Care Home: Vale Road (15a)

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What the care home does well The physical design and layout of the home promotes independence for people using this service, some of who have dual disabilities.The home is domestic in size and character, comfortably furnished and clean. Policies and procedures promote equality and diversity and non-discriminatory practice. People considering using this service and their advocates have access to information enabling an informed choice of home. They receive a comprehensive needs assessment before admission, ensuring individual needs, expectations and aspirations can be met. There is a person-centred approach to care planning and delivery of care and support, based on the rights of dignity, privacy, autonomy and respect. Staff on duty were evidently aware of the needs and preferences of the people they support and addressed them in an age appropriate, friendly and respectful manner.Health needs are monitored and care plans and records evidence health care treatments and interventions. There is an efficient medication policy, supported by procedures and practice. People using services enjoy a varied, healthy diet with choice of meals and special dietary needs are met. They engage in meaningful daytime activities within individual levels of capacity and are supported to use community amenities during the week. Relationships with relatives and other people significant to them are fostered by staff. The stability of the team in the past year has enabled continuity of care; additionally incremental service improvements, as staff become more experienced, knowledgeable and skilled. We evidenced an open management culture that encourages people using services and their advocates to express their views or concerns in a safe, understanding environment. There is strong commitment to continuous staff training and development, ensuring a skilled and competent workforce. The home`s policies and procedures safeguard people using services from abuse and neglect. What has improved since the last inspection? The home has complied with the previous requirement for the manager to register with the CQC. The statement of purpose and service users guide has been updated. A new standardised care planning system is currently being implemented. A new personcentred format is used to prepare for care reviews. This is also used at team meetings for reviewing action plans and practice. Staff have supported individuals` to access specialist medical services and have received specific training to support the management of epilepsy and behaviours. The provider organisation has made progress in clarifying and agreeing individual responsibilities for the maintenance of the building with the housing provider. A programme of improvements to the premises is in progress which actively involves two staff members. New appliances have been purchased for the kitchen. A tree has been removed from the garden which has improved natural lighting in the lounge and some bedrooms. Shutters have been fitted to two bedroom windows to enhance the dignity and privacy of individuals using services. A programme of redecoration is ongoing. Additional staff have been recruited and the relief staff bank has been expanded. The team has secured workable solutions to achieving a suitable balance between day care and active home support for individuals. What the care home could do better: Kitchen cupboards and bathroom floor covering in a poor state of repair at the time of the last inspection has not received attention. A development plan is in place to replace lights in corridors to meet the needs of a person using services; also for replacement of carpets in the hall and corridor, for hygiene reasons. A recent internal safety audit identified this work to be necessary. The need for improvement in record keeping specific to health care and weight monitoring was identified.The transfer of information to new care documentation being implemented needs to be accelerated as significant information was not recorded in the care file sampled. Observation confirmed no change to weekend staffing levels since the last inspection. This shortfall continues to be a barrier to people using services engaging in community based activities at weekends. Key inspection report Care homes for adults (18-65 years) Name: Address: Vale Road (15a) 15a Vale Road Ash Vale Nr Aldershot Hampshire GU12 5HH     The quality rating for this care home is:   one star adequate 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: Patricia Collins     Date: 1 2 1 0 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 33 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 33 Information about the care home Name of care home: Address: Vale Road (15a) 15a Vale Road Ash Vale Nr Aldershot Hampshire GU12 5HH 01252334880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): None United Response Name of registered manager (if applicable) Ms Beverley Kay Hilton Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category 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 categories: Learning Disability - (LD) Date of last inspection Brief description of the care home 15a Vale road is a care home providing personal care and accommodation for up to five adults of both gender, whose primary needs on admission are within the category learning disability. Situated in a quiet residential cul de sac in Ash Village, the home is near to local shops and other amenities and a railway station. It is served by good road links to the nearby towns of Aldershot, Farnborough and Guildford. This purpose built bungalow is owned Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 5 0 5 1 1 2 0 0 8 Brief description of the care home by English Churches Housing and managed by United Response.All bedrooms are for single occupancy. Facilities include two assisted bathrooms and equipment and aids to meet the needs of people with physical disabilities. Communal areas include a dining room, lounge, kitchen and utility room. The home has a furnished patio in an enclosed garden. Parking facilities are available for several cars and the homes minibus. Fees range between 1,354.79 pounds and 1,400.70 pounds per week. Additional charges include contribution to transport costs, personal items, hairdressing and holidays. One individual self-funds one of two weekly support visits received from a community worker. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector between 9:45 a.m. and 2 p.m. on 12th October 2009.The visit was facilitated by the two senior support workers on duty. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgements about the service and how well it is meeting the National Minimum Standards (NMS) for Adults. This includes accumulated evidence, knowledge and experience of the home since the last key inspection. Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. The AQAA provides quantitative and numerical information about their service. It requires assessment of the service against the NMS outcome areas, demonstrating both areas of strength and where improvements can be made. Care Homes for Adults (18-65 years) Page 6 of 33 The homes AQAA was received on time, its content was clear and mostly validated by evidence. We spoke with individuals using this service during the visit. We gained insight into the state of well-being of those we were unable to communicate with through observations of body language, behaviours and their interaction with staff. Discussions took place with the two staff on duty. We viewed the premises and garden and gathered information through reviewing records and direct observation of practice.Documents sampled included policies and procedures, information about the home, care records and assessments, staff files and rotas. We also examined complaint and quality assurance systems and records relating to maintenance and safety of the environment. We sampled menus, observed lunch and medication practice, recording and storage. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Kitchen cupboards and bathroom floor covering in a poor state of repair at the time of the last inspection has not received attention. A development plan is in place to replace Care Homes for Adults (18-65 years) Page 8 of 33 lights in corridors to meet the needs of a person using services; also for replacement of carpets in the hall and corridor, for hygiene reasons. A recent internal safety audit identified this work to be necessary. The need for improvement in record keeping specific to health care and weight monitoring was identified.The transfer of information to new care documentation being implemented needs to be accelerated as significant information was not recorded in the care file sampled. Observation confirmed no change to weekend staffing levels since the last inspection. This shortfall continues to be a barrier to people using services engaging in community based activities at weekends. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. The needs and aspirations of people considering moving into the home are assessed before admission, to be assured these can be met. Evidence: The home has an up to date combined statement of purpose and service users guide which sets out the service objectives and philosophy. The document includes all statutory information about the homes services and facilities, details of staffs qualifications and experience and the complaint procedure. This information is supplied to people considering moving into the home or their representatives. The document is written in plain English. It doesnt include symbols or pictures as it was stated these do not meet the communication needs of the homes current population. Four of the five people living at 15a Vale Road have lived there since the home registered in 1996. The last admission took place in 1997. As at the time of the last Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: inspection their pre-admission assessment records were unavailable for inspection owing to having been archived. The homes admission procedure sets out the expectation for copies of care management assessments and care plans to be obtained for all new referrals. Pre-assessment procedures include a visit to prospective people using services. The assessment explores, using appropriate communication strategies, what is important to and for individuals, consulting with relatives, carers and relevant professionals. The people currently living at this home require a significant amount of support from someone who knows them well, to help them communicate their views and choices. Their views and choices vary, dependent on the individual, and not all people would have had capacity to make a decision about where they wish to live. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessed and changing needs are reflected in person-centred support plans. Staff assist people using services in making decisions, promoting independence and informed risk-taking within individual levels of capacity. Evidence: The majority of the people using this service are unable to verbally express their choices or opinions. The member of staff who is the homes designated communications representative liaises with an internal communications group, attending communication workshops and training; also feeding back best practice information to the team. Discussion with staff confirmed their understanding of the individual communication methods of each person using services, enabling choice in their daily lives. This is achieved through observations of behaviours and by knowing individual likes and dislikes. Some staff have known the people living in this home before their admission whilst working in other care environments. Staff sometimes Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: need to institute a process of elimination to establish what an individual wants. The home had discontinued using a communication board which used to display photographs and pictorial images showing what is planned for the day and staff on duty. This was on the basis it had not met the communication needs of the people using this service. A flexible and individualised approach to the care and support of people using services was evident during the visit. This afforded continuity of structures and routines. All five people living at the home were present during the visit. Most were up and dressed at the outset of the visit and good attention given by staff to their personal appearance and standard of dress. On arrival one person was in the dining room eating his breakfast and another self-propelling her wheelchair from her bedroom towards the dining room, for breakfast. The person in