Page 27 of 41 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People received support in ways that they preferred. Peoples health care needs were being met. People were generally protected by the medication practices but some improvements need to be made to keep people safe. Evidence: The ways in which people liked to be supported were recorded in their support plans. Personal care took place in the privacy of the bedrooms and bathrooms. Each person was registered with a GP and had a health action plan. These plans had been reviewed in January 2009. They identified any health needs and action taken to meet these needs for example appointments for different health checks. Appointments with health professionals were recorded. We saw that people had appointments with their GP, audiologist, the community nurse, continence nurse, podiatrist, optician and dentist. One person said that they also had hospital appointments to have special shoes made. We made a requirement at the last inspection that people must be offered the opportunity for routine healthcare checks. We saw from the records that some routine health checks were occurring such as blood tests and blood pressure checks. Peoples weight was checked and monitored. There were records in the person centred plans of peoples consent to take medication. Care Homes for Adults (18-65 years) Page 28 of 41 Evidence: Medication was stored in a locked cupboard. This had a flimsy external padlock on the door and the cupboard was easily accessible to people so this may pose a risk. We recommended at the last inspection that a cupboard is installed that meets the requirements for the storage of controlled drugs. A controlled drugs cupboard had been installed. A local pharmacist provided the medication and also some printed medication administration record (MAR) sheets. Medication received was recorded on these sheets. There were also separate records of the weekly audit of medication received into the home, administered and returned to the pharmacy. We observed staff giving medication to one person. They put the tablets into a medicine pot and gave them to the person with a drink of water. They watched the person take the tablet then signed the MAR sheet in the appropriate way. We made a requirement at the last inspection that when staff administer medication to a person they must sign the MAR sheet or insert a symbol to explain why the person has not taken the medication. We looked at the MAR sheets and saw that there was one gap where a staff member had not signed or recorded a symbol. It was therefore not clear whether the person had had the right medication at the right time. We made a recommendation at the last inspection that when a member of staff makes a written addition to the MAR sheets they should sign the record and a second member of staff should witness the addition and sign the record to confirm it is correct. We saw that some written additions had been made to the sheets. Some of these had been signed by two members of staff and there was a date at the top of the sheet when the medication was started but not next to the signature. Some additions were signed by only one member of staff. It was not clear when the addition was made so it was also not possible to cross reference the changes with the health care records to see whether a doctor had directed the change. One member of staff had made several handwritten additions to one chart which looked muddled. The owner said that she would make sure that staff have copies of blank MAR sheets to complete instead. She also said that she would go through the medication procedures with the staff concerned. We saw that one medicine was recorded as directed with no clear information about how to take the medication. Care Homes for Adults (18-65 years) Page 29 of 41 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There were systems for recording any complaints or concerns and peoples complaints were listened to and acted upon. People were safeguarded from abuse and harm. Evidence: There is a copy of the complaints procedure within the statement of purpose. This had been updated since the last inspection. We recommended at the last inspection that a complaints log should be developed. We saw that a record had been developed. One person had complained about a member of staff. A record was kept of the allegation, the investigation and the outcome. Three out of four people who completed surveys said that they knew how to make a complaint. All four said that they knew who to talk to if they were not happy. We saw that there was information about No Secrets, the guidance about safeguarding adults, in the office. Staff confirmed that they understood the contents of the guidance and the whistle blowing policy. They also said that they had attended training in safeguarding people. When we looked at the training records we saw that staff had training about safeguarding adults and this was refreshed. During the inspection the owner booked two newer staff on to safeguarding training for the following Thursday. Two staff who completed surveys said that they knew what to do if someone had concerns about the home. Staff helped people to manage their money and records were kept of transactions with receipts. Since the last inspection clearer information had been provided in the Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: statement of purpose and service user guide so that people knew what they were expected to pay for, including meals out. Care Homes for Adults (18-65 years) Page 31 of 41 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 home was clean, fresh and hygienic. Improvements had been made to the decor and the lighting. The owners had plans for further improvements to peoples environment. Evidence: The home was a large mid terraced house situated on a main road close to Swindon town centre. It was in keeping with other houses in the