Care Home: The Mount

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What the care home does well The manager and her staff team have created detailed care plans for each person identifying their needs and providing staff with guidelines to meet those needs. Care plans are reviewed at regular intervals and this enables staff to identify people`s changing needs. People are supported to make decisions about their lives and the service provided at the home is lead by people`s needs and wishes. Risk assessments are in place that identify and minimise potential risks to people. People lead active and varied lifestyles and staff supported people appropriately as required. The home has a pictorial complaints procedure to support people with communication difficulties to make a complaint if they are unhappy. The home is decorated to a high standard throughout, it is well-maintained, clean and tidy and meets peoples current needs. Recruitment procedures are robust and protect the people living in the home. Staff training records provide evidence of staff receiving training to maintain peoples safety and meet their specific needs. Health and safety procedures and staff training minimise potential risks to people. What has improved since the last inspection? Since the previous inspection the manager has implemented a quality assurance procedure. The requirement of the previous inspection report has been met. What the care home could do better: Where people are moving between homes within the organisation there should be a procedure in place to ensure that the admission/assessment procedure is consistent in all occasions. The manager should review the home`s policies and procedures to ensure that they accurately reflect the procedures followed by staff. The manager needs to ensure that staff accurately record people`s progress towards the goals they wish to achieve. People living in the home should be involved in their monthly reviews wherever possible. Life plans should be developed in a user friendly format using pictures, symbols and plain English. The staff team need to complete training in behaviour management to ensure that people are not being put at unnecessary risks. Key inspection report Care homes for adults (18-65 years) Name: Address: The Mount Main Road Whiteshill Stroud Gloucestershire GL6 6JS     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: Paul Chapman     Date: 1 8 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 30 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 30 Information about the care home Name of care home: Address: The Mount Main Road Whiteshill Stroud Gloucestershire GL6 6JS 01453757291 01453757291 grapevinecareadmin@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Grapevine Care Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: That 1 service user with learning difficulties and an underlying mental health need is accommodated until such time as this is no longer required. Date of last inspection Brief description of the care home The Mount is a care home for adults with learning disabilities who may also present with mild challenging behaviour. The home opened in August 2003. At the time it was registered for up to four people, but a variation was successfully applied for, increasing the registered numbers to six. The home is a large, renovated Georgian property on the outskirts of Whiteshill, near Stroud. There are two bedrooms on the second floor, three on the first floor and one bedroom on the ground floor. There are two lounges and a separate kitchen/dining area. The home is set in large, attractive grounds and has views over the surrounding countryside. Prospective service users and others involved in their care are provided with Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home information about the home including a copy of the Statement of Purpose and Service Users Guide. Fees for living in the home are based on a persons assessed needs. Care Homes for Adults (18-65 years) Page 5 of 30 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: Before completing the inspection site visit to this service we (the CQC) sent the registered manager questionnaires to distribute to people living in the home, staff and other professionals to complete. In addition to questionnaires the registered manager also completed an AQAA (Annual Quality Assurance Assessment). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). Care Homes for Adults (18-65 years) Page 6 of 30 The manager supplied us with the completed AQAA and we received questionnaires from 6 people living in the home, 5 staff and 3 other health and social care professionals involved with people in the home. We completed the site visit to this service on Wednesday August 18th 2009 and the manager was present throughout our visit. We started the day by completing a tour of the premises and observing the relationships between staff and people in the home. We examined the care of 2 people in detail looking at their assessments, care plans, risk assessments, the range of activities they took part in and other documentation supporting their placement in this service. Further evidence about the quality of the service was gathered from speaking to staff and people living in the home. In addition to examining documents relating to peoples care we looked at records relating to staffing and health and safety. When speaking with people living in the home included; The food is really good, the actvities we do are really good, they are good at providing activities, taking me to college and the other things I like to do, the staff treat me well, the home is lovely and I like it here. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Where people are moving between homes within the organisation there should be a procedure in place to ensure that the admission/assessment procedure is consistent in all occasions. The manager should review the homes policies and procedures to ensure that they accurately reflect the procedures followed by staff. The manager needs to ensure that staff accurately record peoples progress towards the goals they wish to achieve. People living in the home should be involved in their monthly reviews wherever possible. Life plans should be developed in a user friendly format using pictures, symbols and Care Homes for Adults (18-65 years) Page 8 of 30 plain English. The staff team need to complete training in behaviour management to ensure that people are not being put at unnecessary risks. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person admitted to the home was assessed before they were offered a place. The homes admission policy needs to be reviewed to ensure that it accurately reflects the process staff follow. Evidence: There has only been 1 admission to the home since the previous inspection was completed. This was from another home in the organisation. Examining the process followed by both of the services it showed that a thorough assessment had been completed and this was supported by a report identifying what the persons needs were. We spoke to the person and asked them what they thought of the process. They felt it was alright, Staff spoke to me about it, I was able to visit before I decided I wanted to move in. A good practice we saw was the person has a file in their bedroom that contains the Service Users Guide, the homes complaints procedure and Gloucestershires safeguarding Vulnerable Adults procedure. We examined the homes admission policy which had been adapted from another organisations policy (The incorrect organisations name was printed on the top of the Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: policy). The manager needs to ensure that the policy also accurately reflects what steps they would take in assessing a potential admission to the service. The policy should also include an element that details what steps should be taken if a person is moving between homes within the organisation. The reason for this is that the process we examined was difficult to assess. Care Homes for Adults (18-65 years) Page 12 of 30 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. People living in the home have a range of care plans that identify their needs and provide staff with guidelines to follow enabling them to meet those needs consistently. Monthly summaries completed by staff do not accurately reflect peoples achievements and do not provide evidence of people being involved in their creation. Risk assessments are in place that minimise potential risks to people whilst enabling them to take acceptable risks. Evidence: We examined the care of 2 people in detail including the person who had moved in since the previous inspection. Each person has a range of care plans in place and these covered topics including; sleeping, family, personal care, communication, Independence, eating and drinking, work and leisure, money and finance, expressing sexuality, health, medication and mobility. Each of the plans we examined were well written providing the reader details of the persons needs and the steps required by staff to meet those needs. Each of the plans we examined were reviewed monthly by staff. We received comments from other health and social care professionals involved Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: with the home. When asked what they thought the home did well they stated, they provide detailed care plans and management guidelines for individuals, recommendations are taken on board and well supported, there is good communication with us. Both of the people whose care we were examining had life plans in place. The manager stated that these were in the process of being updated for all of the people in the home. Looking at the documents in place we recommend that manager ensures that all of the updates are user friendly making use of pictures and plain English. Each person has a key worker and they complete a document monthly named a reducing sheet. The reducing document is very good in identifying what is happening in peoples lives. These documents are usually completed by peoples key workers. We spoke to the manager about the recording, specifically around IPP records. Looking at 1 persons records they had clearly achieved a number of goals identified in their IPP, but staff had recorded One person had an IPP meeting in February this year. Looking at the minutes it was clear that they had achieved a number of the goals but these had not been recorded by staff who made the comment on going in the monthly recording. Speaking to the manager about this she said they would speak to staff about this and ensure future recording is more accurate reflecting what goals have been achieved. The reducing sheets we examined provided little evidence of staff working with the actual person to complete these documents and we recommend that people should be involved in completing the reducing sheet with staff. Speaking with people living in the home, staff and from examining records we were able to gather a range of examples that showed people were able to make choices in their day to day lives. We saw examples of people being able to choose what they eat, the activities they wish to complete and the people they spend time with. In addition to this 1 person is supported by an advocate to make some decisions and the home work closely with them when required. With another person we saw good examples of the home working with a psychologist to support decisions made with another person. This has resulted in the person signing contracts agreeing to what they like to do and any restrictions put on them. These were seen to be reviewed at regular intervals. Both of the people we whose care we were examining had a range of risk assessments in place that were written in February 2009 and have been reviewed each month since. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead active lifestyles supported by the staff as required. Evidence: The reducing sheets completed by staff every month identify the activities each person takes part in. Speaking with staff and people living in the home confirmed the following activities take place regularly; some people attend college, there are shopping trips in local towns, people enjoy watching TV, there is a computer with Internet access for people to use, some people enjoy puzzle books, some people have facials and massages, people enjoy visiting pubs, people attend church regularly, people attend treasure seekers which is a local social club, staff support people to go 10-pin bowling regularly, work, some people enjoy colouring and listening to music, going to a local disco, Using a local sensory environment, arts and crafts, walking and gardening. 2 of the people living in the home are working, 1 person is in supported employment whilst another has a work experience placement. We spoke to 1 person Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: about their work. They said they really enjoyed it and had been working there for a while, in their bedroom they had lots of photos from parties they had attended with their work colleagues. Holidays have been arranged and taken by people this year. Destination included France, Spain and holiday camps in the UK. Family and friends are welcome to visit people at the home, speaking to 1 person they said they see their parents quite often. On the day of this site visit 1 person who is in a relationship was due to see their partner, they were coming to visit them at the home. The manager, her team and people in the home produce a newsletter named Grapevine which is sent to friends and family updating them on what has been happening in the home. We saw a copy of the last edition dated January 2009. When speaking with staff we asked them what they thought of peoples lifestyles in the home. All staff agreed that they thought people led active lifestyles and from the evidence gathered at this site visit we agree. This was supported by comments from staff in questionnaires we received. Another professional involved with the home commented, staff have done their best to provide the person with a good quality of life and a wide range of experience. We saw good examples of people being supported to complete activities on a 1 to 1 basis, as well as small groups. People living in the home are encouraged to take responsibility for day to day chores/tasks around the home. Speaking to people they explained that they are encouraged to take part in washing their clothes, cleaning their bedrooms and cooking. At the time of this site visit a member of staff was supporting people to bake cakes in the kitchen. We examined the current menu and this showed that people there was a good variety of meals made available to people. Speaking with people in the home they confirmed that they were able to have snacks when they required and that the food at mealtimes was nice, and they were able to choose. Staff explained that they sit with people on a Sunday afternoon and support them to choose what they want to eat for the next week. Considering the communication difficulties that some people have we recommend the use pictures to support people in choosing what they would like to eat. Care Homes for Adults (18-65 years) Page 16 of 30 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. Peoples personal care needs are identified and care plans provide staff with guidelines to meet those peoples needs. Health professionals are used to meet peoples health needs. In general medication procedures minimises potential risks to people but some minor adjustments will make these procedures more effective. Evidence: As identified earlier in this report people have a range of detailed care plans in place that identify their needs and provide staff with guidelines to follow to meet those needs consistently. Each of the peoples whose care we were examining had care plans in place that addressed their personal care needs. Records showed that the home work closely with health professionals to meet peoples health needs. Each of the people whose care packages we were examining contained a completed health action plan and there were good records of appointments with other professionals (doctors, dentist, nurse, etc. This included both people attending their GPs surgery for annual health checks. We examined the homes medication admission procedures. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: All but 1 person has their medication administered by staff, and those people have given their consent to staff administering their medication. Before staff are allowed to administer medication they must complete training and this involves observations by the manager and staff completing a written questionnaire/training package supplied by a national pharmacist. Looking at the daily records of medication administration showed there were no shortfalls, but we recommend that the person who administers their own medication signs to confirm they have received it. There is a risk assessment in place for the person who administers their own medication. We looked at the storage of medication and discussed it with the manager. Medication is stored in lockable kitchen cupboards in the homes office (which is locked when not in use). Looking at the medication stored in the cupboard we found that there were a number of creams and topical ointments that should have been labelled with the date they were opened, but had not. We recommend that the manager speaks to the pharmacist who supplies the home about the length of time various creams can remain open before they are unsafe. The home stores Medazolam and staff complete regular audits to ensure that the amount stored is correct. We recommend that considering the home stores Medazolam they should think about purchasing a dedicated medication cupboard. Care Homes for Adults (18-65 years) Page 18 of 30 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 living in the home are aware of the complaints procedure and understand how to use it if they were unhappy with something. Where people are unable to manage their own finances procedures followed by the team minimise potential risks to people. There are detailed guidelines in place that enable