Care Home: Wendover Road (87)

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What the care home does well The home provides a comfortable, pleasant and safe environment for users. Standards of housekeeping are good and good standards of hygiene are maintained. Service users are supported in being involved in day to day activities in the home. The home supports service users in accessing a range of activities in the community. Comprehensive support plans are in place for each user. The home is sensitive to the diverse needs of users and endeavours to adjust its service to meet those needs. Staff have access to a good staff training programme. The home maintains good liaison with health and social care services in the community. What has improved since the last inspection? A number of areas within the home have been redecorated and refurbished and the overall standard of the accommodation has improved. The work included installing a new shower, new tiling in a bathroom, a limited refurbishment of the kitchen, and redecoration of users bedrooms. Users are reported to be more involved in the day to day running of the home including gardening, shopping and loking after their own rooms. Users have been involved in the redecoration which has taken place over the past year. Work in the garden has made it a more attractive area for users, staff and visitors. The home has been awarded a four star rating by the local environmental health department. Staffing has stabilised and there is now less reliance on agency staff. What the care home could do better: A regular programme of proprietor`s visits should be re-established by senior managers. The home should continue to seek opportunities for new activities for users. Efforts should include consulting stakeholders of the service. The home must obtain a copy of the current Buckinghamshire joint agency guidance on safeguarding vulnerable adults and associated materials. These should be stored in a place which is accessible to staff and staff should be informed of its contents. The registered persons should build on work already started aimed at establishing a `person centred` approach to support plans in a format which is considered to be accessible to users of the service. It is recommended that the registered persons seek the advice of a pharmacist on the advisability of transferring medication from one container to another. This should include ascertaining whether such action amounts to secondary dispensing. Key inspection report Care homes for adults (18-65 years) Name: Address: Wendover Road (87) Stoke Mandeville Aylesbury Bucks HP22 5TD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 1 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: Wendover Road (87) Stoke Mandeville Aylesbury Bucks HP22 5TD 01296615403 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 87wendrd@nildram.co.uk Hightown Praetorian & Churches Housing Association The registered provider is responsible for running the service care home 4 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: That the home may care for two service users with a Learning Disability- who also have a Physical Disability. That this condition applies to two specific service users- and should the service users in question leave the home for whatever reason this condition will cease to apply. That no further users with a physical disability are admitted to the home unless the home applies for a further variation to their registration. Date of last inspection Brief description of the care home 87 Wendover Road cares for 4 female service users with a learning disability. The home is located in a residential area about one mile from the centre of Stoke Mandeville. The home is a bungalow situated in relatively secluded grounds, with a large rear garden. All of the bedrooms are single and there is a kitchen / diner and a separate sitting room. The home has its own transport and is accessible to local Care Homes for Adults (18-65 years) Page 4 of 31 2 7 0 8 2 0 0 8 4 2 Over 65 0 0 Brief description of the care home amenities. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out by one inspector in August 2009. The inspection included an unannounced but brief visit to the home on Friday 14 August 2009. The visit took place between 09:30 am and 10:00 am. During the course of that brief visit we met three of the four users living in the home (the fourth was on a visit to her GP) and the two staff on duty (a third staff member was accompanying the fourth user to her GP appointment). We briefly looked around the home and garden. All was in very good order. Since staff and users were preparing to go out for the day we adjourned the inspection at 10:00 and resumed it a few days later, on Tuesday 18 August at 09:30 am. That visit lasted most of the day. The registered manager (the manager) sent us the services annual quality assurance assessment (AQAA) prior to the inspection. The AQAA was clear, detailed and comprehensive and gave us the information we asked for. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection included consideration of the information in the AQAA. It also included discussion with the manager and staff. We watched activity in the home - especially how staff supported and interacted with users. We inspected records including support plans, staff records and other records relating to the care of the users living in the home. We looked at things people told us about the home in a survey. We looked around the house and garden.We looked at the arrangements for giving out medicines. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: A regular programme of proprietors visits should be re-established by senior managers. The home should continue to seek opportunities for new activities for users. Efforts should include consulting stakeholders of the service. The home must obtain a copy of the current Buckinghamshire joint agency guidance on safeguarding vulnerable adults and associated materials. These should be stored in a place which is accessible to staff and staff should be informed of its contents. The registered persons should build on work already started aimed at establishing a person centred approach to support plans in a format which is considered to be Care Homes for Adults (18-65 years) Page 8 of 31 accessible to users of the service. It is recommended that the registered persons seek the advice of a pharmacist on the advisability of transferring medication from one container to another. This should include ascertaining whether such action amounts to secondary dispensing. