Care Home: The Laurels

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What the care home does well The home offers a clean, comfortable and wellmaintained place in which to live. A range of activities are available to people who use the service for relaxation, mental stimulation and learning life skills. A person who lives in the home told us that they enjoyed the activities that they do. They showed us their care plan. They said that the staff team is supporting them to become more independent.Meals at the home cater for the things each person likes and needs.People who use the service have access to healthcare services. A health and social care professional wrote to us that they were impressed with the way the home had helped a person to settle in. Another health and social care professional told us that the home is well organised and that "the residents look well cared for and happy".Staff members are trained to help them to meet people`s needs.The service helps people to keep in touch with their relatives and friends. A relative had said in the home`s own survey "A lovely welcoming place to visit. All the staff are wonderful. My daughter is very happy. She is well cared for. A big thank you to all. It is lovely to know my daughter is safe and well cared for. Home from home". What has improved since the last inspection? The home now has a suitable storage cabinet for certain types of medication that people who live in the home may be prescribed. There have been improvements made to the house. For example, each person who lives there has a newly decorated bedroom.There is a new kitchen with a low level worktop so that people who use wheelchairs can make their own meals. What the care home could do better: The home must make sure that proper checks on staff who work at the home are always carried out, to protect the people who live in the home.All staff should have supervision meetings with their manager at least six times a year, to make sure that they are being supported to do their job well. Key inspection report Care homes for adults (18-65 years) Name: Address: The Laurels 1 Lower St Helens Road Hedge End Hampshire SO30 0NA 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: Laurie Stride Date: 3 0 0 9 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 37 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 37 Information about the care home Name of care home: Address: The Laurels 1 Lower St Helens Road Hedge End Hampshire SO30 0NA 01489-799119 02392251331 dolphin.homes7@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dolphin Homes Ltd Name of registered manager (if applicable) Miss Nicola Houghton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 7 0 0 care home 7 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home Seven people live at the home. They all have their own bedroom. The home is a suitable place to live for people who use wheelchairs. Care Homes for Adults (18-65 years) Page 5 of 37 Each person has a care plan, which tells staff how to support them and about the things each person wants to do. The home provides transport for the people when they go out to other places. Care Homes for Adults (18-65 years) Page 6 of 37 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 37 How we did our inspection: This is what the inspector did when they were at the care home We (the commission) visited the home and did not tell them we were coming. We looked at how well the home was doing and checked that they were doing what we had asked at the previous inspection on 02/10/08. We were in the home for eight hours. We met the people who use the service and spoke with one of them. We also talked with the Care Homes for Adults (18-65 years) Page 8 of 37 manager and two staff members. The home gave us information about what they were doing in their annual quality assurance assessment (AQAA). We sent survey questionnaires to people who use the service, staff and other people who have contact with the service. We received responses from two social and health care professionals, three staff members and a person who lives at the home. Staff helped the person to complete the form. Care Homes for Adults (18-65 years) Page 9 of 37 What the care home does well The home offers a clean, comfortable and wellmaintained place in which to live. A range of activities are available to people who use the service for relaxation, mental stimulation and learning life skills. A person who lives in the home told us that they enjoyed the activities that they do. They showed us their care plan. They said that the staff team is supporting them to become more independent. Care Homes for Adults (18-65 years) Page 10 of 37 Meals at the home cater for the things each person likes and needs. People who use the service have access to healthcare services. A health and social care professional wrote to us that they were impressed with the way the home had helped a person to settle in. Another health and social care professional told us that the home is well organised and that the residents look well cared for and happy. Staff members are trained to help them to meet peoples needs. Care Homes for Adults (18-65 years) Page 11 of 37 The service helps people to keep in touch with their relatives and friends. A relative had said in the homes own survey A lovely welcoming place to visit. All the staff are wonderful. My daughter is very happy. She is well cared for. A big thank you to all. It is lovely to know my daughter is safe and well cared for. Home from home. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 12 of 37 The home now has a suitable storage cabinet for certain types of medication that people who live in the home may be prescribed. There have been improvements made to the house. For example, each person who lives there has a newly decorated bedroom. There is a new kitchen with a low level worktop so that people who use wheelchairs can make their own meals. Care Homes for Adults (18-65 years) Page 13 of 37 What the care home could do better The home must make sure that proper checks on staff who work at the home are always carried out, to protect the people who live in the home. All staff should have supervision meetings with their manager at least six times a year, to make sure that they are being supported to do their job well. Care Homes for Adults (18-65 years) Page 14 of 37 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 Laurie Stride CQC South East Citygate Gallowsgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 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 15 of 37 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 16 of 37 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 who are interested in using the service have their individual needs and aspirations assessed prior to a place being offered, to ensure that the home can meet these needs. Evidence: We saw that the home has a Statement of Purpose that provides information about the service and this included details of the assessment and admissions process. This document states that care is modelled on the four key principles of rights, independence, choice and inclusion, and that care will be offered to suitable applicants regardless of cultural backgrounds, religious persuasion or sexuality. The manager told us in the homes annual quality assurance assessment (AQAA) that there had been two new admissions since the last inspection. The AQAA informed us that a full initial needs assessment was completed prior to any visits with the service users, family or someone who knew the service user very well. Staff training and specialist equipment relevant to each persons needs had been put in place prior to people moving in. During our visit we looked at the care plans and records for the two people who had recently been admitted to the service. Both files contained full assessments of the individuals social and health care needs, which had been carried out by the services Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: managers prior to their admission. As part of the assessment, we saw that information had been obtained from the individuals previous placements, their care managers and a speech and language therapist. The assessments also included some relevant personal history details about each person, obtained from the individuals and/or their relatives, to enable the home to have as full a picture as possible of their needs and wishes. One of the people whose records we saw had special dietary needs and required equipment and support for feeding. We saw records showing that staff had received the relevant specialist training prior to the person being admitted and staff we spoke with confirmed they had received this training. We received completed survey questionnaires from three health and social care professionals who are involved with the service. All said that the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people. One wrote that they were Impressed with the service level given to help client settle in and support family maintaining family links. Care Homes for Adults (18-65 years) Page 18 of 37 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 assessed and changing needs and personal goals of the people using the service are reflected in their individual plans. Staff support people who live in the home to make decisions about their lives and to take risks as part of an independent lifestyle. Evidence: The homes annual quality assurance assessment (AQAA) told us that care plans and risk assessments are reviewed and updated regularly and that care plans are working documents which the staff and service users update daily. We looked at the care and support plans for three of the people who use the service. These were in a pictorial format and provided clear and detailed information about the individuals’ needs and how they like staff to support them. One person who uses the service had written sections of the plan himself and held the care plan in his room. This person told us that staff support him in the way that he wants and are assisting him to achieve his goal of getting out and about more independently. Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: Two of the people whose plans we saw were still on a three month trial period and daily records gave details of ongoing observation and assessment by staff. Following this period, the manager reviews each persons care plans on a six monthly basis or sooner if necessary and this was recorded in the other persons plan. Risk assessments were included in the care plans, showing how people are encouraged and supported to do things as independently as possible. Examples of these were accessing the community and using the kitchen. Each file contained a personal fire evacuation plan. Care plans gave information about how staff members communicate with each person who lives in the home, for example using picture boards and objects of reference. We spoke with two members of staff who demonstrated a good knowledge of the people who use the service and their needs and wishes. The staff members told us how each person communicates and gave examples of using different communication tools to support people to exercise choice and control over their lives. The manager told us that one of the people who live in the home has an independent advocate to help ensure that the individuals own wishes and choices are represented. The responses from the three health and social care professionals who completed our survey questionnaire indicated that peoples social and health care needs are always properly monitored, reviewed and met by the service. Two said the service always respond to the diverse needs of individual people. The other person said it usually does. One health and social care professional told us the