Care Home: Veedale

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What the care home does well We received a good response to our written survey and all those who took part expressed satisfaction with all aspects of the service. Comments we received included; `People enjoy a varied lifestyle and go out to lots of different places.` `We are very person centred and the manager is always looking at ways to improve.` `People are given the opportunity to be individuals.` `When someone new comes to the home anything they need such as equipment or a new wheelchair is sorted out immediately.` `The manager of Veedale has provided me with unlimited support and time and effort to help me do my job well. She has a wealth of knowledge and experience and is always happy to assist in all areas.` `The management of the Dalesview company are always courteous, open and respectful to residents and staff.` We met a number of residents during our visit and observed carers going about their duties. The Residents we met appeared happy and relaxed in their surroundings and several people we observed were enjoying individual time with staff members. We noted that staff went about their duties in a pleasant and cheerful manner and addressed residents with courtesy and respect. Making a decision as to whether to move to a care home is an extremely important one and it is important that people are provided with a good level of information to help them make an informed choice. The home provides a detailed Service User Guide to all prospective residents and their families which details all aspects of the service provided and other information such as daily routines in the home. We were able to confirm that this guide is available in a variety of formats including a DVD guide which residents have been involved in producing. This means that more people have access to the information. The home has thorough processes in place for assessing and planning for people`s care needs. The manager demonstrates a good understanding of person centred practice and this is evident when viewing residents` individual plans. The home`s person centred approach means that people`s support is planned in line with their individual needs, strengths and wishes. The strong emphasis and creative approach to communication within the home means that people are enabled to express their views to as great an extent as is possible. The level of detail in people`s individual plans means that support staff have a good understanding of the support people need and how they want that support to be provided. People`s health care needs are carefully assessed and their ongoing health is carefully monitored. Any health related issues are quickly identified by staff and prompt action istaken, such as referral to a health care professional. The lifestyle programme is an important aspect of the service provided and each person has an individual lifestyle programme which is developed in line with their own strengths, likes and dislikes. People who don`t want to take part in group activities are provided with one to one opportunities and staff work creatively to ensure that all residents have the opportunity to spend their time in an enjoyable way. There is a good mix of home based and community based activities. There are a number of ways in which residents are enabled to have a say about the running of the home. For example, residents take part in staff interviews and can join the Service User Council which meets regularly to discuss things such as activities or menus. Thought is also given to how people who live at the home are provided with information that is important to them. For example, pictorial rotas are displayed on the notice board so that residents know who is on duty. Residents are provided with pictures of all staff so that they can request to see a certain staff member if they want to. Staff at Veedale are carefully recruited and well trained. Training is provided in a number of areas to help people carry out their roles well, including effective communication and training specific to the health care needs of people who live at the home. In addition, all staff are encouraged to obtain National Vocational Qualifications in care at level 2 or above. At the time of our inspection, over half the staff members held these qualifications. The turnover of staff at the home is low which means a good level of consistency for people who live there. Veedale benefits from clear leadership provided by a competent manager who staff describe as supportive and approachable. The manager demonstrates a good understanding of person centred working and we saw evidence of this approach put into practice throughout our inspection. The manager is provided with regular supervision from the registered provider who also maintains regular contact with residents and staff. The registered provider carries out regular visits during which she explores all aspects of the service provided and seeks the views of people who live and work at the home. What has improved since the last inspection? A requirement was made following the last inspection of the home regarding the recruitment of staff from outside the country. We were able to confirm during this visit that the requirement had been addressed. During this inspection we saw a number of examples of how the service has developed and the manager shared a number of ideas for further improvements. What the care home could do better: There were no requirements made as a result of this inspection.A recommendation was made that all handwritten entries on residents` medication administration records are witnessed and countersigned. This is to help reduce the risk of errors that could compromise the health and safety of residents. We noted that efforts are made to involve residents in the recruitment of new staff at Veedale. However, procedures are not formally established and currently there is no training available for residents in areas such as interviewing. We recommended that the manager look at the processes and establish procedures, so as to ensure that residents are fully involved wherever possible. