Care Home: The Minster

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What the care home does well The people who live in the home we spoke with, or who wrote to us, said they are treated well by staff, who listen to them and act on what they say. They know who to speak to if they are unhappy and know how to complain should they wish to. People continue to have freedom around the home and are supported in a friendly guiding manner by staff. People have access to transport; they are able to choose from a wide range of courses and activities where they are well supported by staff. The staff members we spoke with or who who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. They are provided with appropriate training and feel well supported in their roles. The healthcare professionals who wrote to us said the home does meet each person`s health care needs, seeks their advice and acts upon this to manage and improve individuals` health care. The Minster is set in a good location, close to local shops and other facilities. It is well maintained and people told us it is always kept fresh and clean. The home is run in an open and inclusive way. The views of people who live in the home are considered when planning improvements. What has improved since the last inspection? Staff recruitment information is now well recorded. This ensures thorough checks are carried out on new staff to ensure they are suitable to work in the home. People are now weighed regularly to ensure that their nutritional needs are being met. This helps to ensure the home provides good health care support. Staffing levels at the weekend have been reviewed to ensure they are maintained at a good level; there are enough staff working in the home to ensure each person`s needs are met. The home has worked hard to ensure that staff are supported to gain a National Vocational Qualification (NVQ). This helps to ensure people are supported by competent and qualified staff. What the care home could do better: No areas for improvement were identified during our visit. Key inspection report Care homes for adults (18-65 years) Name: Address: The Minster Mill Street North Petherton Bridgwater Somerset TA6 6LX     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: David Smith     Date: 0 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: The Minster Mill Street North Petherton Bridgwater Somerset TA6 6LX 01278661528 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Voyagecare.com Voyage Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 10. The registered provider 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 categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection Brief description of the care home The Minster is a large home situated in the village of North Petherton, near Bridgwater. It is one of a number of services operated by Voyage, an organisation who provide a range of services for people with a variety of specialist needs. The home is close to local shops, post office, church, pubs, chemist, doctors surgery, library and hairdressers. It has a car parking area at the front of the home, where the homes mini buses are usually parked, and a very large, well kept, garden at the rear. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 10 10 Brief description of the care home The home can accommodate up to 10 people who have a learning disability and associated physical needs. It is arranged over two floors; there is no passenger lift although there are bedrooms on the ground floor for people who may have mobility difficulties. The rooms on the first floor are only suitable for people who can manage stairs. The communal areas are on the ground floor and these include a lounge, dining room and kitchen. There are usually six staff on duty during the busiest part of the day (10am to 5pm); this reduces to four until 8.30pm which is when the two waking night staff begin their shift. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection of this service was completed on 22/08/07. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent approximately six and a half hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in August 2007 and the Annual Service Review carried out in September 2008. We also looked at the service history, which details all other contact with the home. Care Homes for Adults (18-65 years) Page 6 of 34 We provided a number of surveys for people who live in the home to enable us to carry out the last Annual Service Review. We sent new surveys to the individuals who live here, health professionals and staff members as part of this Key Inspection; eighteen were completed and returned. The views of each person who wrote to us have been included in this report. We spoke informally with some of the people who live in the home and joined eight of them for lunch. This allowed us to spend time in communal areas observing interaction and communication between staff members and some of the people who live in the home. We spoke with the Manager, her Deputy and other members of staff who were working in the home on the day of our visit. We gathered additional information for this report by looking at a number of records within the home such as individuals care records, risk assessments, accident and incident reports, medication administration, complaints and compliments, finance records, staffing rotas and other staff records and some health and safety procedures. We viewed all communal areas of the home, the grounds and some of the bedrooms used by the people who live here. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 34 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are given the information they need about the home to enable them to make an informed choice about where to live. People are confident the home can support them as their needs are thoroughly assessed before they are given the opportunity to move in. Evidence: The home has both a Statement of Purpose and Service Users Guide, which are regularly updated. These provide clear information regarding the range of services and support the home is able to offer. Each person has a copy of their guide to the service kept as part of their care records. If people are interested in moving to The Minster a thorough assessment is carried out; this involves accessing as much information about them as possible and visiting them in their present home. Each individual, and people close to them, are encouraged to visit as often as they wish to meet the other people who live here and staff members who would be supporting them. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Each person who lives in the home we spoke with, and those who wrote to us, said they were asked if they wished to move to the home and that they did receive enough information to decide if this was the right home for them to live in. One person said I came to have a look around with my parents. I met the people who were living here and some of the staff. I thought the home was really nice and so did my parents. Each person who lives in the home is provided with a contract which describe the homes aims, objectives, level of fees and who is responsible for payment, complaints procedure and each persons rights and responsibilities whilst living in the home. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals needs and goals are met and each person has a plan that they, and people close to them, have been involved in making. Each person is supported to make decisions about their lives and to take risks to enable them to live as independently as possible. Evidence: We looked at the care records for three of the people who live in the home. Each person has a very detailed plan which describes the care and support they require and how staff should provide it; information is also included about their likes and dislikes, any particular conditions they may have, who the important people in their life are, how they communicate and what daily routines they may have. The goals people are working towards are clear: these may be both short or longer term goals. The home has a good system in place to ensure each care plan is regularly reviewed and updated. Staff write a monthly report which describes each persons progress Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: towards any agreed goals and other areas such as the activities they have participated in. Each individual has regular review meetings, which they, staff from the home, a representative from their Funding Authority and family members usually attend. The staff members we spoke with or who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. Comments from staff include the home is good at identifying needs of the individuals and doing their best to meet them, we give support to 10 people with all different backgrounds and we care for each individuals needs. The people who live here have various levels of communication skills and abilities; staff work hard to ensure that people are offered choices in a way that they are able to understand. Work has already begun to develop information in a range of formats, which may help people understand information more easily; care plans will also be written in a way that makes them accessible to each person. We looked at part of one persons plan which has been completed in a more accessible format; this is clearly written and contains many picture symbols. The Manager said they are supported by other professionals, who offer advice and support. Each person who lives in the home will require an individual plan and it is clear that this work will take some considerable time to complete. The are regular meetings with the people who live at The Minster. Records are kept of each meeting and the ones we looked at show that various topics have been discussed. Interaction between staff and some of the people who live in the home was observed informally during our visit. These show that staff have a good knowledge of each persons support needs and how to communicate with them effectively. Both the people who live here and staff appear relaxed in each others company; there is a very good rapport between individuals and staff. We saw that people are given choices; staff support them, and sometimes help by explaining options, but let each person choose. Those individuals we spoke with, and those who who wrote to us, said they make decisions about what they wish to do during the daytime, evenings and at weekends; staff listen to them and act on what they say. One person who lives here said they help me make choices and treat me as an adult and another person said they help me make decisions and choices as far as I am able. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: The home uses assessments to identify risks to each of the people who live here; these are kept as part of their care records. We saw that these assessments are detailed and reviewed regularly. They cover a wide range of topics such as activities people take part in and how to keep people safe within the home. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as a individual and has opportunities and appropriate support to access leisure and educational facilities. Each persons rights are respected. Individuals are able to keep in touch with families and friends. People have healthy, well presented meals which they are involved in choosing. Evidence: People who live in the home are supported to pursue their hobbies or leisure interests as well as attending college or other day services. Our visit took place during the holiday period and people are offered other activities during these times in place of their college or day service. People were given the opportunity to help with the shopping, go out for walks, spend time with staff in the lounge or relax in their own Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: rooms while we were there. They told us they like going out and helping with things like shopping. It is clear that people are offered the opportunity to go out when they wish; the home is located close to local facilities within the village of North Petherton and there are two minibuses available which staff are trained to drive. People who live in the home told us the staff help me do lots of activities and