Care Home: Trinity Court (4)

Similar services:

• Flint House
• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• The Cotswold Home
• Fairways
• Treloar College

What the care home does well Support plans are comprehensive and detailed and aim to ensure that care and support is provided in line with people`s needs and personal preferences. People are supported in making choices about how they want to spend their time. The home offers people living there many opportunities to enjoy a range of experiences, both in the local area and further afield. Staff provide good support to people whether this is provided entirely by the home or in liaison with local health and social care services. The home provides a bright, comfortable, spacious and generally well maintained environment for people. It is well located for the amenities of Aylesbury town centre. Staff maintain positive and supportive arrangements with users and are continuing to explore improved means of communication with users. Staff have access to a good programme of training which aims to ensure that they have the skills to meet the needs of users of the service. What has improved since the last inspection? A Registered Manager has been appointed and is clarifying priorities for development and action to improve the quality of the service for users. This work will include developing Person Centred Plans (PCPs), some aspects of which will utilise information technology in order to improve communication between users and staff. The manager reports that the use of the advocacy service has increased over the last 12 months. The home has a good and long lasting relationship with a local advocacy service. The home is adopting what it says is a more flexible approach to `lifestyle plans`. This work includes the introduction of more flexible formats for planning and recording activities and phasing out the use of fixed daily and weekly planners which are currently in support plans. New furniture has been acquired for shared areas of the home and for some users of the service. Areas of the kitchen and bathroom have been re-tiled. Some bedrooms have been redecorated in line with the wishes of the users. The home has carried out a small survey of stakeholders. What the care home could do better: Repair or replace the assisted bath. This will not only improve the service to users but should also avoid the risk of accidents or other adverse events from water pooling on the floor. Review the home`s policy on routinely prescribing Paracetamol for individuals thereby holding large stocks of the drug for users.Ensure that the following is clear to staff administering medicines: when the dosage of a prescribed medicine has changed, when the former dose has been discontinued, and when the current dose starts. Build on its experience of the stakeholder survey carried out this year, and, in conjunction with others in the organisation as necessary, develop a comprehensive and systematic approach to quality assurance. Key inspection report Care homes for adults (18-65 years) Name: Address: Trinity Court (4) Aylesbury Bucks HP19 8AB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 0 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Trinity Court (4) Aylesbury Bucks HP19 8AB 01296486444 01296486444 4trincrt@nildram.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hightown Praetorian & Churches Housing Association Name of registered manager (if applicable) Mr Adam Gough Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accomodated is 5 The registered person may provide the following categories of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Learning disability (LD) Date of last inspection Brief description of the care home 4 Trinity Court is a ground floor residential Home for five Service Users with Learning and Physical Disabilities. Twenty-four hour staff support is provided to ensure the needs of Service Users are met. The Home is part of a larger complex of flats providing supported living for people with Disabilities. The Home is situated not far from the centre of Aylesbury town and is a five to ten minute walk to local amenities. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 5 5 2 8 0 8 2 0 0 8 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: This key inspection was carried out by one inspector in August 2009. The inspection included an unannounced visit to the home on Thursday 5 August 2009. The visit took place betwee 10.00 am and 5.00 pm. The registered manager (the manager) sent us the services annual quality assurance assessment (AQAA) prior to the inspection. The AQAA was clear, detailed and comprehensive and gave us the information we asked for. The inspection included consideration of the information in the AQAA. It also included discussion with the manager and staff. We spent time in the lounge with users. We watched how staff supported users (observed practice). We inspected records. Care Homes for Adults (18-65 years) Page 5 of 34 We looked around the house and garden. We looked at the arrangements for giving out medicines. We looked at things people told us about the home in a survey. Care Homes for Adults (18-65 years) Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Repair or replace the assisted bath. This will not only improve the service to users but should also avoid the risk of accidents or other adverse events from water pooling on the floor. Review the homes policy on routinely prescribing Paracetamol for individuals thereby holding large stocks of the drug for users. Care Homes for Adults (18-65 years) Page 7 of 34 Ensure that the following is clear to staff administering medicines: when the dosage of a prescribed medicine has changed, when the former dose has been discontinued, and when the current dose starts. Build on its experience of the stakeholder survey carried out this year, and, in conjunction with others in the organisation as necessary, develop a comprehensive and systematic approach to quality assurance. 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 8 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of this service can be assured that the home will carry out a good assessment of their needs and consider whether it is able to meet those needs before offering a place in the home. The prospective user will be involved in the process, have an opportunity to visit the home, and have a suitable period of time to try out the service before accepting a permanent place. Evidence: The home has not had a new admission since the last inspection was carried out in August 2008. The manager outlined the process of assessing a prospective users needs and of considering whether the home would be able to meet those needs. The prospective service user (the person) and their family are provided with information on the home - in particular the service users guide and statement of purpose. Should they wish to move the matter forward, then further information is requested from the referring care manager. This normally includes a copy of the Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: persons present community care plan, a risk assessment, and other relevant information - for example reports from NHS services such as a Community Learning Disability team (CLDT). This information is considered by the manager. Arrangements are then made for the home to meet the person to carry out its own assessment of the persons needs and to discuss their goals and aspirations with them. The person and a member of their family are invited to view the home and its facilities and to meet staff and current users. This is a small home and compatibility between a new user and those already living there is important. Where both parties, the prospective user and the home, agree to take the matter forward, arrangements are made for admission. A review is held after three months and again at six months. The manager said that the home has a flexible approach to the transition period and that it can be varied to meet individual needs. Care Homes for Adults (18-65 years) Page 11 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using this service will have a comprehensive support plan which guides the provision of care. The plan is based on an assessment of the persons needs and takes account of his or her preferences and aspirations. The service is exploring means of making support plans more accessible to users. Evidence: At the time of this inspection the home was reviewing its format for support plans. It was intending to develop a computer based format which would be more accessible to users of the service. The manager said that it was consulting with other organisations on this matter and expected progress over the next few months. An example of what was in mind was shown to us during the visit to the home.The manager pointed out that this will require considerable further development and it was a bit early to say what the final product will look like. In the meantime the home will continue with its present arrangements. Aspects of the Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: support provided to each user are recorded in five documents:(i) the support plan - a summary of current support requirements, (ii) personal information - correspondence, detailed health records and communications with other agencies, (iii) activity file including photographs of activities in which the user has been involved, related brochures, and a picture version of the complaints procedure, (iv) a page-a-day diary in which notes of activity, care and support provided are recorded three times each day, (v) medicines administration record (MAR chart). Each support plan include a photograph of the user and a pen picture. They also include a Diversity Statement in which matters particular to the individual user are recorded. Each of the support plans examined included a year planner, week planner, monthly record of activities and weekly record of activities. The manager said that such records can appear inflexible in that they do not reflect changing needs. They were currently being supplemented by a board on the wall in the dining room in which the participation in activities is recorded on a day to day basis for each user. It is intended that this will replace the diaries or activity records in support plans. Support plans are comprehensive. Those examined included information on nutrition, contacts with family and friends, a communication profile, list of likes and dislikes, risk assessments, appointments with health professionals, details of the support required by the user. The plans were comprehensive, well written, detailed and generally of a very good standard. However, they are not in a format which is accessible to users and the home is to be commended for exploring alternative formats. The present group of staff have a good knowledge of the users and were noted to involve users in decisions over the course of the inspection visit. The home hold a weekly informal meeting with users to discuss routine matters (such as menus and outings). As stated elsewhere in this report the home has good ongoing contact with a local advocacy service. Advocates support users through monthly meetings and may also attend house meetings. All of the support plans examined had risk assessments aimed at enabling users to take managed risks. The risk assessments included: the risk of pressures sores from lack of movement, of falling from the hammock in the multi-sensory room, of drowning in the hydrotherapy pool, of suffering injury while ice skating, of a special chair tipping over, of risks associated with epileptic seizures, those associated with working in the kitchen, of using cot sides (bed rails), and risks in moving and handling. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Each risk assessment had a detailed plan aimed at minimising the risk of injury to the users, staff or others. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service have opportunities to participate in a range of social and leisure activities. The home is aiming to ensure that the mix of activities is focussed on the needs and aspirations of individuals. Evidence: Staff provide a lot of support to users in terms of lifestyle. This key aspect of the home was under review at the time of this inspection. From what we have been told the review is addressing four points: (i) reviewing the use of some of the current documentation in support plans, (ii) how to expand the range of opportunities for users in the community, (iii) how to focus more on individual needs and aspirations, and, (iv) how to engage users in the process. The documentation issue has been referred to in the previous section of this report. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: An example of a clearer focus on individuals was a recent holiday in which one user and their key worker went away for almost a week to Great Yarmouth. The manager said that he hopes to be able to increase the range of such individual outings over the coming year. The manager is also intending to devlop more evening activities for users. One member of staff works a crossover shift (10:00 am to approximately 7:00 pm) to facilitate this. Engaging with users, getting the right fit between activity and user needs and aspirations, is a matter of building on existing good work in the home.This will include improving aids to communications such as presenting activities in picture form (using photographs for example) or on DVD or computer. The manager and staff expressed some frustration in fully achieving these aims because of a shortage of suitable specialist education and employment facilities in the area. Users attend the Gateway and Connect social clubs in Aylesbury. Users are encouraged to be involved in day to day activities in the home. Trips out in the locality might include walks in the area, going into the town centre (about a ten minute walk), going out for a drive (the home has its own transport), lunch at a local pub or cafe, and going shopping. Trips a little further afield have included ice skating at Milton Keynes, an outing by train to London (including a trip on the London Eye), a day trip on a canal boat in Oxford and on the Grand Union canal in Hemel Hempstead. Users are routinely involved in doing the weekly house shopping with staff. Holidays have included the trip to Great Yarmouth and to Butlins in Bognor Regis. In previous years users have also had holidays in Brighton and the Lake District. Users contribution towards holidays covers the cost of the accommodation for the user and staff. the organisation contributes an amount for food and other day to day expenses while the user and staff are away. Users are supported in maintaining relationships with their families Meals are planned in consultation with users. Staff and users do the shopping together. The home has access to the advice of a dietician on nutrition and, where required, on weight management. Records of users weights are recorded in their Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: support plans. Details of the support users need when eating is recorded in the support plan. The menu for the day is displayed in the dining room. The menu is presented in laminated picture format showing the menu for each meal. Breakfast is light meal of cereals, toast or bread, and drinks. Lunch is a light meal - on the day of the inspection visit it consisted of soup, bread and drinks. The evening meal is the main meal of the day and consists of a main course with vegetables followed by a dessert. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service receive good support in meeting their healthcare needs. This includes support in using the services of a range of community healthcare agencies where required. Evidence: Staff take account of users preferences when providing support. These are recorded in support plans. The staff are experienced and appear to have good knowledge of service users wishes. Staff were observed to support users with care and sensitivity. All users of the service are registered with a local GP. Support plans include numerous references to the arrangements for supporting users in meeting their healthcare needs. Plans include details of appointments with the GP and a brief note of the advice given. Evidence was also noted of the involvement of dieticians, podiatrists, dentists, opticians, physiotherapists and audiology. Some support plans included referrals to Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: neurology and to the local NHS wheelchair service. Each user has a Health Passport. This is considered to be more useful when visiting the local Accident and Emergency department than individual health professionals who already have knowledge of the person. Some users attend hydrotherapy sessions at the nearby Royal Buckinghamshire Hospital. Some users have warm stone massage and aromatherapy sessions from a visiting therapist. Medicines are prescribed by the users GP and dispensed by Boots Chemists in Aylesbury. Most medicines are dispensed using the Boots MDS (monitored dosage system) system and delivered monthly. Medicines are stored in a locked metal cabinet in each persons room. Medicines are recorded on receipt in the home. Medicines requiring cool storage are kept in a lockable container in the kitchen fridge - there were none at the time of this inspection. Medicine records include a photo of the person, the medicines administration record (MAR sheet), a laminated copy of the patient information leaflet on the prescribed medication, and, where indicated, a protocol for prescribed as required (PRN) medicines. Key points of the organisations medicines policy are also stored in the cupboard. The administration of medicines is carried out by two