Care Home: The Willows

What the care home does well This home assesses the needs of the people who live there and produces very good plans to tell staff how people want and need to be enabled to live their lives. There are good details of the action which staff need to take to support people in areas such as daily living, personal care, communication and behaviour. The staff make sure that people`s health needs are met by a variety of health professionals. Staff make sure people have regular health checks and manage their medicines safely. The staff make efforts to involve people living there in decision making and participation. They know the preferred ways in which people communicate and encourage them to make choices throughout the day. The staff make sure that people lead full and active lives based on their individual needs and capabilities. People are enabled to attend various activities including shopping, day trips, bowling. People go on annual holidays and have opportunities for `new experiences`. People are helped to eat a healthy diet and to try new foods. They choose when and where they eat, and their cultural and health needs are met. The home has complaints procedures that are included in the service user guide that is given to relatives who may wish to raise concerns on behalf of their relative. The physical design and layout of the home enables people with mobility difficulties and aids and equipment help them to move around easily. People`s bedrooms have been made nice and are personal. Staff receive good training which helps them to understand and know how to meet the needs of people living at the home better. New staff are checked out to ensure they are suitable to work as carers. The home is well run and staff receive good support from the manager and trust. The staff team work well together and are committed to providing a good quality service. What has improved since the last inspection? No requirements were made at the last inspection. The home has continued to sustain good outcomes for people who live there. Since the last inspection the home has continued to developed in their recording of information about people`s needs and wishes. The home has set up `Tree of Life` plans for each person. These plans will help ensure person centered care is delivered. The home continues to look for ways to communicate with the people who live there to ensure needs are being met in ways acceptable and preferable to residents. What the care home could do better: There was very little that the inspector found to be improved. The manager should ensure that all medicines to be administered are clearly labeled. The manager needs to ensure all staff have training in the safeguarding of vulnerable adults. This could help them promote the safety and protection of residents better. No requirements have been made at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Willows, The 4 & 5 Sadler Gardens Coalpit Fields Road Bedworth Warwickshire CV12 9HG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie McGarry     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Willows, The 4 & 5 Sadler Gardens Coalpit Fields Road Bedworth Warwickshire CV12 9HG 02476315794 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Coventry and Warwickshire Partnership Trust care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The home is registered to provide care and accommodation for seven service users under 65 for reasons of learning disability. Date of last inspection Brief description of the care home 4/5 Sadler Gardens, known as The Willows, is a purpose-built, large, semi detached pair of bungalows. The home was built to accommodate seven peoplewith learning disabilities and additional physical disabilities. The home is registered under Coventry and Warwickshire Partnership Trust and is staffed 24 hours a day. The premises are leased from a local housing association. The bungalows are linked internally via a connecting door in the main halllways. Single room accommodation is provided, with up to three people accommodated in number four and up to four in number five. Each bungalow has laid out gardens to the side and rear, which are fenced around the perimeter. The home is situated in a housing estate approximately half a mile from the centre of Bedworth, North Warwickshire. A local bus service stops nearby and the shops and Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home amenities of the town centre are within walking distance. Two speciality vehicles are available to provide transport for the people living at the home. Fees for this service can be obtained by contacting the service directly. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This Key Inspection was unannounced it was undertaken over one day on the 5th May 2009. This inspection was carried out to establish the outcomes for people living in the home and to confirm whether they are protected from harm. The pre-fieldwork inspection record was completed, as well as a site visit to the home during which time staff, one relative and the manager were spoken with. Time was spent in both bungalows with the residents. It was not possible to ask them directly what they think of the home because of their learning disabilities and Care Homes for Adults (18-65 years) Page 6 of 32 communication difficulties. An annual quality assurance assessment (AQAA) was completed as part of this key inspection, as is required. This asks managers to say what they think their home does well, could do better, what has improved in the last year and their plans to improve it. It also has information about the people living there, staff and other aspects of the service. Policies, procedures and care records were examined. Staff records environmental checks and risk assessments were also read. During the inspection the care of two people who live in the home were examined in detail. This included reading assessments, care plans and other documentation observing care offered to them and that staff have necessary skills to care for them. This is part of a process known as case tracking where evidence is matched to outcomes for the people who live in the home. The manager was present throughout the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 32 There was very little that the inspector found to be improved. The manager should ensure that all medicines to be administered are clearly labeled. The manager needs to ensure all staff have training in the safeguarding of vulnerable adults. This could help them promote the safety and protection of residents better. No requirements have been made at this inspection. 