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of this service can be assured that the home will carry out a good assessment of their needs and carefully consider whether it is able to meet those needs before offering a place in the home. The prospective user will be involved in the process, will have an opportunity to visit the home, and have a suitable period of time to try out the service before accepting a permanent place. Evidence: The home has not had a new admission since the last inspection was carried out in August 2008. The most recent admission was in 2001. The home has arrangements in place for assessing, and considering whether it can meet, the needs of a person who may be considering living there. It is essentially a three stage process. Firstly, an exchange of information - about the home and about the person who is considering living there. Secondly, an assessment Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: by the person and their representative on whether the home seems suitable, and by the home on whether it can meet the persons needs. Thirdly, the offer of a place and acceptance by the person - initially on a trial basis. The information given to the person includes the homes statement of purpose and service users guide. The assessment by the home includes consideration of information provided by the referring care manager, other relevant information (such as that provided by NHS services), and completion of the homes own assessment process. Should both parties decide to proceed to admission then a trial admission is arranged. This allows the user to see if the home can meet their needs and if they feel happy living there. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive plan of support is in place for each user of this service. These support the organisation and delivery of an effective package of care for each user. The home is looking into ways of making support plans and associated material (such as notes of meetings) more accessible to users. Evidence: A support plan was in place for each user of the service. The home was developing a more person centred approach to support plans and it was expected that the format would change significantly over the next year or so. Further development would take account of experience with Person Centred Planning (PCP) in similar services elsewhere in the organisation. The support plans for all four users were examined on this inspection. Plans were a combination of text, easy read and picture format. Plans included a photograph of the user, basic essential information, a diversity statement, communication likes and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: dislikes, key information on the users current activities under the heading My Life Now, a list of things which the user likes and dislikes, what the person would consider a good day, evening and weekend to be, matters that are important to the person, goals, and an action plan for the year ahead. Some plans included a communication dictionary consisting of detailed descriptions of a range of behaviours - verbal and non-verbal - related to a range of needs (including bored, tired, sad/upset, frightened, thirsty, interested, not interested (among others). The plans set out the care needs and particular support requirements for each user. Plans are reviewed monthly within the home and annually with care managers. The frequency of review is increased where necessary - evidence of this was noted during the course of this inspection. We thought that the quality of care plans had improved since the last inspection in 2008. Staff support users to participate in day to day activities such as trips out, menu planning and shopping. Users are also involved in the recruitment of new staff which includes a session between the users and the candidates. The responses of users are taken account of by the interview panel. Support plans were noted to include risk assessments covering a range of matters. These included moving and handling, challenging behaviours, impulsive behaviours (such as running in to the road while out of the home), support needed at mealtimes (to avoid choking), falls (in particular where reduced bone density could increase the risk of fracture in the event of a fall), and drowning (while swimming). Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service are supported in participating in a range of social and leisure activities. The home aims to ensure that the activities are focussed on meeting the needs of users and take account of issues of diversity. Evidence: The home supports users to participate in meaningful activity each day. This inspection included two visits to the home - one brief and unannounced, the second extended and short notice. On both days staff and users were involved in activities together, both within the home and in the wider community. Recent trips out had included visits to Wendover Woods, Kew Gardens, to a farm near Milton Keynes and to a model village in Beaconsfield. Users and staff regularly go Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: shopping together in Aylesbury. They also have lunch out on occasions in local pubs and cafes. Some users regularly go to a local club (the Connect club), to events regularly run by the Turnstone organisation in Aylesbury, ten pin bowling, or to at a specialist centre in Winslow. One user regularly goes to an Asian Ladies Group. One regularly goes swimming at the Guttmann Centre at Stoke Mandeville Hospital. Users are supported in routine daily activities such as keeping their room clean and tidy, personal shopping and doing their laundry. The manager believes that the garden offers many opportunities for users to