Care Home: Watson House

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Watson House 12 Huckleberry Close Purley on Thames Berkshire RG8 8EH The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dickens Date: 2 9 0 4 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 35 Information about the care home Name of care home: Address: Watson House 12 Huckleberry Close Purley on Thames Berkshire RG8 8EH 01189427608 01189426671 Rachelk@purleyparktrust.org 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) : Purley Park Trust Limited care home 7 Number of places (if applicable): Under 65 Over 65 7 7 0 0 learning disability physical disability Additional conditions: 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; Physical disability (PD) Learning disability (LD) The maximum number of service users to be accommodated is 7 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Watson House is a one storey sevenbedded home providing care for adults with learning disabilities. The house provides care to residents with higher needs, although nursing care isnt provided. Everyone has their own bedroom with a shower and toilet. There is an assisted bath that is available to all. Watson House is part of Purley Park Trust, where there are eight registered Homes. People who live here are able to go out and about in the grounds and use other services provided by the Trust including horticultural therapy (learning about plants), day care, and social events at the Clubhouse. Local community activities include using the shops in the local village, and visiting the Church. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 35 How we did our inspection: This is what the inspector did when they were at the care home This Inspection was on 29th April 2009 and took 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector, and the Registered Manager, Miss Emma OConnor, represented Watson House. The inspector looked around the home and asked to see care plans, staff records, and the Annual Quality Assurance Assessment (AQAA) which the manager sent to the Commission before the inspection. The inspector met those residents who were at home and spoke with 4 members of staff during the day. A total of 9 surveys were returned to the Commission from residents, staff and health professionals who work with this service, and these were used in writing this report. Current fees at this home start from 999.00 per person per week. Please contact the home for more details about fees. The inspector would like to thank the residents, staff and the manager for their time, assistance and hospitality. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well Watson House has a friendly and homely atmosphere. It is purpose built and is comfortable. Those with special mobility aids have no difficulty moving around the home and there are aids in place to ensure people who live there can use all the facilities. The level of care offered at Watson House is good and community workers who know the residents at this home said the people who live here are well looked after. There are excellent arrangements in place for activities including arts and crafts, literacy and numeracy sessions, outdoor activities such as camping and golf, and going out for coffee and visiting local places of interest. There is a full time horticultural therapist who teaches people about plants. They have a workshop and greenhouses for residents to grow their own plants and take part in gardening activities. There are also suitable activities arranged for those residents who are physically very frail, including sensory sessions with all the latest equipment available. Staff training arrangements are good, and there is a full programme of ongoing training. More than half the staff have a qualification in care. Community health professionals said staff had the right skills and experience to care for residents and on the day of the inspection staff were seen to communicate well with residents, Care Homes for Adults (18-65 years) Page 8 of 35 and to be sensitive their needs. What has got better from the last inspection The home had no Requirements or Recommendations at the previous inspection. Some things noted in the previous report have now been improved including a better format for residents daily notes, and this includes a record of what each person has eaten each day. The manager said arrangements have improved for introducing new staff to the work they will be doing (their induction) and this is now more detailed. As mentioned above, sensory sessions have now started and these were observed to be enjoyed by those residents who joined in. There are more activities overall so residents have more choices than they did 12 months ago. Five residents now have their own motorised chairs or vehicles to allow them to move about more easily outdoors. Care Homes for Adults (18-65 years) Page 9 of 35 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Helen Dickens 33 Greycoat Street London SW1P 2QF 02079792000 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. Care Homes for Adults (18-65 years) Page 10 of 35 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 11 of 35 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 12 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective residents needs and aspirations are assessed prior to them being offered a home at Watson House. Evidence: The AQAA states that prospective residents receive a full in-depth assessment carried out by the home manager and the operations manager. This includes accessing a local authority care assessment, talking and meeting with the resident, and their family and carers where applicable. Most of the residents have been at the home for many years and therefore their original assessments have been archived, but there has been a new admission this