Care Home: The Thicket

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What the care home does well People`s needs are properly identified through a comprehensive care planning process. Everyone has a person centred plan that outlines their wishes and aspirations or choices that have been made in their best interest if they are unable to make their wishes and aspirations known. People`s needs are well met. The following comments were made when we asked staff what the home does well. "Evaluate needs of individuals." Promote choices, dignity and independence." "Help people develop." Focus on everyone`s welfare." "Everyone cares, we look for the best and adapt quickly when we need to make changes." We work really well as a team." People have a varied and stimulating lifestyle. In the AQAA the registered manager said, "Each young person has a varied and individually tailored activity plan. The young people access local shops, supermarkets, pubs, restaurants, swimming, bowling, and the country parks. In the holidays and weekends all four young people have enjoyed full days out at the seaside, fun parks and have been on steam trains and canal boats. They also go to museums. Everyone has been on holiday this year." Very good systems are in place to make sure people receive a nutritional and well balanced diet. Staff said the menus are very popular and have been very successful. The home is good at meeting people`s personal and healthcare needs and the home has a good relationship with healthcare professionals. Care records have guidance and check lists for staff. For example, one person`s care plan said, "I need prompting to get up on a morning. Please could staff start running the bath for me and check the temperature. I then get dressed and in the bath myself." People live in a home which is safe, well maintained and comfortable. The design and layout encourages independence. People are supported by staff who are trained and properly recruited. Staff we spoke to said they have received good quality training, which includes training that covers the specialist needs of the people who live at the home. Training records confirmed that staff have received a good range of training. The home is well managed and everyone feels supported. Staff gave examples where they have been well supported by the management team and described the manager as `approachable`, `flexible`, `easy to talk to`. What has improved since the last inspection? The service has re-registered and this is the first inspection under their new registration. What the care home could do better: In the main, good systems are in place to make sure people receive the right medication but there were discrepancies for some creams that should be applied. For example the medication administration record (MAR) said one person should have cream applied twice a day but staff had not signed to say it had been applied at all. The registered manager said the MAR should say `as and when required`. Another MAR said `Aqueous cream` should be applied three times a day but staff had only applied the cream twice a day. Medication administration records should accurately reflect when topical applications should be applied. This will make sure people are receiving the correct treatment. Key inspection report Care homes for adults (18-65 years) Name: Address: The Thicket The Thicket West Chevin Road Otley Leeds LS21 3HA     The quality rating for this care home is:   three star excellent 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: Carol Haj-Najafi     Date: 0 6 0 5 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Thicket The Thicket West Chevin Road Otley Leeds LS21 3HA 01943851424 01943851471 admin@roxbyhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Options The Thicket Ltd Name of registered manager (if applicable) Miss Anne Sylvia Hall Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4. The registered person may provide the following category of service user 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: Service users with a Learning Disability - Code LD. Date of last inspection Brief description of the care home The Thicket, a converted, extended stone built property, provides care and support for people with autistic spectrum disorders. Care is provided on two floors. The first floor has two bedrooms with en-suite bathrooms and shared lounge, dining and kitchen facilities. The ground floor is divided up into two separate flats. Each flat has its own bedroom, lounge/dining area and bathroom. It is situated in a rural area of Otley, Leeds. It is close to Otley Town Centre, with Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home many shops, supermarkets, pubs and restaurants close by. There are extensive grounds, which include a courtyard area, stables and barns. The barn has facilities for an arts and crafts area and a space where people can do horticulture activities. There is ample car parking space. Inspection reports, the statement of purpose and service user guide are available on request from the home. At the inspection in May 2010 the registered manager confirmed the fees at the home range from £2289 to £3389 per week. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk. 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 significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The home re-registered with us in November 2009 and this is their first inspection under the new registration. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Care Homes for Adults (18-65 years) Page 6 of 29 Ten surveys were sent out to staff and eight were returned. Information from the surveys has been included in the report. The registered manager advised us that people who live at the home would not be able to complete our surveys because they have limited communication and cannot tell us if they are happy with the care they receive or if their needs are being met. The home specialises in providing a service to people with autism. We gave the manager one days notice that we would be visiting the home so people who live at the home could be informed of our visit before we arrived. Although on the day of our visit, two people were at home, we did not spend time with them. One person was busy completing their programme then chose to go to their room for an afternoon nap and the other person needs time to get to know people before they are comfortable with them. One inspector was at the home for one day from 09:45 to 15:30. We spoke to staff and the registered manager. We looked around the home and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the registered manager at the end of our visit. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: In the main, good systems are in place to make sure people receive the right medication but there were discrepancies for some creams that should be applied. For example the medication administration record (MAR) said one person should have Care Homes for Adults (18-65 years) Page 8 of 29 cream applied twice a day but staff had not signed to say it had been applied at all. The registered manager said the MAR should say as and when required. Another MAR said Aqueous cream should be applied three times a day but staff had only applied the cream twice a day. Medication administration records should accurately reflect when topical applications should be applied. This will make sure people are receiving the correct treatment. 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 29 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 29 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. Peoples needs are properly assessed before they move into the home which makes sure their needs are known. Evidence: The registered manager confirmed that the same people have lived at the service since September 2008. We inspected the service in December 2008 under its previous registration and found that people had good outcomes in this area. We made a judgement that people who use the service can be sure that the home will meet their needs following assessment. In the AQAA the registered manager said, A full assessment is completed for all young people coming into the service. Where ever possible the young person is involved in the assessment process and decision making regarding the choice of home. In the AQAA they said detailed assessments show that when the last person moved into the home, they had a very detailed transition programme in conjunction with the Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: past placement, family and social worker. They said the last admission was excellent and opportunities to work along side staff in the previous placement were provided. Care Homes for Adults (18-65 years) Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are identified and well met. People are involved in decisions about their lives according to their understanding and abilities. Where this is not possible, decisions made on behalf of people are made in their best interests. Evidence: In the AQAA the registered manager said, Each individual has an individual tailored programme of activities, these programmes reflect their needs and preferences. Programmes and care plans are person centred and where ever possible the wishes of the young person are taken into account. Where this is not possible due to their impairments in communication, the process is facilitated by family, social workers, psychologists and other paid professionals using best interest approaches. We spoke to seven staff. They said the service is good and peoples needs are well met. The following comments were made when we asked what the home does well. Evaluate needs of individuals. Promote choices, dignity and independence. Help people develop. Focus on everyones welfare. Everyone cares, we look for the best Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: and adapt quickly when we need to make changes. We work really well as a team. Staff surveys gave us examples of what the service does well. For example, one survey said, Meets peoples needs well, always putting the people who live at The Thicket first. Another survey said, Good person centered programmes, protocols, activity plans, lots of varied outings and opportunities for the young people. The young people are well cared for. Staff talked about how they meet peoples individual needs. The care they described reflected what is recorded in the care plans. Staff said the care planning process works well and they have the right skills and knowledge to meet peoples needs. We looked at three peoples care files. Information in the care plans and risk assessments was good and gave detailed information about potential risks and how individual needs should be met. Everyone has a person centred plan that outlines their wishes and aspirations or choices that have been made in their best interest if they are unable to make their wishes and aspirations known. The person centred plans are regularly reviewed. Care plans, risk assessments and activity planners are developed around the person centred plans, and each person has agreed targets to help them achieve goals set out in the person centred plan. For example, one person has a long term plan to manage their personal care independently. The short term goal is for the person to wash their body. Their care plan has clear guidance for staff to make sure the person receives consistent support, which includes staff being aware of relevant documentation, following the set timetable and making the person aware of what is happening to prevent them from becoming anxious. Staff record information about what people have been doing. The records are detailed and show how peoples needs are being met and how choice and independence are promoted. For example, one persons daily record stated that they seemed tired and went to bed early. The next day they woke at around 9:50am and had a long soak in the bath. We received eight surveys from staff who work at the home. Six