street. We looked at all the communal living areas, including the lounge, dining room and the bedrooms. There were three peoples bedrooms on the first floor and two bedrooms on the ground floor. One of the ground floor bedrooms had an en-suite toilet and shower. The home was clean, tidy and free from any offensive odour. Four people said in their comment cards that the home is always fresh and clean. One person commented, Cleaned every day, kitchen and dining room painted, new chairs, lounge very nice to watch television. My room has been painted and decorated completely. We made a requirement at the last inspection that the mould in the double bedroom must be treated and the decor made good so that the people sleep in a pleasant and safe environment. We saw that the mould had been treated and the bedroom had been redecorated and there were new tiles around the wash basin. We also made a recommendation that consideration should be given to re-decorating Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: and refurbishing areas in need of attention. One person showed us their bedroom downstairs which had also been redecorated. We saw that the living room had been redecorated and people told us that they thought it was a big improvement. The kitchen and the dining room had also been repainted and new dining chairs had been provided. A member of staff told us that one person had been asked if they wanted their room redecorated and they had said that they did not. There were new carpets in the living room, dining room, hall and stairs and some of the bedrooms. New light fittings had been installed in all the shared areas. During our visit electricians were installing light sensors for the benefit of people who had difficulty turning on the lights. We noted at the last inspection that the shower room required attention. The bathroom was also in need of updating. The owners told us that they had not attended to these yet as they thought they needed completely replacing and they wished to give careful thought to making them suited to peoples needs. They had therefore given priority to more straightforward decorating. There was a laundry area next to the dining area. This contained a washing machine and tumble drier and there were hand wash facilities for staff. Cleaning materials were stored in a locked cupboard under the sink. There were infection control guidelines. Care Homes for Adults (18-65 years) Page 33 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were benefiting from support from staff who were properly recruited, inducted, qualified and trained. Evidence: We looked at the rota, which showed that there was usually one member of staff on duty during the day. The manager also worked during the day in both the Laurel and the home next door. There was one member of staff on duty in the evening for the Laurel and one member of staff sleeping in at night for both homes. A member of staff told us this was usually the case. There was a chart in the kitchen with pictures of staff to show who was on duty each day. As we noted earlier in the report one person told us that there were not enough staff on duty on a Saturday for people to go out. We asked staff in the surveys what the home could do better. One member of staff Could may be have more staff at weekends to go places so we can go as a group rather than one to one. We looked at the files of two staff who had been recruited by the new owners since they were registered. The staff had both completed an application form including a declaration that they had no convictions. One member of staff had a gap in their employment record and there was a record of the explanation for this. Copies of their passports were being kept as proof of identity. Two written references and a protection of vulnerable adults (POVA) first check check had been received for each member of Care Homes for Adults (18-65 years) Page 34 of 41 Evidence: staff before they started work. Their criminal records bureau (CRB) checks were received after they started work. Following a recommendation at the last inspection each member of staff had a risk assessment and control measures for starting work before their CRB was received. We also recommended that a checklist should be used to record when all recruitment checks are received and when a new staff member starts work. A checklist was being used to record what checks had been received. We saw that these checklists recorded yes when a check was received and some dates were recorded. It would be easier to tell if all checks were received before a member of staff starts work if the date was recorded when a check was received. One person told us that they had been involved in interviewing the new staff. The manager told us that one other person had also been involved in interviewing the staff. The statement of purpose said that staff were given in house training up to National Vocational Qualification (NVQ) level 2. We looked at the training matrix which the owner had produced. This showed that there were seven staff. Four of the staff had NVQ level 2 and one had NVQ level 3. The training matrix showed that staff received training in health and safety, food hygiene, manual handling, first aid, protection of vulnerable adults, medication and equality and diversity. One staff member had also had training about the Mental Capacity Act and introducing infection control. We recommended at the last inspection that staff would benefit from equality and diversity training so that they can recognise and record how to meet these needs. This had been addressed and five staff had received this training and the two new staff were going to attend the training. We also recommended that new staff should receive Learning Disability Award Training as underpinning knowledge for NVQs. The two new staff had started Learning Disability Award Induction training. Care Homes for Adults (18-65 years) Page 35 of 