Care Home: Willows (The)

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What the care home does well People who use the service have care plans and risk assessments in place that ensure their health and personal care needs are being met. The principles of respect, dignity and privacy are put into practice. Residents are supported to make choices with support from staff. Social, cultural and recreational activities are provided for residents to partake in. Residents choose meals that are provided. People who use the service, and their relatives, have access to a complaints procedure that enables them to raise concerns. Residents are protected from abuse through the organisation`s policies and procedures and staff training. The design and layout of the home enables the people who use the service to live in a comfortable home. The arrangements for staffing are satisfactory, and staff are provided with the training required to ensure the residents` needs are met. People who use the service are protected by the organisation`s recruitment policies and practice. The arrangements for management and administration ensure the home is run in the best interests of residents, and their safety is promoted and safeguarded. What has improved since the last inspection? The three requirements made during the key inspection of October 2008 have been complied with. The organisation has commenced a redecoration programme for the home. The two lounge/dining rooms and the kitchen have been completely redecorated and refurnished. What the care home could do better: The reason why residents are not able to sign their care plans should be recorded. The bath chair in one identified bathroom requires attention as the base has began to rust. The issues in regard to the bath panel and flooring of the identified bathrooms require repairing or replacing. The manager should develop a plan of how the home is to achieve the minimum of fifty percent of the staff holding a NVQ level 2 and above. Key inspection report Care homes for adults (18-65 years) Name: Address: Willows (The) The Old Grove High Pitfold Hindhead Surrey GU26 6BN     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: Joseph Croft     Date: 1 6 0 9 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: Willows (The) The Old Grove High Pitfold Hindhead Surrey GU26 6BN 01428609851 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): willows@robinia.co.uk Robinia Care South Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 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: 10 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Robinia Care Ltd provides a range of residential and day services for people with disabilities on the Old Grove Site at High Pitfold Hindhead. The Willows is a detached bungalow that offers long term residential care for up to 10 adults aged between 19 and 50, with learning disabilities who require a high level of support. The care home has 10 single rooms, three bathrooms and a shower room. The home Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 10 1 0 0 9 2 0 0 8 Brief description of the care home can be viewed as having two units each providing support for five service users whose rooms are situated in each unit. Each unit has large lounge/dining rooms, although kitchen and laundry facilities are shared. Although designed as two units, residents were able to access all communal areas of the home. Weekly care costs are £1152. 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: The quality rating for the service is Two stars. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) (us, we) undertook an unannounced site visit to the service on the 16th September 2009 using the Inspecting for Better Lives (IBL) process. The site visit was undertaken by Regulation Inspector Mr Joe Croft and took over five hours, commencing at 10:45 and concluding at 16:40. The manager assisted throughout the site visit. The inspection process included a tour of the premises, direct observation of practice, sampling of care plans, risk assessments, duty rota, medication records, health action plans, activities, staff recruitment and training files and certificates for the servicing of the health and safety equipment used at the care home. The Statement of Purpose, Service users Guide and Complaints policy and procedure were viewed. Discussions took place with the manager and four members of staff during the course of their duties. Due to the complex needs and communication Care Homes for Adults (18-65 years) Page 6 of 31 difficulties we were not able to have discussions with residents. Staff were observed interacting with residents in an appropriate and professional manner, were aware of residents communication needs, and called them by their preferred names. The manager told us that they had not received any of the surveys that were sent to the service from the Care Quality Commission, therefore were are not able to include iformation from these surveys in this inspection report. The manager returned the completed Annual Quality Assurance Assessment (AQAA) when we asked for it, and this has been used as a source of evidence throughout this report. The inspector would like to thank the manager, staff and residents for their cooperation during the site visit. Weekly fees charged are 1152 pounds. The last key inspection for this service was undertaken on the 10th September 2008. 