develop a range of skills. Staff and users are now responsible for the garden. Together, the activities above, are designed to ensure that each user is supported in participating in activities which are meaningful, which reflect their individual interests and maintain or develop a set of skills. The activities also support users to maintain involvement with the local community. The preferred routine of each individual user is set out in their support plan and individual differences were noted when examining records and talking to the manager.Users privacy is respected. Bedrooms are locked when users are out of the house. Meals are planned with users as much as possible - using prompts such as picture menus, objects of reference or tasting sessions where required. Breakfast usually consists of cereals, fruit, juice, hot drinks and toast. Lunch may be taken as a picnic lunch, a snack in the home or as a light meal at a cafe or pub. Supper is eaten at around 5:00 - 5:30 pm and consists of a one course meal comprising main course and vegetables. Individual preferences or needs (such as the use of Halal meat) are taken account of. A dietician was closely involved in the diet of two of four residents. Each user is generally weighed monthly - using special weighing scales at the dieticians office. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service receive good support in meeting their healthcare needs. This includes staff support in using the services of a range of healthcare agencies where required. Evidence: Users wishes with regard to their care are recorded in individual care plans. These include the individuals wishes on their morning and evening routine, their likes and dislikes, details on particular aspects of personal care, and things that are of particular importance to them. All users are registered with a local GP practice in Bedgrove, Aylesbury. District nurses and audiologists have been accessed through the users GP. All are registered with the local Community Learning Disability Team (CLDT). A Psychiatrist, psychologists, dieticians, physiotherapists and CPNs are accessed through the CLDT. Occupational therapists have advised on the replacement of equipment in the bathroom. An optician will visit the home if required. Dentistry is provided through a dental clinic in Aylesbury. A chiropodist visits regularly to provide treatment to two users. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Support plans included evidence of liaison with a range of community health services as required. Staff provide support as needed. Medicines are prescribed by the users GP in Aylesbury and are dispensed by a pharmacy in St Albans. Medicines required between scheduled deliveries are supplied on receipt of a faxed copy of the prescription by the pharmacy - the original prescription is collected on delivery of the medicine. Records are retained of medicines received and returned to pharmacy in the home. Copies of prescriptions are held on file in the home. Medicines are stored in medicine cabinets in each users room. The temperature of the cabinet is recorded through use of a digital thermometer. Facilities are available for storing suplus medicines if necessary. At the time of this inspection no medicines required stotage in cool conditions. A medicines folder is in place for each user. This includes: copies of staff signatures, the medicines administration record (MAR sheet), record of expiry dates, an as required (PRN) protocol and copies of any correspondence with the GP. It was noted that one user had a stock of around 130 tablets of Paracetamol. This was said to be a consequence of the organisations policy that the administration of medicines for homely remedy use needed to be prescribed by the persons GP and supplied on an individual basis for each user. Staff practice is governed by the organisations policy on the administration of medicines. Staff training is provided by the organisation and staff competence is assessed by the registered manager. The supplying pharmacy has also done some training in the home. The pharmacy has carried out one audit of the homes practice since the last inspection and found the arrangement to be good. Information leaflets on medicines prescribed are filed in the office. Reference texts available to staff included a 2007 British National Formularly (BNF), and a copy of 2007 Royal Pharmaceutical Society of Great Britain Guidelines for Medicines in Social Care. The home should consider obtaining a general textbook on medicines for staff reference and downloading a copy of our guidance on medicines (obtainable from our Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: website). Examination of the homes arrangements found good standards of practice with the exception of one medicine which staff were transferring from a stock bottle to a dossette container on a weekly basis. This might be considered secondary dispensing and the home was advised to seek the advice of a pharmacist. In view of the homes very good arrangements for storage there seemed no reason why the bottle should not be stored in the users own cabinet in her room. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users interests and well-being are protected by the homes arrangements for safeguarding vulnerable adults, managing complaints, and liaising with a local advocacy service. These however, need to be informed by the current guidance published by the local authority. Evidence: The home is required to conform to the policies and procedures of Hightown Praetorian and Churches Housing Association in respect of complaints and protection. A copy of the complaints procedure was available. A pictorial version of the procedure was on file and in each users bedroom. The complaints procedure is included in the statement of purpose (SOP). The version in the SOP (under the heading Appendix 2) was detailed and formal - surprisingly so in such a service. Systems are in place for recording complaints and compliments. The home has not had any complaints since the last inspection. The home had received four compliments during that time. The home has had contact with a local independent advocacy organisation for many years. Evidence of a user being supported by an advocate was noted during examination of care records (in relation to NHS services on that occasion). The manager told us that a new advocate had been allocated to the home and that a meeting was scheduled for early September 2009. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The organisation has a policy on safeguarding adults (last reviewed in 2007) and its training department offers training at induction and update levels. Although the manager was aware of the document a copy of the current Buckinghamshire joint agency guidance on Safeguarding Adults could not be located at the time of the inspection visit. The manager undertook to obtain a copy from the relevant office after the inspection. There have been no safeguarding referrals from this service since the last inspection. The organisation requires staff to attend training on managing aggression and violence and Positive Approaches to Challenging Behaviour. Challenging behaviour was a evident in the home at the time of this inspection and staff appeared to be responding appropriately. The response included liaison with local health and social services. Systems are in place for dealing with money on behalf of users. An account is opened for each user and a cheque book account opened with a local bank. Small amounts of cash are held in secure circumstances for the personal needs of each user. The procedure in relation to one user was demonstrated and records coincided with the balance in the users container. Cash balances are checked twice a day. They are also checked by the manager and deputy manager and during the monthly proprietors visits. The organisation does not act in an appointee capacity for any user. This role is carried out by Buckinghamshire County Council. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a pleasant, comfortable, clean, well maintained and safe home. Evidence: The home is a detached bungalow situated in a residential area betwee Aylesbury and Stoke Mandeville. There are some parking spaces for cars to the front of the house and in nearby roads. The area is well served by buses from Aylesbury. The nearest rail stations are Stoke Mandeville and Aylesbury. The home has its own vehicle for staff and resident use. Entry is controlled by staff. All of the accommodation is on the ground floor and almost all areas are accessible to a person in a wheelchair. The accommodation is comprised of: entrance hall, staff office, staff sleep-in accommodation, four single bedrooms, bathroom, WC, laundry, open plan kitchen and dining room, living room and store rooms. There is a very pleasant garden to the rear and side of the house which is mainly accessed from the dining room. The garden includes a patio area, lawn, mature trees and shrubs, a summer house, swings and shed. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The quality of the accommodation was much improved since the last inspection in 2008. An area of dampness had been repaired. Much of the interior had been redecorated and presented a much brighter appearance. The kitchen had been refurbished. The living room and bathroom were scheduled for redecoration. Plans are in place for further improvements. The bathroom included a shower, WC with handrails, changing trolley, and assisted bath. The refurbishment of the bathroom will include replacement of the present bath and changing trolley in accordance with the advice of occupational therapists. It will also include repainting and the installation of a new heating system. The kitchen diner includes a large dining table, sufficient dining chairs for current use, a freezer and a fridge freezer, and electric cooker. The kitchen had been refurbished since the last inspection. The manager told us that they were waiting for the lighting to be completed. The home had been awarded four stars following a recent inspection by the local environmental health department. The bedrooms seen during the inspection visit were all pleasant. Each had been personalised in line with the users wishes. All areas of the home were very clean and tidy. The plans to build a Snoezelen cabin in the garden referred to in the report of the last inspection were still active. The manager told us, however, that these did not now include plans to make the facility available to other homes. In the meantime, the lounge (and one of the bedrooms) has some equipment for sensory stimulation or relaxation. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users are supported by staff who have undergone a good process of recruitment, have the personal qualities and skills for the job, are well supervised, and have access to an ongoing programme of training and development. Evidence: There are three staff on duty in the morning, three in the afternoon and evening, and one waking staff and one sleep-in at night. These numbers are considered sufficient to meet the current needs of users. Stafff qualities and skills are assessed on recruitment and are developed through the organisations programme of staff training, supervisison and development. The staffing of the home had improved since the last inspection. New staff had been recruited, staff retention had improved, and the home was making less use of agency staff. The registered manager expected to cease using agency staff soon after this inspection. The home is supported in the recruitment of new staff by the organisations Human Resources (HR) department located at its head office in Hemel Hempstead. Three staff had been recruited since the last inspection. Two of these had transferred from other Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: care homes run by Hightown Praetorian and Churches Housing Association. One file was examined. Recruitment information - application form, medical, CRB and references - were in order. However, one aspect of proof of identity, a recent photograph, was not on file. The manager undertook to correct this. Newly appointed staff are required to follow the organisations induction programme. This includes induction to the home, completing an induction