Care Home: Wellesley

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What the care home does well Wellesley benefits from being well managed and having a stable staff team. The people who live at Wellesley have all lived together for some time and know one another well. Friendships have developed at the home. Support provided by staff is flexible and provided at the person`s own pace. Healthcare needs are anticipated and support is planned and regularly reviewed. The home is located as to give good access to nearby towns and people are encouraged to retain their independence in accessing the local community. What has improved since the last inspection? At the last key inspection no requirements and three recommendations were made. The recommendations were in relation to staff training. The home has taken action on these recommendations and they are not repeated in this report. What the care home could do better: We have made two legal requirements as a result of this inspection in relation to assessment of decision making capability and completion of medication records. If people do not have the capacity to make decisions in relation to handling their finances this needs to be formally assessed. Medication recording gave risk to potential errors in administration, protocols for recording medicines in the home needs to change. We have also made recommendations to promote good practice in this report. We saw that people are supported to self-medicate and that this is risk assessed. However, the risk assessment should be expanded and consider all potential risks and control measures be recorded to demonstrate that the person self-medicating is safe to do so. Two policies in the home would benefit from review. These are the home`s deprivation of liberty policy and the home`s adult protection policy. Key inspection report Care homes for adults (18-65 years) Name: Address: Wellesley Landkey Road Barnstaple Devon EX32 9BZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judith McGregor-Harper     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Wellesley Landkey Road Barnstaple Devon EX32 9BZ 01271373755 NONE wellesley1@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Nigel Duncan McCowen Smith care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Wellesley is a home for 10 adults with learning difficulties, offering plenty of space for individual privacy. The home is suitable for people who like companionship, personal space, social and physical activities and who need help with personal care and life skills. The home is situated in an Edwardian house set in large walled gardens on the main road in Newport. Barnstaple is within easy reach. Access is level and current service users have no need for an internal lift. The home is comfortably furnished and well decorated. The current fee range is from 393 - 588 pounds per week. Please contact the provider for more details on fees levied. 10 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 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 quality rating for this service is 3 star. This means that people who use this service experience EXCELLENT quality outcomes. This key inspection was unannounced and was a scheduled visit as part of our routine inspection programme. The homes last key inspection was in March 2007 and the home received a rating of excellent at that inspection visit. We have carried out two Annual Service Reviews since the 2007 key inspection. Annual service reviews in March 2008 and March 2009 were completed using information supplied to us by the home and surveys from people with an interest in the home. In these reviews the information we received gave us no reasons for concern or to bring our planned inspection schedule forward. For our inspection on the 14th January 2010 we (the Commission) were at the home on one day spending a total of 5 hours at the home. We looked at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment, staffing; and Care Homes for Adults (18-65 years) Page 5 of 29 conduct and management of the home. During the visit we spoke with or observed the majority of people who live at the home. We looked closely at the care, services and accommodation offered to 2 of the 10 people who were living at the home. This is called case tracking and helps us to make judgements about the standard of care and helps us to understand the experiences of people who live at the home. We looked at care and attention given by staff to people we case tracked and we looked at their assessment and care planning records. We spoke with a visitor to the home, with duty staff and with the Registered Manager (who is the homes owner). We also spoke with one visiting health and social care professional. We visited some of the bedrooms to briefly view accommodation of people we case tracked and we saw all communal areas of the home. During 2009 the owner sent us the Annual Quality Assurance Assessment (AQAA). This is a service self-assessment document giving us information about the home, its management and information about the needs of people living there. The AQAA asks for evidence in relation to what the home does well and what they think they can improve upon. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 29 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 8 of 29 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. People living at Wellesley are supported and encouraged to be fully involved in the assessment process in order to meet their needs. Evidence: The home is full with 10 people living there. There have been no changes to the mix of people living at the home since the last key inspection. Therefore National Minimum Standards have not been re-assessed in relation to admission processes followed at the home. The home has a Statement of Purpose and this was available in the entrance foyer at the home. On the day of the unannounced inspection routine placement reviews were taking place with the funding authority. We were able to discuss with the visiting professional from the North Devon learning disability team how well the service communicates changing needs of the people who live at the home with them. We were informed that the manager is open, appropriate and active in reporting issues to social services. All Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: people currently living at the home are placed and care managed by the local authority. Care Homes for Adults (18-65 years) Page 10 of 29 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. The homes very detailed and up to date holistic care planning ensures that peoples needs are met. People are consulted about their daily routines and the home adapts around peoples personal schedules. Risk taking is assessed but needs to be further developed to demonstrate robustness. Evidence: We case tracked two people. This included reading their care plans and discussing with them their support needs. We also spoke to staff about peoples current needs. We looked at two care plans in close detail and another in parts. We saw that peoples plans of care were holistic and person centred. By this, we mean that there was a plan of care in place that reflected current and potentially changing needs and the plan gave the reader the detail of how a person viewed their needs to how best staff could assist them in meeting these needs and promote their well being. It was clear that people are involved in their care planning and review. In reading records we saw that the home puts in place plans to keep people safe and Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: also promotes independence. For example, people were encouraged to access the community independently, use public transport and seek employment opportunities. These activities were risk assessed, in partnership with appropriate external sources. We also saw that one person is encouraged to take responsibility for some limited selfmedication. A written risk assessment had been completed but lacked discussion of what risks may present the individual and how such risks will be controlled practically. The risk assessment for this activity should therefore be reviewed and all presenting risks be identified and explored. We observed staff presenting choices to people in a natural and adult manner and we viewed records of when the home has made choices on behalf of people. This included decision making in relation to financial matters in managing personal allowances. The homes owner acts as appointee to people in the home. We inspected financial records of the people we case tracked and record keeping of personal spending was robustly recorded. There was no assessment recorded under the Mental Capacity Act for when people may have lacked the capacity for decision making in relation to making important decisions about their finances; specifically in contributing to pooled funds in the home or deciding to spend money for a holiday. An assessment is required. There are both formal and informal processes at the home for seeking peoples views in the running and conduct of the home. There is an in-house newsletter, house meetings and regular quality assurance questionnaire; results of which are collated and ideas to adapt the service are taken forward. Records in the home were stored confidentially with people also having their own care plans in their rooms if they chose to do so. Care Homes for Adults (18-65 years) Page 12 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wellesley lead meaningful lives in ways that enable them to maintain family and personal relationships and develop new skills. There are few restrictions at Wellesley. Meals are varied and take into account individual preferences and choices. Evidence: The homes AQAA informed us, We have a comprehensive timetable of activities throughout the week which are held both within the home and at various places within the community. In reading care plans and talking to people at the home it was evident that people experience a full timetable that suits their personal interests and social contact needs. People told us they had friendships within the home and had developed friendships outside of the home. On the day of the unannounced inspection people had opportunities for staff to provide 1:1 escorts for shopping trips and some people took part in an afternoon group skittling activity in the town. People told us they are able to attend church at the weekend if they want to go. We saw how Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: educational and work programmes are supported to enrich peoples sense of selfesteem, pride and sense of contribution toward society and people who are materially worse off than them. People told us they either walked into Barnstaple, or used local shops, took public transport or had a lift in the homes transport. We saw in peoples records that weekly schedules reflected both evening and weekend pursuits, as well as activities scheduled during weekdays. We met one relative visiting