they tell me about activities and I choose what I want to do. The records we looked at show that people go shopping, go out for walks, have meals out of the home, go to the pub and to coffee shops, the cinema and garden centres. They also go on longer trips, such as to the coast, Longleat and Crealy Park. The Manager told us she is very pleased that so many of the people who live at The Minster are either attending or starting college courses. People have chosen a variety of courses including agriculture, film and media and working towards independence; out of the 10 people who live in the home, six or possibly seven of them will be attending college when the new term starts. People are supported to organise and go on a holiday of their choice; the records we looked at show that people have recently been on holidays in the UK. One person told us they are going to France with their sister this year where they intend to visit Disneyland Paris. Each person is supported to maintain links with their family and friends; visitors to the home are welcome. People visit their families and some go on holidays with family members. One person said I see my parents on the weekend; my Dad comes to pick me up. Since I moved here I have a much better relationship with my family. The health professionals who wrote to us said the home supports people to live the life they choose, responds well to their different needs and respects each persons privacy and dignity. One professional said staff are excellent at balancing residents with strong personalities with those who are of a more vulnerable nature. The staff we spoke with feel that each person is treated as an individual. People who live at the home require different levels of care and support; staff understand and respect these needs. One staff member said some people are quite independent others need more support; we have enough staff to support people and another said people have very mixed abilities and we know how to support them. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: The home continues to provide a variety of meals and snacks, which are healthy and nutritious. We joined eight people who live in the home, and the staff supporting them, for lunch. People knew they had a choice of meals and drinks and these are also displayed on a notice board using picture symbols; everyone ate together in the dining room, which overlooks the back garden. There was a very relaxed, informal atmosphere during lunch. Staff supported people who need help at mealtimes in a very sensitive and professional way; people chatted between themselves and with staff. Again, there was a good rapport between people who live in the home and the staff team. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in they way they prefer and their healthcare needs are well met. The home supports each person with their medicines in a safe way. Evidence: Care plans provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. The home is currently developing detailed health action plans; these include information on how the Mental Capacity Act affects each person, describes who is to facilitate their health care and provides a detailed medical history of each person. People require different levels of support; some are independent in this area or only require prompting, others need intimate personal care from staff members. Both male and female staff are employed at the home, so people have a choice of who they wish to support them. Each person is registered with a local G.P., dentist and optician. Other specialist Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: services are accessed when a need arises. Clear records are kept of each appointment with health professionals; these note the reason for the appointment and the outcome. The records we looked at show that people are accessing doctors, dentists, chiropodists, opticians and more specialised services such as psychiatry, speech and language therapy and psychology. We asked following our last visit that people are weighed regularly to ensure that their nutritional needs are being met and that any changes are easily noticed; the records we looked at show that people are weighed each month and this is recorded in their care records. The healthcare professionals who wrote to us said the home does meet each persons health care needs, seeks their advice and acts upon this to manage and improve individuals health care. The home uses a monitored dosage system of medication administration, which is well managed. Each person has their own medicine profile as part of their care records; these give staff clear instructions to follow, such as how and when people prefer to take their medicines and also explain what the medicines are for. Medicines are stored securely and can only be accessed by staff; no one who lives in the home self medicates. Medicines are usually dispensed by senior members of the team; night staff do have access to basic medicines used as and when required such as painkillers. All staff who give medication to people are trained to do so and also have a competency assessment completed in the home. The medicine records we looked at were completed in full and signed by staff; there are regular stock checks and any medicines entering or leaving the home are clearly recorded. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If individuals who live in the home, or people close to them, have concerns about their care they know how to complain; their views would be listened to and acted on. People are safeguarded from abuse, neglect and self harm and the home would take action to follow up any allegations. Evidence: The home has a formal Complaints Policy, a Safeguarding and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding poor practice. We looked at one complaint the home has received in the last year; this was investigated in line with the homes policy and the complainant was advised of the outcome. We also looked at compliments the home has had; there are a number of complimentary cards and letters where people have said they are very happy with the care and support provided by the home. The people who live in the home who wrote to us said they know they are able to complain if they are unhappy about any aspect of the home. Health professionals who wrote to us said they do know who to speak to if they have any concerns regarding the care and support provided at the home; they feel their views would be listened to and taken seriously. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The staff we spoke with and those who wrote to us are clear about the important role they have to ensure people are happy with their service and remain safe; they know what to do if an individual, family member or a friend is concerned about any aspect of the care and support they provide. The home has guidelines and risk assessments in place for supporting individuals who become distressed, anxious or present difficult behaviours which may be seen as challenging the service provided, such as being verbally or physically aggressive towards staff or self-harming. They use an approach to support people which is accredited by the British Institute of Learning Disabilities (known as BILD), and all staff receive training in this area. The records we looked at and the staff we spoke with show that some individuals can become anxious and aggressive; on the day we visited one member of staff was pushed very hard by one person who lives in the home. Staff told us the approaches detailed in care plans and the training they receive helps them to manage these incidents. They may at times need to physically intervene to keep people safe; they are trained to do this and thorough risk assessments are in place. Staff also told us they are supported by other professionals in this area. They are accessing support through psychology and speech and language therapy for one individual, whose difficult behaviours are increasing. Staff are provided with training in relation to Safeguarding Vulnerable Adults and are subject to enhanced Criminal Record Bureau disclosures (known as CRBs), before they start work in the home. The home maintains thorough records of each accident, incident or other significant event which occurs in the home. We are always notified of significant events together with any other concerns regarding individuals who live in the home. We looked at the financial records of three people who live in the home. Each person has their own bank account; withdrawals are made, overseen by staff, and any money they keep in the home is stored securely for them. Each time peoples money is spent a receipt is obtained; a monthly sheet is kept for each person which keeps a running record of money coming in or being spent. The Manager told us that she checks each persons bank statement to ensure a thorough check is kept on the balance in each persons account and the withdrawals being Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: made. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Minster provides a homely and comfortable environment for people to live in. Evidence: The Minster is a large home situated in the village of North Petherton, near Bridgwater; it is close to local shops, post office, church, pubs, chemist, doctors surgery, library and hairdressers. It has a car parking area at the front of the home, where the homes mini buses are usually parked, and a very large garden at the rear. The home can accommodate up to 10 people. It is arranged over two floors; there is no passenger lift although there are bedrooms on the ground floor for people who may have mobility difficulties. The rooms on the first floor are only suitable for people who can manage stairs. There is a large lawned garden and patio area. The communal lounge, which is well furnished, has doors opening onto the garden. There is a large dining room, which also has doors which open out onto the garden. Meals are prepared in the kitchen and then served through a hatch servery into the dining room. Other rooms on the ground floor include a laundry and a room currently used as office space although there are plans to change this into an IT room in the future. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: There are 10 single bedrooms; each have their own en-suite facilities. Some of the people who live in the home said we could see their rooms; there were all clean and tidy and decorated to reflect peoples own tastes. Each persons room contains many personal items, pictures and photos which help with the homely feel. All areas of the home we saw were clean and tidy; night staff are mostly responsible for cleaning tasks although individuals are encouraged to help as much as possible. The people who live in the home who wrote to us said they liked the environment and it is always kept fresh and clean. One health professional said I love the garden. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons needs are met and they are provided with safe and appropriate support by a competent and well trained staff team. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. Evidence: The staff who work in the home are given job descriptions; staff who wrote to us, and those we spoke with, said they are clear on their own responsibilities and those of other members of the team. The people who live in the home we spoke with, and those who wrote to us, said they are treated well by staff who listen to them and act on what they say. One person told us I love every single one of them. The staff we spoke with said and those who wrote to us said they are happy working in the home and told us they are always given up to date information about the people they support. They feel there is generally a relaxed atmosphere in the home, they feel listened to and that their views are taken seriously and acted upon wherever possible. Comments from staff include: this is a very nice house to work in, all the staff are Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: friendly and I think it is lovely here. There are usually six staff on duty during the busiest part of the day (10am to 5pm); this reduces to four until 8.30pm which is when the two waking night staff begin their shift. Following the last inspection