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 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Prospective residents and their carers are given information about the home which is available in different formats. Evidence: The Annual Quality Assurance Assessment (AQAA) received prior to the inspection states we have had two new service users at the Willows since March 2008. Therefore we have been able to test our admission procedure which has proved to be structured and robust leading to successful placements in our services. The files of two residents admitted since the last inspection was examined to assess the pre-admission assessment process. Both records show a person centered plan complied of information received prior to each person moving in, both had been updated as the staff learn more about each persons individual needs and preferences. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: For one individual, a communication book was established between staff and the residents relative prior to them moving in, however this record of events and information was not available at the inspection as it has been kept by the relative. During the inspection we spoke with the relative who confirmed that a communication book was maintained and both the resident and relatives were able to frequently visit the home before the person moved there. Another resident moved to the home from another county (Out of County Placement). Records show that a member of staff visited this person and their family for one week to assess this persons needs, and to provide an opportunity for the individual and their family to become familiar with a member of staff. An action plan was developed for this persons needs and this included a travel plan based on information obtained at a best interests meeting to ensure this person needs were fully assessed before moving. Records also show that an Independent Mental Capacity Advocate (IMCA) and other professionals were involved with the change in care home to ensure this individuals rights were protected and needs fully assessed. The homes Statement of Purpose was looked at as part of the inspection. This document clearly identified the levels of service that could be offered to specific user groups. It was detailed, informative and reflective of the actual service being provided. Care Homes for Adults (18-65 years) Page 12 of 32 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. Each person has a detailed care and support plan which is flexible and reflects individual needs. Staff provide people with the appropriate support they need to make decisions about their own lives. People have a variety of relevant risk assessments which identify how risks will be managed safely. Evidence: Each person living at the home has a care plan. Care records include important background information about each person and the plans identify their care needs with any support needed to meet them. The homes approach to care planning is appropriately person centered (PC) in that the plans focus on the preferences, skills and goals of each person. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Care plans are reviewed regularly to ensure changing needs will be met appropriately. Staff support people to make decisions by talking to them or observing their responses to ensure the care provided meets their needs and their personal preferences. Particular care staff are allocated to each person as their keyworker and they take specific responsibility for aspects of their care. They can provide some 1 to 1 support and have a role in drawing up and reviewing their plans. This offers residents some individual attention and means keyworkers get to know them their needs likes and dislikes and so can advocate for them better. The care plans of two people case tracked were seen and reviewed in detail. Both plans follow a similar pattern, providing information about such things as individual needs, preferred routines, likes and dislikes, communication and abilities amongst others. The required levels of support were detailed, thus enabling staff to provide appropriate assistance and care for each person. Relevant risk assessments are carried out to promote each residents safety. Risk assessments seen in care records sampled had been recorded in a standardised format. When necessary specific plans had also been put in place to manage particular behaviours in the best way and to keep that resident and other people as safe as possible whilst promoting their independence. Any limitations to an individuals freedom and choice are agreed and recorded e.g. using bed rails. Advice and input had also been sought from other health and social care professionals when appropriate. People that live in the home have communication difficulties, which make it hard for them to make their needs and wishes known in a verbal manner. It was apparent from watching them with the staff members on duty that they are competent at making their wishes known in a non verbal manner and that the staff are able to interpret these as appropriate. The home has a high staffing ratio to ensure that each individual is able to do what they choose when they choose as one of the methods of promoting independence and providing person centered care. Where possible the home encourages families to be involved in drawing up care plans to support people with communication difficulties. All the staff spoken with were enthusiastic and had a positive attitude on promoting peoples independence. Staff receive training that covers respect, privacy, dignity, equality and diversity. Care Homes for Adults (18-65 years) Page 14 of 32 Care Homes for Adults (18-65 years) Page 15 of 32 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 