surveys said they are always given up to date information about the needs of the people they support. One said they are usually given enough information and one survey said they are sometimes given enough information. Two said the way they share information always works well five said it usually works well and one said it sometimes works well. Care Homes for Adults (18-65 years) Page 14 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a varied and stimulating lifestyle. Very good systems are in place to make sure people receive a nutritional and well balanced diet. Evidence: In the AQAA the registered manager said, Each young person has a varied and individually tailored activity plan. The young people access local shops, supermarkets, pubs, restaurants, swimming, bowling, and the country parks. In the holidays and weekends all four young people have enjoyed full days out at the seaside, fun parks and have been on steam trains and canal boats. They also go to museums. Everyone has been on holiday this year. All outings are documented on activity planners and evaluated after each outing by doing this we can monitor if individuals are enjoying activities or having bad experiences. We also take photographs and put them in individual photograph albums so that family can see what they have been doing. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Each person who lives at the home has an activity planner, which outlines their daily routines. These provide structure and consistency which is important for the people who live at The Thicket. The planners provide clear guidance about the support that people need and identify what people are doing throughout the day. For example one planner stated that the person should do laundry, collect cleaning products, clean bedroom and bathroom between 8:45am and 10:00am, then have choice of two activities taking and printing photos or painting between 10:00am and 10:30am. The activity planners show that people have a varied lifestyle with a good mix of community participation, involvement in daily living tasks and stimulating activities. Staff said the activity planners work very well and felt that people who live at the home have developed as a result of having the right programmes in place. One staff said, The planners are much better and people are very, very different because they are getting good structure and we know what we are doing. Staff and management said staffing levels are good and they have enough staff to support people in the community. Daily records and activity planners show that people go out regularly. Every month keyworkers review the care to find out if peoples needs are being met and if people appear to be happy with the care they are receiving. Daily records contain information about what people have been doing but also contain details of their behaviour and responses. For example one persons health and wellbeing record said they appeared to enjoy the trip to Ilkley in the car appeared anxious and tired but staff feel this may be due to seizure. New menus have been introduced. Staff said the menus are very popular and have been very successful. Recipes and cooking instructions are provided for each menu choice. We looked at the menus which offer good choice, they are varied and nutritionally balanced. Care Homes for Adults (18-65 years) Page 16 of 29 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 health and personal care needs are met. Evidence: In the AQAA the registered manager said, All young people are registered with a local GP which provide an excellent service. All four young people visit the dentist, optician, chiropodist, and regular meetings take place with community nurses, psychologist, psychiatrists and social workers. Some people see the speech and language therapist. The medication is stored in a lockable cabinet and is administered by staff who have been medication trained. All four people are offered a varied and healthy diet. We now have menus in place to reflect this and offer more choice. Some staff have been on healthy eating training. All four young people have had annual health checks with the GP. Staff surveys said they have been given training that gives them enough knowledge about healthcare and medication. Staff said the home is good at meeting peoples personal and healthcare needs and the home has a good relationship with healthcare professionals. People who live at the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: home have a monitoring file which is completed on a daily basis, and provides guidance and check lists for staff. Staff write to confirm that peoples personal care needs have been met. One persons care plan said, I need prompting to get up on a morning. Please could staff start running the bath for me and check the temperature. I then get dressed and in the bath myself. We looked at information that showed us healthcare professionals are involved in peoples care and people who live at the home regularly attend healthcare appointments. Individual records have good information about appointments and showed us that staff are vigilant and look for changes in peoples well-being. We looked at the systems the service has for ensuring the safe administration, recording and storage of medication. We found that there is good medication storage in place and staff who administer medication have completed appropriate training. The medication administration records (MAR) were completed correctly for medication that has been administered but there were discrepancies for some creams that should be applied. For example the medication record said one person should have cream applied twice a day but staff had not signed to say it had been applied. The manager said the MAR should say as and when required. Another persons MAR said Aqueous cream should be applied three times a day but staff had only applied the cream twice a day. Care Homes for Adults (18-65 years) Page 18 of 29 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 