the home on the day of the unannounced inspection. They spoke positively about their perception of the experiences of their relative at the home and summed this up in telling us that if we were to look at other care homes, Im sure you wont find a better one. During the inspection people had free access in the home and around the grounds. The home has a missing persons policy and protocol to follow should someones whereabouts be unaccounted for. Some people hold keys to lock their bedroom doors, others told us that they choose not to. We saw that domestic tasks such as hoovering, personal laundry and washing and drying of crockery was rationalised and agreed in individual plans of care. Care Homes for Adults (18-65 years) Page 14 of 29 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 receive healthcare support that is individualised and anticipates future as well as current needs. The home works in partnership with other professionals to ensure that peoples healthcare needs are met. Because medicines records are not checked by another staff member, mistakes could occur when administering medicines. Evidence: During the inspection we observed people interacting with staff and we asked people if staff listened to them and acted on what they said. People said that the staff treated them well and work with them at their pace. There is a mix of male and female staff, so that peoples gender preference for carers to support them can be matched. The daily routines are tailored to peoples schedules and we saw that people were appropriately clothed for the weather conditions. Because people are independently mobile there is no current need for permanent aids and adaptations to assist peoples mobility within the home environment. All people living at the home are registered with the surgery adjacent to Wellesley. We were advised that specialist GP support is available at this surgery. We saw that a clinical change in one persons condition was being monitored and steps were in place Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: to provide long-term support for the persons changing needs. This was confirmed by a visiting health and social care professional. We looked at how medication was stored and managed. The homes AQAA, from February 2009, stated. Wellesley follows the guidelines as per the Royal Pharmaceutical Society of great Britain [RPS], the requirements of the Medicines Act 1968 and the Misuse of Drugs Act 1971. We were advised by the owner that a dispensing pharmacist inspection had taken place approximately two months previously and some advice was given to the home regarding Medicine Administration Records (MAR) completion. We found that the pharmacists advice had not been followed and that the home was not meeting guidelines issued by the RPS in that on the current MAR there were 7 instances of hand transcribed entries, none of which were signed by the staff member making the entry. This means that there was no record of who had entered the prescription on behalf of the GP, and in addition, as no staff countersignature was present on the MAR it means that a risk of hand transcribing error was present. We saw that the medicines were stored appropriately and that the current MAR showed no gaps in administration of regularly prescribed medicines. We were informed that staff receive medicine administration training via the dispensing pharmacy. Care Homes for Adults (18-65 years) Page 16 of 29 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. People at the home are safe and able to voice their concerns knowing that these will dealt with in an appropriate way. Evidence: We were advised by the owner that the home has not received any complaints since the last inspection. We have not received any complaints directly about this service during this time. The complaints policy was clearly displayed in a public area of the home and a visiting relative said they had no current or past complaints with the service. They also said that if they had an issue they would feel confident in raising issues with the home and that action would be taken to rectify things. People told us that they can talk to staff or the management about problems or concerns. Staff training on safeguarding and abuse detection took place in December 2009. Duty staff confirmed this. The home has a copy of the Devon alerters guidance in reporting suspicions of or abuse to the local authority. Staff were not consistently sure of the process for Whistle Blowing, although staff were aware that outside agencies could be contacted if they had concerns about peoples safety. We fed this information back to the owner, who said that Whistle Blowing would be an agenda item for the next staff meeting. This deomstrates good practice as it will ensure that staff understand the term Whistle Blowing in relation to safeguarding processes. We observed staff interactions with people living in the home. People reacted Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: positively toward staff contact and the home has a relaxed atmosphere, indicating that people feel secure there. We were told by one person we case tracked that staff treat them as an equal. Care Homes for Adults (18-65 years) Page 18 of 29 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. Wellesley is clean, comfortable and well-maintained. In addition it provides people with a good location from which to access the local community independently. Evidence: We checked with the owner that the information provided