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: 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 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 9 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. People who use the service are provided with information that will enable them to make a choice about living at the home. The needs of prospective residents would be fully assessed to ensure they could be met at the home. Evidence: The home has a Statement of Purpose and a Service User Guide that includes information in regard to the purpose of the home, aims, objectives, qualifications and training of the staff and the manager, and a summary of the complaints procedure. Both these documents had been reviewed in June 2009. The Service User Guide included pictures and some photographs that would help the residents to better understand the contents of this document. The manager told us that there have not been any new admissions to the home since August 2007. The pre-admission assessment for the last person to be admitted to the home was viewed. This included information in regard to the prospective residents personal care, hygiene, eating, drinking, toileting, communication, behaviour, health and well-being, medication and social relationships. The manager told us that she Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: would visit the prospective resident at their current placement, and that the resident would be invited to visit the care home to meet the other residents and staff. New placements would be reviewed after one, six and twelve month intervals. The manager told us that a representative from the organisation undertakes the preadmission assessments. The Annual Quality Assurance Assessment (AQAA) informs that the service has a Welcome pack that includes a copy of the Statement of Purpose and Service User Guide. There have not been any referrals during the last twelve months. The service uses a Robinia Assessment Tool for assessing prospective residents. Care Homes for Adults (18-65 years) Page 11 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. People who use the service have care plans and risk assessments in place that ensure their needs can be met. Residents are encouraged and supported by staff to make decisions about their lives. Evidence: Two care files were sampled during the site visit. Each file had a Person Centred Support Plan (PCSP) that was dated May 2009. The manager told us that they had recently commenced using this type of care plan. Each PCSP was in four sections, About me, About my support, My emotions and My future. There was clear information in regard to personal and health care needs, hygiene, dressing, social behaviour, daily routines, weekly activity list, communication, social interaction, environment, eating and drinking, and goals and aims of each resident. Each care plan viewed had had an annual review. We were told that the two residents whose care files we viewed were not able to sign their care, but they had been involved in the process. There was evidence that families had been involved as they had attended the annual review. The manager was advised to record the reason why residents are not able to sign their Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Person Centred Support Plans. A good practice recommendation has been made in regard to this. Daily notes were maintained in each of the files viewed that related to the information in the PCSP. Both care files had risk assessments that included risks in regard to bathing, cleaning teeth, preparing and eating food, social activities, family contact, mobility, night time support and Epilepsy. The manager told us that these are reviewed every twelve months, or as and when required. During discussions it was evident that the staff were knowledgeable of the contents of the care plans, and were aware of the need to review them every six months. One member of staff told us that they also update the care plans as and when residents individual needs change. The care files sampled had a photograph of the resident and a personal information sheet that included the residents next of kin, GP details and other personal information pertaining to the resident. During discussions the manager and staff told us that staff support residents to make decisions for themselves such as the choice of menu, clothes they wish to wear and activities and they want to partake in. Due to the residents complex needs and communication difficulties we were not able to have discussions with all people who use the service. The AQAA informs that each person who lives at the home has a Person Centred Support Plan that outlines goals and risk assessments. Evidence viewed during this site visit supports the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 13 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. People who use the service are encouraged by staff to participate in a range of activities. A balanced diet is provided for residents. Evidence: Residents living at the home are from a multi-cultural background, and they are supported by a multi - cultural staff team. All residents are supported by staff to participate in a range of activities according to their needs, preferences and wishes. Activities include attending day centres, shopping trips, visiting pubs, attending spiritual places of worship and annual holidays. A record of all the weekly activities undertaken by individual residents is maintained in their care plans, and a list of of these activities were observed in the bedrooms viewed during the site visit. There is also a comprehensive list of evening activities displayed in each of the lounges. Each evening there is an organised activity for residents to Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: take part in that included internal and external activities. Weekend activities include trips to the coast and places of interest. During the site visit the home was very busy with residents going to and from activities. There was also a music therapy activity in progress during the site visit. The home has its own transport that is used to take residents out on activities, however, one member of staff told us they would benefit from having more staff who were able to drive. Residents are supported to maintain relationships with friends and families. Care plans contain details of people important to them with addresses and telephone numbers. During discussions the manager and staff told us that there are no restrictions on visitors to the home, and some residents go to their parents homes for weekends. Advocates are provided for residents who do not have any visiting family. Daily routines are flexible with bedtimes and mealtimes arranged to meet individual needs and timetables. Residents are encouraged and supported by staff to undertake daily household tasks, for example, each resident has a separate day for their laundry. Independence is promoted within each individuals ability. The menus were viewed during this site visit. The manager