handbook, attending basic training sessions, and attending a group induction day at head office. All staff are required to maintain an individual training folder. This includes a record of training required and training attended and copies of certificates of attendance. Staff have access to a comprehensive programme of training. This includes Manual Handling, First Aid, Food Hygiene, Fire Safety, Safeguarding Adults (Abuse), Responding to Aggression and Violence, Positive Approaches to Challenging Behaviour, and the Administration of Medicines. Training may be held at the organisations head office, in the home (such as training on medicines run by the pharmacy), involve ELearning (computer based learning), or be run by external bodies such as the local authority (e.g. on Learning Disability and Dementia). The majority of staff had acquired qualifications at NVQ level 2 or above. Personal supervision is well established in the organisation and in the home. Dates of forthcoming sessions were on the staff noticeboard. The manager said that she aims to ensure that supervision sessions are held on a four to six weekly basis. Sessions are planned and records are maintained. All staff are appraised in September. The outcome of the appraisal may affect bonuses which are paid in December each year. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a home which is generally well managed and which aims to maintain a supportive environment focussed on the needs of users. Evidence: The registered manager has managed the home since December 2007. The registered has a qualification in management at NVQ level 4. Since the last inspection a senior support worker has been appointed to the home. As a result of changes in the larger organisation a new service manager and new area manager are in post. The organisations current strategic development plan runs to 2011. The home is required to draw up its own development plan in the context of this. The managers objectives for the home to the end of the current financial year(to end of March 2010) were summarised in a table. A traffic light system tracks progress throughout the year. The organisation does not carry out a stakeholder survey. We carried out a survey for this inspection and received completed forms from staff, health or social care Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: professionals and a relative. A relative wrote The service provides a homely atmosphere with many homely comforts. Individual needs are catered for. A health or social care professional, with regard to a question on what the home does well, answered Seeks advice and support from support services e.g. community team and Stronger management of the service. Another professional, to the same question, answered treats each lady as an individual and works hard to meet their individual needs. In answer to a question on what the home could do better, the respondent wrote Be supported to have a wider range of activities for service users. Staff responses on what the home does well included: Support the residents and staff working together which is so important. Keep up a good standard of work and use our skills to help the residents. I think the staff cope well with all things that the residents need......We often get hit by residents but it is always dealt with calmly. Supervision - Training - Quality care. We meet the demands of the service users in the home. Regular informative team meetings. Involvement with service users in small tasks e.g. gardening, laundry. A number of staff responses included reference to the challenging behaviour which confronts them on occasions. This was also referred to by a relative respondent. The manager explained the background to this and the efforts the home was making to resolve the situation - in particular, in the best interests of the individual user. In terms of what the home could do better, responses included: More key structured activities (management are working towards this), improve communication and team work, We need to get a few more activities in place, More holidays for all the residents, and, ...include service users in things e.g. projects, screening.... (we feel the point being made here was a feeling that users might currently be disadvantaged because they are unable to express consent directly and may therefore be prevented in taking part in a wider range of activities). The standard of proprietors visits in this organisation is usually very good - both in terms of frequency and consistency and in the standard of records which are maintained. On this inspection, however, it is thought that changes in management may have led to a failure to maintain such visits over the quarter year preceeding this inspection. The manager told us that this is being addressed and that monthly visits will resume from August 2009. Systems for maintaining a safe environment appear satisfactory.The registered manager told us that the homes electrical wiring was last checked in May 2007, emergency lighting was checked in October 2008, fire fighting equipment was checked in June 2009, portable electrical equipment was checked in September 2008, and the Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: gas boiler was checked in October 2008. The home was awarded four stars for food hygiene in November 2008. The assisted bath was scheduled for replacement. Procedures are in place for recording accidents to users and staff. Support plans included evidence of actions by staff in response to such events where required e.g. referral to the falls clinic, use of hip protectors and changes to a users programme of activity. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 22 13 The registered persons must 30/09/2009 obtain a copy of the Buckinghamshire joint agency guidance on safeguarding vulnerable adults and associated documents. This must be stored in a place which is accessible to staff. To ensure conformance to procedures aimed at protecting vulnerable adults Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 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). 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