Care Home: The Old Vicarage

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What the care home does well The Old Vicarage is a pleasant and homely place to liveAdmission to the home is well planned and people are supported in their move to the home. There is also a `buddy system` available where a person living in the home is available to help with showing people around and answering their queries.People receive a healthy diet and their likes and dislikes are also taken into account.People living in the home are consulted about the day to day running of the service, recruitment of staff and policy development through the regular residents meetings, `Our Voices` group and a robust Quality Assurance system.Care plans have lots of information in them about people, so then can be supported in the way that they prefer. What has improved since the last inspection? The home now notifies the Care Quality Commission of any untoward incidents within the home in accordance with regulations. There is now more permanent staff in the home. Staff have received training identified previously, to develop more skills enabling them to support people more effectively. What the care home could do better: Once a suitable person for the Managers post has been recruited, they should be registered with the Care Quality Commission.In order to meet the standard of having 50% of the care staff team with an NVQ level 2 qualification, staff should be given the opportunity and support to achieve this. Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Vicarage 48 Church Lane Stallingborough Lincolnshire DN41 8AA 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: Wilma Crawford Date: 0 1 1 2 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: The Old Vicarage 48 Church Lane Stallingborough Lincolnshire DN41 8AA 01472882891 01472882891 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home From Home Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 13 Number of places (if applicable): Under 65 Over 65 13 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, maximum number of places, 13 Date of last inspection 0 8 1 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home The Old Vicarage is one of a group of homes owned by Home From Home Care Limited. The home is registered to provide care for 13 adults aged 18-65 who have a learning disability. It is a large country house situated in its own grounds at the end of a gravel driveway. The home is situated in the village of Stallingborough, next to the church and within walking distance of local shops and amenities. It has a large private garden with generous parking facilities to the front and rear of the building. The home has 10 single bedrooms all with en suite bathroom facilities. There is a range of communal rooms and facilities including a lounge, activity room, and dining room with a quiet sitting area, sensory room, and spacious kitchen. Three flats have been built to the rear of the building to provide more independent living opportunities for people. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager or staff on the home. The range of fees charged is from £1400 to £2300 based on information given to the inspector on 16/12/2009. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this home is 2 star. This means that people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The site visit was unannounced and took place on December 1st 2009. Six people living in the home and four staff were spoken with during the visit. The acting manager was available to assist throughout the visit. The main method of inspection used was called case tracking which involved selecting three people living in the home and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. The premises were looked at and the records of four people living in the home and three staff were examined. An Annual Quality Assurance Assessment (AQAA) document asking for information was sent out before the visit and information from this was included as part of the Inspection process. Ten completed surveys were returned from staff, people living in the Care Homes for Adults (18-65 years) Page 7 of 33 home, and professionals. The comments from these and from discussion during the site visit are included in this report. The range of fees charged at the time of the site visit on December 1st 2009 was 1400 pounds to 2300 including additional costs for identified 1:1 support provided. What the care home does well The Old Vicarage is a pleasant and homely place to live Admission to the home is well planned and people are supported in their move to the home. There is also a buddy system available where a person living in the home is available to help with showing people around and answering their queries. People receive a healthy diet and their likes and dislikes are also taken into account. Care Homes for Adults (18-65 years) Page 8 of 33 People living in the home are consulted about the day to day running of the service, recruitment of staff and policy development through the regular residents meetings, Our Voices group and a robust Quality Assurance system. Care plans have lots of information in them about people, so then can be supported in the way that they prefer. Care Homes for Adults (18-65 years) Page 9 of 33 What has got better from the last inspection What the care home could do better Once a suitable person for the Managers post has been recruited, they should be registered with the Care Quality Commission. Care Homes for Adults (18-65 years) Page 10 of 33 In order to meet the standard of having 50 of the care staff team with an NVQ level 2 qualification, staff should be given the opportunity and support to achieve this. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Wilma Crawford Care Homes for Adults (18-65 years) Page 11 of 33 St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 12 of 33 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 13 of 33 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. A full assessment of needs is carried out and people are given enough information about the home and its facilities before admission, for them to be confident that their needs can be met by the service. Evidence: The home has a statement of purpose and this details all of the information required by this standard and Schedule 1 of the Care Homes Regulations 2001 for adults 18-65 years. A service user guide is available and this contains all the information required by National Minimum Standard 1.2. These documents are currently available in written format; the home has now made these available in a pictorial, large print format. The Annual Quality assurance assessment submitted prior to the site visit states that each individual is assessed prior to moving into the home. The assessment includes the identified needs to be met and both the individual and their families are involved in this process. Other information is collated from other sources, such as the family, social care teams and professional bodies e.g. psychologist. The care files of four people living in the home were examined. Each contained a range of assessments carried out by a variety of professionals who had been involved in the care of the service user in previous care settings. The staff team had more than enough information on the assessed needs of the Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: individual and this enabled them to provide a specific tailored service to meet their complex needs. Written information, discussion with people living in the home and staff members evidenced that people living in the home had been offered and had taken up the opportunity of visits and overnight stays prior to making a choice about living at the home. In addition to this there was evidence that the other people in the house had been consulted about the new person moving in and had agreed to it. People have been introduced to the home gradually and the staff numbers increased as each new person has been admitted to the home. This has made it easier for the people living in the home to accept the changes and cause the least disruption possible. The organisation has a group of people who are representatives of each house, known as Our Voices. This group has developed a buddy system (a person living in the home) for new people wishing to visit or be introduced to the service. The buddy would make time to show people around, discuss their experiences of the home and answer any questions people may have, as well as staff and the acting manager being available. Care Homes for Adults (18-65 years) Page 15 of 33 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 using the service are able to make decisions and everyday choices as part of an independent lifestyle. Evidence: At the last key inspection visit a requirement was made asking the provider to ensure that the care plans of people living in the home were kept under review and any changes made, to be updated within the individuals care plan. During the visit a sample of four care plans were seen, these were found to be up to date and showed evidence of regular review. This requirement is now considered to have been met. Each care plan has an index page which gave details of each part of the care plan and include: personal details, current care plan, risk assessments, daily support plan, daily records, contact records, health information, report forms analysis information and financial records. The profile of each individual gives details of their medication, its use, the persons likes and dislikes, aspects of their behaviour and an explanation of how this manifests itself and the reasons behind this. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Individuals care plans have a pictorial and written booklet called my hospital passport all about me. This gives information about the individual, their communication, any aids or adaptations they may need, current medical conditions, allergies, what they might do if they were in pain, how they prefer their medicines to be given, how they would tolerate the nursing staff, what they may do if they were upset and any other information which hospital staff may need to ensure that their needs are met during their stay in hospital. People living in the home also have a health action plan, containing similar information. Care plans examined were found to be comprehensive, very detailed and based on the individuals assessed needs and give precise information of what support staff need to provide for each individual. There is also information about base line skills and abilities, in order to build on these and demonstrate progress. This is especially important at The Old Vicarage as the people that live here have more complex needs and require a high level of staff support. People living in the home are consulted in the development of their care plan and place their thoughts on the daily record sheet and sign it. Risk assessments and care plans are evaluated and are usually reviewed in line with the individuals changing needs; a gap in one persons care plan was identified in the record of their food intake for one meal and needed to be acted upon. Risks had been identified, assessed and were being minimised by the production of risk assessments that staff were familiar with and followed, a number of these related to measured risk taking allowing people users to develop and maintain their independence. Evidence of this was further supported during discussion with people living in the home and staff. Care plans also documented areas of specific needs and charted the progress or deterioration in these areas. Minutes of reviews showed that multi agency decisions were made and agreed with the individual and that reviews were held regularly in line with the individuals changing needs. People also had benefited from a person planning book which covered all areas of the individual: their previous life, likes/dislikes, hopes and dreams and an individual action plan on how the person could be supported to achieve these. These records were documented on a daily basis by the individual and their key worker. Information about any specific conditions that the person had was also available in the care plan for example Epilepsy and Cornelia de Lange syndrome. The inspector observed service users being offered opportunities to participate in the day to day running of their own home; assisting with shopping for the home. There are regular residents meetings taking place for which minutes are kept. The home has a representative group of people who attend a monthly our voices meeting. This gives people living in the home an opportunity to be involved in further decision making within the organisation. The group has been involved in helping to develop an updated care plan, which is available in pictorial and symbol format. Staff and individuals confidential information was observed to be securely kept. Staff were