bed was clean and appeared comfortable. He was waiting for a home from his general practitioner requested by staff who spoke of progressive deterioration in his medical condition and mobility.The two people who are were ambulant were observed to freely access their bedrooms and all communal areas including the garden. Staff continue to accommodate the preferences of one individual who is high on the autistic spectrum, in an innovative way, reducing his anxiety levels and behaviours that challenge services. New person - centred tools are used to engage people using services in the care planning process, meeting individual, holistic needs. The organisation is committed to the Way We Work person- centred approach to planning care and support. An ongoing staff training programme supports staffs learning in this approach and use of these tools. A whole team approach to reviews was demonstrated, involving care managers, families and other people significant to people using services. A designated staff member is trained to coach and support staff in using person-centred tools. These are now used at team meeting and have become the accepted way for developing and updating care plans. Learning logs provide staff with information about the people they support. They are used for updating care plans and enable a more creative choice of activities. We examined the care file of one individual and sampled care plans of two other individuals. These observation informed judgements about how well the home is meeting the individual needs and choices of people using services. The care plans and assessments examined for one individual were last reviewed at a care management review meeting in May 2009. Records included a personal profile clearly identifying what is important to and for this individual. It described what would contribute to a good day for this person and what would be a bad day.Guidelines were in place for staff when handling this persons money, for bathing and hoisting practice also specific Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: to locking his room when not used by this individual, to safeguard his privacy. Work was in progress for the transfer of information to a new standardised care planning system. For this reason some records in this individuals files were incomplete. This included his communication profile and records relating to relationships, activities and healthcare. Care plans were person-centred, reflecting individual diverse needs and mostly addressed needs and risks. The need for records to provide an audit trail of individuals lifestyles, care and support was discussed. Though the shift planner system provides a daily record of care and support responsibilities delegated to named staff these records are not integrated into each individuals personal files. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and skilled to enable people using services to have choice in their daily lives. They participate in age, peer and culturally appropriate activities, within individual levels of capacity. Opportunities for participation in community activities however continue to be restricted to weekdays, for most people.They are supported in maintaining relationships with relatives and friends and are offered a healthy diet. Evidence: Daily routines promote independence, individual choice and freedom of movement, so far as possible within individual levels of capacity. People using services engage in meaningful daytime activities according to known and established interests, diverse needs and capabilities. Two people attend a music therapy/dance activity on different days, during the week. One person attends a Mencap Day Centre four days a week and another attends this day centre once a week. Here there is opportunity to meet friends and participate in a range of activities, which include dance, drama, arts and Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: crafts. Mencap support workers enable three people using services to engage in culturally and age appropriate community activities during the week. They enable individuals to use restaurants and cafes, go swimming, for walks and shopping. One individual who has two sessions a week with a Mencap support worker self-funds one of the sessions. These are funded for other individuals by their Local Authorities. One of these individuals requires a two to one staff ratio when out in the community. Discussions with staff confirmed they carefully select community activities according to the needs, understanding and behaviours of each individual, to avoid distress. People using services do not access employment or further education services due their capacity levels and communication needs. For the same reason they do not go to cinemas or church. The proposed provision of day trips in lieu of an annual holiday agreed with his care manager for one individual did not take place on the basis he instead enjoyed a holiday, with staff support. He had not been away on holiday for some time as it was felt he did not gain any real benefit from the experience. However when the team discussed all the factors, using person-centred planing tools, it was decided to try again and the holiday reported to be successful for this individual. Three other people using services had also benefited from a holiday this year, with staff support. Discussions with staff confirmed the choice of holidays was based on their knowledge of what individuals like, what is important to them and what has worked previously. Relatives and friends of people using services were stated to be welcome to visit at any time. One individual attends a specialist day service one day a week. Observations confirmed a best practice approach to meeting his complex needs. Records and discussions with staff confirmed their understanding of his condition and behaviours and how he sees the world. Structures are in place to look holistically at this person, trying to establish needs, likes and dislikes. His key worker had recently completed the Autism Focus Award and is the homes designated link between the National Autistic Society and the team. Observations confirmed clear behavioural management guidelines and risk assessments in place for this person. A whole - team approach to managing his complex needs and behaviours was demonstrated. These can be destructive and adversely impact on the rights and privacy of people using services. Strategies are in place to minimise the impact on others. His key worker was observed to have been creative in making provision of a low arousal bedroom environment to meet his needs. This was aimed to reduce anxiety levels and minimise destructive behaviours. Staff accommodate the preference of this individual to eat alone in the dining room before others. He continues to enjoy going out with his key worker in the homes vehicle when transporting other people using services to and from their day services. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: A mid-shift operating Monday to Fridays flexibly enables staff to transport people using services to and from day services and to other appointments. Discussions with staff confirmed that, as at the time of the last inspection, staffing levels remain a barrier to people using services accessing community amenities and being part of their community at weekends. Senior support workers and support workers have generic roles. They engage in domestic, catering and gardening tasks in addition to providing care and support, as part of their duties. Staff said they shop for food twice a week and have received food hygiene training. They know the favourite foods of people using services and accommodate their preferences and special diets when planning menus. Menus are not produced in a symbols/pictorial format as this does not meet the communication needs of people currently using services. Practice observations at lunch time confirmed an individualised approach to catering, meeting the dietary needs and preferences of individuals. One person was encouraged and supported to engage in the preparation of her sandwich. Meals were nicely presented and appeared substantial. Staff were sensitive to the needs of individuals requiring assistance with meals. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people using services receive is based on their individual needs and preferences. Record keeping needs to improve to ensure an audit trail of evidence demonstrating health needs are fully met. Principles of respect, dignity and privacy are put into practice and medication procedures are safe. Evidence: We viewed all the care records for one individual and sampled care records of two other individuals. These observations informed judgements about how well the home is meeting these standards. People using services are registered with a general practitioner (GP). The personal and healthcare support they receive is underpinned by quality principles and values that respect rights of privacy, dignity and equality. Personal and intimate support needs are recorded in care plans, based on individual needs assessments and known preferences. Since the last inspection effort had been made to streamline care documents to make this information easier to retrieve. A new standardised care planning system was in the process of being implemented. Though not all information had been transfered to the new system on the file fully viewed, these records were Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: easier to navigate than the former system. They provide a comprehensive overview of health and personal care needs.Care plans and risk assessments specific to medical conditions and behaviours were sampled. We also examined the management of seizures. Though evident that relevant health and other professionals are consulted and have input to the health and wellbeing of people using services, record keeping practices did not include all external health practitioners contact and interventions. At the time of the visit records available for inspection did not evidence the action since reported by the registered manager to improve the health of a person whose file we examined. The need to maintain an audit trail of the care and support received and of weight monitoring was discussed. Staff are trained to provide safe and appropriate personal and healthcare, specific to the needs of the people they support. The home has an action plan to support best practice in prevention and control of infection. Aids and equipment are provided in accordance with assessed needs.These include wheelchairs, profiling beds, pressure relieving mattresses, cushions and a mobile sling hoist. The building is wheelchair accessible and wide pathways are available in the garden. Bathrooms have tracking and ceiling hoists and specialist baths, one with a jacuzzi facility. There is an efficient medication policy and procedure, which staff understand and follow. Medication records sampled were fully completed, containing required entries and signed by appropriate staff. Medication training was evidenced for staff and medication securely and appropriately stored. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home complaint policy is clear and robust policies and procedures safeguard people using services from neglect and abuse. Evidence: The home has a corporate complaint policy and procedure which is clear and transparent and relatives were stated to have received a copy. A pictorial complaint leaflet was on the files of people using services. Staff confirmed they would not have read or understood this stating they would need support from relatives or advocates to make a complaint. Staff use observations of changes in behaviour as an indicator that they are not happy or may be in pain and this is meticulously followed up. A system is in place for logging comments, concerns and complaints and this is an agenda item for team meetings. The homes records confirmed no complaints had been received by the home since the last inspection. Both staff on duty were aware of the complaint procedure and of the action they must take. Discussions with staff indicated that none of the people using services have a standard or urgent authorisation depriving them of their liberty, under the Mental Capacity Act. Staff said if people want to go out they will take them, even if just for a walk. The organisations policies for staff recruitment, handling money, management of challenging behaviours and staff training, protects people using services. Agreed working practices and risk assessments were on files viewed for behaviour Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: management. Policies and procedures for safeguarding adults are in place, including the latest edition of the local multi-agency safeguarding procedure. There is a clear and effective system for staff to report any concerns about colleagues and managers. The whistleblowing procedure was used since the last inspection, resulting in a safeguarding referral and investigation. The referral was well-managed and the case is now closed. The home followed its own disciplinary procedures in this matter, in agreement with the Local Authority safeguarding team. Since the last inspection all staff have received safeguarding training. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes physical design and layout is suitable for its stated purpose. The home was comfortable, clean and mostly hygienic but in need of further attention to maintenance. Evidence: A full tour of the premises and garden was carried out during the visit. The building was clean and tidy throughout and odour was well - managed. The enclosed secluded garden was tidy and the gate leading to canal was locked. Individual members of the team maintain the garden and have created attractive areas using patio planters. A financial donation is enabling proposals for a soft surface area in the garden to go ahead. This will meet the specific needs of one individual. A garden summerhouse is a new development this year, enabling another person using services to spend time on his own, if he so chooses. The respective responsibilities of the registered organisation and housing provider for the buildings maintenance had been clarified and agreed since the last inspection. Also inspection natural light to the lounge and two bedrooms had improved due to the removal of a tree in the garden by the housing provider. A support worker led programme of redecoration is in progress which had enhanced the lounge and a new Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: oven and hob had been purchased. Kitchen units in a poor state of repair at the time of the last inspection had not been replaced and it was not clear if this was planned. An internal hazard audit had recently identified the need to change the lighting in the hall and corridors to meet the needs of a person using services; also for floor covering in these areas to be replaced for hygiene reasons.Some exterior lights were also not working. The homes annual development plan stated the intention to redecorate bedrooms and replace some flooring. It was not clear if this included the water damaged flooring in both bathrooms identified at the time of the last inspection which has not been addressed. The home has two supported bathrooms with overhead tracking for hoisting and specialist baths one of which has a jacuzzi feature. Bedrooms, with the exception of one, were comfortable, well furnished and personalised with possessions reflecting the individuality and interests of their occupants. Discussions were stated to be taking place with a relative for the purchase of a second wardrobe for one individual, to alleviate storage problems. This was also a difficulty for another individual. The home supports one person with autism spectrum disorder who rejects furniture and objects in his room. His key worker had creatively found a resolution to this problem by making him a static bed. A person - centred approach to establishing what is important to and for this individual underpins longterm plans for personalising his bedroom, taking account of his needs and respecting his wishes. Since the last inspection shutters have been fitted to this persons bedroom window and of another person, safeguarding their privacy and dignity. A potential safety hazards in the environment was discussed with a staff member. Washing powder and cleaning materials in the utility room was not securely stored and remedial action since reported to have taken place the next day. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and skilled but not always in sufficient numbers to enable people using services to access community amenities at weekends. Recruitment practice is safe. Evidence: The homes staff recruitment policy and procedure has the needs and the safety of people using services at its core. New staff are fully vetted in accordance with statutory requirements. Low staff turnover enables good continuity of services and of care and support to people using services by staff who know them well. Since the last inspection a support worker had left and three support workers had been recruited also relief staff. Recent appointments had enhanced the teams diversity and increased the number of approved drivers.This was stated to have afforded increased opportunity for people using services to go out during the week. Use of agency staff has been kept to a minimum Where possible the home uses a consistent pool of agency worker who are familiar with the people the home supports.The induction training programme covers the mandatory common induction standards. Staff confirmed the organisations induction and training programme to be targeted and focused on improving outcomes for people using services. The organisations mandatory training standard is for two yearly refresher training for prevention of harm Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: and challenging behaviours and three yearly for all other statutory training. All staff have current certificates for their mandatory training and the home accesses external training to meet the specific needs of people using services. Examples include training for the management of epilepsy and behaviours. The homes management ensures staff training needs identified in personal development plans are met.One staff member has achieved the Autism Focus Award since the last inspection. The organisation has concluded negotiations with an external provider for National Vocational Training (NVQ) in health and personal care and two staff are preparing to enrol for NVQ Level 3 qualifications. Staff roles are generic and include domestic and catering tasks, gardening and driving in addition to care and support responsibilities. Individual staff also undertake minor repairs and some redecoration work. Staff rotas confirmed usual staffing levels are consistently two support workers across the waking day. This is enhanced by a mid shift during weekdays, providing a third support worker for peak periods of activity. Night staffing levels provide two staff on