year and the inspector sampled this new residents file. There was a great deal of information for staff, including the full assessments, care plans, risk assessments and health information from this residents previous home. There was a detailed local authority assessment from the placing authority and the operations manager said she had gone out to visit and do the written assessment for this resident herself. This Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: residents written assessment by the home was unavailable on the day of the inspection but it was clear very detailed and comprehensive information had been sought and was at the home. Following the inspection the operations manager confirmed that the collated written assessment had been located. Four surveys were returned to CQC from residents who had been assisted by their care workers to complete these. All four said they had been asked if they wanted to move in to this home and three said they had been given sufficient information; one said they could not remember. Three health professionals also returned surveys and among other positive comments, one noted, in relation to their specialist assessment that staff Listen carefully and play and active role in the assessment process. Excellent follow up regarding recommendations made. Another wrote, when asked What do you feel the service does well?, noted Caring for their residents with warmth and compassion and acting as their advocate as required. In answer to the same question, another wrote: ‘Looking after the overall care needs of residents, and treating them as individuals in their own right. Care Homes for Adults (18-65 years) Page 14 of 35 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 . Residents have a care plan but the current project to up date all care plans into a more person centred format must be progressed. Residents are encouraged to make decisions and to take reasonable risks in their daily lives. Evidence: Three residents files were selected by the inspector and care plans were looked at as part of this. The new residents file contained care plans and risk assessments from their previous home which the manager said had been looked at prior to admission. As the home were in the process of changing their care planning format, the manager said they had decided to use these existing care plans and risk assessments, which had all been reviewed and were suitable, until they could transfer them directly to the new care plan style. The second file sampled had used the Watson House care planning format which was very basic and used mainly tick boxes. The Trust who manage all the homes on this site has recognised the need to change their older style care planning format and this is an ongoing project. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: The Manager was asked how staff can deliver person centred care without much written guidance and she said staff are trained to work with individual residents and get to know their needs well. This was confirmed by staff and during an interview with the training manager who said all new staff would be shadowing for at least the first 2 weeks. The manager has started one care plan in the new format and, though only partially completed, it showed an excellent start. There was a great deal of detail on that residents care needs, and how they would like their care to be delivered. A Requirement will be made that all residents should have a person centred care plan, which clearly states how their care is to be delivered, within 2 months. In addition, care plans for residents aged 65 and over need to be reviewed on a monthly basis, as recommended in the National Minimum Standards for older people. A Recommendation will be made in this regard. No evidence was found that residents were not getting the care they required. Health professionals who returned surveys commented positively on the home including noting that staff Follow up and adhere to recommended guidelines and have Good awareness of risks and identification of potential risk areas. When asked what the service did well, a GP wrote: Looking after the overall care needs. Treating them as individuals in their own right. Respecting their needs and wishes. Seeking medical help without delay when needed. Service user surveys returned to CQC showed that all four agreed that staff Always treated them well. Residents at this home were observed to have very varied abilities with regard to being able to make decisions. Staff were seen to communicate well with residents and to give them options and choices. Residents were noted to be given choices about which activities they participated in, what they wanted to eat and drink, and where and how they wanted to sit. All the staff, including the activities staff, knew the residents well and were knowledgeable on their needs and how these would be met. Residents were heard (or seen) at times, to choose a different option from the one on offer, and these choices were respected. The chief executive and operations manager were asked to take advice from the local authority regarding whether two residents who have safety belts or vests on their chairs may need an assessment under the Deprivation of Liberty Safeguards Guidance which came into effect on the 1st April. Residents can have money kept for them in the accounts department of Purley Park Trust. Residents can access their own money to spend as they wish, and receipts are kept. This is then reimbursed by accounts. Some residents can sign for their own money and this is encouraged by staff. Surveys received from residents confirmed they can choose what they want to do during the day, and in the evenings and weekends. Three out of four said they Always made decisions about what they did each day, and one ticked Sometimes. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: On all three files sampled, there were risk assessments in place and residents were encouraged to take reasonable risks. Activities such as horticulture, camping, and cake making, may pose risks, but sensible arrangements are in place. For example, the activities co-ordinator explained that camping had three different levels of risk depending on the ability of the residents who wanted to participate. For the very able, they went camping off site. For those who needed more support, camping in someones garden, and on the site at Purley Park, offered safer options. Health care professionals who responded on surveys confirmed that the home followed specialist guidance for example in relation to risks such as choking. Care Homes for Adults (18-65 years) Page 17 of 35 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 . Residents benefit by the range of activities and opportunities available at Purley Park, and they are also able to be part of the local community. Residents are supported to make and maintain family and friendship links, and are treated respectfully by staff. Nutritious meals are offered, and residents with special needs in relation to eating and drinking are well catered for. Evidence: There is plenty of support for residents to participate in activities with three full time equivalent activities workers, plus the horticultural therapist, and 7 vehicles to share across the whole site. Opportunities for personal and educational development are available for residents and these were outlined by the activities co-ordinator. One resident attends a reading, writing and communication skills course, and visiting professionals pass on skills to residents, for example photography.Thames Valley University provide staff to do Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: numeracy and literacy courses for residents. There are craft sessions (residents recently made their own Easter cards) and art.The Gateway Award on a Friday enables residents to learn about skills such as camping and cooking, and these can be put towards achieving the Gateway Award. On site activities often take place in the Clubhouse for example the Ladies Corner, music sessions, and parties. Day care is also offered in the Clubhouse. The site has a separate horticultural centre and at least one resident from Watson House takes part in horticultural therapy. This facility was visited during the inspection and was seen to offer excellent opportunities for learning about horticulture, with residents being able to grow things themselves. On the day of the inspection they were potting on small plants as residents were working towards having enough plants for their forthcoming plant sale which is open to the public. The manager said they also do their own composting on site. Other active pursuits include golfing, bowls, and trips out. The activities co-ordinator was knowledgeable about residents’ favourite activities and was able to describe in detail the preferences of each of the three residents whose files were sampled by the inspector. Those who are less able are also catered for and multi sensory equipment has been set up in the lounge at Watson House to facilitate therapeutic sessions for residents. One such session was observed during the inspection with relaxing music, lights and giant bean bags, and those residents participating certainly seemed to be enjoying the session. Foot and hand massage is also offered. There are opportunities to be part of the local community and residents use local facilities, including the swimming pool at a local school. The activities organiser also mentioned that some residents like to go out for a coffee, visit the Child Beale Park, or visit local garden centres. Not all residents are having a week away and when asked, the manager said that some residents prefer having days out, especially those who have very high care needs which would make it difficult for them to be away from the home for an extended period. However, two are going away on holiday this year, and the manager said that one of the new residents, whilst not planning a holiday for this year, will certainly have that as an option next year. Residents have opportunities to have friendships and personal relationships. Residents were seen to mix freely across the site with others who lived at Purley Park, one telling the inspector he was going to visit his girlfriend. Residents can have visitors when they choose and there are many social opporunities with the Clubhouse being the hub for parties and musical events. The AQAA states that residents are supported by staff to maintain family links including calls and visits to family members. Daily routines were seen to offer residents choice and some independence. Staff were heard to give residents choices, to ask their opinions, and to try to engage them in Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: activities and the everyday life of the home. Staff were seen to be respectful towards residents and to include them in conversations. People who live at Purley Park can move around the site freely and at Watson House two residents go out into the local community on their own motorised vehicles. The AQAA states that residents have breakfast when they get up, but have lunch and evening meals together, and with staff as well. On the day of the inspection lunch was a sausage casserole and creamed potatoes which residents were seen to enjoy. There was plenty of support available for those who needed it, and the Speech and Language Therapist who completed a questionnaire for the Commission, complimented the home on how they dealt with this aspect of residents care. The manager said she tries to ensure residents have a well balanced diet, and certainly there was a large selection of fresh fruits in the