service does well at Taking on guidelines and recommendations for service users new to the home. Contacting us for advice. Another health and social care professional said that the staff at the home work well with clients who have complex physical and learning disabilities. Care Homes for Adults (18-65 years) Page 20 of 37 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. The home supports people to take part in activities of their choice and to develop independent living skills in line with the individuals abilities and wishes. People who use the service are encouraged and supported to maintain personal and social relationships. The home caters for individual diets to suit peoples needs. Evidence: Two of the three health and social care professionals who completed our questionnaire indicated that the service always support people to live the life they choose wherever possible. The other person said it usually does. One health and social care professional told us the service does well at Offering opportunities to engage in activities and choice. Another said that the service Provide a good range of social opportunities and interests for people who use the service. During our visit we saw there is a weekly plan of structured activities based on the things that the individuals who live in the home like doing. This includes both in-house activities and outings and community services such as day centres. In-house activities include daily Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: living skills for those who wish to take part. We looked at the relevant sections of care plans for three people who use the service. These indicated that two of the individuals had taken part in specific activities on a daily basis over the week, such as going out for lunch, arts and crafts at home, day services, shopping and visiting a relative. The records for the other person were not as clear and indicated that the individual had not been out of the house for a period of six days. Some of the entries recorded were In, relaxing, Indoors and Chilling. The manager said that this person often becomes tired, however she would raise the matter with the staff team to ensure that the person receives the same social opportunities as other people who use the service. One person who uses the service told us how he had written to the service providers because he wanted to be able to access the kitchen to improve his cooking skills. We saw that the kitchen had recently been refurbished and now has a low level worktop to support people who use wheelchairs to take part in preparing their meals. The person we spoke with told us that he visits his fiance who lives locally. The home supports him to do this by providing transport to and from the town. He likes going to college once a week to study music and art and said he had watched the swimming that morning and was going to join in with this activity the next time. He has his own bank card, for which there is a support plan, and is now managing his own bills. He helps with daily routines such as tidying his room when he wants to and also with doing the health and safety checks around the home. This person told us he had visited a Royal Navy base with staff and had enjoyed this. There are support plans for individuals visiting relatives and the manager told us how the home provides regular transport for relatives who wish to visit the home. During our visit three relatives telephoned the manager for updates and the manager responded in an open and welcoming manner. The home has a vehicle that is equipped for transporting people who use wheelchairs. One person who lives in the home had taken part in our survey. Asked what could the home do better, the person said The Laurels could do better food. During our visit a person we spoke to who lives in the home told us they like the food provided and can eat their meal at a time that suits them. The home has a four week menu showing breakfasts of cereals or toast, light lunches except on Sundays and two choices of dinner. For the current week many of the dinners and listed alternatives comprised of similar meals, for example two choices of fish on one day, two choices of pie on another and two choices of pasta on another. The manager acknowledged that the range of choice appeared limited and said she would take action to improve this. We saw that staff members keep records of each persons daily food and fluid intake, which the manager said she monitors. One of these records showed that a different dinner alternative to the one listed on the menu had been given to a person the previous day. The manager informed us in the AQAA that the home carry out nutritional screening on everyone admitted to the service. Six staff members have received training in malnutrition care and assistance with eating and a Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: further four staff were currently doing the training. The manager told us that one staff member had also registered to do a more comprehensive six month training course on malnutrition and diet. Two staff members we spoke with told us they had received training before they gave assistance to people with eating. Care Homes for Adults (18-65 years) Page 23 of 37 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 who use the service have their physical and emotional needs met and receive personal support in the way they prefer and require. People who live in the home are protected by the homes policies and procedures for dealing with medicines. Evidence: The manager told us in the AQAA that Service users are supported to access all necessary health appointments as and when required. All service users have en suite bathrooms or showers depending on choice so that privacy and dignity can be respected at all times. Service users are supported to maintain as much independence as possible. Service users are supported to go out to buy their own toiletries of their own choice. A person who uses the service told us that staff support him in a way that suits him and we saw that individual preferences are recorded in peoples care plans. We observed that staff provided personal care in the privacy of peoples rooms. People who use the service have complex support needs and staff use a checklist to ensure that all aspects of personal care are completed in line with the care plans. Technical aids and equipment were in place to meet the assessed needs of people using the service, such as hoists, wheelchairs and specialist beds. We saw records detailing when such equipment is serviced and observed routine maintenance taking place during our visit. Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: We saw that records are kept of individuals health care appointments and the outcomes of these, including visits by a physiotherapist and a speech and language therapist. One person who uses the service had a doctors appointment at the time of our visit and their relative phoned to ask about the outcome. Peoples diets and weight charts were being monitored by the manager and staff and there was a pressure care monitoring programme in place. All three of the staff who completed our survey questionnaire indicated that they feel they usually have enough support, experience and knowledge to meet the different needs of people who live at the home. The two staff members we spoke with during our visit told us that they receive relevant training before working with people who use the service, for example moving and handling and medication administration training. We received completed survey questionnaires from three health and social care professionals who are involved with the service. All said that the service seek advice and act on it to meet peoples social and health care needs and improve their well-being. All said that the service always respect peoples privacy and dignity. Two indicated that the service manage peoples medication correctly. The other stated that they did not know. The manager reported that no-one living at the home is currently able to manage their own medication. Since the last inspection the home has obtained a suitable storage facility for any controlled drugs that individuals may be prescribed, in line with changes to the legislation about peoples medication. This meets a requirement made at the last inspection. There were no controlled drugs being held on the premises at the time of our visit. However a certain type of non-controlled medication was being stored in the controlled drugs cabinet, as a safe practice measure. Other medication is individually stored in another locked cabinet in the office. We looked at a sample of the medication administration records, which were up to date and signed by the staff member giving the medication and there were no gaps. A second staff member checks the medication being given and signs an additional record. Staff also record when food supplements are given to a person who uses the service. The home orders medication on a monthly basis and there is a system for returning any unused medication to the pharmacy. Care Homes for Adults (18-65 years) Page 25 of 37 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. People who use the service are assured that any complaints they have will be taken seriously and acted upon and that they are protected from any form of abuse, neglect or self harm. Evidence: The manager informed us in the AQAA that All service users have a copy of the complaints procedure in their care plans. There is also a copy on the wall in written and picture format. There is regular communication with service users and family to ensure that any complaints or concerns are dealt with within 28 days. Staff are trained in the safeguarding of adults and a copy of the policy is available for all to see. The AQAA indicated that there have been no complaints and no safeguarding referrals or investigations and the manager confirmed this during our visit. The service had notified us of any incidents affecting people who use the service and of any actions the home had taken in relation to these. During our visit we saw a copy of the complaint procedure. We spoke with one person who uses the service, who told us that he would speak with the staff if he was not happy about anything. The majority of people who live in the home have limited ability to verbally communicate any worries or concerns they may have. We spoke with two staff members, who told us how they would be able to assess if a person using the service had a concern by observing their behaviour and knowing how individuals communicate. Both staff members were clear about recording and reporting any concerns so that these could be followed up. Three members of staff completed our survey questionnaire and all Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: indicated that they know what to do if someone has concerns about the home. The responses from the three health and social care professionals who took part in our survey indicated that the service always respond appropriately if they or another person have raised any concerns. The two staff we spoke with and the manager were aware of their responsibilities in relation to the local authority safeguarding adults procedures. Care plans were in place giving guidance for staff on how to deal with any challenging behaviours. Staff we spoke to were aware of these issues and of how to use nonconfrontational techniques such as distraction in order to diffuse any situations. The home has a system for handling small amounts of money belonging to people who use the service, which is overseen by the manager. We saw that receipts and records of expenditure are kept and the manager does a monthly audit of the system. Care Homes for Adults (18-65 years) Page 27 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a