Care Home: Woodlands (Horley)

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What the care home does well The service provides a friendly and welcoming environment for people living there. People living in the service and their representative’s spoke positively about the care and support provided by the home. "The staff are very nice to me”;” The staff are very kind and helpful" and "I like it here, I am happy and its very nice”;” Woodlands is a most remarkable establishment, which I have known for a long time and I cannot commend it more highly, this is especially true of the staff they are outstanding as professionals"; "The service provides a warm and comfortable home for my relative and there is a happy atmosphere"; "Permanent staff are really pleasant and seem dedicated and my relative`s key worker is very understanding of their needs and character”;” Staff are always polite and welcoming" and "Caring and organised". The service has developed person centred support plans, which are complied in consultation with people. These plans contain detailed information about how people`s needs are to be met. People are encouraged to make decisions and choices about their lives and their views are listened to. The service holds home meetings and provides feedback quality assurance questionnaires. People take part in a range of meaningful activities and their independence is promoted. People are supported with participating in shopping, household tasks, cooking and budgeting. A range of adaptations have been provided in the environment to assist people with sight impairment. Two people told us, "I like cooking" and I go shopping". Another person said, "I go to the pub every week and my life has been improved since I have lived here". People benefit from a stable staff team who know people well and how to meet their needs. A relative surveyed said, “Staff selection is always of a high standard". What has improved since the last inspection? Since our previous visit the home has reviewed and completed person centred support plans for all people, which detail the actions needed to meet people`s needs. Staff have received training in mental health awareness ensuring that they are able to meet the specialist needs of people living in the service. The home has also madeprogress in arranging further specialist training. The staff rota was seen during this visit, which now recorded the hours worked by the manager and staff. What the care home could do better: The registered provider must ensure that reports of all monthly quality monitoring visits undertaken are available in the home for inspection. During this visit we looked at some of the service`s accident and incident forms maintained by them and it was observed that two matters had not been reported promptly to the local authority ensuring people’s safety and protection. These matters were also not brought to the attention of the Commission as required by legislation. Key inspection report Care homes for adults (18-65 years) Name: Address: Woodlands (Horley) 42 Massetts Road Horley Surrey RH6 7DS The quality rating for this care home is: one star -adequate 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: Lisa Johnson Date: 0 4 0 1 2 0 1 0 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor.       Evidence: This box describes the information we used to come to our judgement      They reflect the 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 Care Homes for Adults (18-65 years) Page 2 of 29 type of care service. Copies of the National Minimum Standards – Care homes for Adults (18-65) 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 Information about the care home Care Homes for Adults (18-65 years) Page 3 of 29 Name of care home: Address: Woodlands (Horley) 42 Massetts Road Horley Surrey RH6 7DS 01293 784235       woodlands@seeability.org       SeeAbility       care home 7 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : learning disability      mental disorder, excluding learning disability or dementia sensory impairment                   Additional conditions: Number of places (if applicable): Under 65      7      7      7                   Over 65 0 0 0 The maximum number of service users to be accommodated is 7 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) Mental disorder, excluding learning disability or dementia (MD) Sensory impairment (SI). Date of last inspection: Brief description of the care home: Woodlands is a large detached converted domestic house situated in a residential area and close to the local facilities and amenities of Horley town centre. The home has been opened ten years and is registered to provide care and accommodation for up to seven people who have a learning disability and visual impairment. The home is owned by and managed by the registered charity, SeeAbility. Care Homes for Adults (18-65 years) Page 4 of 29 D D M M Y Y Y Y The home is presented across two floors with access to the first floor via stairs. Residents accommodation consists of all single accommodation all of which have their own en-suite facilities. Communal space consists of two kitchen, lounge and dining room. There is large rear garden which in part has been paved with raised beds. There is a summer house used for occasional activity sessions. The weekly cost is £1,098 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: One star adequate service   Choice of home Individual needs & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This site visit was part of a key inspection. The visit was unannounced and we arrived at 10:am and left at 4:45pm. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment (AQAA). This is a self assessment that focuses on how well 0utcomes are being met for people using the service. We received the AQAA by the expected date, which was clear, detailed and gave us all the information we asked for. Reference is made to this assessment throughout this report. Care Homes for Adults (18-65 years) Page 6 of 29 During this visit we met with three people who live in the service. We met with the registered manager and discussion took place with three members of staff. We received four feedback surveys from people using the service, four were received from relatives and we received one survey from a social and health care professional. We also received surveys from five members of staff. These comments are included in this report. During this visit we spent time observing activities and staff interaction. We sampled staff recruitment, and training records, care plans, risk assessments, menus, complaint, accident/ incident records, quality assurance systems, medication administration policies, health and safety records and policies and procedures. We also reviewed other information that we have received since our previous visit including notifications. What the care home does well: What has improved since the last inspection? Since our previous visit the home has reviewed and completed person centred support plans for all people, which detail the actions needed to meet peoples needs. Staff have received training in mental health awareness ensuring that they are able to meet the specialist needs of people living in the service. The home has also made Care Homes for Adults (18-65 years) Page 7 of 29 progress in arranging further specialist training. The staff rota was seen during this visit, which now recorded the hours worked by the manager and staff. 