the premises, one awake and one sleeping, on-call. On the morning of the visit an untoward incident involving a support worker due to work the early shift prevented her from reporting for duty until the late shift. Staff had promptly reorganise their shift times to ensure two staff on duty that morning. Relief cover had not been arranged owing to the short notice. The two staff on shift clearly stepped up to the challenge, ensuring continuity and consistency of support and routines. Observations confirmed a calm, efficiently managed care environment that morning. This was despite the additional pressures created by the inspection visit also the need to request a home visit from a general practitioner. Staff were evidently aware of the individual needs, methods of communication and personal preferences of people using services. Shift planning records and discussions with staff confirmed no change to weekend staffing levels though reported to be a continuing barrier to people using services using community facilities. This was discussed with the registered manager during the last inspection at which time it was understood weekend staffing levels would be increased. The registered manager has confirmed recruitment of relief staff is ongoing. It was stated effort is being made to improve weekend staffing ratio though budgetary constraints are a factor that must be taken into account. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a suitably qualified, competent registered manager. Shortfalls in healthcare records, staffing and the environment were identified. A potential safety hazard relating to the storage of cleaning products has since been addressed.People using services and their representatives can be confident their views underpin self-monitoring reviews. Evidence: The registered manager is suitably qualified and responsible for the day-to-day management of this home and one other in Aldershot. The management structure includes a deputy manager post, supporting the management of both homes. This post was vacant at the time of the visit, though we have been informed that an appointment has since been made. A new deputy manager plans to take up post in January, subject to satisfactory vetting outcomes. Since the last inspection the manager has complied with the requirement to register. The registered manager and deputy manager posts have clearly defined roles and responsibilities. The extended roles of both managers was reported to have worked well across both homes since the Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: last inspection. The stated advantages of this structure has promoted consistency of practice, record keeping and staff management. The structure supports teams to work in an integrated way, particularly communications representatives and person centred planning coaches. At the time of this inspection the registered manager was on leave. Both senior support workers competently facilitated the inspection visit. An area manager was on call and offered to attend the inspection however due to distance was advised this was not essential. The management structure includes senior support workers who assume shift leader responsibilities. A senior support worker said the manager is approachable, listens to staff, is friendly and effective in her management style. The registered manager is currently managing both homes. Individual staff members have taken on areas of responsibility and have shown they are skilled, organised and competent in their roles. Observations confirmed most sections of the AQAA completed, with the exception of staffing data. The information provided gave a reasonable picture of the current situation within the home. Office organisation and administration had improved since the last inspection. The need for review of confidentiality of record keeping was identified, specifically files of people using services stored on open shelves in the office and kitchen. A development plan for improvements to the environment had now been agreed with the the housing provider. It was not clear however whether this will include remedial action to replace damaged kitchen units and floor covering in bathrooms, outstanding from the time of the last inspection. Staff levels at weekends continues to be a barrier to community inclusion as at the time of the last inspection. Observations confirmed management awareness of the Mental Capacity Act deprivation of liberty safeguards. The records viewed however did not demonstrate capacity levels to make sure restrictions of freedom are reasonably proportionate. This is an area for further development. The organisations getting it right policy and procedure, sets out how the organisation expects to find out the quality of its service provision. The latest quality survey involved stake holders in the service. Feedback from professionals, relatives and advocates indicated overall good levels of satisfaction with service provision. The area manager was stated to usually visit the home every week. She undertakes statutory monthly visits on behalf of the responsible individual, generating reports which are kept in the home. Reports were not available for visits carried out in May, June and September however. People using services have bank accounts. There is a safe in the home for security of their money. Two staff signatories are required for the withdrawal of money from Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: these accounts. Systems are in place for recording and receipting transactions and audits are carried out of bank statements and the management and expenditure of personal finances. Care Homes for Adults (18-65 years) Page 29 of 33 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 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 30 23 The registered person must ensure the planned maintenance and renewal programme includes replacement of damaged kitchen units and bathroom floor covering. This will ensure the dignity and health of people using services. 16/02/2010 2 33 18 The registered person must review weekend staffing levels and ensure these are adequate. This will ensure the holistic needs of people using services can be met, enabling people using services to be part of their community 16/12/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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