staff to support people whose behaviour may challenge, but training is needed to ensure that people and staff are not put at unnecessary risks. Training in safeguarding vulnerable adults minimises potential risks to people in the home. Evidence: The home has a complaints procedure produced in an easy read format and 1 of the people we spoke to showed us the copy they keep in their bedroom. We also saw a copy of the complaints procedure on the homes noticeboard. Speaking to 3 of the people living in the home they confirmed that they knew how to make a complaint if they were unhappy. The manager stated that they had received 2 complaints from relatives since the previous inspection was completed and have responded to both of the complainants. The manager stated that they have not received a response from either complainant. The CQC has not received any complaints about the service. At the time of this site visit none of the people living in the home managed their own monies. This is managed by the manager and her staff team. We examined records of income and expenditure which were detailed and correct at the time of this site visit. It is recommended that people are asked whether they would like to manage their Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: own monies. We looked at plans to support behaviour management and found a support plan and related risk assessment in place. The support plan provides the reader with potential pre-cursors to behaviour, a description of the behaviour and beliefs. Reading the document we noticed a good practice with the guidelines clearly stating that ***** is not a child and therefore should not be told off!. Guidelines are clear and tell staff what they must do. After any incident staff complete an anxiety chart that details the incident thoroughly. This is good practice and clearly explains what has happened, and the staffs actions. We had a discussion with the manager about the training completed by staff to manage these situations and they stated they were planning on accessing some behavioural management training. Considering the frequency and scale of the behaviour displayed it becomes a requirement of this inspection report that all staff complete behaviour management training. The home has a whistle-blowing policy. All staff have completed training in safeguarding vulnerable adults, while the manager has completed enhanced training in this area. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable, friendly and well-maintained environment that meets their current needs. Evidence: We completed a tour of the premises with the manager. The building is situated in good-sized grounds that provide people with access to a large lawn with a swing, trampoline and a patio. This was well-maintained and the manager said that people living in the home help maintain the garden. On entering the home via the front door is a good-sized entrance hall with stairs leading to the 1st floor. On the wall in the hall was a picture of the people living in the home, and there was a dresser with some ornaments and flowers in a vase. On the ground floor there is a good range of communal accommodation consisting of the main lounge (with a range of furniture, TV, DVD, games console, cable TV and a stereo), 2nd lounge (the old boot room, had a TV, computer,and table that enabled people to eat in there if they wished), and a large kitchen dinner. All of these areas were decorated to a good standard and personalised with peoples possessions. In the kitchen cupboards had been labelled with symbols/pictures of what they contained. There are bathrooms and toilets on both floors and visiting each of these showed that they were well maintained. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The home has a dedicated laundry area on the ground floor that houses 2 washing machines, and 2 tumble dryers. We recommend that this room is decorated as it looks a little tired. 3 people showed us their bedrooms. Each of the rooms we saw were decorated to a good standard and 2 people confirmed that they had chosen the colour schemes themselves. All of the rooms reflected peoples interests (Elvis, pottery, music), and contained TVs, DVDs and stereos. In addition to this 1 person has a computer with Internet access. At the time of this site visit the home was clean, tidy and did not smell of any offensive odours. We felt that this home had a great atmosphere. It was very friendly, comfortable and people appeared to be really happy in their environment. Questionnaires completed staff supported this, see Conduct and Management of the home. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedures are robust and this minimises the risk of people being put at unnecessary risks. Staff receive to meet the needs of people in the home and maintain their safety. Evidence: We examined the recruitment documentation for 4 staff which showed that each person had all of the documentation required by these regulations. This minimises potential risks to people living in the home. We spoke to the last person employed by the manager and asked them what their induction to the home had been like. They confirmed that they had completed structured, accredited induction training (Skills for Care) as well as a range of other courses including; food hygiene, manual handling, Safeguarding vulnerable adults and epilepsy. Whilst working in the home they have been supported by 2 senior members of staff and have read policies and procedures. The home employs 10 staff (full and part-time) and according to the AQAA around 337 hours are worked each week by the team. When speaking to staff about staffing they commented that there were always enough staff available, it was a good team and a good place to work. Each of the staff files we examined contained a good record of the training that had Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: been completed. We saw certificates to support a wide range of courses completed by staff. The AQAA highlighted that all staff have been completing a course on infection control, via distance learning. Speaking to the staff on duty they were in agreement that there is always training available and the manager makes them aware of it. Records in staff files confirmed that the manager completes regular supervision sessions with all staff. Speaking with staff they confirmed this. The manager explained that they have just started completing appraisals with staff. CQC questionnaires ask staff what the service does well? staff commented that they thought that the training available for staff was good. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a service that is well-managed as this minimises the risk of their needs not being met. Health and safety risks are minimised through the homes procedures, checks and staff training. Evidence: The manager of the service is a registered learning disability nurse and is registered with the CQC after successfully completing the registration process. We discussed their continued professional development with them. They explained that they had completed the Registered Managers Award and training on the Mental Capacity Act (MCA 2005), Deprivation of Liberty Safeguarding (DOLS) and some on behaviour management. The manager explained they were due to complete training in staff supervision and appraisal. Speaking with staff about what it was like to work at the home they made comments including; Its an amazing place to work, Its a really good place, Its a good team and the manager is good, The Mount is a lovely and enjoyable place to work. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: A number of steps are taken by the manager to ensure that people receive a quality service that meets their needs. Examples of this include care plans and risk assessments being reviewed regularly, people being asked their opinions of the service, and what they would like to do in regular house meetings. Staff commented in a questionnaire that they felt the home did well at arranging regular meetings for staff and people in the home. The manager explained that in the past 12 months they have sent questionnaires to parents/families asking their opinions of the service. As a result of the findings the manager introduced the newsletter Grapevine which should be published quarterly. Unfortunately only 1 has been published this year. We suggested that when the manager repeats the surveys they could also send them to other professionals involved in the care of other people in the home. It would also be good practice for the manager to produce a quality assurance report identifying any shortfalls and the actions taken to address them. Where a service provider is not in day to day charge of the service the regulations state that a monthly unannounced visit must be completed by someone outside the home. A report must be completed after each of these visits and we were able to see copies of these reports kept in the home. After examining the homes admission policy we recommend that the manager reviews the homes other policies to ensure that they are accurate. Health and safety around the home is taken seriously. Potential risks are minimised through policies, procedures, risk assessment and staff training. In addition to this there are a range of regular checks that are completed by staff and other appropriately qualified engineers. We saw evidence of the following: - fire safety equipment is checked by staff and a qualified engineer, fire drills are completed weekly, hot water outlet temperatures are checked and recorded monthly, fridge and freezer temperatures are tested twice daily, window latches are tested monthly, Portable Appliance Testing (PAT) was completed in December 2008 and the homes vehicle is checked weekly for maintenance issues. In a questionnaire we received from staff they stated, Ensuring safety is always the prime concern. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 18 Staff must complete training 27/11/2009 in behaviour management. Failure to complete this training may put people in the home and staff at unnecessary risks. 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 2 The manager should recview the homes admissions/referral procedure to ensure that it accurately reflects the procedure staff must follow. When staff complete the monthly summaries they must ensure that they accurately reflect what has happened during that month, including peoples progress towards meetuing their goals. Peoples life plans should be written in a user friendly format making use of pictures and plain English to enable people with communication difficulties to understand them. Wherever possible people living in the home should be involved in developing and reviewing their care plans and monthly reviews. 2 6 3 6 4 6 Care Homes for Adults (18-65 years) Page 28 of 30 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 5 17 To help people choose the meals they wish to eat the home should introduce a range of pictures of potential meals/foods. The manager should consider purchasing a dedicated medication cupboard due to storing Medazolam. Topical creams and ointments should be labelled with the dates they are opened. The manager should also speak to the pharmacist used by the home to identify how long different creams and ointments can be left open before they become unsafe. Staff should ask the person that administers their own medication to sign confirming they have received their medication. People should be asked whether they would like to manage their own finances. The laundry looks a little tired and would benefit from being re-decorated. The manager should send surveys to other professionals involved with the service as part of the future quality assurance procedure. They should also collate the findings into a report detailing shortfalls and the corrective actions. The manager should review the homes policies to ensure that they all accurately reflect the procedures followed by staff. 6 7 20 20 8 20 9 10 11 23 24 39 12 40 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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