kitchen, and a record in each residents daily notes about what they have eaten. Care Homes for Adults (18-65 years) Page 20 of 35 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 . Residents receive personal support in the way they prefer or require and their health needs are met at this home. Arrangements for the safe administration of medication are satisfactory. Evidence: Residents were seen to be given choices and staff communicated well with them about how they wished to be supported. Staff spoken with very knowledgeable on residents’ personal and healthcare needs. As noted earlier, current care plans lacked detail, but there was plenty of evidence that sufficient and personalised support is being given to residents. Personal support is provided in private, though less intimate support was seen to be offered throughout the day in the lounge and dining area. Technical aids and adaptations are available and all residents have use of en-suite facilities plus the use of specialist communal bathing facilities. Residents get continuity of support through a key worker system and because the home has such a low turnover of staff. The shortfalls on written instructions for staff are currently overcome by each staff member having detailed knowledge of residents Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: needs, new staff being trained to support individual residents, and plans to introduce better care planning documents in the next two months. Healthcare arrangements for residents are well organised with evidence of close involvement with community health professionals, including the district nurses. For example, some residents need intensive pressure area management to prevent pressure sores, and specialist equipment such as beds, mattresses and cushions are used. Staff have routines in place to ensure residents pressure areas are relieved, and the manager said there are currently no pressure sores at this home. There are risk assessments in place relating to residents health and nutritional needs, and community professionals such as the speech and language therapists and psychologists carry out specialist assessments and ongoing support to residents. Each resident has a health action plan and one was sampled. It set out the health needs of the resident and included details of health contacts, medication, and covered each part of the body e.g. tummy, legs etc, which makes it a very user friendly format for residents. The plan also covers diet and exercise, and has action plans for each area. Each resident also has the Royal Berkshire PCT Information about me.. folder which has been completed by staff and sets out crucial information about the support they would need if they had to go into hospital. A number of positive comments were received from health professionals including: The GP noted, in response to What do you feel the service does well?; Looking after the overall care needs and treating people as individuals in their own right. Seeking medical help without delay when needed. A community nurse wrote They are always very prompt and proactive in managing and improving individuals healthcare needs. The Speech and Language Therapist wrote They take heed to guidelines and follow them through. And they interact in an appropriate and respectful way with residents. Medication is inspected and monitored by a community pharmacist who last visited the home in March of this year. They made only one recommendation relating to the disposal of unwanted medicines, and they rated the home as 3, which is Standard met. Care Homes for Adults (18-65 years) Page 22 of 35 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 . Residents can be confident that their complaints would be taken seriously, and the policies, procedures and staff training at this home should protect vulnerable adults from abuse. Evidence: The home has a complaints procedure in place and on the four surveys returned from residents, all ticked Yes in answer to the question about whether they would know who to speak to if they were not happy about something. Two of the four said they wouldnt know how to make a complaint. This was discussed with the manager who was asked to think about whether there were any additional ways to ensure the complaints procedure was accessible to all residents, even those with profound communication difficulties. The home has not received any complaints, nor has the Commission received any concerns or complaints about this service. There are procedures in place for safeguarding vulnerable adults and the home uses the West Berkshire local authority procedures. Staff are trained in safeguarding issues, and the training manager said all new staff cover this subject in their induction. No safeguarding adults reports have been received by the Commission in relation to this service. In answer to the survey question Has the care service responded appropriately if you or the person using the service have raised concerns about their care, all three health professionals ticked Always. One added Staff have been open to comments, and Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: participate actively in multi disciplinary team meetings. Care Homes for Adults (18-65 years) Page 24 of 35 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 . Watson House offers a comfortable and very accessible home for residents to enjoy, and is clean and pleasant throughout. Evidence: The AQAA states that the home has adequate living space for residents, and all have their own bedroom and en-suite facilities. On the day of the inspection a tour of the premises took place and all communal areas and two bedrooms were visited. The home is purpose built, and very spacious. It is easily accessible for those with walking aids, wheelchairs and motorised vehicles. There is a homely and friendly atmosphere with plenty of visitors throughout the day. The home was hosting the Ladies Club on the morning of the inspection and residents joined craft activities with some of their neighbours in the lounge/dining room. The home offers a safe and comfortable environment for residents which is bright, cheerful and fresh and clean throughout. The furnishings and fittings are domestic in character, supplemented by specialist equipment such as hoists and a special bath. Sensory equipment, TV and music facilities are fitted in the lounge area for communal use, and individual residents have their own entertainment systems in their bedrooms. Bedrooms visited were noted to be nicely decorated and furnished, and personalised with plenty of photographs and residents own personal memorabilia. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: There is a handyman and three gardeners across the site to ensure the premises and surrounding gardens are well maintained. The AQAA states that The home is kept clean and residents help with chores. The home has all the relevant policies in maintaining hygiene. During the inspection the home was indeed found to be clean and fresh with no unpleasant odours in any part of the building. Suitable laundry facilities are provided including commercial washing machines and a tumble drier. There is a washable floor covering in this room to enable staff to keep the floor clean, and a dedicated worker who looks after residents clothes and does most of the cleaning at the home. Staff training records showed that staff receive training on infection control. The Environmental Health Officer visited the home in June 2008 and looked at the entire premises. They raised no issues in relation to infection control. The relevant policies mentioned in the AQAA were discussed with the manager as most of the policies and procedures noted on the AQAA are overdue for review. According to the AQAA the infection control policy has not been reviewed since 2002. This had been highlighted to the Trusts management by the inspector at a recent Annual Service Review of another home on the site, and the operations manager is currently ensuring all policies and procedures are brought up to date and reviewed regularly thereafter. Arrangements for the prevention of legionella are discussed under Standard 43 on Health and Safety. Care Homes for Adults (18-65 years) Page 26 of 35 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 . Residents are supported by competent staff who are trained to meet their needs. Recruitment arrangements are well developed but more work is needed to fully protect residents. Evidence: The AQAA states that Staff are supported, trained and guided to respect residents. Their inductions cover knowledge about various disabilities and illnesses that are relevant. They are trained and supported in communication techniques and attend speech therapy sessions to oversee practices. All staff either have, or are working towards NVQs. During the inspection staff were observed to communicate well with residents and to anticipate their needs. Residents were seen to approach staff for support and to seek their guidance. It was noted that all staff were knowledgeable on the needs of residents, including the activities staff. During an interview with the training manager she said all care staff start their NVQ qualification after 6 months probation, and senior staff can do NVQ Level 3 or Level 4. Currently 7 of the 11 care staff have an NVQ 2 or 3, and the manager has an NVQ Level 4. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: The AQAA states that residents are involved in the recruitment process. At least two references are obtained, one from the last employer, and an enhanced CRB check is completed. Recruitment is overseen by the operations manager and files sampled were kept in an orderly and accessible format. Two staff files were sampled and both had application forms, interview assessment notes, photographic identification, and Criminal Records Bureau checks, including a POVA check to ensure the staff member had not been deemed unsuitable to work with vulnerable adults. One staff file showed unexplained gaps in their employment history, (which was thought to be whilst they brought up a family, but this was not documented), and one reference which should have been on file was missing. The operations manager said she would ensure the gaps were filled in the next day when the worker came on shift and she would telephone for a verbal reference from the previous employer in the interim. She telephoned the Commission to confirm that this had been done. The follow up written reference was faxed to the home later the next day. The inspector also checked CRBs for 3 staff who had started work at the home since the last inspection, and two were satisfactory. One however showed that a POVA check had not been requested on the CRB form. The operations manager carried out a risk assessment and put a plan in place regarding this worker until a new CRB application could be completed and a POVA first check returned to the home. A Requirement will be made that all staff files are checked to ensure the information set down in Schedule 2 of the Care Home Regulations is on file for each person working at the home. The AQAA states that All staff have a training programme that includes all core and mandatory training. All staff receive at least 5 training days a year, with new staff receiving twice as much in the first year. During the visit the inspector spent time with the training manager who outlined the arrangements in place, including the induction arrangements. All new staff do the Common Induction Standards on line assessment, as well as the Purley Park Trust in house induction. All new staff shadow existing staff for at least 2 weeks. Staff are also given