in the AQAA about the home environment remained correct and this was confirmed as so. The AQAA states, Built in the early 1900s Wellesley is a very attractive bay fronted detached Victorian residence standing in half an acre of walled garden which include lawns and boarders, a productive orchard and vegetable garden. There is ample car parking and a large garage (8.3m x 5.3m) with an additional rear workshop, laundry and loft storage. Wellesley is on a level location within easy reach of shops in Newport. There is a bus stop directly outside with a very good regular service. The main town of Barnstaple is a one mile walk away, there is a doctors surgery next door and we are a short walk from a popular garden centre and a Tescos supermarket. There is a large playing field opposite suitable for ball games. Attached with interconnecting doors on all levels is the Managers Accommodation. This large purpose built extension was built in 2002 and is where [the proprietor and his family] currently live. Wellesley Living Accommodation. Ground Floor. There is a attractive Porch area with the main entrance door that leads to a Reception Area this leads to a main lounge, Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: office and Reception Hall with coat storage and stairs leading to the first floor. The Main Lounge (5.5m x 4.5m) has two large windows one of which is a bay window, there is a coal effect gas fire, a large colour television with a video, ample seating, bookcases with a variety of topics and reading ability and a selection of videos (some of which are owned by the Residents). The Office is also situated on the ground floor of the reception area. Leading from the Reception Hall is a Inner Hall with doors to Dinning Room, Kitchen, Store Room, Toilet and Rear Hall. The Dinning Room (8m x 3.5m) has a solid beech wood original parquet floor, there is a solid fuel brick fire place and a small carpeted lounge area. The dinning room is usually set for a sitting of 12 but additional numbers can easily be entertained. The Kitchen (5.2m x 3m) is fully fitted and has a gas fired AGA. We have Two Store Rooms with enough food for one months supply for all residents and staff. Also on the ground floor are Two Toilets. Bedroom Number 1 (3.5m x 4m) is situated on the ground floor of the inner hall. This is a single room with an en-suite toilet and shower. First Floor. The stairwell leads to a first floor landing which lead to bedrooms, bathroom and a toilet. Bedroom Number 2 (5m x 4.7m) is a spacious double room with fully fitted modern furniture designed to give those sharing as much privacy as possible. There is a large South facing bay window. 4 power points. Television point. Sink with light and shaving point. Bedroom Number 3 (5.5m x 3.35m) is spacious single room fully furnished with 2 large windows, one facing to the south and a bay window facing East. Sink with light and shaving. Television point. 6 power points Bedroom Number 4 (4.75m x 3.35m) is large single room with fully fitted modern furniture. There is a large East facing window. Sink with light and shaving point. Television point. 6 power points. Bedroom Number 5 (4.88m x 3.05m) is spacious single room with an East facing window. Sink with light and shaving point. Televisions point. 4 power points. Bedroom number 6 (3.45m x 3.05m) is a single room with a North facing window. Built-in cupboard with a sink with a light and shaving point. Television point. 3 power Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: points. Bedroom numbers 7 to 6 currently share a large Bathroom with a bathroom suite and separate shower cubicle with a electric shower. These bedrooms also have the use of a 2nd separate Toilet with sink. Second Floor.The stairwell leads to a second floor landing from which are bedrooms, bathroom, toilet, kitchenette and lounge. One the second floor we have a elegant Second Lounge with a television, sofa and chairs. Adjacent to this is a Kitchenette with fitted kitchen furniture and a small breakfast table. Bedroom Number 7 is a unused single room with on-suite shower and toilet. 3 Double plug sockets and a south facing window. Room number 8 is a deluxe single 12 sqare plus room with on-suite shower and bath and toilet. This room also has its own dedicated lounge area with comfortable furnishings. Room number 9 (4.m x 3m) is a single room. Sink with light and shaving point. 5 power points. This room has en-suite shower, toilet and hand basin.. Room number 10 Is a single room with en suit facility for staff sleep over duties. This room is not registered for use by Residents. Some people showed us their rooms, which were comfortable and personalised. The home was clean with people who live there participating in domestic duties. Care Homes for Adults (18-65 years) Page 21 of 29 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. There is a stable staff team at Wellesley providing consistency of support for the people who live there. There is a training and development culture at the home that is constantly being reviewed and ensures that people are cared for by staff with the right knowledge and experience. Evidence: Daily staffing levels, confirmed by duty staff, are of a minimum of two care staff during the day and two sleeping-in staff. Additional care and managerial support is regularly deployed. People told us that staff were flexible to support them and that there were always staff around if they needed someone. We saw in some staff files that job descriptions were