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Veedale Back Lane Clayton le Woods Chorley Lancashire PR6 7EU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Cordingley     Date: 1 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Veedale Back Lane Clayton le Woods Chorley Lancashire PR6 7EU 01772335098 01772322602 dalesview@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dalesview Partnership care home 18 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 18 The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of people who can be accommodated is: 18. Date of last inspection Brief description of the care home Veedale stands in its own grounds and has open views to two sides. The building is a single storey purpose built establishment, with wide doorways and easy access throughout. It comprises four small units, each with its own kitchen, bathroom and lounge area, allowing service users to enjoy greater privacy. The premises are on the same site as two other homes, Rowandale and Hollydale, which are part of the same group. Veedale can accommodate eighteen service users who have a learning disability. The home provides eighteen single bedrooms. The rooms have been decorated and furnished with specific service users in mind and are all individually furnished. The bathrooms have been specifically designed to provide a suitable environment for Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home assisting service users with physical disabilities. In addition there is a laundry and office. The gardens have been landscaped to the front and sides and there is also a large conservatory and patio, which service users can access. The home is situated in Clayton-le-Woods on the edge of a housing estate. There is a range of facilities including a supermarket, library, leisure centre, public houses and park. These are within walking distance and service users from the home access them. Clayton-le-Woods is situated on the A6 which is the main road linking the city of Preston and the market town of Chorley. This means the service users also have access to the facilities offered in these towns. At the time of the inspection the standard care and accommodation fees for this home ranged from £900 to £1300 depending on the assessed needs of the individual resident. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service included an unannounced site visit which was carried out over two days. As the inspection was unannounced, the manager, residents and staff did not know it would be taking place until we arrived. During the visit we spent time talking to the manager and staff and observing residents. We examined a variety of paperwork including residents individual plans and staff training records. We also carried out a tour of the home viewing communal areas and a selection of residents bedrooms. As part of the inspection we carried out a case tracking exercise. This involved us looking very closely at the care of a number of selected residents from the point of Care Homes for Adults (18-65 years) Page 6 of 31 their admission to the home. Prior to our visit we wrote to the registered manager and asked her to complete a detailed self assessment. The assessment examines all aspects of the service provided and asks the manager to identify strengths of the service as well as areas for development. The assessment was returned to us within agreed timescales and completed to a very good standard We also wrote to people who live and work at the home and asked them to take part in a survey to share their views about all aspects of the service provided. We received a good response to the survey. What the care home does well: We received a good response to our written survey and all those who took part expressed satisfaction with all aspects of the service. Comments we received included; People enjoy a varied lifestyle and go out to lots of different places. We are very person centred and the manager is always looking at ways to improve. People are given the opportunity to be individuals. When someone new comes to the home anything they need such as equipment or a new wheelchair is sorted out immediately. The manager of Veedale has provided me with unlimited support and time and effort to help me do my job well. She has a wealth of knowledge and experience and is always happy to assist in all areas. The management of the Dalesview company are always courteous, open and respectful to residents and staff. We met a number of residents during our visit and observed carers going about their duties. The Residents we met appeared happy and relaxed in their surroundings and several people we observed were enjoying individual time with staff members. We noted that staff went about their duties in a pleasant and cheerful manner and addressed residents with courtesy and respect. Making a decision as to whether to move to a care home is an extremely important one and it is important that people are provided with a good level of information to help them make an informed choice. The home provides a detailed Service User Guide to all prospective residents and their families which details all aspects of the service provided and other information such as daily routines in the home. We were able to confirm that this guide is available in a variety of formats including a DVD guide which residents have been involved in producing. This means that more people have access to the information. The home has thorough processes in place for assessing and planning for peoples care needs. The manager demonstrates a good understanding of person centred practice and this is evident when viewing residents individual plans. The homes person centred approach means that peoples support is planned in line with their individual needs, strengths and wishes. The strong emphasis and creative approach to communication within the home means that people are