living at the home are enabled to take part in activities they enjoy and go out in the wider community if they wish. Their daily choices and individual rights are respected and contact with their families is supported. Staff ensure that residents are offered a variety of healthy and suitable meals they like. Evidence: On the day of the inspection, all of the residents currently living at the home were out for the day, attending their individual supported activities program. They returned at about 2pm and were welcomed back and given the choice to relax in the lounge or spend some quiet time in their own room. People who live in the home do not access local community day service provisions. Support is provided by the staff team on a 24 hour a day basis to enable them to Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: participate in whatever activities they choose to undertake. Peoples plans include an activities programme and daily reports show what they have actually taken part in and where they have been. On the day of the inspection, the planned activities included visits out to the local shops, going out for lunch and gardening in the well maintained homes grounds. Information in peoples records showed that the activities people participated in on the day inspection reflected those previously planned between residents and staff in one to one meeting or house meetings. The home ensures there is time available for staff to support residents flexibly with their activities and outings they enjoy. Key worker meetings with people who live at the home, ensures they are part of any planning of activities within or outside of the home. We also observed staff offering choices during the inspection in less formal ways. We saw records which are used to monitor when people take part in a variety of activities based on their individual needs and capabilities. These include the shopping, gardening, bowling and floor exercises . Records and photographs displayed on notice boards outside each person room show the range of trips and holidays people have been on. Such trips include days out to Warwick Park and Ash farm. Where possible, family members also go on the outings. Records show that residents are provided with opportunities to participate in new experiences every month. Staff support residents to participate in a range of new activities, for example, going on a canal boat and ice skating . The range and diversity of activities enable residents to develop their interests, hobbies and life experiences. In both houses there are numerous items such as arts and crafts and sensory items. We observed a member of staff supporting one person in a sensory and physical activity, and another member of staff sitting quietly with another resident relaxing. The home does not employ catering staff. The care staff team prepare all meals and snacks and are provided with training in basic food hygiene. In relation to household tasks there are limitations to the extent that residents are able to be involved. However staff encourage them to do so as much as possible even if this is just being with them and observing and the home plans to try and promote their daily living skills more actively. They do involve them in choosing decor etc in their bungalow and bedrooms and some people are helping to grow plants for the home. There is clearly an emphasis on making sure daily routines meal times and activities are flexible and take into account residents moods and behaviours at any Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: time. Menus are produced in pictorial formats and where alternative meals are requested additional pictures are available to enable people to identify their preferred choices. A record is kept of meals taken which enables concerns to be identified. Where applicable concerns are discussed with the relevant health care profession. The cultural and religious needs of people living at the home are respected and suitable arrangements have been made to meet these. The manager told us that the staff support people to maintain contact with families and friends. We saw examples of visits made by peoples families and some are involved in and consulted about most aspects of the care. Residents are also helped to attend church if they have chosen to do so. Care Homes for Adults (18-65 years) Page 18 of 32 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. The health and personal care that people in this home receive is based on their individual needs. Staff respect the people and promote their dignity and privacy. Medication systems in place are safe. Evidence: Care plans show that the personal and health care needs of the residents are identified and care is offered in a person centered way. That is each individual resident is offered support in a way that they personally prefer and meets their individual needs in regard to the time that go to bed, support for their personal hygiene and their preferred routines. Records are kept of all the support people receive from staff. Residents were seen to be well presented and appropriately clothed in relation to their age, disability, and the weather. Care records provide information about residents medical history conditions and any current health issues showing how they should be monitored and dealt with and by whom. Staff receive moving and handling training and plans with risk assessments regarding residents mobility are in place as well as a range of aids, hoists, and Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: equipment provided. Physical care checks are also carried out to promote good health e.g. weight with records kept and for seizures. One persons records show that they have epilepsy. Records detail actions staff need to take should this person have a seizure. Staff spoken to were able to tell us how they would respond if this person had a seizure. Information provided by staff reflected that in the care and risk assessment plans. Another person is at risk of reflux. The records identify this risk and associated skin integrity concerns. Information provided shows input and guidance from a Speech and Language Therapist. Staff spoken to were able to tell us about