staff. the homes arrangements are examined twice a year by a Boots pharmacist. the notes of the pharmacy inspection carried out in March 2009 were seen during the visit. Staff attend training run by Boots Chemists. After this staff are required to successfully complete three assessments by the manager before being approved to administer medicines. These are completed during the six month probationary period of employment. These arrangements were examined during the inspection visit. The cupboards were in very good order and MAR sheets were generally in good order. The inspection raised two queries however. One person who had been prescribed a medicine where the dosage changed after a short period of time had not had the space for recording the administration of the previous higher dose crossed out on the MAR chart. Theoretically, since both doses of the drug were on the MAR chart - both in terms of the prescription and space for recording, an error in reading could have led to the administration of an amount three times that currently prescribed. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Secondly, all of the MAR charts seen included a prescription for Paracetamol up to four times a day. we were told that the organisation does not have a homely remedies and this allowed staff to administer an analgesic if required. This leads to the home holding relatively high stocks of Paracetamol for each person - in one case 209 tablets. We were told that staff do not misuse this facility - records (both individual MAR charts and of checks on stocks of medicines) confirm this. This policy would benefit from review. Reference texts for staff on medicines include a Sept 2008 BNF (British National Formularly) and a 2001 copy of the BMA Guide to Drugs. There is now a 2007 edition of the latter text. The home did not have a copy of our guidelines on medicines in care homes nor of the current guidelines of the Royal Pharmaceutical Society of Great Britain Guidelines on Medicines in Social Care (both published in 2007 and downloadable from the respective websites. The latter is also available in book form). Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users interests and well-being are protected by the homes arrangements for safeguarding vulnerable adults, managing complaints, and liaising with a local advocacy service. Evidence: The home is required to conform to the complaints policy and procedures of Hightown Praetorian and Churches Housing Association. A picture version of the procedure was included in the activities file for each person. This file is retained in the persons room. A copy of the procedure is not on display on a notice board. The home has not received any complaints since the last inspection. We have not received any complaints about this service since that inspection. The organisation has a policy governing staff response to abuse (Safeguarding). this was last reviewed in 2004 and is scheduled for review again at the end of 2009. The staff training programme includes training on Abuse and the manager said that both staff and users had attended a training session in the home since the last inspection. All were provided with a certificate of attendance. A copy of the current Buckinghamshire joint agency policy was not readily accessible at the time of the inspection visit. The manager undertook to contact the relevant office at Buckinghamshire County Council the following day to obtain a copy of the policy and associated materials (such as information leaflets for reporting concerns if required). Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The home has good contacts with a local advocacy service, Aylesbury Vale Advocacy. Leaflets on the service are on display in the home. Advocates are in contact with some individual users and attend the monthly residents meeting. The staff training programme includes training on responding to physical aggression Preventing and Responding to Physical Aggression. The home does not manage monies on behalf of users, although staff inevitably find themselves dealing with small amounts of cash when supporting users in town, trips out or while on holiday. The organisation has a policy and procedure governing the handling of money and staff are required to abide by this. In this home the local authority has appointee responsibilty for most users. The manager said that three users have significant family involvement which can include support in managing their financial affairs. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a spacious, clean, comfortable and generally well maintained home. The home is in a good location for the amenities of Aylesbury town centre. Evidence: The home was formerly part of a larger complex of supported accommodation. It is now independent as a service although there are some technical links with the larger building. It is a few minutes off of the Bicester Road in central Aylesbury and approximately a ten minute walk to the centre of town, bus and rail stations. The area is served by local buses. the nearest station is Aylesbury. There is limited parking to the front of the building. All the accommodation is on the ground floor. All areas are accessible to a person in a wheelchair. Entry is controlled by staff.The entrance hall leads to a central corridor which connects with all areas of the building. The accommodation includes; a laundry, staff office, five single bedrooms (none of which have en-suite facilities), a large lounge/diner, multi-sensory room, kitchen, bathroom, shower room, WCs, and store rooms. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: The entrance hall has a board on which are photographs of the staff and details of who is on duty for the day. The walls of the corridor include photographs of trips out and a colourful selection of art by users of the service. Bedrooms are single and have been decorated in accordance with the occupants wishes. Each has been personalised to reflect the persons interests and preferences.Some service users have their own specialist chairs and the home intends to acquire another such chair in order to meet the changing needs of one user. The lounge and dining room is a large and pleasant area. This area is the centre of the home and it was used throughout the day of the inspection visit. A door leads from the dining room to the garden. The kitchen and sensory room are also directly accessible from this area. The menu for the day is displayed in picture form. The lounge and dining room is well furnished and meets the current needs of the people currently living in the home. The dining area seems to comfortably accommodate the users and staff and, as on previous inspections, meals are taken at a pace which suits the needs of users, with staff providing support as required. The lounge area is comfortably furnished with armchairs, sofas, coffee tables, flat screen TV, music centre, and a computer. A small sensory room just off the dining area provides an area for sensory stimulation and is in regular use. The kitchen is domestic in size, furnishing and equipment and is considered suitable for current needs. It has been retiled since the last inspection. There is one bathroom with an assisted bath, overhead tracking hoist, and space and materials for providing personal care when required. Water was noted on the floor of the bathroom. The water was pooling and was not draining as intended through the floor drain. Staff said that the water was due to a damaged seal on the bath. The manager undertook to contact the maintenance company with a view to bringing a repair forward. The manager was also considering replacing this bath. The shower room is a good size and accessible to a wheelchair. WCs have support rails. There is a staff call system in place but the manager said it is not required and is not operational. The home has a portable hoist for use where required. The laundry is considered suitable, both in size and equipment for current use. The Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: machinery was in constant use throughout the day of the inspection visit but seemed to be coping well. The room was well organised and standards of hygiene were good. The garden is a pleasant area - accessible direct from the dining area. It includes area of lawn, flower beds, a patio, greenhouse and shed. The manager intends to acquire a new shed and was considering repairing or removing the greenhouse to improve the garden for users. Of particular note on this visit were colourful hanging baskets at the front and rear of the home. These really brighten up those areas. The home has plans to decorate further areas of the home over the coming year (2010). All areas of the home were tidy and clean. No untoward odours were noted. Two points of concern were discussed with the manager. The apparent leak in the assisted bath and the need to ensure that materials for cleaning (gloves, detergents and sprays) were thoroughly risk assessed. Overall however, the home provides a pleasant environment for users, it is well organised, and standards of cleanliness are very good. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users are well supported by a team of trained, experienced and well supervised staff. Evidence: The home has two staff on duty in the morning, two in the afternoon and two at night. Between 10:00 am and 7:00 pm there is an additional staff member working a crossover shift. This provides additional support for social activities during the day. The previous sleep-in arrangement has now ceased and there are now two waking night staff on duty. Staff turnover is low and over half of the staff (six of eleven) have acquired NVQ at level 2 or above and more staff were expected to acquire the qualification this year. A senior member of care staff was undertaking the NVQ A1 Assessors course (and was visited by her assessor during the course of the inspection visit). The home is supported in the recruitment of new staff by the organisations Human Resources department based at its head office in Hemel Hempstead. An applicants health status is checked by an NHS occupational health service. No new staff have been appointed since the last inspection. One person has transferred from part-time bank work to a full-time post - with the organisation and in the home. The staff have good knowledge of the service users and were observed to be Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: responsive and supportive to their needs. Care plans and activity folders provide evidence of the range of activities in which staff provide support from personal care, support within the home, to support in the local community, through to support away from the home while on holiday. Staff have access to a good programme of training. This includes Abuse Awareness (Safeguarding), Diversity, Epilepsy. Person Centred Plans, Learning Disability Awareness, and Preventing and responding to Violence. One member of staff was pursuing a course in leadership and management skills run by the Institute of Leadership and Management (ILM). Training is provided by external providers or by the organisation. Much of this is now provided through E - learning with staff doing course work on line. This is reported to be particularly useful for updates of mandatory training - where practicable. Each member of staff has a folder which includes dates of training attended, details of the frequency of update training, and certificates of attendance or qualification. Staff doing NVQ training have separate portfolios. Personal staff supervision is well established in the home. A notice on the subject was on display in the office. Staff meetings are regularly held. The notes of meetings held in June, May and April 2009 were examined. According to the manager the notes of the July meeting were yet to be written up. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a home that is well managed and which aims to maintain a supportive environment focussed on the needs of individuals. Evidence: A new manager was appointed in September 2008. The manager was appointed as registered manager for the home in February 2009. Prior to this appointment the manager worked in a supported housing programme and before that in residential services for people with learning disabilities. The manager has acquired NVQ level 3 in Health and Social care and is to start the NVQ at level 4 in September 2009. The manager holds an Institute of Leadership and Management qualification at level 3 and is awaiting confirmation of a start date for the Registered Managers Award (RMA). The manager is therefore suitably experienced and qualified for the position. We received positive comments on the appointment of the manager. The position had been vacant for a period of time although it had been covered by the service manager (who retained his other managerial responsibilities). Staff reported positive changes since the managers appointment. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The report of the previous inspection in August 2008 included a requirement that the registered persons establish a programme of quality assurance to ensure that the service is continuing to meet the needs of users. The manager said that the organisation is currently addressing approaches to quality assurance in its residential services. In the meantime, since the last inspection, the manager had carried out a small and limited stakeholder survey. Some of the questionnaires completed and returned were examined during the inspection visit. The additional comments made by some respondents were found to be useful. Although the response to the survey was limited it was the first time that the home had conducted such an exercise. The manager expected to have carried out a wider exercise by the time of the next inspection. It was also hoped that the organisation would have agreed an approach to quality assurance by then. We carried out a survey in connection with this inspection. We received a number of survey forms back from staff. All were positive about the home and the organisation. Additional comments included the home caters well for the needs of individuals helping them to achieve as much as they can on their own. There is also great pride in the home in giving choice to residents. Organise outings and holidays (to the question What does the home do well?). We also received a form from a relative who was also positivite in their opinion of the home. The person added All the staff are very sociable, kind and pleasant. Proprietors visits (sometimes also referred to as Reg 26 visits) are carried out by senior managers on a monthly basis. Written reports are made after each visit. The manager said that the reports for May and June 2009 had not yet been printed off from the computer. A paper copy of the April 2009 report was available. Visits are structured and comprehensive. Reports are comprehensive and include action points. Arrangements for ensuring the health and safety of users, staff and visitors are generally satisfactory. There are no gas appliances and no lift. The home had not had a visit from an environmental health officer since the last inspection. The manager reports that contracts are in place for the maintenance of hoists and the assisted bath (although, as mentioned earlier in this report, this was leaking at the time of this inspection). Portable electrical appliances were tested in June 2009. Policies and procedures are in place for dealing with potentially harmful substances (COSHH) but a review of risk assessments for cleaning materials left in bathrooms is recommended. The homes fixed wiring was tested in 2006. Standards of Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: housekeeping are very good and the home maintains a tidy and hygienic environment for users. The home is linked with the adjacent supported living service for the technical aspects of fire safety. The home had an inspection from the fire service earlier in the year. The homes arrangements were considered satisfactory with the exception of test dates for fire extinguishers which were found to be out of date. The manager said that this was quickly remedied by the organisation. A fire risk assessment was carried out in May 2009 (as part of a larger emergency contingency planning exercise). Fire alarms and emergency lighting are checked weekly. The manager said that contracts are in place for the maintenance of fire doors, alarm points, smoke and fire alarms, and emergency lighting. Fire drills are held quarterly. Fire training for staff takes place six monthly - one E-learning session per year and one session led by a trainer per year. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The registered persons are required to ensure that all areas of the home to which users have access are kept in a good state of repair. To provide a comfortable and safe environment to meet users needs. This includes the bathrooms. 30/09/2009 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 The registered persons should review the homes current practice of routinely prescribing Paracetamol for occasional use and the quantity of the drug stored for users. The registered persons should take appropriate action to minimise or eliminate the risk of prescribed medicines being administered when the prescription has changed. The registered persons should take appropriate action to ensure that the risks associated with cleaning fluids and other materials left in areas to which users have access are assessed. The outcome of the assessment should inform management action to minimise risk to users in the context Page 32 of 34 2 20 3 42 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations of the nature of the service. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!