we asked the home to review staffing levels at the weekends; some staff who wrote to us said they felt staffing levels could be improved. We discussed this with the Manager and staff during our visit; the Manager said they have now recruited staff to fill vacancies and they feel staffing levels have improved. The staff we spoke with said the staffing levels are ok now and we have enough staff to support people. We saw staff supporting and interacting with people who live in the home during our visit. It is clear that staff have a good understanding of peoples needs and how to communicate effectively with them. Staff have a very good rapport with individuals and always had time for them; there is a relaxed, homely atmosphere. The home has a robust recruitment process; recruitment is handled centrally and a sheet is held in the home with recruitment details on it. We looked at the records for two staff who have recently joined the staff team; these show that documents proving their identity and eligibility to work in the UK, two satisfactory references and Enhanced CRBs were obtained before they started working in the home. New staff complete a thorough induction training programme; all staff are then provided with mandatory courses such as first aid, food hygiene, how to move and handle people safely and health and safety. Staff are also given training in specific areas such as medication administration, how to manage difficult or aggressive behaviour and how to recognise and respond to abuse (currently known as safeguarding vulnerable adults). Following our last visit we asked that more staff are supported to gain a National Vocational Qualification (NVQ). The home has worked hard to ensure staff do attain an NVQ and the records we looked at show that most of the team are now either qualified or are working towards their award. The staff we spoke with and those who wrote to us are happy with the level of training they receive. They are provided with training they feel helps them understand and meet peoples needs, keeps them up to date on new ways of working and gives them enough knowledge about healthcare and medication. The health professionals who wrote to us said the staff team have the right skills and experience to support peoples social and health care needs. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: The staff team meet regularly. Staff are provided with regular supervision; this is a 1:1 meeting with their line manager. Each supervision is recorded and kept in the staff members own file. In addition to this, staff are provided with an annual appraisal. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and each individual benefits from how it is managed. The views of the people who live in the home are sought to help the home review their practice. Each person is safeguarded as the home keeps clear records, staff understand the ways things should be done and health and safety practices are carried out. Evidence: The home is managed by Mrs Samantha Law; she has a number of years experience in the care sector and has been the Registered Manager of The Minster since December 2007. Mrs Law is suitably qualified and attends training to ensure she is aware of new legislation or new ways of working. She is supported by one Deputy Manager and both the Manager and the Deputy were working at the home on the day we visited and fully supported the inspection process. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The Manager explained that she feels she has now settled into her role and able to make changes she feels would benefit the people who live here. Mrs Law said we are looking at communication, better strategies are being developed, so we can offer choice. That is the direction we are going in. The people who live in the home we spoke with and those who wrote to us and discussions with staff members and the Manager show that there is an open and inclusive management style. People said they are happy to discuss any issues, they feel they are always listened to; people said communication and management support, from both the Manager and her Deputy, is very good. The views of people who live in the home are sought as far as possible. There are meetings held in the home which they are encouraged to attend; they also attend review meetings and know how to complain if they are unhappy. The Manager told us the home is keen to develop more accessible formats so that people who live here have access to more information and to continue to improve methods of communication so that people can make more choices or express their opinion. The record keeping in the home is of a good standard. Files and other documents remain well organised, easy to access and stored securely. The home has a number of policies and procedures, which are designed to ensure that both the people who live in the home and the staff team are safe, the service complies with the law and remains aware of best practice or new ways of working. Staff understand these policies as they are asked to read them and they sign to say they have done so. The home is visited each month by the Area Manager, who completes an audit of the service. During these visits both people who live in the home and staff members are spoken with to gain their views on the quality of care and support provided; written records are also looked at. A clear record of each audit is kept in the home. There are good systems in place to support health and safety in the home; these are are used consistently. Regular checks are made to ensure the home and all fixtures and fittings are in good condition. Fire safety measures are good; we were given thorough briefing on fire safety and what to do if the alarm sounded during our visit. Staff are given training and both staff and people who live in the home take part in regular fire drills so they know what to do in the event of a fire. There is adequate insurance cover in place. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: Care Homes for Adults (18-65 years) Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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