enabled to express their views to as great an extent as is possible. The level of detail in peoples individual plans means that support staff have a good understanding of the support people need and how they want that support to be provided. Peoples health care needs are carefully assessed and their ongoing health is carefully monitored. Any health related issues are quickly identified by staff and prompt action is Care Homes for Adults (18-65 years) Page 8 of 31 taken, such as referral to a health care professional. The lifestyle programme is an important aspect of the service provided and each person has an individual lifestyle programme which is developed in line with their own strengths, likes and dislikes. People who dont want to take part in group activities are provided with one to one opportunities and staff work creatively to ensure that all residents have the opportunity to spend their time in an enjoyable way. There is a good mix of home based and community based activities. There are a number of ways in which residents are enabled to have a say about the running of the home. For example, residents take part in staff interviews and can join the Service User Council which meets regularly to discuss things such as activities or menus. Thought is also given to how people who live at the home are provided with information that is important to them. For example, pictorial rotas are displayed on the notice board so that residents know who is on duty. Residents are provided with pictures of all staff so that they can request to see a certain staff member if they want to. Staff at Veedale are carefully recruited and well trained. Training is provided in a number of areas to help people carry out their roles well, including effective communication and training specific to the health care needs of people who live at the home. In addition, all staff are encouraged to obtain National Vocational Qualifications in care at level 2 or above. At the time of our inspection, over half the staff members held these qualifications. The turnover of staff at the home is low which means a good level of consistency for people who live there. Veedale benefits from clear leadership provided by a competent manager who staff describe as supportive and approachable. The manager demonstrates a good understanding of person centred working and we saw evidence of this approach put into practice throughout our inspection. The manager is provided with regular supervision from the registered provider who also maintains regular contact with residents and staff. The registered provider carries out regular visits during which she explores all aspects of the service provided and seeks the views of people who live and work at the home. What has improved since the last inspection? What they could do better: There were no requirements made as a result of this inspection. Care Homes for Adults (18-65 years) Page 9 of 31 A recommendation was made that all handwritten entries on residents medication administration records are witnessed and countersigned. This is to help reduce the risk of errors that could compromise the health and safety of residents. We noted that efforts are made to involve residents in the recruitment of new staff at Veedale. However, procedures are not formally established and currently there is no training available for residents in areas such as interviewing. We recommended that the manager look at the processes and establish procedures, so as to ensure that residents are fully involved wherever possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 31 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 11 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes thorough and personalised assessment process means that people can be confident that carers have a good understanding of their needs at the point of their admission. Evidence: People who are considering a move to the home are provided with a good amount of accessible information to help them make their decision. This includes a Service User Guide that provides information about the facilities and daily routines within the home. The Service User Guide is available in a number of formats including a DVD version so that more people have access to the information within it. It was pleasing to note that current residents had been involved in the production of this DVD. In addition, the provider of the service has developed a website for people to view. The website includes a variety of accessible information including all the policies and procedures that the home has in place. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: During our visit we looked closely at the processes the home had followed when admitting three new residents. We found that the process had been extremely thorough and in each case had lasted several months. Very comprehensive assessments had been carried out regarding the individual residents needs. This process had involved the residents, their families where appropriate and a number of professionals including a speech and language therapist and physiotherapist. In one case the staff team had undertaken training with a prospective residents previous service provider to help them gain a better understanding of his individual needs. We were also able to confirm that each resident had been enabled to visit the home on several occasions before they actually moved in, initially for short periods and further on in the process, for overnight stays. The homes thorough approach to assessment means that by the time a resident is admitted to the home, carers have a good understanding of their support needs and can plan their care effectively. It was also pleasing to note that during previous admissions, the home had arranged for some prospective residents to access independent advocacy support to ensure that their opinions and views were central to the assessment process. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to direct how their care is provided and to have a say about the running of the home. Evidence: We viewed a number of residents individual plans and found them all to be of an excellent standard. The plans viewed covered all areas of peoples daily lives and contained detailed guidance as to how people would like their support to be provided. Each persons plan included very detailed information about their preferred methods of communication. This helps support staff understand what is important to residents and how they would like their care to be provided. We noted that peoples plans were produced in a pictorial format making the information in them more accessible and meaningful to the people they belong to. In Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: discussion the manager advised us that alternative formats for peoples plans were being considered with individual residents, such as video formats. All residents at the home have access to independent advocates. Advocates are specially trained to support people who may need assistance to express their views and opinions. Where appropriate, advocates had been involved in the development of residents care plans to ensure that they were in line with their individual needs and wishes. In discussion, the manager demonstrated that she has a positive approach to risk taking and she was able to provide examples of situations where residents had been supported in a positive manner, to take well managed risks, thus enhancing their personal development. We viewed a number of risk assessments that had been carried out and found these to be of a good standard, taking into account all the relevant information and providing clear guidance to staff in how to support people safely. We found that there were a number of ways in which residents can be involved in the running of the home including the Service User Council. We saw example of changes that had been made as a result of requests or suggestions from the Service User Council including the purchase of an additional vehicle for residents use and the provision of raised flower and vegetable beds for residents to tend. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are enabled to enjoy a full and stimulating lifestyle. Evidence: Across the Dalesview group of homes there is a strong emphasis on providing people with opportunities to enhance their lifestyle by spending time in enjoyable and fulfilling ways, maintaining existing skills and hobbies and developing new ones. When we viewed peoples individual plans we saw that their individual preferences in relation to how they spent their time had been explored and a personalised lifestyle programme had been developed using this information. We saw many examples of the homes person centred approach to activities. For example, we tracked the care of one person who much preferred community based Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: activities and this was reflected in the opportunities provided to him. We also tracked the care of a resident who didnt like busy and noisy activities and noted that she was supported to engage in more gentle and quieter pastimes. We found that there is an innovative approach to enhancing peoples daily experiences. All staff are trained in intensive interaction which is a therapy designed to benefit those people with profound disabilities. It involves gently interacting with someone in their own way and in a way they find enjoyable. Activities regularly provided include those held within the home, and over recent years the home have increased peoples opportunities to access facilities and develop relationships in their local community. Each person has a community presence plan that outlines their support needs to access the community and the links that they have made. In addition, efforts have been made to establish and maintain links in the community for example, with local schools, churches and organisations providing leisure facilities. All residents at the home have the opportunity to take part in at least one holiday each year. Work has been done to ensure that holidays are person centred and in line with peoples individual preferences. Residents are encouraged to make choices about their holidays and activities such as visiting travel agents and looking at holiday brochures are all classed as an important part of the experience. Menus show that people are offered a varied and nutritious diet and in discussion, the manager advised us that residents were involved in the development of menus where possible. It was also pleasing to see that residents had lots of involvement in grocery shopping and preparing meals. The home have recently started to purchase more products locally for example from local farm shops, as it has been recognised that this is a valuable activity for residents and increases peoples opportunity to engage in their local community. The individual plans viewed contained a very good amount of information about peoples individual dietary needs and preferences. We noted that there was clear guidance to staff in how to support people safely in this area where for instance, someone may have additional needs relating to eating and drinking safely. Care Homes for Adults (18-65 years) Page 17 of 31 Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home benefit from effective, well managed health care support. Evidence: We viewed several residents individual support plans and found that they were very comprehensive in terms of the daily support they required. The plans were based on residents strengths and goals and demonstrated that people had been involved in the development of their own plan. Peoples plans contained enough information to enable carers to provide support individually tailored to the person. On all the plans we viewed there were detailed protocols providing step by step guidance in areas such as bathing, dressing and sleeping. Peoples individual plans included a strong emphasis on promoting independence, choice and dignity. Where people were able to carry out certain tasks for themselves this was clearly detailed and staff were guided to support people to maintain their independence. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Each persons individual plan included comprehensive health information. Peoples health action plans included details of their specific care needs and areas such as optical and dental care. We saw evidence that people living at the home are supported to access specialist services when they require them such as community health care. In addition there are specialists employed within the home including speech therapists and dieticians, to ensure that people have immediate access to these services should they need them. We viewed the homes medication store and records relating to medication. We found that there was extremely detailed information for each resident and the support they needed to take their medication. For instance, if there was a chance that a person may refuse to take medicines that had been prescribed, strategies were detailed so that staff would know what to do in this situation. We also noted that there was a pain management plan in place for every resident. This included information such as how a person may communicate that they are in pain and how to ensure that the person is given the correct medication to address this. In general, we found that all records relating to medication were in good order. Records were kept of all medicines received in the home and disposed of so that an audit trail could be maintained at all times. We did however, identify an error on one residents medication administration record that had occurred when a handwritten entry had been made on the record. We pointed this out to the manager and recommended that all handwritten entries be witnessed and signed by a second party to reduce the risk of errors. Care Homes for Adults (18-65 years) Page 20 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are enabled to voice their concerns and any complaints that are made will be dealt with thoroughly. Evidence: The home has a complaints procedure in place that gives people advice on how to make a complaint and what will happen if they do. The procedure is available in a number of formats including a pictorial and DVD guide, to ensure that the information is accessible to people who live at the home. It was pleasing to note that some residents had been involved in the making of the DVD complaints procedure and the manager commented that people had appeared to enjoy taking part in this process. A record is kept within the home of any complaint made, action taken and subsequent outcome. Records viewed confirmed that the home had not received any complaints since their last inspection. The manager confirmed that all complaints received (if any) would be reviewed at the monthly managers meetings as part of the homes quality assurance processes. All homes are required to have written procedures in place that should be followed in the event that it is suspected someone living in the home has been the victim of any Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: kind of abuse - these are generally referred to as Safeguarding procedures. In discussion, the manager and staff spoke with demonstrated a good understanding of Safeguarding procedures and were confident that they would be supported in the event that they blew the whistle on poor practice. Training records confirmed that all staff had received training in the area of Safeguarding and that this training was regularly updated. In discussion the manager demonstrated a good understanding of recent changes in the law that must be considered when providing support to people who do not have capacity to make decisions in their own best interest. We were able to confirm that the home had updated their policies and procedures to reflect the changes and were in the process of providing training for all staff in this area. Where decisions had been made on behalf of people and in their own best interests, clear processes had been followed and recorded appropriately. We were also able to confirm that the home had sought to include a variety of people in these processes including residents, their relatives and other health and social care professionals. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are provided with safe, comfortable accommodation. Evidence: Veedale is a purpose built home with all facilities on the ground floor. All accommodation is offered on a single room basis and there are ample, accessible bathroom and toilet facilities. During our visit, we carried out a tour of the home and found all areas to be clean, warm and comfortable. We also noted that the home was maintained and furnished to a very good standard. During our tour we noted the use of objects of reference in various area of the home. These are objects that help residents identify areas of the home and what they may be used for. We viewed a selection of residents bedrooms and noted that peoples rooms were nicely personalised and contained lots of personal items such a pictures, ornaments and other treasured possessions. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Each persons bedroom was notably different in terms of colour schemes and furniture and the manager advised us that where possible people are encouraged to choose colour schemes before they move into the home. It was also confirmed that all residents hold a key to their room unless a risk assessment directs otherwise and everyone has a lockable cupboard in their room to keep their valuables safe. Since our last inspection the garden area had been much improved and it was pleasing to note that the home were in the process of providing raised flower and vegetable beds for those residents who use wheelchairs and would like to be involved in maintaining the garden. There is a policy and written procedures in place, in relation to the control of infection and all staff are made aware of these at the start of their employment. We were also able to confirm that staff are provided with training in infection control at the start of their employment. One staff member takes part in a local infection control forum which enables her to keep up to date with good practice and developments in the area. The staff member feeds back any relevant information to the rest of the staff team. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive their care from carefully recruited well trained staff. Evidence: We were able to confirm that the home follow careful procedures when recruiting new staff so as to help ensure the safety and wellbeing of people they support. All prospective staff members are required to complete an application form which includes a full employment history. We saw evidence that any gaps in an applicants employment history are investigated and a record kept of reasons given. Formal interviews are carried out with all applicants and prior to employment all applicants are required to provide two references, wherever possible from previous employers. In addition, all candidates are required to undergo a Criminal Records Bureau check prior to starting employment. We discussed how residents are involved in the recruitment of new staff and the manager advised us that this was done in a number of ways. Recently, an exercise has taken place with the Daleview Service User Council where residents were asked to Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: submit the questions they would like to see asked at interview. These questions are now used in all interviews. The manager also told us that residents frequently take part in staff interviews and are asked for their feedback. In discussion we advised the manager that it may be beneficial to formalise this process to ensure that the processes for involving residents are understood by everyone. We also advised the manager to consider the possibility of providing training for residents in the process of interviewing to help ensure that they benefit from the experience. There is a structured induction programme in place and records confirmed that new staff are provided with induction training at the start of their employment. More in depth induction which is in line with Skills for Care standards follows and new staff are expected to complete this within 8 weeks of their employment. In addition to the mandatory health and safety courses, staff are provided with training in a number of areas including sexuality, dealing with complaints, intensive interaction and communication skills. All support staff are encouraged to gain their National Vocational Qualifications. At the time of our inspection 20 out of 38 staff members were qualified at level 2 or above. Additional duties associated with senior carer positions are recognised and training in areas such as appraisal is provided. In addition, all seniors are encouraged to obtain National Vocational Qualifications at level 3 and in some cases at level 4. We looked at staffing rotas and found that staffing levels were adequate to meet the needs of people living at the home. We received comment cards from a number of staff who were all very positive about their role and highly complimentary about the service provided and the support they received from their manager. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from clear leadership and is managed in the best interests of people who live there. Evidence: The registered manager of the home has extensive experience and throughout the inspection demonstrated a good understanding of her role and that she was highly competent to manage the service. In addition, the manager communicates a good understanding of person centred practice and was able to give a number of examples of how this was reflected in the support provided to people living at Veedale. All the staff who responded to our written survey were very positive about their roles and several commented on the fact that they felt very well supported. One staff member wrote You feel as though your comments and ideas are welcomed by the manager and she is always approachable. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Prior to our visit the manager completed a comprehensive self assessment which explored all aspects of the service. The assessment was completed to a very good standard, gave details of a number of improvements that had been made since the last inspection and also demonstrated that the manager was able to identify areas for further development. There is a good approach to quality assurance and there are a number of ways in which residents are involved in this area. A Service User Council which is made up from people living in homes across the Dalesview Group meet on a regular basis to discuss the service. We saw a number of examples of changes that had been made as a result of requests or suggestions from the group. The registered provider of the home visits regularly and every month carries out a thorough inspection during which she speaks with residents and staff. A report is then completed which is given to the manager and maintained in the home. This demonstrates that any issues raised in the providers visits are addressed. There is a health and safety policy in place which is supported by a number of individual procedures such as infection control and fire safety. Records viewed also confirmed that all staff complete the mandatory health and safety training courses soon after their employment and that this training is regularly updated. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 Hand written entries on peoples medication administration records should be witnessed and counter signed. This is to help reduce the risk of errors which could result in the health and safety of residents being compromised Processes for involving residents in the recruitment of new staff should be formalised to help ensure that people benefit from the experience. 2 34 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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