Care Home: Whitegates (The Cottage)

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What the care home does well Some comments from the surveys, completed by the people who live at the home included, `They look after me well`, `the staff are good, they help me every day`, `they get us out and about, support and help us well`, `I like it here`, `we have a good manager`, and `I like living at Whitegates, I like my own bedroom and my new bed.` All of the nine staff members, who completed surveys, made complimentary remarks about what the home does well including, `I have always found Whitegates a very happy place to work, and that the people who live here are very happy. Many visitors comment on how homely it is here, which is basically what we strive for`, `we work in a person-centred way and put the people who use the services` needs first at all times`, and `the people who live at Whitegates and the Cottage choose how they live their lives`. Person centred plans and support plans are completed with the people who live at the home and other people involved in their lives, to ensure effective support, and the wishes, aspirations and needs of individuals are identified, recorded and monitored regularly. All information is available in formats, which are accessible to the people living at the home to ensure their involvement. Transport is provided to enable the people who live at the home to access the community and they are supported to take holidays of their choice and visit places of interest both locally and further afield. The people who live at the home are supported and encouraged to be independent, and to be involved in all aspects of the running of the home, they are consulted with and listened to and their wishes and aspirations are taken into consideration in the development of the service, which is run in their best interests. The service benefits from retaining a well-qualified, experienced and enthusiatic manager, who welcomes any changes, which benefit the people who live at the home, and strives to continue to provide them with an excellent service. What has improved since the last inspection? Audio tools had been introduced to ensure information was more accesssible to the people who use the service. Some of the people who live at the homes had completed recruitment training and awareness, to enable them to be involved in the recruitment of new staff and to ensure they would be supported by people they liked. The aspirational goals of the people who live at the home had been identified and recorded in picture formats, and risk assessments had also been recorded in picture formats to make them more accessible to the people living at the home. The garden of the Cottage had been made fully accessible by people who use wheelchairs, and redesigned for the enjoyment of the people living at the home. What the care home could do better: Eight of the nine staff, who completed surveys could think of nothing the home could do better, but one staff member thought that the house meetings could be more structured and that it would be helpful if the night staff did some deep cleaning. The manager identified areas for improvement in the AQAA, and full and detailed development plans had been compiled to show how these improvements would be achieved. Key inspection report Care homes for adults (18-65 years) Name: Address: Whitegates (The Cottage) Elizabeth Fitzroy Support Farnham Road Liss Hampshire GU33 6JE     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: Christine Bowman     Date: 1 2 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 32 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 32 Information about the care home Name of care home: Address: Whitegates (The Cottage) Elizabeth Fitzroy Support Farnham Road Liss Hampshire GU33 6JE 01730894350 01730895607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.efitzroy.org.uk Elizabeth FitzRoy Support care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 14 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 category: Learning disability - LD Date of last inspection Brief description of the care home Whitegates (The Cottage) provides a service for fourteen adults with a learning disability, some of whom may have associated physical disabilities, in two separate establishments that are managed by one registered manager, Mandy Lashbrook. Whitegates provides support for eight adults and The Cottage for six adults, each with their own separate support team. The home is situated in a rural part of Hampshire, on the outskirts of the village of Liss. Transport facilities are provided for service users to access local facilities and larger towns in the area. Developed and managed by Elizabeth FitzRoy Support, Whitegates and The Cottage are well established in the local community. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 14 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: This was an unannounced key inspection. Before we visited the home, we looked at the last key inspection report completed after the site visit on 13th March 2007, the Annual Service Review, and other information gathered about the service since that time. The manager sent us the Annual Quality Assurance Assessment (AQAA), when we asked for it. This document gives us up to date factual evidence about the running of the home, informs us of what they think they are doing well, how they have improved the service over the previous twelve months, and of their plans for further improvements. Four people, who live at the home, and nine staff members, completed surveys giving us their views on the service provided at the home. The site visit was carried out over four hours and we met three of the thirteen people who currently live at the home, the manager, the deputy manager and four staff members. We looked at the service user guide, care plans, medication records, staff files, maintenance and other records. We looked at all the communal areas of the home and sampled the bedrooms of four of the people, who live there. Care Homes for Adults (18-65 years) Page 5 of 32 Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Eight of the nine staff, who completed surveys could think of nothing the home could do better, but one staff member thought that the house meetings could be more structured and that it would be helpful if the night staff did some deep cleaning. The Care Homes for Adults (18-65 years) Page 7 of 32 manager identified areas for improvement in the AQAA, and full and detailed development plans had been compiled to show how these improvements would be achieved. 