seen to knock on doors and to ask permission to enter bedrooms. Care Homes for Adults (18-65 years) Page 17 of 33 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 using the service have opportunities to access a range of activities, are supported to maintain relationships and have their nutritional needs met. Evidence: Each individual has their own time table of planned activities in the home and the community. The timetable is based on vocational, occupational, recreational and educational activities. A sample of a daily programme included cleaning their bedroom, a trip to the seaside, a walk to the post office and then watching a film. During the visit different activities were observed, 0ne person went out with staff to do some shopping at the local supermarket, another went out into the village, two people were going to Our Voices meeting and Christmas lunch, while another were involved in cooking and other domestic tasks. One person currently attends local day services. In addition to this there are also holidays, day trips, and visits to the theatre, cinema, discos, pubs and clubs. People living at the Old Vicarage have significant needs and all require a high level of support from the staff team, therefore no one currently has a work placement. Two people previously had a college placement, but this has now stopped due to their age. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: However, the staff team have received training in supporting people with a City and Guilds qualification (NPTC), which is based on independence skills. As people demonstrate specific independence skills they are awarded a certificate for their achievement. The acting manager and staff promote a healthy eating menu. Breakfast is usually cereals/porridge and toast. Lunch is either taken whilst people are out in the community or there is a choice of pasta bakes, homemade burgers and chips or anything the person may request, provided by the home. As part of individual independence programmes people are involved in preparing their own meals, with staff support. People living in the home that were spoken with and feedback from their surveys confirmed that they enjoyed the food and they were involved in both the menu planning and shopping for the home. They also commented that staff would prepare anything that they wanted. One person has a special diet which is provided for and in close consultation with the individual. They were able to explain how they were involved in this and how a record of this was kept. It was felt that the balance was right for people living in the home and ensures their physical well being and ongoing good health. People living in the home were very excited about the forthcoming birthday party of one of their peers and some were involved in preparations for this. There were a number of Christmas trees and decorations throughout the home, including bedrooms, which people had been involved in decorating. Individuals spoken with, talked about forthcoming events for Christmas, which had been planned in consultation with them and included, a special Christmas themed day and lunch at a local farm, pantomime trips and Christmas shopping trips. During the visit people were seen to be supported to go out and visit their families, whilst others were given post from friends and relatives. The acting manager informed the inspector that people are supported to maintain contact with their families in a variety of ways, including home visits and this was confirmed during discussion with staff and people living in the home. Care Homes for Adults (18-65 years) Page 19 of 33 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 living in the home receive appropriate health care and personal support. Evidence: The health action plans are complete and detailed, providing valuable information about individuals health needs, but also further information about how they would demonstrate that they were ill or in pain, as well as their response to medical treatments and how they could be supported to manage this effectively. This would help ensure that symptoms are identified quickly and the appropriate support offered. Staff and people spoken with were aware of this process and able to give clear examples of when it had been used successfully. In addition to this the recording of outcomes to health appointments were detailed on a separate sheet to make it easier for staff to follow treatments or appointments Records examined confirmed that service users health needs were met by GP, dentist, chiropody and that they had access to a wide range of other health professionals e.g. psychologist, if and when required. Discussion with people living in the home and staff, confirmed that the staff promoted service users dignity, privacy and respect. This was supported further in observations of their interactions with individuals. Home from Home Care has robust medication policies and procedures that include receipt, storage, administration and disposal of medication. The medication policy, states that people coming into the home can self - medicate if they wish to after a risk Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: assessment has been completed and agreed. No one currently chooses to administer their own medicines. A blister pack system is used in the home. The medication system and records were found to be accurate up to date and well managed. Medication is only administered by a senior member of staff who has completed medication training and has been judged competent to do so. Care Homes for Adults (18-65 years) Page 21 of 33 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 using the service feel able to air their concerns without any fear of repercussions. The staff vetting procedure is sufficiently robust to ensure the safety of the service users. The safety of people living in the home may be compromised by the lack of safeguarding situations within the home being referred to the Local Authority. Evidence: All of the surveys received back from people living in the home indicated that they knew who to go to if they had a complaint or concern. Minor issues were dealt with through the house meetings, while more serious issues were taken to the acting manager and a mechanism is in place for responding to these areas of concern and/or complaint. The home had a well developed complaints procedure. This contained contact details for the Care Quality Commission and the ombudsman and gave an