in place for staffing duties. We spoke to staff about peoples current needs and how changing needs are communicated in the home. Staff had good awareness of how to support people and staff told us that communication about peoples changing needs was good at Wellesley. Most staff employed at the home (80 ) have achieved a care qualification of at least the level 2 in NVQ. We saw in staff records that all staff now complete the Common Induction Standards following recruitment. There is a staff training plan and staff Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: confirmed the most recent training as Challenging Behaviour, in December 2009. We established that the three recommendations made at the last key inspection in 2007 regarding staff training have been acted upon. We were informed by the owner that no new staff have been employed at Wellesley since the last inspection, therefore staff recruitment records were not inspected. We asked duty staff how they receive feedback and support in the home. Staff told us they had received one-to-one supervision, as well as attending staff meetings and feeling able to approach the owner to discuss issues. Care Homes for Adults (18-65 years) Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wellesley is a service that is well run by a competent manager, who also owns the home. Quality assurance systems ensure that peoples views are heard and respected at the home. Not all policies reflect current changes in legislation and therefore should be revised and updated. Evidence: At the last key inspection the registered managers portfolio was verified that he has attained the Registered Managers Award and holds NVQ level 4 in Care and Management. The homes AQAA also informed us that he has achieved the NVQ D32 and D34 assessors training qualifications. Since the last inspection the home has devised an annual development plan to provide a strategic overview of quality assurance methods and processes. The home conducts twice yearly satisfaction surveys with people living at the home, stakeholders and families. These results are published and are available for inspection in the home. People told us their views are sought and that the manager is approachable and acts to change things if something is not right for them. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: We inspected some of the homes written polices. There is a comprehensive document file of home policies. We saw that the home has developed a detailed policy on restrictions of liberty. However, the current policy does not reflect introduction of legislation under the Mental Capacity Act and the associated Deprivation of Liberty Safeguards. We also saw that the current policy in the home for adult protection was not robust in asserting the homes responsibility to provide safeguarding training to staff so that they have the knowledge to recognise signs of abuse, nor did the policy assert staff accountability to report suspicions of abuse. We recommend, therefore, that the homes policy on restriction of liberty and the policy on adult protection be reviewed and revised. AQAA information provided told us that equipment in the home had been regularly serviced. We spoke with people who live at the home about fire drills and they told us that they knew that they should leave the building if the fire alarm sounded. We saw in care plans that some people are at risk of choking when eating. We saw that risk assessments with control measures had been written to minimise the risk. We spoke with duty staff who confirmed that they had undertaken first aid training and that this training included responding to choking incidents. The AQAA told us that there had been no events reportable under Regulation 37 since the last inspection, for example, no accidents requiring hospital admission, no deaths, no safeguarding referrals and no complaints received at the home. We looked at accident records and saw that there had been few accidents and these had been minor in severity. One staff member expecting a baby confirmed that the owner had discussed with them and completed a risk assessment for their pregnancy progression whilst working at the home. This had included possible management of challenging behaviours in the home. We discussed with the owner the financial viability of the service and insurance cover at the home. A current certificate of employers liability insurance was displayed in the home. The home continues to enjoy full occupancy and a stable staffing level. There are clear lines of managerial accountability at the service. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 An assessment must be 17/03/2010 completed of peoples ability to make decisions in relation to making important choices with a financial cost to them. This is required under the Mental Capacity Act. 2 20 13 Hand transcribed entries on a medication administration record must be signed and counter witnessed. This is prevent hand transcribing errors. 08/02/2010 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 9 Risk assessments for people who self-medicate should consider all risks posed and list control measures to minimise identified risks. The homes policy on deprivation of liberty should be Page 27 of 29 2 40 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations reviewed and revised. 3 40 The homes policy on adult protection should be reviewed and revised. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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