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 8 of 32 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 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to use this service are provided with appropriate and accessible information to help them to decide if it might be the right place for them to live. The assessment process is designed to ensure that the home is able to meet the needs of the people who choose to live there. Evidence: The statement of purpose promised the adults with learning disabilities, who might consider living at the home, that they would be given practical support so that they can develop to the best of their individual ability, make choices and take part in everyday life. The vision and mission statements of the home expressed an intention to support peoples happiness, to help them to achieve their full potential, and take a valued place as respected members of society. Nine principles of belief supporting the equality and diversity, rights and choices of individuals living at the home set out how this was to be achieved. Colour photographs of the home were included and full details as required, including comments from the people currently living at the home including, I like going on holiday and choosing where I want to go, I like cooking and doing my own laundry, the staff help me when I need help, I like the parties and Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: music sessions we have, and the staff support me to visit my family, who live some distance away, and take me to events at Goodwood. Symbols, drawings, and clear and easy to understand explanations, were used in the service user guide to make it more accessible to the people who use the service, and the manager stated that an audio version was available for those who would prefer to listen. The four people, who live at the home, who completed surveys, recorded that they were asked if they wanted to move into this home and one wrote, I asked to move to Whitegates. They all confirmed that they had enough information about the home before they moved in to decide if it was the right place for them. The summary of needs assessments of people living at the home identified the support needed to live the life they want to live. Assessments identified the support required by individuals with respect to mobility, health, personal care, safety and social and developmental needs. The manager stated that the assessments are completed as much as possible with the individuals wishing to move to the home and the important people in their lives such as family, friends, community nurses and case managers. The process included visits to the home to meet the people currently living there and the staff team and to experience the environment. Visits at different times of day and overnight stays are arranged so that the person gets a complete picture of life at the home, the AQAA recorded, and a link worker is allocated to support them and to provide a link with relatives and professionals involved. After the assessment is completed a meeting known as a placement review is held to confirm or not confirm the placement. If there is agreement that the placement is suitable, all the information gathered in the assessment process becomes the basis of the individuals Person Centred Plan. The previous inspection report recorded that Elizabeth Fitzroy Support, who is the provider of this service, is planning to re-provision the people who use the service, and to develop Whitegates into smaller self-contained units. The people, who live at the home, had already been identified as being able to move into supported living and preliminary work had been done with them in discussing a move to other establishments to enable building works to be completed. This has been done at the pace and understanding of each individual so as not to overburden them with information or to raise unnecessary anxieties, in view of the delayed timescale. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The approach of the service in planning for the needs of the people they support means that the person can be confident that their needs will be responded to with detailed, accessible and meaningful plans that place them at the centre of the support they receive. Evidence: The care plans of two people, who live at the home, were sampled. The care plans were person centred and contained very clear and specific information covering all areas of daily life. The manager wrote in the AQAA, everyone has a comprehensive and detailed Person Centred Plan and Support Plan which identifies the support they need to live their life. One persons Essential Life Plan (ELF) sampled, included colour photographs, pictures and symbols and was easy to read. All the things that were important to them such as, photographs of my family, choosing when I get up, and having nice smelling toiletries were recorded. A clear picture of the individual was built up from their likes, dislikes, needs, preferences and aspirations, and clear Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: instructions were included for the staff to follow to ensure the person received support in their preferred way. These plans had been regularly reviewed on a monthly basis and