told us that the menus are produced with the residents every Monday evening, and that Speech and Language Therapists have put in place the menu planning system. this was confirmed during discussions with staff. Meals provided include fresh meat, fish, pasta, fresh vegetables and fruit. Photographs of different foods are used to help residents make decisions. The food is bought fresh every week. Fresh fruit was available on the day of the site visit. Care plans viewed included information in regard to residents diets, and informed staff of the support that may be required. The viewing of the training matrix, provided to us on the day of the site visit, provided evidence that the majority of staff had attended training in regard to food hygiene, and new staff had covered this during their induction training. Evidence was also viewed of future dates that had been arranged for other staff to attend. Records confirmed that fridge/freezer and cooking temperature checks are undertaken. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The AQAA informs that various outings are offered, family participation is welcome, residents attend day centres and activities include music therapy, aromatherapy and reflexology. Evidence viewed during the site visit supported the information provided in the AQAA. 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. Personal support provided to residents meets their preferences and their physical and emotional needs are well met. The arrangements for medication are robust and protect residents. Evidence: The two care plans viewed provided information in regard to the level of support each resident required with their personal care needs. Staff spoken to were knowledgeable of these needs, and stated that they attend to the personal care needs in the privacy of bedrooms and bathrooms. We were told that staff always knock on bedroom doors before entering, and call each resident by their preferred names. This was evidenced during the site visit. The AQAA informs that the duty rotas are written to reflect individuals preference with regard to their gender support, and that training in regard to diversity and equality is provided for staff. From discussions with the manager and staff, and the viewing of Healthcare plans for two residents, it was clear that residents have access to all health care professionals Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: as required. Each of the two care plans viewed maintained information of all health care appointments that included the GP, dentist, Psychiatrist, opticians and other specialist health care professionals. This information was clearly recorded and easy to access. Care plans included detailed information about the specific medication residents were prescribed, and also included information and guidelines in regard to PRN medication that had been signed by the residents GP. Each of the healthcare plans had a section entitled How I say I am not well, and the support I need at health care appointments. Each healthcare plan included documentation that accompanies residents if and when they are admitted to a hospital. Staff at the home follow the organisations Medication Policy and Procedure that was last reviewed in December 2007. The home obtains medication and printed Medication Administration Record sheets (MARS) from the local pharmacy. The Medication Administration Records for two residents were viewed. Medication was appropriately stored in a locked metal cabinet. The MARs sheets included the quantity of medication received, and were accurately maintained, however, the manager was advised to carry over the running total of medication to each MAR sheet. No omissions were noted in the records viewed. The home has a book for recording medication that has been returned, and this had been signed by the pharmacist. The manager told us that one resident is taking a controlled drug. This was stored in a secure medical cabinet and a Controlled Register was accurately maintained and signed by two staff. We were told that all residents have an annual medical review with their GP. The viewing of the staff training matrix provided evidence that they had received training in regard to medication that is updated every two years. The AQAA informs that the personal and health care documentation is in place for all residents, that they have access and contact with a wide range of medical professionals, and all residents have health action plans. Evidence viewed during the site visit supported the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 18 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. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are protected from abuse through the homes provision of staff training and policies and procedures in regard to Safeguarding Adults. Evidence: The home follows the organisations Complaints Policy that was last reviewed in April 2007. The complaints policy included the timescales for responding to complainants. Each resident has a copy of this document in their Person Centred Support Plan. It was noted that this document had the incorrect contact details for the Care Quality Commission (CQC), and there were no copies available throughout the home. The manager told us that this is currently being reviewed by the organisation, and this updated document will be displayed throughout the home. A copy of this document is included in the Statement of Purpose that did include the correct contact details for the CQC. The AQAA informs that the home has not received any complaints since the last key inspection. During discussions staff told us that they are able to tell if residents are unhappy through their body language and moods, and some residents would let them know if they were unhappy. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: The home has a copy of the recent Surrey Safeguarding Procedures, and staff follow the organisations abuse Policy that was last reviewed in 2007. This was discussed with the manager who told us that this would be reviewed to ensure it is within the current guidelines of the 2008 local Safeguarding procedures. The training matrix provided on the day of the site visit provided evidence that staff had attended training in regard to Safeguarding Adults, and new staff receive this training during their induction training. Different scenarios in regard to abuse were discussed with the manager and staff. They were knowledgeable about the procedures to be followed and were aware that the safeguarding issues must be reported to the local Safeguarding Team. Staff told us that they would follow the organisations Whistle blowing procedures and would not hesitate to report bad practice. The manager told us that there have not been any Safeguarding referrals made by the home since the last key inspection. The manager told us that staff do not have power of attorney for residents finances. The home holds small amounts of monies for residents, and these are signed by two members of staff for each transaction. Evidence was viewed of the audits both the manager and senior staff undertake. The money held for the two residents who being case tracked were viewed. The amount held for one resident had ten pence too much, however, the manager told us that this persons records would be scrutinised again. The AQAA informs that the service welcomes and listens to the views of people living at the home, there are procedures regarding Safeguarding and protection from abuse in place, and staff have attended training in regard to Safeguarding Adults. Evidence viewed during this site visit supports the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the service live in a comfortable, clean and fresh environment, however, the identified issues raised in this report must be addressed to ensure that residents live in a safe, well maintained environment. Evidence: The immediate requirement made at the last key inspection in regard to the protruding nails on the identified door was complied with during that site visit. A tour of the premises and the sampling of residents bedrooms were undertaken during the site visit. The Willows is a detached bungalow that has 10 single rooms, two bathrooms and a wet room. The home is divided into two units that provide support for five residents in each. Each unit has large lounge/dining rooms, and the kitchen and laundry facilities are shared. The home is currently undergoing a programme of redecoration, both the lounge/dining rooms have been redecorated and had the furniture replaced since the previous key inspection. The manager has undertaken an audit of all the furniture and carpets, and provided evidence that new furniture and carpets had been ordered. This was in compliance with a requirement made at the last key inspection. The home has a newly refurbished kitchen that all staff are very pleased with. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Communal bathrooms and toilets had liquid soap dispensers and paper towels. A bath chair in one identified bathroom requires attention as the base has began to rust. The bathroom wood surround and flooring in one identified bathroom require repair and/or replacing as they have suffered water damage, and the other identified bathroom requires attention to the floor. These issues were discussed with the manager and also the health and safety officer who was undertaking an annual audit on the day of this site visit, and had also been identified as requiring repair or replacement. A requirement has been made that the identified issues in regard to the environment must be resolved. Bedrooms viewed were appropriately decorated, and residents had their personal belongings that included photographs, televisions and stereo players. As stated earlier, the manager has a programme to replace all bedroom furniture and some carpets in the home. One bedroom sampled included sensory lighting. The home has a laundry that includes washing machines with sluice facilities and tumble driers. Controls of Substances Hazardous to Health (COSHH) were kept secure in locked cabinets. The manager and the health and safety officer told us that risk assessments in regard to the COSHH are in place, and are reviewed on a regular basis. The home has a cleaning rota that ensures the cleanliness of the home is maintained. On the day of the site visit the home was very clean and tidy. One identified bedroom had a mild odour, however, this was rectified during the site visit. The training matrix provided evidence that staff had attended training in regard to Infection Control, and evidence of further training was viewed during the site visit. Residents were observed to have access to all the communal parts of the home, including a secure and appropriately maintained garden to the rear of the property. The AQAA informs that bedrooms are designed and decorated to meet the individual needs, that the home is clean, hygienic and mostly odour free. Staff attend regular Health and Safety, COSHH and Infection Control training as part of the mandatory training. Care Homes for Adults (18-65 years) Page 22 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. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of people using the service. Recruitment procedures and practices ensure people who use the service are protected. Evidence: The duty rota viewed during this site visit provided evidenced that there is a minimum of seven and a maximum of ten members of staff on duty on each shift that always includes two senior members of staff. Currently there are two waking night staff and one member of staff doing a sleep in duty. The home uses one to one staff for three identified residents, and other one to one staff are deployed as and when these are required for other identified residents. During discussions staff told us that there are enough staff on duty to cover all the activities, and there have been a lot more staff recruited since the new manager took over in June 2009. The manager told us that there has been a turnover of staff. Of the current twenty permanent staff employed at the home, only eight hold the minimum of an NVQ level 2 and above. A good practice recommendation has been made that the manager should develop a plan of how the home is to achieve the minimum of fifty percent of Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: the staff holding a NVQ level 2 and above. Each member of staff has a training