41 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefited from a home run by a manager who was appropriately qualified, experienced and supported. Systems had been developed to capture the views of the people who live in the home and their representatives so that the home is run in peoples best interests. Peoples health and safety were promoted within the home and improvements had been made to the environment to make sure people were kept safe. Evidence: The registered manager is qualified and has many years experience within the care sector. Since the last inspection he had shown that he was aware of the areas in need of development and had been working towards achieving this. We made a recommendation at the last inspection that the manager should receive regular supervision from the owner. The manager and the owner told us that he was now receiving regular supervision and we saw records to confirm this. The owner made regular visits to the home and records were kept of each visit. At the last inspection we felt that they were not sufficiently auditing the service to ensure they were meeting the National Minimum Standards. We recommended that the Care Homes for Adults (18-65 years) Page 36 of 41 Evidence: regulation 26 visits should focus more on the standards of care in the home to ensure people are receiving appropriate care. We looked at the records of these visits. They showed that the owner was focusing on the standards of care. They consulted people during the visits and concentrated on improving peoples lives. We made a requirement at our last inspection that the registered person must ensure quality assurance and quality monitoring systems are in place to take account of the views of the people using the service and their representatives. Questionnaires had been sent to the people who lived in the home to obtain their views about the service provided. One of the people who lived in the home had been involved in developing the questionnaires. We also recommended that the owner should produce a development plan, prioritising areas to focus on, to assist the manager in developing the service. One of the owners told us that he had used the improvement plan produced at the last inspection as a basis for the development plan. We saw that many of the improvements in the plan had already been actioned, for example the redecoration and new carpets. Overall health and safety checks were regularly carried out to ensure the safety of staff and the people who live in the home. We saw that there was a gas safety certificate and portable appliance testing took place once a year. Checks of the fire safety measures were also taking place regularly. The hot water temperature to the bath was restricted. New temperature controls had been fitted on the boiler. At the last inspection we made a requirement that the registered person must ensure a fire risk assessment is completed and kept under review. We saw that there was a fire risk assessment completed for each room in the house and this was due for review in August 2009. We made another requirement that all staff must receive regular fire instruction and fire drills must take place so that staff know how to protect people in the event of a fire. When we looked at the fire safety records we saw that these were taking place. We also required that all risks from hot surfaces are assessed and minimised where possible. All the radiators had been covered so that they no longer posed a risk. Restrictors had been placed on all windows. The manager told us that the Environmental Health Officer had visited and said that these measures were suitable. We made a requirement that the upstairs landing carpet must be repaired or replaced. The carpet had been replaced. We recommended the environmental risks should be reviewed to safeguard people. Several environmental risks, for example hot surfaces and windows had been eliminated. There was a risk assessment about using the lawn mower as one person liked to cut the grass. Care Homes for Adults (18-65 years) Page 37 of 41 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 20 13 (2) When staff administer 22/07/2008 medication to a person who lives in the home they must sign the medication record sheet or insert a symbol to explain why the person did not take the medicine. This is to show that the person has been given the right medicine at the right time. Care Homes for Adults (18-65 years) Page 38 of 41 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 When staff administer medication to a person who lives in the home they must sign the medication record sheet or insert a symbol to explain why the person did not take the medicine. 21/08/2009 This is to show that the person has been given the right medicine at the right time. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Medicines with instructions to take as directed should be referred back to the prescribing doctor for clear directions about how to take them. A more secure lock should be provided for the medicine cupboard so that people are protected. 2 20 Care Homes for Adults (18-65 years) Page 39 of 41 3 20 When a member of staff makes a written addition to the medication administration records they should sign the record and a second member of staff should witness the addition and sign the record to confirm that it is correct. The date when the addition was made should also be recorded so that it is possible to cross check the change with advice recorded in the care records. The staffing levels should be reviewed to make sure that there are enough staff at weekends to take people out. The date when recruitment checks are received should be recorded on the recruitment checklist to make it easier to see that all the required checks have been received before a member of staff starts work. 4 5 33 34 Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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