updated to ensure that the information was relevant in supporting the individual. The nine staff members, who completed surveys, recorded that they are always given up to date information about the needs of the people they support. Communication strategies were in place to help the staff to understand the best way of involving the individual in decision making. Included in these plans was detailed information on how each individual communicates, which aids they prefer to use, and what different sounds/signs/speech means to promote understanding. All the people who live at the home had chosen their link workers, who act as their advocate within the service, and the AQAA recorded that, everyone has access to an independent advocate if they wish. Risk assessments were also recorded in a person-centred way and covered personal care, the activities of daily living, medication and accessing the community. The positive outcomes of taking the risks was recorded, actions to minimise the risks and clear instructions to the staff of action to take to ensure the people who use the service would be protected from harm. Care Homes for Adults (18-65 years) Page 13 of 32 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. The people living at the home are supported to engage in a range of activities that take account of their needs and preferences. They are supported to maintain personal relationships and be part of the local community. Their rights are recognised and they are offered a healthy diet which reflects their individual taste and dietary needs. Evidence: On the day of the site visit, snow and ice on the roads prevented the people who use the service from attending the day centre provided by the organisation. Everyone was at home and two of the staff from On Track (the day service) were providing some activities for the people to join in. Some of the people who live at the home spent some time in the sensory room, others were taking the opportunity to relax in their bedrooms, and some were involved in completing their chores. All the people who live at the home had their own activities schedules, confirming they Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: had the opportunity to engage in a variety of activities throughout the week including baking, bowling, craft, games and puzzles, seated exercises, art, local ramble, gymnastics, music, culture, create media recordings, mural skills, art, wild life, garden plants and Information Technology. One individual had a work experience placement at the coffee shop at the day service (On Track). The AQAA recorded that, Individuals who choose to attend On Track are supported to identify the sessions they want to do and taster sessions are also offered to ensure people have opportunities to try different experiences. The home provided transport to enable the people who use the service to access the community. Two people, who are wheelchair users, wanted to be able to go out together but the home had only one vehicle adapted for wheelchair users. The manager stated, this is in the process of being arranged for them by hiring a vehicle which can take two wheelchairs. The four people, who completed surveys people, confirmed that they always make decisions about what they do each day, and that they could do what they want to do during the day, in the evening and at the weekend. Peoples person centred plans identified the contact they would like to maintain with their families. Some maintained contact by telephone or letter and by remembering birthdays and other important anniversaries. The manager stated that relatives and friends were always welcome at the home. For those who live some distance away, arrangements were made for the people who live at the home to take their holiday close to their families to enable them to be involved. One persons Essential Life Plan showed that they had chosen a holiday in Cornwall last summer and there was a display of photographs on their bedroom wall confirming they had enjoyed it. Four people were planning to take a trip to Centre Parks together this year, and one person had recently visited Lapland, the manager stated. Some people chose to attend church weekly, access local clubs either weekly or monthly, and plan social events such as barbecues and seasonal celebrations such as Halloween. Trips to the seaside, the countryside and shopping were arranged at the weekends, and sometimes people like to take a walk to the village centre and enjoy the amenities there. People who enjoy going to the theatre, are on mailing lists, the manager stated, and visiting professionals included aromatherapists, music therapists and a PAT dog. Daily routines in the home promoted the independence of people who use the service. Some of the people, who lived at the home, prepared lunch for themselves on the day of the site visit, with support from the staff, and the manager stated that individuals Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: were given encouragement and support to achieve their potential. One person had been very keen to learn how to do their ironing and could complete this task safely, the manager stated. Staff observed supporting the people, who lived at the home, did so with respect. The AQAA recorded that, mealtimes are completely flexible to meet the needs of the each individual, not the service, and individuals are able to choose what they wish to eat, when they want to eat, and where they wish to eat. One the day of the site visit some individuals were observed preparing their own lunch and eating in the kitchen. Information with respect to dietary needs and preferences was available in each individuals support plan. One persons support plan recorded that special equipment had been provided to support them, and that a dietician had been consulted with respect to their diet. Individuals are supported to choose the foods they wish to eat by using pictures, the