the risks and detail the support required to manage them. On the day of the inspection this persons skin integrity appeared intact indicating that the home is following practice guidelines from professionals to minimise identified risks and meet individual needs. Information was available to confirm that people continue to be offered routine health care appointments such as the dentist, optician, and chiropodist at the recommended intervals. Information was also available to demonstrate that more specialised health care needs are addressed as appropriate such as the Speech and Language therapist appointments along with physiotherapy and learning disability nurse specialist services. Since the last inspection, the home has included a Tree of life plan to develop the person centered practice of care at the home. The home has also been more proactive in their multi disciplinary approach to identifying and meeting peoples individual needs. We saw and heard staff seeking permission to enter residents bedrooms before entering, talking to individuals in a friendly and respectful manner, and offering assistance with personal care discreetly. Sampled records showed that care is provided in the ways indicated in the plans. Regarding the management of residents medicines no one living there currently is able to self administer and so staff take full responsibility. Good arrangements continue to be in place for the safe storage of medication. Staff are trained in the safe handling and administering of medication and manage medication on behalf of all people currently living at the home. Medication is supplied to the home by Lloyds Pharmacy in blister packs that are accompanied by medication administration records (MARs). A sample of blister packs were audited and found to be correct. One person receives medication in a separate Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: medicines container. Information on the label of this container could not be read. When this was highlighted to staff they immediately contacted the pharmacist to request replacement medication with a clearly defined label. We found two gaps in staff recordings in the MARs. One resident is currently having multi vitamins administered by staff at the request of this persons relative. It is recommended as good practice that staff discuss this with this persons GP to ensure the vitamins do impact upon any medications prescribed. Staff are fully trained in safe handling of medicines and the home has a comprehensive policy and procedures. A Pharmacist regularly inspects the medication system. During the visit it was noted that all people living at this service are treated with respect and dignity. Personal care was carried out in privacy and all those seen were appropriately dressed in clean clothes and looked comfortable and neat. Each person was able to spend time where they choose and it was observed that the staff and those living there had a comfortable and trusting relationship. Care Homes for Adults (18-65 years) Page 21 of 32 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. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. Evidence: The manager told us that people living at the home are supported to raise concerns. The home has a complaints procedure that is included in the service user guide and given to relatives who may wish to raise concerns on behalf of someone living in the home. There have been no complaints made to us about the home since the last inspection and the manager explained that there have been no complaints received at the home from relatives or others not living at the home. We saw that there is a copy of Warwickshires multi agency protection procedures in the home along with the homes policy on the protection of vulnerable adults. The homes policy is detailed and informative. The organisation has recently reviewed and updated its policy in respect of the protection of vulnerable adults. 12 out of 26 staff have attended training in identifying and understanding potential abusive situations and the different kinds of abuse. Staff are encouraged to record any changes noted in behaviour, and investigate any unusual signs or changes. The home Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: needs to ensure all staff have training in the Protection of Vulnerable Adults. We saw that there are policies and procedures, secure facilities and a suitable recording system for managing money on behalf of people living in the home. We checked the balances of the money held for the three people and found them to be correct. This means that people are protected from financial abuse. Care Homes for Adults (18-65 years) Page 23 of 32 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. The appearance of this home creates a pleasant, comfortable and homely environment that is well maintained. The home presents as clean and hygienic. This judgment has been made using available evidence including a visit to this service. Evidence: The registration for this home covers both numbers 4 and 5 Sadler Gardens. These are a pair of semi detached bungalows that are connected via an internal door in a hallway between the two. Information detailed in the homes AQAA states we offer an environment that is warm and welcoming. Service users bedrooms are decorated to reflect individual needs and interests. All specialised equipment is provided to enable service users to access all areas and facilities safely. As reported at the last inspection, the decor throughout both properties is immaculate with very good quality soft furnishings and modern furniture. Peoples bedrooms looked at were seen to be decorated to individual taste with plenty of personalisation in the form of pictures, photos and ornaments. Although the bungalows are leased Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: from Bromford Corinthia Housing Association the maintenance issues are undertaken by the trusts maintenance department. Since the last inspection, the home has continued to develop the environment to reflect individual needs and choices of people who live there. Staff have purchased special lounge chairs for three residents and bedrooms have been decorated to peoples