file. Training undertaken by staff includes communication, equal opportunities, Epilepsy, Autism and Supporting People with a Learning Disability. During discussions staff told us that they are provided with the training they require to fulfil their roles. The home follows the organisations Recruitment Policy and Procedure that was last reviewed in October 2006. Staff recruitment and training files were available at the care home. This was in compliance with a requirement during the last key inspection. The recruitment files of three members of staff who recently commenced duties at the home were viewed. These included an application form, two referees, full employment history, health declaration and proof of identity and a photograph of the members of staff. Each member of staff had a Protection of Vulnerable Adults (POVA) first and Criminal Record Bureau checks undertaken. The service has reduced the amount of agency staff used since the manager took up her post in June 2009. The home has evidence from the supplying agency that all the necessary recruitment checks have been undertaken on the staff they supply, and the CRB reference numbers have been passed to the service. New staff attend the organisations induction training programme that is in line with the Skills for Care Council. During discussions staff told us that they receive formal one to one supervision every month. The AQAA informs that the service promotes staff development and encourages staff with their training. A training matrix is in place that identifies the training staff have completed, and what training they require to complete. Evidence found during the site visit supports the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 24 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. People who use the service benefit from a well managed home and their views influence the running of the service. The health, safety and welfare of service users are promoted and protected. Evidence: The home has had a change of manager since the last key inspection. The new manager told us that she has been managing the home part time from February, and full time since June 2009. We were told that she is in the process of submitting an application for registration to the Commission. Her Criminal Record Bureau application has been signed by a member of staff at the Commissions London office. The manager told us that she holds the NVQ level 4 and the Registered Managers Award (RMA). The manager has been working with Adults who have a Learning Disability since 1998. Other training undertaken by the manager include Safeguarding Adults, first aid, Epilepsy and the mandatory training as required, however, the manager did not have her training file at the home. We were told that she has this at her home waiting to take with her when the fit person interview has been arranged. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: During discussions staff told us that the manager is supportive, has an open door style of management and has made positive changes for the benefit of the residents and staff since commencing her duties. We were told that more permanent staff have been recruited by the manager and this has resulted in much less reliance on the use of agency staff. It was evident throughout this site visit of the improvements the manager has made, this includes all documentation used by the home, and the regular auditing of records organised by the manager. Quality assurance is undertaken through monthly meetings with residents and staff meetings. The minutes of these meetings were sampled during the site visit. The manager has produced a user friendly agenda for the recording of residents meetings that includes a photograph of all who attend the meeting. The home had undertaken a survey to ascertain the views of how well the home was meeting the needs of residents in March 2008. The manager told us that new surveys had been sent out to all stakeholders this month, and showed us copies of the surveys that were sent. The organisation undertakes monthly Regulation 26 visits, and copies of these reports were available at the home. The Annual Quality Assurance Assessment was returned to us when we asked for it. This document was comprehensive and provided all the information we asked for, including plans for improvement during the next twelve months. The viewing of the staff training matrix provided evidence that staff were receiving the mandatory training as required. The AQAA was completed on the 18th June 2009, however, the servicing of the health and safety equipment used at the care home, according to the AQAA, were overdue. Therefore the certificates for these were requested. Through the viewing of these certificates we were able to evidence that the equipment used had been serviced in accordance with the manufacturers recommendations. The AQAA informs that all health and maintenance checks had been undertaken as required. There is a full time experienced qualified manager in post who has experience of trouble shooting under achieving homes. The manager undertakes quarterly reviews of accidents and incidents, and generic risk assessments including COSHH and fire risk assessments are in place. Evidence viewed during this site visit Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: supports the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 27 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The registered person shall 16/11/2009 having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; equipment provided at the care home for use by service users or persons who work at the care home are maintained in good working order. The registered person must ensure that the identified issues in regard to the environment raised in this report are attended to. Care Homes for Adults (18-65 years) Page 29 of 31 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 2 6 32 The reasons why residents are not able to sign their care plans should be recorded. The manager should develop a plan of how the home is to achieve the minimum of fifty percent of the staff holding a NVQ level 2 and above. 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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