clean and comfortable environment that is suited to their individual needs. Evidence: The AQAA informed us that The service users at The Laurels requested a user friendly kitchen so we are in the process of having an adapted kitchen fitted with low work tops and accessible equipment. We have decorated all bedrooms to each individual choice. The bath has been changed to a wet room to accommodate the service users’ needs. During our visit we saw that the work had been completed. Peoples bedrooms were individually decorated and furnished and reflected the individuals interests. Each bedroom has an en suite shower, toilet and wash basin. The kitchen had been equipped with new cabinets, cooker and fridge and a low level worktop. A person who lives in the home told us that he now uses the kitchen and prepares his own meals. The communal areas are fitted with laminate flooring to make these areas suitable for wheelchair users. There is an enclosed rear garden with ramp access. One person who lives in the home has a trampoline in the garden. The home had notified us when the passenger lift was in need of repair. The manager told us that there is now an eight hour servicing agreement and there have been no further problems. A stair gate and risk assessment was in place in relation to one person who uses the service, who is not able Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: to operate the lift on their own. Bedrooms are fitted with overhead hoists, which staff members are trained to use to assist people with their mobility. There is a small utility room that has a sink and lockable storage for cleaning materials, a washing machine and tumble dryer. Infection control procedures are in place and staff members encourage people who live in the home to help with domestic tasks. At the time of our visit we observed a good standard of cleanliness in the home. One person who lives in the home had taken part in our survey. Asked what does the home do well, the person told us Keep the home clean. A person we spoke to who uses the service and takes part in doing the homes health and safety checks told us that he thought that the home is ok in this respect. Care Homes for Adults (18-65 years) Page 29 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by staff who are trained to meet their needs. Staff recruitment procedures have not always been adhered to, which could put people who live in the home at risk. Evidence: Three members of staff completed our survey questionnaire. One indicated that there are usually enough staff to meet the individual needs of all the people who use the service. The other two staff members told us there sometimes are. We looked at the staff rota and this reflected the number of staff on duty at the time of our visit. We observed that staff members were available to assist people with various activities throughout the day. The manager told us how the staffing level had been raised from three to four care staff on duty during the day following the admission of two people new to the service. A staff member we spoke with said that there are always four staff members on duty at this time. There are two staff on duty at night and the manager said that this is currently under review. The manager told us that people who use the service are encouraged to participate in staff interviews. Staff confirmed in our survey that their employer carried out checks and references before they started work in the home. We looked at a sample of four personnel records relating to staff who had commenced work in the home this year. A pro forma is used to record details of the checks carried out on each staff member prior to Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: employment. We saw details including dates and reference numbers of POVA First (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks for each person. The records stated that two written references had been obtained for all but one of the staff members, for whom there was one reference. The manager said she would follow this up and telephoned us after the inspection to confirm that a second reference request had been sent. It is a requirement that two written references are obtained for staff members before they start work in the care home. The records we saw for each person indicated that a full employment history had been taken. We saw that the manager was in the process of obtaining photographs of each staff member for the files as proof of identity. Our survey asked staff if their induction covered everything they needed to know to do the job when they started, one staff member told us mostly and two said partly. Two indicated that they are being given training which is relevant to their role and gives them enough knowledge about health care and medication. One confirmed that their training helps them understand and meet the needs of people who use the service and keeps them up to date with new ways of working. Another staff member said it did not. The third staff member did not give a response to this part of the survey. At the beginning of this inspection visit the manager informed us that the continuing professional development files for each of the staff were at the head office for auditing, so that training certificates, induction workbooks and copies of contracts were not available for us to see. We saw a copy of the staff training programme, which includes practical and theoretical training on subjects such as Health and Safety, First Aid, Fire Safety, Moving and Handling and Food Hygiene. Other training courses included Safeguarding Adults, Medication Awareness and Epilepsy Awareness. There were dates on the programme indicating when staff completed each training course. The manager said that some staff were still working through training books, so the record was not an up to date one. We spoke with two members of staff who