the General Social Care Council Code of Practice. There is a staff development programme and an ongoing programme of mandatory and optional training available. Mandatory training included safeguarding adults, health and safety with infection control, first aid, moving and handling and fire safety. Additional courses are arranged as necessary and these included training on epilepsy and dementia, and supervision and disciplinary procedures training for senior staff. The training manager uses a comprehensive training matrix and was able to demonstrate that staff were up to date with their mandatory courses for example moving and handling, and safeguarding adults training. She could also see when refresher training was due. Staff each have their own individual training record, in Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: addition to the central record which is used for planning and development purposes. Surveys returned from residents said staff treated them well and listened to what they said. Surveys from health professionals contained a number of positive comments including Staff receive training to enable them to support the individuals social and health care needs. The respondent from the speech and language therapy team wrote Those staff I have observed have always supported people in an appropriate manner. Their awareness of good feeding skills have been to a high standard. Care Homes for Adults (18-65 years) Page 29 of 35 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 . Residents benefit from a well run home where their views are taken into account. Satisfactory arrangements are in place to promote the health, safety and welfare of residents and staff. Evidence: The current manager has the skills and experience to manage this home and has been in post since it opened in 2004. She has completed the Registered Managers Award. She ensures that the policies of the Trust are implemented, and that the home meets the legal requirements relevant to running a care home. As mentioned earlier, many of the Trusts policies and procedures are overdue for review and this is being dealt with by the operations manager. The manager is well thought of in the home and was seen to interact well with both residents and staff. There is a happy and friendly atmosphere within the home and the management approach creates a positive, open and inclusive environment. Residents views are taken into account in running the service, and when changes are planned. For example residents wishes are considered when choosing furnishings and Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: fittings, especially for their own bedrooms. Their wishes regarding their care and support are taken into account during their regular reviews. The AQAA also states that residents are involved in recruiting new staff. There is a quality assurance policy in place, and there are a number of ongoing monitoring activities to ensure the quality of the service is maintained, for example in relation to health and safety, and weekly audits of medication are carried out. The home has monthly Regulation 26 visits on behalf of the provider, and the management team are working on a new quality assurance survey which the manager said would be ready by the summer. The AQAA states that better quality assurance procedures have been put in place in the last year and there are plans To further develop our self assessment quality assurance procedures. There are a number of measures in place to maintain good health and safety arrangements, including relevant policies and procedures, risk assessments and staff training. Relevant staff training includes health and safety with infection control, food safety, moving and handling, fire safety, and first aid. The chief executive is designated as the person responsible for health and safety, and the monthly Regulation 26 visits are part of the regular agenda. The manager said there are maintenance engineers available on site for any repairs and maintenance work, and aids and equipment are serviced regularly. The arrangements for the prevention of legionella are well developed but the inspector asked the chief executive to ensure that their current procedures were in line with the Health and Safety Executive guidance on the prevention of legionella in care homes, including having a written risk assessment. The Environmental Health Officer visited last year and suggested only one improvement which was in relation to having regular documented building checks. Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes  No  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 32 of 35 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 Description 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 Description Timescale for action 1 6 15 Each resident must have a 29/06/2009 person centred care plan which clearly documents how they would like their support to be delivered. For the safety and wellbeing of service users. 2 34 19 29/05/2009 Staff recruitment records must contain the information set down in Schedule 2 of the Care Homes Regulations 2002 (as amended). for the safety and well being of residents. 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 6 Residents who are aged 65 or over should have their care Page 33 of 35 Care Homes for Adults (18-65 years) plans reviewed on a monthly basis as set down in the National Minimum Standards for older people. 2 42 The home should ensure that the current arrangements for the prevention of legionella fit with the guidance from the Health and Safety Executive on the prevention of legionella in care homes, and this should include having a written risk assessment. Care Homes for Adults (18-65 years) Page 34 of 35 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). 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