manager stated. The menu showed that the people who live at the home had lots of choices for their packed lunches, when out for the day, or they could choose from hot or cold snacks for lunch if staying at home. The main meal was provided in the evening and included each individuals choices with plenty of fresh vegetables and fruit included to ensure a healthy and balanced diet. Care Homes for Adults (18-65 years) Page 16 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from the staff according to their needs and preferences, their healthcare needs are met in individual ways, and safe procedures are in place to promote their access to medication. Evidence: Person-centred plans illustrated how the people, who live at the home, were involved in making decisions about their lives. Detailed communication charts informed the staff of how to interpret the actions, body language and responses of the people, who use the service, to understand their needs and wishes, and recorded what they should do to support them. Key workers were allocated to individuals to provide consistency and continuity of care. Individuals person centred plans sampled, recorded that they chose how they would like to have their hair, the time they like to get up and that they like to have their music playing when they get up. The AQAA recorded, all the people who live at the home have an OK Health Check completed annually. The last key inspection report completed, three year ago, confirmed this was very comprehensive and covered every aspect of an individuals Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: health, including their mental and physical health, as well as a dietary assessment. After this check is completed, the manager stated, an action plan is completed, which identifies specific health needs to be investigated, appointments that need to be arranged, and the person responsible for supporting the individual. The action plan is reviewed monthly as part of the Person Centred Plan and therefore ensures that no actions are forgotten or not completed. Records were kept of appointments with healthcare professionals such as General Practitioners, and all the people living at the home, whose records were sampled, had health action plans, showing how they were supported to live a healthy lifestyle. The manager stated that individuals could choose to be registered with the local GP practise or retain a GP of their choice, and the specialist support in the community was accessed through the GPs, as and when required. Professionals accessed by the people living at the home, whose records were sampled, included dentists, the epilepsy nurse, chiropodists, dieticians and opticians. The home had a clear medication policy and procedure, which had been signed by all the staff who administer medication and a list of the staff who had received medication training was kept with a list of their signatures. The AQQA recorded that all the staff have to undergo theory and practical assessments before they are permitted to administer medication, for the safety of the people who live at the home. Practical assessments are maintained six monthly and the theory training is maintained every three years, the manager stated. Two staff files sampled contained certificates in the Care and Control of Medication, and the staff training logs confirmed that up to date training had been undertaken. Photographs of the individuals with their MAR (Medication Administration Records) sheets ensured that the right person would be identified, and a description of the medication, informing the staff of any potential side effects, was available. Records confirmed that two people witness that people have received their medication. Records were kept of medication received and returned to the pharmacy to ensure all drugs were accounted for. A local pharmacy supplied the medication which was blister-packed for safety and convenience. A secure metal cabinet was available for the storage of controlled drugs, in the event of this being required and a controlled drugs register was also available for recording. The manager stated that medication was audited on a daily basis to ensure the people living at the home had received their prescribed medication. Care Homes for Adults (18-65 years) Page 18 of 32 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 are supported to raise issues if they have concerns about their care and the home responds positively, regarding them as opportunities for improvement. The home has safeguards in place to protect the people who live there from abuse, neglect and self-harm. Evidence: The homes complaints procedure was readily available in the statement of purpose, the service users guide and displayed on notice boards. Timescales were included for reporting the outcome, and any action to be taken as a result of the complaint, back to the complainant All the people, who lived at the home, were provided with an accessible complaints procedure, illustrated with colourful drawings, and written in large print. They were informed that they could bring things up at the regular residents meetings, or talk to someone they trust. The manager stated that, to ensure that the people we support maintain their awareness around using the complaints/compliments procedures, this is kept as an item on their house meeting agenda. The AQAA recorded, Whitegates/Cottage are proactive in identifying, listening and discussing concerns with individuals, with the view of acting on them before formal complaints are made. Records are kept and monitored to ensure trends are identified and people supported appropriately. All the people, who live at the home, confirmed in the surveys they completed, that they knew who to speak to if they were not happy, and that they knew how to make a complaint. The AQAA Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: recorded that no complaints had been received over the