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 set out on page 4. The report of this inspection is available from our websitewww.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 29 Details of our findings Contents Outcome area (for example: Choice of home) .........................................................2 Choice of home ................................................................................................10 Individual needs and choices ..............................................................................12 Lifestyle ..........................................................................................................14 Personal and healthcare support .........................................................................16 Concerns, complaints and protection ...................................................................18 Environment ....................................................................................................20 Staffing ...........................................................................................................22 These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:................................22 Conduct and management of the home ................................................................24 Outstanding statutory requirements.....................................................................26 Requirements and recommendations from this inspection........................................27 Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with accessible information that they need to know about the home. Peoples needs are assessed prior to admission ensuring that the service will be able to meet them. Evidence: The home provides a statement of purpose and service user guide, which can made more accessible to people in braille and audio version. Since our previous visit the statement of purpose has been reviewed to make reference to the aims of the service, range of needs the home is able to meet and the terms and conditions. Since our previous visit there have been no new people admitted into the home. Referral and assessments procedures are in place, that are currently under review. During this visit we looked at the records for the last person who had moved into the home, who had been accommodated following an assessment of their needs. Information is also gained from peoples representatives, care managers and health care professionals. We were informed that the service is currently working with the funding authority in assessing the needs of a new potential person. Staff have been working in this persons current home with their staff to assist them with their understanding of visual impairment issues. This person is visiting the service on a weekly basis providing them with the opportunity to spend time with staff, other people living in the service and orientation. Care Homes for Adults (18-65 years) Page 10 of 29 Each person has a terms and conditions of residency, which were available at this visit for us to view and a copy was maintained with each persons records. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan of care that they have been involved in making. Peoples needs and goals are met and they are able to make decisions about their lives. People are supported to take risks as part of an independent lifestyle. Evidence: Since our previous visit the service has completed person centred support plans for all people living in the service. During this visit we sampled three peoples support plans, which were clear and detailed providing information how peoples needs are to be met. Care plans sampled had been discussed in consultation with people, they had been regularly reviewed and were up to date. One persons care plan had been formulated with pictures. Each person has an assigned key worker. Care plans are reviewed monthly and people are provided with the opportunity to make comments or add to their plans. A further formal review is also carried out six monthly and an annual review is held with the person and their funding local authority. The service is supported by a rehabilitation worker who visits the service once a week to set out programmes for all people with independent living. Some of the care staff have attended social inclusion training and are known as rehabilitation support workers who assist in this process. One persons care plan sampled identified that they wish to move on to more independent living and their are plan goals reflected this such as acquiring skills with shopping, cooking and money skills. The home maintains daily diaries and activity logs, which reflect the outcomes of peoples goals. Care Homes for Adults (18-65 years) Page 12 of 29 People living in the service are supported to maintain responsibility for their finances, this was documented in their support plan. People hold their own meetings, which are facilitated by a volunteer, who was a former resident in the home. Information supplied in the AQAA states that people elected one of their peers to represent them on the Quality Action Group, which is a forum run by the organisation (SeeAbility) to ensure that people are involved in the shaping of the organisation. The service has developed information into accessible formats such as an audible menu, speaking clock and staff rota, which we observed during this visit. Two people told us that they attend meetings and have reviews to discuss how they getting on. People living in the service are encouraged to take risks, which were supported by risk assessments that were maintained on peoples files. People are supported to carry out activities out as safely as possible. Risk assessments sampled included cooking, tea making, using electrical appliances, mobility, bedroom safety, road safety, travelling and using public transport. All risk assessments had been reviewed by the agreed dates and were up to date. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferences, recreational, educational social, cultural and religious needs are met. People maintain contact with their family and friends and the local community and they are provided with well balanced and varied meals. Evidence: Peoples educational, therapeutic, recreational, cultural and social activities were outlined in their care plan. People are supported in producing a daily planner so routines and choices can be accommodated. A number of people attend in house keep fit sessions and a monthly music appreciation session. There are a range of other community activities such as self improvement groups, drama and gardening projects. A therapeutic session was observed to be taking place in the afternoon, which some people attended. A number of people access college and one person enjoys art, where paintings and sculptures are sent to their home with audio descriptions. We were informed that one person enjoys carriage driving sessions. Information supplied in the AQAA states that people are supported in choosing their own activities. These activities range from enjoying meals out, socialising at local pubs and restaurants, theatre trips and day trips out to places of interest. One person’s activity planner said they go to the pub, which was evidenced in their daily records. During discussion with this person they said, I go to the pub every week and my life has been improved since I have lived here”. Two other people said,” I like cooking and I go shopping at a local supermarket”. A relative surveyed that there relative would benefit from more Care Homes for Adults (18-65 years) Page 14 of 29 activities. People’s religious needs are respected and some people attend church. The home promotes peoples independence and personal development. Each person has a rehabilitation plan in place. A rehabilitation worker attends the service on a weekly basis to assist and advise in the process. The service provides a large training kitchen, where a variety of aids have been acquired to assist people with visual impairment. At the time of this visit some people were being supported to make their own lunch and another person was preparing their lunch using a personal recipe book, which they are building up. Another person was undertaking their laundry and some people were making drinks. People are also supported to clean their rooms and learn budgeting skills and they are supported to manage their finances and benefits. People maintain links with their family and friends who are welcome to visit and some peopletold us about their families during this visit. The AQAA has identified that they plan to improve social networking opportunities for people to seek and make new friends and,relationships. The home is also supported by volunteers. Four relatives surveyed said that the service helps their relative to keep in touch with them. During this visit people were seen accessing all areas of the home and some people chose to spend some time in their bedrooms, which was respected by staff. Good staff interaction was observed to take place with people living in the service who were attentive and respectful. Post boxes have been provided close to the front door and one person was observed to be supported to collect this and to answer the front door. People have also been provided with keys to their rooms and front door and some peoples locks have been adjusted so they are thumb turns on the inside for ease of locking and unlocking. Staff told us about how they support people’s rights to make choices and promote independence. Three people living in the service told us that staff respect their privacy. Comments included, The staff are very nice to me”; “The staff are very kind and helpful and I like it here, I am happy and it’s very nice. People are involved in shopping and cooking and a number of people cook their own individual meals two or three times a week. A group cooking session is also facilitated one day a week, where all people are involved in cooking the main meal. The home also has a communal menu for people who are unable to cook independently, which the housekeeper was observed preparing in the evening. The menu is chosen by each person every week, which was observed to be well balanced and varied. People are supported to have their meals at times when they wish and as a result of listening to peoples views the home has supplied cereal dispensers, which people have said makes it easier for the them to get their own breakfasts, which we observed in the dining room. A food diary was maintained for each person to monitor meals eaten. Three people told us that they enjoy their meals and two relatives commented, Excellent and Good Meals. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met and their preferences for support are respected. The home supports people with their medication in a safe way Evidence: Peoples likes, dislikes, preferences and routines were outlined in their person centred care plan and information supplied in the AQAA stated that people can choose who they wish to support them whenever possible. Information included in care plans also contained What’s important to me”. People’s personal care needs were documented in their support plan and detailed how these are to be supported such as providing verbal support or prompts. The service has completed health action plans and How to keep me well booklets. People access a range of health care professionals and health action plans sampled at the time of this visit demonstrated this including, General practitioner, Chiropody, ophthalmology, chiropody , dentist and one person was supported by the Community Mental Health Team. Information was available to evidence that people receive health screen checks, which were recorded. The service has developed detailed communication profiles for each person, which provides clear guidance to staff. Mood records were in place for monitoring the emotional needs of one person. Since our previous visit staff have received training in mental health awareness that covered bipolar disorder. Weight records were maintained and one person has received support with their specialist dietary needs. Care Homes for Adults (18-65 years) Page 16 of 29 A health and social care professional surveyed said, The service liaises with the community team and a person being supported is improving with their independence, they have provided an excellent service to our patient concerned and We are really pleased with the service provided. A number of positive comments were received from relatives about the support and care provided including, Woodlands is a most remarkable establishment, which I have known for a long time and I cannot commend it more highly, this is especially true of the staff they are outstanding as professionals”;” The service provides a warm and comfortable home for my relative and there is a happy atmosphere; My relative is always smart in appearance except for shaving, for which they need help;”Permanent staff are really pleasant and seem dedicated and my relatives key worker is very understanding of their needs and character”;” Staff are always polite and welcoming and Caring and organised. People maintain their medication in a lockable cabinet in their bedrooms, which we were told is risk assessed. One person currently self medicates independently, which is supported by a risk assessment. The home receives their medication from a local chemist and the pharmacist visits the home to carry out audits. Systems are in place for the receipt and disposal of medication. Medication administration records sampled were maintained in good order and a photograph of the person was available for identification. Staff receive medication administration training that was confirmed by training records sampled and through discussion with members of staff. A list of staff signatures were available for those who trained and authorised to administer medication. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns they know how to complain. Staff receive sufficient safeguarding training but reporting procedures need improvement ensuring peoples safety and protection. Evidence: The service has a complaints procedure in place, which is also available in audible form. Information supplied in the AQAA states that people living in the service are made aware of the complaints procedure and they are reminded of their rights at home meetings and on going discussions with their key worker. Three people spoken with during this visit said they knew who they could speak to if they had any concerns and they would speak to the manager. Three out of four people surveyed also confirmed this. Three out of four relatives surveyed said that they knew how to make a complaint if they needed to and said that service has responded appropriately if they have had to raise any concerns. Since our previous visit no complaints have been received by the service and complaining logging records are maintained. The service has safeguarding vulnerable adults from abuse procedures in place including the local authority multi agency procedure. Staff training records sampled during this visit confirmed that they receive safeguarding training and arrangements are in place for staff to undergo refresher training. The manager also informed us that they had attended the local authority multi agency training. Discussion with staff at the time of this visit indicated that they had received training and they were aware of their responsibilities should they ever witness or be made aware of any incident where the safety of people is compromised. However during this visit we sampled some of the accident and incident forms completed by staff and it was noted that two incidences pertaining to physical aggression between people living in the service had not been reported to the local Care Homes for Adults (18-65 years) Page 18 of 29 authority following their safeguarding procedures or reported to the Commission at the time ensuring peoples safety and protection. Therefore an immediate requirement was made. During this visit the manager compiled a local policy which included the contact details of the local authority, which they said that they would bring to the attention of staff. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is safe, well maintained, comfortable and clean. Evidence: The home is located close to Horley Town Centre with access to public transport, shops and local college. The home has undergone a process of refurbishment over the last few years and provides a range of adaptations for people with sensory impairment to assist with orientation. The home provides a domestic and homely feel providing a sitting room, large, kitchen with a range of appliances and separate dining room. There is an accessible sensory garden to the rear of the home. Some of the paint work in the home looks tired improvement, which the manager has identified along with some of the shower rooms. It was observed that radiators in the communal areas did not provide protective covers. However the manager has carried out and completed risk assessments in relation to this. Improvements have been made as a result of recommendations made by the water board, fire authority and health and safety audits, which has included improved fire protection and improved lighting in darker areas of the home. Information supplied in the AQAA states that that peoples bedrooms have been repainted and re carpeted as required and that they are able to choose their preferred colours when decorating their rooms. A person living in the service invited us to visit them in their bedroom, which was comfortable and personalised. They were particularly happy about having their own comfortable chair and en suite shower facilities, which are provided in all of the bedrooms. A relative surveyed said, My relative has a nice room. A separate communal bathroom is available for people who enjoy a bath, which is provided with a portable raising chair to assist people to access the bath safely. Care Homes for Adults (18-65 years) Page 20 of 29 During this visit the home was observed to be clean and hygienic and a member of staff is employed to carry out these tasks. We were informed that staff access infection control training. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by sufficient staffing levels and they are demonstrating that people using the service are supported by staff that are competent and trained to meet their needs and they are protected by the homes recruitment policies and practises. Evidence: At the time of this visit there were two members of staff on duty and a third member of staff was working on an administration day. We were informed that there is always two members of staff on duty throughout the day headed by a shift leader and people are supported by a sleep in member of staff. On call arrangements are in place should extra support be required and a lone working risk assessment has been completed. Members of staff said that the current levels of staff usually meet the current needs of people. During this visit we looked at the duty rota ,which confirmed the names of staff on duty and the hours that they work. The home also employs a housekeeper and an administration member of staff. The manager currently has one day supernumerary time and they told us during this visit that the staffing levels are currently under review with senior management to look at the staffing numbers provided. The home also employs bank workers to cover any short falls. At the time of this visit activities were observed to be well planned and organised. Out of nine care staff employed eight have completed National Vocational Qualifications (Level 2) or above. New staff receive induction,which follows the Skills for Care induction standards. The organisation (SeeAbility) provides a programme of staff training. Three members of staff training files sampled demonstrated that they receive statutory training. During Care Homes for Adults (18-65 years) Page 22 of 29 discussion with the deputy manager who books staff training they informed us that they have reviewed all members of staff training needs and provided evidence to us demonstrate that statutory refresher training has been booked. Since our previous visit staff have now received mental health awareness training and future training is being arranged in autism, epilepsy, promoting Equality and Valuing diversity and Disability, Equality and Human Rights. The manager has undertaken Person Centred Thinking Training, which they have cascaded to all support staff, who have also been enrolled on a two day Person Centred Thinking training facilitated by the organisation. Discussions with members of staff indicated that they are supported to attend training and development. Four members of staff surveyed also said that they feel they have enough support, experience and knowledge to meet the differing needs of people who live in the service. Comments included, I have worked in other homes and this is the best company to work for as the needs of staff are fully met with ample training opportunities; We have a good staff team with some very experienced people who have worked in care for many years, we work together to support our residents to be as independent as possible in their day to day lives. People using the service benefit from a stable and consistent staff team who through discussion demonstrated that they had a good understanding and knowledge of peoples needs. Recruitment is based on the organisations equal opportunities policy. During this visit we sampled three members of staff recruitment files, which contained the required information including a completed application form, two written references and enhanced criminal records bureau check. (CRB). We also looked at the personal file for a new member of staff who has recently been appointed, which indicated that all the required checks had been carried out prior to them commencing employment. The manager has identified in the AQAA that that they are planning to continue to involve people using the service in recruitment processes. A relative surveyed said, Staff selection is always of a high standard. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run by an experienced manager, which is in the best interest of people living there. Further improvement is needed to ensure that peoples wellbeing and safety is fully protected. Evidence: The home continues to be run by an experienced registered manager who holds appropriate management qualifications and undertakes training and development to maintain and update their knowledge. During this visit they told us that they had completed deprivation of liberty safeguards training. The manager is also supported by a deputy manager who holds a range of National Vocational Qualifications. Staff spoken with during this visit said that they were happy working in the home, they receive one to one meetings with the manager to discuss how they working and felt supported. A member of staff surveyed said, The manager is always available for staff to talk to and he is very approachable, but some staff do not always use the time time to communicate with him very well. The manager provided us with a detailed and comprehensive AQAA, which detailed the improvements that the service has made and future developments that they have identified. Information supplied in the AQAA and evidence seen at the time of this visit confirms that the manager has a good understanding about the importance of equality and diversity. Care Homes for Adults (18-65 years) Page 24 of 29 Annual quality assurance feedback surveys are carried out to gain the views of people, representatives and other stakeholders about the care and support provided. The outcomes were available for viewing. The service also holds regular consultation meetings with people, which was confirmed by people spoken with during this visit and by records maintained. Some records were maintained of monthly quality monitoring visits, which are carried out on behalf of the registered provider, however there were some reports that were not available. We were informed that the organisation has a system in place where by managers from other services within the organisation carry out these visits and the reports had not all been returned. Therefore it is required that the registered provider ensures that reports for all visits required by Regulation 26 are available for inspection in the home. Systems are in place to ensure the health, safety and wellbeing of people living in the service. A range health and safety policies are in place, up to date risk assessments were completed, the cupboard for storing substances hazardous to health was locked and water temperature monitoring is conducted. Records sampled during this visit confirmed that regular servicing and maintenance of equipment is up to date. Staff receive statutory training including fire awareness, health and safety and first aid. Accident and incident records are completed, however further improvement was identified to ensure that the Commission is notified of all events that we need to know about, which is required by the legislation. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action                                                                                           Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 23 13 The registered person must 12/01/2010 ensure that staff are made aware of the safeguarding procedures and to report any safeguarding matters to the local authority promptly. This is to ensure the protection of people living in the service.                                                             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 39 26 The registered persons must ensure that reports for all quality monitoring visits carried out at the home are available for inspection. To ensure that standards at the home are being monitored consistently by the organisation and action taken to rectify any areas of shortfall. 12/02/2010                                                             Recommendations These recommendations are taken from the best practice described in the National Care Homes for Adults (18-65 years) Page 27 of 29 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations                                                       Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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