told us that they are receiving the training and that staff are not allowed to perform various care tasks until after they have completed the relevant training, for example medication administration and moving and handling. One of the staff who had recently started work at the home said he was working through the induction workbook and we saw a version of this on the homes computer. The other staff member said she had completed National Vocational Qualifications (NVQ) in health and social care at level 2 and 3 and had taken part in a moving and handling refresher course the previous week. The manager had informed us in the AQAA that all staff have had a Skills for Care induction and that a minimum of 80 of care staff have either completed or are working towards completing NVQ in care. We received completed survey questionnaires from three health and social care professionals who are involved with the service. One told us that the homes managers and staff always have the right skills and experience to support peoples social and health Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: care needs. Another said they usually do. One wrote does appear to be. A person who uses the service told us that staff treated them well. One of the staff who completed our questionnaire indicated that their manager gives them enough support and meets with them often to discuss how they are working. The other two staff members said that such meetings sometimes take place. The two staff members we spoke with told us that they received regular support and supervision. We saw that the manager has a schedule of planned supervisions and she told us she records all such meetings. We looked at the dates when three staff had received formal supervision and these generally took place every two months, with the exception of one staff member whose records showed meetings taking place every three months, which is below the national minimum standard. The manager acknowledged this and said she would ensure that all staff members receive formal supervision at least six times a year. Care Homes for Adults (18-65 years) Page 32 of 37 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 managed and seeks the views of people who live there to ensure the service is run in their best interests. The health, safety and welfare of people who use the service and staff are promoted and protected. Evidence: The manager has been in post since November 2008 and was registered with the commission in June 2009. Miss Nicola Houghton has previous management experience within a care setting and at her registration interview demonstrated her knowledge and commitment to working with people with learning disabilities and complex needs. She has an NVQ level 4 in care and has completed the Registered Managers Award. The manager has also undertaken other training and qualifications relevant to care work. One of the health and social care professionals who completed our survey questionnaire wrote The manager is good at communicating with the surgery when appropriate. The home has been much better organised since she took over. The atmosphere in the home is much improved when I have visited. The residents look well cared for and happy. The manager sent us the annual quality assurance questionnaire (AQAA) and provided us with Care Homes for Adults (18-65 years) Page 33 of 37 Evidence: the information we requested. In the AQAA the manager told us that quality assurance is reviewed regularly and questionnaires are sent out on a six monthly basis to service users, family and staff. A monthly regulation 26 visit is completed by the area manager or the Director of Care. During our visit we saw that the manager completes a monthly quality assurance checklist, for example to ensure that choice is being promoted in the service, suitable activities are being offered and risk assessments are in place. We also saw that monthly regulation 26 reports were on file and that actions identified in the most recent report had been carried out. The manager showed us the completed questionnaires from the homes most recent quality survey, which was sent to people who live in the home, their relatives/visitors, staff and social and health care professionals. The responses were overall positive and the manager said she had checked the results for any issues to follow up but had not yet fully collated all the results and formed a development plan. A person who uses the service told us that staff ask him if everything is ok. Health and safety checks are carried out in the home and we also saw records of gas and electrical appliance tests and servicing of the lift and hoists. We looked at the fire safety log book, which contained a risk assessment that was just due for review and up to date records of equipment and systems checks. A fire evacuation drill had taken place on 31/08/09 with three staff and all the people who live in the home. Records showed that fire safety instruction is given to all new staff on their first day of working. Each person who uses the service has an individual fire evacuation plan based on their current needs. Care Homes for Adults (18-65 years) Page 34 of 37 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 Care Homes for Adults (18-65 years) Page 35 of 37 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 34 19 30/10/2009 Two satisfactory written references must be obtained for each staff member prior to them starting work in the care home. This is to ensure that care workers are fit to work in the home so that people who use the service are protected. 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 36 All staff should have regular, recorded supervision meetings at least six times a year with their senior/manager in addition to regular contact on day to day practice. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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