individual taste when they moved in. Each bungalow has a separate utility room, that house the washing machines and tumble driers. Cleaning products are also kept in these rooms in locked cupboards. Risk assessments relating to cleaning products were in place, as were the appropriate Control of Substances Hazardous to Health (COSHH) data sheets. During the inspection there were no offensive odours and the home presented as homely and clean. Staff have received training on the prevention of infection and management of infection control. The kitchens were clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home are protected by robust recruitment practices and supported by a skilled and competent staff team. Evidence: The manager explained that there are always at least four staff on shift and additional staff are on duty each day to support people to participate in a range of activities in keeping with their wishes and interests. This was verified by sampling recent rotas. The rotas show a pattern of familiar staff, providing consistency of care and support for people. The numbers of staff available to support the people living in this home are sufficient to meet their assessed needs. The total number of staff within the home is twenty seven this includes the post of a full time manager. Information supplied by the manager states that 11 members of care staff are qualified to National Vocational Qualification in Care Level 2 (NVQ level 2). This is below the national Minimum Standard for 50 percent of staff to be qualified. The manager advises us that ten staff are currently enrolled in college courses to achieve their NVQ 2. Twenty one care staff have attained their (LDQ) Learning Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Disability Qualification. We sampled the records of three members of staff in order to assess the homes recruitment and selection practices. They contained references and evidence of checks through the Criminal Records Bureau to ensure people living at the home are safeguarded from harm or abuse. Records read show that staff are appropriately supervised by the manager and are given opportunities to meet with her on a regular basis both individually and as a team. An annual appraisal is also held and staff personal development needs are identified. Induction training records were seen on the new staff members file as evidence that new staff are trained and supported in their jobs. Staff spoken with said that they felt the training they attended was good especially with regard to the specific needs of those who spend time at the home. Staff were aware of the homes policies and procedures and said that they felt the staffing levels were satisfactory and enjoyed working as part of the team. The home has a handover system at the start of each shift. We observed one handover and found staff to communicate with each other in a concise yet comprehensive way. Staff complete a record of the meeting and sign over the keys. The concern relating to the unclear label on one persons medication was discussed and staff were informed of the action the home had taken. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are protected by the arrangements for managing the home, monitoring the quality of care and checking equipment, so that their health, safety and welfare are promoted. Evidence: The home continues to be run by a well-qualified manager who holds many years experience of working with people with learning disabilities. Staff spoken with said that there were good relationships between the manager and the staff team. The atmosphere in the home is relaxed and friendly, befitting the service it provides. The Annual Quality Assurance Assessment (AQAA) completed by the manager was completed to a adequate standard. Information provided was supported by brief descriptions of evidence. The Annual Quality Assurance Assessment (AQAA) informed us about the development of the service and future plans for improvement. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: There are number of measures in place to support the smooth running of the service. The fact that it is a small service means that the manager has daily contact with the people living in the home, making it easier to pick up any concerns they might have. During the visit staff appeared confident in their roles, the home was relaxed and the people who live there appeared at ease and comfortable. Information provided by the manager in the pre-inspection questionnaire indicates that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. The fire alarms are tested on a weekly basis and a fire risk assessment is in place. The personal monies of the individuals living in the home are kept securely and accurate records of income and expenditure are kept. Audits of peoples personal monies was found to be correct. The quality auditing system is robust and there are systems are in place to improve the service and the improvements are being sustained. Recent questionnaires were completed by relatives and professionals. Reponses included: wonderful place, with wonderful care - relative very impressed with the care given in this home Macmillan nurse Quality of life has improved so much for x the care she receives is first class relative. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 Staff to consult the GP when administering any over the counter medicines or vitamins to ensure they do not impact upon the effectiveness of prescribed medicines. Staff should ensure all medicines are clearly labeled before administering them. Staff should receive regular refresher training in all the mandatory health and safety topics and in respect of procedures such as Safeguarding. This is to ensure that they are all clear about the procedures they should follow and know and understand the currently accepted practice guidelines in areas that promote the safety and protection of people living at the home. 2 3 20 35 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: 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) Commission for Social Care Inspection (CSCI). 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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