are safeguarded and their rights protected. The home welcomes suggestions about the service and uses these positively. Evidence: In the AQAA the registered manager said, We have a clear complaints procedure for staff, young people, family and other professionals, this procedure is available in text and widget symbols. We ensure that all complaints are dealt with following company policies and procedures. Separate files are kept for staff. Accurate records are kept. All information is stored in accordance with the confidentiality policy. All staff receive a POVA (Protection of Vulnerable Adults) and staff understand the need to whistle blow if necessary. All staff have current CRB (Criminal Record Bureau) checks and these are updated every two years. Staff only start induction when the checks have been completed. All the young people have challenging behaviour and staff have training in PRICE (protecting rights in a caring environment ). All young people have individual cash tins and books and are kept safe and locked away. The money is checked daily. All receipts are numbered and all entries in the cash books are signed. Staff support the young people to do personal and food shopping and will ensure that the shopping is value for money. All complaints are documented in the complaints file. Locked cash tins, cash books and bank details are locked away. The cash books show evidence of money spent together with the receipts and cash remaining. Company policies and procedures. Induction programme timetable that meet LDQ (Learning Disabilities Qualification) and CQC requirements as well as organisational. All Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: information is stored according to the confidentiality policies. Staff told us the management team and organisation encourage everyone to talk about any concerns and make suggestions for improvement. All of the staff surveys we received said they know what to do if someone has concerns about the home. Staff we spoke to said they have received appropriate safeguarding training, and said they would report any concerns to the management team if they suspected abuse or had an allegation of abuse made to them. They were confident that the management team would deal with everything appropriately. The manager and deputy have recently completed train the trainer safeguarding training and are putting together a package to provide additional training for staff. On occasions staff may use holds which are a form of restraint to prevent people from hurting themselves or other people. Staff said they have received appropriate training and are confident in using restraint. A detailed record is made on each occasion that restraint is used. The manager and staff discussed the system in place for looking after personal monies for people who live at the home. They all said the system is robust and protects peoples monies. We looked at two peoples records. The amount of money held for each person corresponded with their financial record. Receipts were available for all transactions. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is safe, well maintained and comfortable. The design and layout encourages independence. Evidence: In the AQAA the registered manager said, The Thicket provides a calm and homely environment furnished to a high standard. Each young person has their own bedroom and bathroom with shared living room and kitchen upstairs. The two flats downstairs are fully independent living units. Sensory rooms have been put in place for two of the young people. We looked around the home and visited most communal areas, bathrooms and bedrooms. The home was attractive, clean, tidy and homely. Bedrooms were very personal, and consideration had been given to the decor and furnishings to make sure it reflects the hobbies and individuality of the people who live there. The bedrooms all have an en-suite bathroom, with bath, shower, sink and toilet. Some areas of the home were showing signs of wear and tear, for example, paintwork and woodwork was damaged and marked. The manager said they have plans to decorate all areas of the home and have started choosing colours, bedding and curtains etc. The upstairs part of the home has two bedrooms and a shared lounge, dining area and Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: kitchen. The downstairs part of the home is split into two flats. Each having a bedroom, bathroom, lounge/dining area and kitchen. This gives people the opportunity to be more independent. The home has a courtyard garden at the back and a lawned garden and car parking space at the front. There are also rooms in the stable block that have been converted to an arts and crafts room and office. The units have domestic laundry facilities but the home also has a separate laundry facility which means that soiled laundry is managed more hygienically. The washing machine has a sluice cycle which means laundry can be washed at a high temperature. Bags that go straight in to the washing machine have been provided for staff to transfer washing to the laundry in. This reduces the risk of cross infection. Clinical waste is properly managed. Staff wear protective clothing such as aprons when attending to the personal care needs of people who live at the home. Staff have received training in infection control as part of their induction. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels are available. This ensures good hygiene practice. Care Homes for Adults (18-65 years) Page 22 of 29 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 are supported by staff who are trained and properly recruited. Evidence: In the AQAA the registered manager said, A rigorous recruitment procedure is in place and the home has just recruited some new staff to meet the needs of the young people living in the home. All staff receive an intensive induction programme to LDQ (Learning Disability Qualification) standards as well as training relevant to the home and young people. Staff are registered for NVQ level 2. Staff meetings are held on a regular basis and a supervision and appraisal system is in place. We received staff surveys in the middle of February 2010. Some surveys raised concerns about staffing levels, high staff turnover and staff sleep-ins. Two staff surveys said they always have enough staff to meet peoples needs, four surveys said they usually have enough staff and one said they sometimes have enough staff. When asked what the service could do better, one staff survey said, More staff so we can take people out more. Three staff suggested the home could do better if staff did not have to do sleep- ins. One staff said they do not get much sleep because one person who lives at the home is awake during the night and makes a lot of noise so staff are tired when they are doing their shift the following day. Two surveys also said they are concerned because there is a high turnover of staff. One survey said, The Thicket Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: seems to have a high turnover of staff and although staff are well trained the constant turnover is frustrating. In the AQAA the registered manager said, Staffing has been an issue since I was appointed as the Manager fifteen months ago and there has been a high turnover of staff. We have now changed the rota and restructured the staff team, this will enable the staff team to develop and hopefully keep them interested in their work. We talked to the registered manager and staff about the concerns raised. The staff team said the issues have been resolved. The new rota pattern has addressed the problem with sleep-ins. A number of staff started work in the middle of February so the staffing levels are better. Staff said because the staffing problems have been resolved, things generally have improved and staff morale is very good. One staff said, The team is more solid. Another staff said, Its a really good team and we all talk to each other, you never feel alone. We received eight staff surveys. Every survey said they are given training that is relevant to their role and keeps them up to date with new ways of working. Seven said they are given training that helps them understand and meets individual needs. One survey said the home could be better if there was more relevant training and a better induction. Another survey said staff training is good. Staff we spoke to said they had received good quality training, which includes training that covers the specialist needs of the people who live at the home. Staff said they have a clear understanding of their role and know what is expected of them. Training records confirmed that staff have received a good range of training. Staff complete a Learning Disability Induction Award when they start working at The Thicket. The manager said every staff attends an indepth induction and complete a workbook that has some modules which are specifically about working with people who have a learning disability. Staff surveys said their employer carried out checks such as a criminal records check before they started work. We looked at the recruitment process for two people who have recently started working at the home and found that all necessary pre employment checks had been completed. Care Homes for Adults (18-65 years) Page 24 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and everyone feels supported. Evidence: In the AQAA the registered manager said, The Registered Manager has been in post for one year and five months supported by a Deputy Manager and two Team Leaders. On call is provided over a 24 hour period to support the staff team. The service was registered in November 2009. The home was previously registered and the same registered manager is still in post but because there was a change in ownership we have rated it as a new service. When we previously inspected the service we said the service was good and people who receive a service experience good outcomes in the area of conduct and management of the home. Staff said they thought the home was well managed and we received some good feedback about the manager. Staff gave examples where they have been well supported by the management team and described the manager as approachable, flexible, easy to talk to. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The manager said she is well supported by the organisation and senior management regularly visit the home. Staff also said the organisation is supportive. We looked at some reports that had been completed by senior management when they have visited the home. These told us that during their visits they have checked that proper systems are in place to make sure the home is running smoothly. The service also sends out quality assurance surveys to different groups of people and uses the information to help monitor and improve the service. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us good information about the service. It gave us good examples of what they do well, what they could do better and how they plan to improve. In the AQAA the registered manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. We did not observe any unsafe working practices during our visit. The service has sent us notifications to let us know about things that have happened since our last key inspection and they have shown that they have managed issues satisfactorily. We looked at some incident records, which had sufficient detail about what had occurred occurred. Individual care records have risk assessments that help minimise risk and keep people safe. Care Homes for Adults (18-65 years) Page 26 of 29 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 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Medication administration records should accurately reflect when topical applications should be applied. This will make sure people are receiving the correct topical treatment. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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