last twelve months A copy of the local authority safeguarding adults policy and procedures and No Secrets guidance were available at the home, and local policies, based on them, informed the staff of action to take, with respect to protecting the people who lived at the home from abuse. The manager stated that safeguarding training is included in the induction of new staff, and that all staff sign to confirm they have read and understood these policies for the protection of the people living at the home. The staff training logs sampled, recorded that safeguarding adults training had been updated regularly, to keep them informed. Over the previous twelve months, three safeguarding referrals had been made, but no safeguarding investigations carried out as a result. All the residents had their own bank accounts, as well as a cash account, held at the home. Cash was stored appropriately in a locked facility, transactions were recorded and receipts retained. Balances checked were consistent with those recorded. Care Homes for Adults (18-65 years) Page 20 of 32 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. The people, who live at this home, benefit from a well-maintained, comfortable and homely environment, which meets their needs and is clean and hygienic. Evidence: Whitegates and the Cottage are situated in their own grounds and located on the outskirts of the village of Liss. Whitegates is an imposing three-storey building, which has been a residential care home since the 1960s. Due to its elevated situation, the people who live at the home can enjoy views of the surrounding countryside. The Cottage, which is a bungalow, is adjacent to Whitegates. There is a car park to the front of the home for the homes vehicles, staff and visitors cars, and the village centre, with public amenities such as shops, public houses, restaurants and a train station, is within walking distance of the home. Whitegates provides accommodation for eight people, with communal living rooms on the ground floor and bedrooms on the first and second floor, accessed only by a staircase, which means that the people living here must be ambulant. The Cottage, being a bungalow, provides level access for people with mobility needs, and accommodation for six people. The Cottage has a separate lounge and a kitchen cum dining room, a walk-in shower room and a separate bathroom. All the people who live Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: at the homes have their own bedrooms. Whitegates large entrance hall had on display for the people, who live at the home, a photo rota to make them aware of which staff would be on duty and available to support them. The communal living room was well-equipped with television, DVDs, videos and Sky providing entertainment for the people who live there. Framed photographs, of the people who live at the home, were displayed on the fire surround and an imitation coal fire was giving a warm glow to the room on a cold and wintry afternoon. Comfortable sofas, chairs, warm carpets, framed pictures, plants and shelves displaying interesting ornaments, gave a homely ambiance to the room. Two staff from the On Track day service, which was closed due to the icy condition of the roads, were engaging with the service users, who were laughing and appeared to be enjoying the interaction. French windows and a ramp made accessing the garden, located to the rear of the building, easy for wheelchair users. Garden furniture and a barbecue were available for outdoor entertainment in the summer months. Other communal rooms included a quiet room, which could be used for private meetings with visitors, for using the telephone in private or just for relaxing in the comfortable chairs provided. This room had a notice board with a pictorial complaints procedure, for the people who live at the home. Some artwork on canvas painted in oils and glitter paint, which had been produced by the people who live at the home, was displayed on the walls. The dining room was set out with domestic tables and chairs, and the large kitchen, which the manager stated, was a favourite room for the people to gather in, had an AGA and a seating area for the people, who live at the home to take meals or snacks at any time. On the first floor was a sensory room, which was well equipped with items such as bubble tubes, wind chimes, glitter ball, colour projector, musical instruments, music centre, mobiles, cushions, and vibrating mattresses to provide stimulation and interest to the people living at the home. There was also a room set up with comfortable chairs in which, the manager stated, reviews are held. The three bedrooms sampled were personalised with photographs of families and holidays, soft toys, bedside lamps, music centres, individually chosen furniture including dressing tables, wardrobes and bedside cabinets. One person had chosen to have a waterbed. All had been provided with a lockable facility in which to store valuables and a hand basin for their convenience. One persons bedroom had ensuite facilities, and sufficient baths, showers and toilets were provided for the other people who live at the home. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The home was clean and fresh on the day of the site visit and appropriate infection control facilities were in place to protect the service users. The AQAA recorded that all the staff had received training in the prevention and control of infection, and that the home had an action plan to deliver best practice in the prevention and control of infection. The laundry room was equipped with the necessary equipment for laundering the clothes of the people living there, and the manager stated that some people like to do their own washing, including folding it up and putting it away, and that one person loves ironing. Care Homes for Adults (18-65 years) Page 23 of 32 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. The people living at the home benefit from being supported by a safely recruited staff team, who provide consistency and continuity of support and are well-trained to meet their needs. Evidence: The AQAA recorded that, eight of the thirty staff members, had achieved a National Vocational Qualification (NVQ) in Health and Social Care at level 2 or above, which is well below the fifty per cent target for April 2008. The AQAA also recorded that. The manager is a NVQ work based assessor, and since the last inspection one member of staff has successfully completed their NVQ at level 2, and she is currently supporting another member of staff who was registered in July 2009. Local Colleges were also accessed to ensure that all staff have equal opportunities to access NVQs. Over the previous twelve months, only one staff member had left the employment of the home, resulting in consistency and continuity for the people living there. Photographs of the staff were displayed in the entrance hall, and an accessible rota, made the people living at the home aware of which staff were on duty. Observations of the staff on the day of the site visit, confirmed that they worked together well as a team and were committed to providing the best service possible to the people they supported. Interactions between the staff and the people they supported were sensitive and caring. The four people who completed surveys confirmed that the staff always treat Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: them well and always listen and act on what they say. The staff personnel files, of the two most recently recruited staff, were sampled. The manager confirmed that the people who live at the home had been involved in the interviewing of prospective new staff at the home and had received training in interviewing. In addition to the interview notes of the manager and the deputy manager in the files sampled, there was recorded feedback from the staff member supporting the service user during the interview. Application forms had been completed and the required information had been supplied. All the important checks such as references and enhanced Criminal Record Bureau (CRB) checks had been carried out prior to the offer of a post for the protection of the people living at the home. The manager confirmed that the staff had completed induction training in line with the Skills for Care Common Induction Standards, which introduce new staff to the caring role, and promote the individual rights of the people using the service, to have their equality and diversity needs respected. The AQAA recorded that twenty six of the thirty staff members had completed the induction. Staff files contained probationary reviews and regular support and development records to confirm this process had been completed. The AQAA recorded that, all the staff must read and sign to confirm they have read, policies on equality and diversity awarenessduring their induction and annually to ensure their awareness is maintained at a high level. The nine staff members, who completed surveys, confirmed that recruitment checks had been carried out before they started work, and seven thought that their induction covered everything they needed to know to do the job when they started, very well, and two thought it mostly did. Staff training logs were in place, confirming that the staff had been regularly updated with respect to fire safety, manual handling, food hygiene, safeguarding adults, first aid, health and safety (including infection control), the care and control of medication and training with respect to epilepsy medication. Staff training and development files contained certificates for mandatory and specialist training to support the needs of the people living at the home. These included, the principles of learning disability support, Makaton, effective communication, challenging behaviour, dementia and learning disabilities, and person-centred approaches. All the staff, who completed surveys confirmed that they were being given training that is relevant to their role, helps them understand and meet the individual needs of the people using the service, keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: The manager stated that the orgainsation produce a training brochure, which includes training specific to the whole organisation, including business planning, support and development, and Mental Capacity Act training and the Southern Region provide mandatory training and training, which is specific to the people who use the service. She also wrote in the AQAA that the organisation consults with the staff and encourages them to be involved in Regional Forum meetings. Some of the improvements made over the previous twelve months included accessing E learning for some training, team building days, and completing change training involving the personalisation agenda, initiated by the Government to give people with learning disabilities more control over their lives. Over the next twelve months staff will be supported with respect to the reprovision of the people living at the home, which will begin in 2011. This includes providing smaller domestic living units for the people using the service. Care Homes for Adults (18-65 years) Page 26 of 32 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. The people, who live at the home, can have confidence in the management to protect their best interests, listen to them and take into consideration their views in the running of the home. The environment is safe for the people and the staff because health and safety practices are carried out. Evidence: Amanda Lashbrook continues to be the registered manager of the home, and at the previous inspection three years ago, had already obtained the registered managers award (RMA) and a NVQ (National Vocational Qualification) at level 4 in care, as well as obtaining City and Guilds D32 and D33 as an internal assessor for NVQ training. She also holds a degree in Managing Health and Social Care. She has a wealth of experience, having worked with adults with learning disabilities in residential care settings, and day care for twenty-seven years. The manager has completed Train the Trainer courses in Safeguarding Adults, Report Writing, Person Centred Care and Team Building and continues to develop and run training courses for the Southern Region of the organisation (Elizabeth FitzRoy Support) (EFS), in addition to providing Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: the training for Whitegates and the Cottage staff teams. There are clear lines of responsibility within the two homes and the deputy manager leads a separate team of staff at the Cottage, whilst the registered manager is based at Whitegates. One staff member commented in the survey they completed, Ive worked for different agencies and care homes and never come across any that have the same standard of care as Whitegates. Thanks to the hard-working and good manager we have at Whitegates and the Cottage, its such a lovely place to work. Another staff member wrote, Id just like to say I feel proud to work here. There is such a real feeling of teamwork and always a happy atmosphere. The views of people who use the services are promoted by the provision of monthly house meetings. The people who live at Whitegates and the Cottage have their own house meetings, which take place monthly and are facilitated by a member of staff, whom the people who live at the home have chosen to support them. The AQAA recorded that, at their meetings an agenda, which they have agreed is followed. Everyone has the opportunity to discuss topics including sharing information, good news, whats happening in their home, activities, whats happening in Elizabeth FitzRoy Support, any health and safety issues, and complaints. Minutes are recorded in visual and written formats and are given to each person to go through with their key worker or the facilitator of the meeting if they choose and a main copy is posted on their notice board in the quiet room. Both Whitegates and the Cottage have a service user representative, who has been elected by their peers, to attend the Regional Service User Forum every three months. Representatives have the opportunity to meet with other representatives from different services in the Southern Region who may have different lifestyles, experiences and different opinions, to share and discuss. Issues are then taken to the National Service User Forum, which meets with the Directors and Trustees of Elizabeth FitzRoy Support at least three times a year. Agreed actions are then reported back to the Regional Meetings and then to house meetings, so that everyone who lives at the home has an opportunity to be involved totally in what is going on in their home and in their organisation. Quality assurance questionnaires are also completed annually to gain feedback from the people who live at the home about the service provided. Outcomes are collated and recorded in an action plan with time limits, which are monitored as part of the homes development plan for the forthcoming year. The home had detailed development plans covering all outcome areas. Some of these plans sampled were entitled, To provide Improved Life Experiences, To Maintain a Motivated and Stable Workforce, To Develop and Maintain Effective Monitoring and Reviewing. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: As a result of listening to the people who use the service the AQAA recorded that, some of the people we support do not easily access written and visual formats and therefore during this year we have introduced an audio version of the house meeting minutes. One of the service user representatives from Whitegates the Cottage has recently been elected to join the Regional Service User Forum Committee for the organisation and she will be taking on her role within the committee in the January meeting of this year. Additional funding has been received for some of the people we support, which has enabled them to have additional one to one support. The Cottage garden has been made more wheelchair friendly so that everyone can access their own garden. Further changes planned as a result of listening to the people who use the service included the planned exchange of one of the homes three vehicles for a vehicle which will enable two wheelchair users to go out together, and plans to work with the Southern Region Service User Forum, so that they can support individuals who live at Whitegates and the Cottage to complete their quality assurance questionnaires, rather then the staff who support them, to ensure that individuals opinions are really from them and not staff led in any way. The AQAA recorded that equipment had been tested or serviced as recommended by the manufacturer or other regulatory body, and certificates sampled, confirmed that servicing had been carried out in a timely manner, for the protection of the people using the service and the staff supporting them. The Control of Substances Hazardous to Health risk assessments had been reviewed and updated to safeguard the people living in the home. Policies, procedures and codes of practise in relation to health and safety had been reviewed in a timely manner to ensure the staff had been kept up to date with current legislation and practice. The staff training logs confirmed that mandatory training had been updated on a regular basis to ensure safe practise. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 32 More staff should be undertaking National Vocational Qualification at level 2 in Health and Social Care to meet the planned targets for April 2008, and to ensure the people living at the home are supported by qualified staff. Care Homes for Adults (18-65 years) Page 31 of 32 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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