assurance that people living in the home and their families would not be victimised for making a complaint. The timescale given for responding to complaints was 21 days. Examination of the complaints record showed that five complaints have been received by the home and these have been dealt with appropriately within the specified timescales. Since the last key inspection visit, the organisation and the Our Voices group have developed a pictorial complaints procedure. Discussion with staff and people living in the home demonstrated that they were aware of the complaints process and who they needed to go to with any concerns of any sort. People felt that they would be listened to and were confident that any concerns would be taken seriously. Staff were aware of their role in the complaints process, including supporting service users with any concerns or complaints they might have. They Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: were also aware of local advocacy services and how they could be contacted on individuals behalf. The home has a separate whistle blowing procedure. The acting manager oversees the recruitment process, an application form, two written references; a Criminal Records Bureau check and a Protection of Vulnerable Adults check are undertaken prior to a person starting employment. On the day of the visit three staff files were examined and all information was available in each file. Discussion with recently appointed staff members indicated that the recruitment process had been fully adhered to and all the necessary checks completed prior to them being given a date to start work in the home. The risk of harm to people is minimized due to the stringent procedures for staff recruitment in place. During a random check of incident records, it was evident that each situation had been appropriately referred to the local authority, since the acting manager had been appointed. This has resulted in the home working alongside the local authority in order that individuals behaviours could be looked at in depth and joint working being undertaken to manage aspects of behaviours more appropriately. Records of action that had been taken as a result of these safeguarding referrals being made were also available in individual files. Care plans had been amended to reduce the risk of further situations occurring. At the last key inspection a requirement was made requesting that all safeguarding incidents were reported to the local authority, this is now considered to have been met. Staff spoken with had a clear understanding of the local authorities’ referral procedures and their role within this process, to ensure that all safeguarding incidents are appropriately referred. Care Homes for Adults (18-65 years) Page 23 of 33 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 living in the home have been provided with a homely, comfortable environment that is clean and has been decorated to a high standard, with both private and communal space being suitable for their needs. Evidence: The Old Vicarage is situated in the village of Stallingborough and is owned by Home from Home Care. The accommodation is provided in a two storey detached building set in a large private garden with generous parking facilities to the front and rear of the building. The home is close to local transport links, parks and the resort of Cleethorpes. All fixtures/fittings and furniture were of a good quality and on the day of inspection the house was extremely clean and tidy and very well presented. Accommodation is provided in 10 single bedrooms all with en suite bathroom facilities. There is a range of communal rooms and facilities including a lounge, activity room, dining room with a quiet sitting area, sensory room, and spacious kitchen, as well as an office, staff sleeping in room and additional toilet facilities. A lift available between the ground and first floor for anyone unable to use the stairs, or alternatively bedrooms available on the ground floor of the home. In addition to this there are three self contained flats in the grounds of the home. This accommodation is also registered with the Care Quality Commission and has been built to a high standard with quality fixtures and fittings. Only one of the flats is currently occupied. Information about the home and its service can be found in the statement of Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: purpose and service user guide, both these documents are available from the acting manager or staff on the home. People living in the home said that they were proud of their home and were keen to show the inspector their rooms and how they had personalised them. The person living in the Mews was delighted with their new home and having the opportunity to choose their own furnishings for it. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by staff that are supervised and undertake training. The staff vetting procedure is sufficiently robust to ensure to protect people. Evidence: At the previous key inspection there were a five requirements made relating to staffing levels, staff training, communication between staff and supervision. Since the last inspection visit, the previous manager has resigned and considerable work has been completed to ensure that staffing levels have been increased, staff have accessed identified training. Supervision and staff meetings are being held regularly and there is now very little use of agency staff. In doing so the care delivery within the home has been improved and provided within a consistent manner, to support people more effectively. Staff have attended training to develop their skills further and feedback indicates that they are more confident, are communicating more effectively and are working as a team. These requirements are now considered to have been met. There are currently nine people living in the home who are supported by the acting manager and seven care staff during the day. Some of the people living in the home have identified additional support needs and additional staffing hours have been agreed to support with this. However it was not clear from the staffing rota, which staff were working with which individuals, to provide this. When staff and people living in the home were spoken with, it was clear that this additional support was in place and each staff member was aware of Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: their duties during the shift and which individual or individuals they were responsible for supporting. This was further detailed on the daily communication sheet used at handover. Rota’s demonstrated that staff worked shifts a number of different shift patterns within the period between 7a.m. and 10p.m.in line with individuals needs and preferences. This ensures that service user’s diverse needs and person centered plan goals can be met and planned for. The staff also provides support with domestic tasks and with cooking. On the day of the visit, observation of staff practices confirmed that the staff team have developed appropriate relationships with the people living in the home and treat them in an age appropriate way, with dignity and respect, whilst offering guidance and support in a firm but sensitive manner. The staff team are supported by a wide range of health professionals e.g. psychologist and audiologist. Two new staff members files were examined as part of the site visit and this evidenced that Home from Home Care recruitment policies and procedures are robust and staff have CRB disclosures, POVA checks, all identity as required by regulation and references obtained prior to commencement in employment. Discussion with two staff members confirmed that they had been a thorough induction and a period of time where they were supernumerary, in order that they could shadow the staff ,observe their interactions with people living in the home and the preferred manner in which people chose how care their support was offered. The staff spoken with had found this process beneficial, giving them an opportunity to build up working relationships with the established staff team. They also said that there was good support for staff. Further support is offered to staff through regular recorded supervision, staff meetings and de briefs. Supervision records were examined and were in order and the current staff team are up to date with their mandatory training and have undertaken other specialised training relevant to the needs of the service users, i.e. epilepsy, autism, managing difficult behaviours, health action planning, person centered planning, and introduction to learning disabilities and sign along training. All new staff members complete the Learning Disability Award Framework training during their induction, providing them with a good knowledge base to understand the needs of the people they are supporting and offer them the appropriate support. Only one staff member has completed a national vocational qualification at level 3, they also have an assessor’s award. There has been some turnover of staff during the last year, and currently 20 of staff has an NVQ at level 2 or above. The others are either registered to undertake this award or waiting to commence the award. Care Homes for Adults (18-65 years) Page 27 of 33 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 using the service overall benefit from a safe and well managed place to live. Evidence: The previous manager of the home has resigned from their post since the last key inspection visit made in December 2008. The deputy manager Amanda Rudland is working as the acting manager of the home, while this post is appointed to. She has previously worked at the Old Vicarage for the past three years and has an NVQ level 4 in care. During the time she has been in place, there has been extensive support available to help support her in the management role. This includes regular supervision and Regulation 26 visits. Regular residents meetings that include staff and people living in the home, staff supervision and the key worker system ensure that staff and service users have the opportunity to influence the way the service is delivered. During discussion, staff had commented that things had improved considerably within the home recently, including communication, support networks, staff morale and consistency in approach. All of these were considered to have had a positive effect on the service and the care provided. The acting manager is considered by staff and people living in the home as being approachable, supportive, service user focused and hands on. The organisation has a corporate periodic service review in place where every aspect of the service is Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: looked at and certain criteria met. This quality assurance audit demonstrates how the service is performing and what action needs to be taken to improve any areas that need to be further developed. In addition to this regular visits are made by the area manager to audit areas of the home and practice within the home. These visits are recorded and action plans agreed for any areas which are considered to need improving. Outcomes from these have led to the development of information being made available in suitable formats for people using services and a larger role in decision making within the organisation through the Our Voices’ group. As part of the inspection all maintenance records were seen and were up to date and in order ensuring that the service users live in safe environment. This corresponded to the information provided by the home in the AQAA document. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 23 37 The registered person must ensure that all safeguarding issues are immediately reported to the local authority in accordance with their safeguarding procedures. 04/12/2007 Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 7 The registered provider must 31/03/2010 appoint an individual to manage the care home and make an application on appointment, to register them with the Care Quality Commission where there is no registered manager in respect of the care home. A registered manager who is qualified and competent would ensure that the care home is able to deliver the service that it is intended to deliver in line with the homes aims, objectives and philosophy of care. 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 6 The Registered Provider must ensure that all care plans are Page 31 of 33 Care Homes for Adults (18-65 years) 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 regularly checked to ensure that information in all areas of each individual care plan is kept fully up to date. 2 32 The registered provider should ensure that care staff have access to NVQ level 2 courses to meet the standard of having 50 of the care staff team with this qualification Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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