Care Home: Woodstock

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Detailed care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. A comment received from a healthcare professional tell us, "the home is a good caring environment". The staff team consists of care staff who respond to service users in a respectful and appropriate manner. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. One person using this service responded in the survey that "I do like the lounge sofa`s" Daily routines in the home are flexible and people can choose when they take part in activities. One comment received from a service user under the heading "what the home does well" tells us they like the games and the shopping. Comments received from staff include, "residents are doing more activities inside and out of the home" and "all of the residents do plenty of activities that are varied and they access the community a lot." Communication between people who use the service and staff was observed to be positive and open. Comments received from staff have acknowledged recent changes under a new manager and include, "the home provides a friendly, caring and supportive atmosphere for staff and service users alike. Teamwork has improved greatly under the guidance of our enthusiastic manager to ensure the service users have the best we can give them in all aspects" and "most of us are working together better as a team, but some staff still need to get on board" and a comment from a health care professional said the home are good at, "sharing information and collaborative team work". The people who live in the home enjoy a range of activities which suits their recreational and social needs. The provision of meals and mealtimes are of a good standard and meet the nutritional needs of people using this service. Comments received from staff working in the home tell us, "residents are given more choices in what they would like to do and this includes what they would like for dinner" and "residents choose their weekly menu`s." There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. There is a robust recruitment procedure in place that ensures service users are protected from harm.There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. There is a registered manager in post who has implemented changes into the home. Several comments received by staff in the surveys have acknowledged the improvements made by the manager and these include, " the home has improved in many small but important ways with the new manager" and "some of the staff could be more supportive of the changes to the home as I feel they are all very positive changes" and "I think our manager needs the due respect and recognition for bringing the home up to a modern way of thinking and doing, and enabling both staff and service users to fulfill their full potential and maintain a family orientated atmosphere within the home." One comment from a healthcare professional said there is "an excellent manager." Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? Person centred care plans have been improved and produced for all people living in the home. These are informative and detailed. The recruitment procedures have been improved and employment checks have been completed before staff start working at the home to make sure that people using the service are not placed at risk of harm. Staff meetings take place at least six times each year to make sure that people have opportunity to discuss and share ideas. What the care home could do better: Some entries in the care plans are vague and these would benefit from more detail that provides staff with specific information on how the service users needs are to be fully met. The kitchen is old and shabby. Worktops are worn and many of the cupboards and drawers are broken. The home would benefit from a new kitchen and the organisation should address the repairs needed in the kitchen. The laundry facilities for the home are sited so that washing has to be taken through the dining room and the kitchen to access the laundry. This does not ensure safe working practices to control the spread of infection. The organisation need to address this by seeking advice from Environmental Health and Infection Control services. Key inspection report Care homes for adults (18-65 years) Name: Address: Woodstock 186 White Lion Road Little Chalfont Amersham Bucks HP7 9NR     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: Barbara Mulligan     Date: 2 4 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 30 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 30 Information about the care home Name of care home: Address: Woodstock 186 White Lion Road Little Chalfont Amersham Bucks HP7 9NR 01494765401 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.woodstock@fremantletrust.org www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Miss Kimberley Amanda Eve Evans Type of registration: Number of places registered: care home 8 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: 8 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 Woodstock is a large detached property located in Little Chalfont. The home is close to local shops and is accessible by public transport. It is owned and staffed by The Fremantle Trust and registered to provide accommodation for up to eight people with learning disabilities. There is a large enclosed garden at the rear and a front garden with parking spaces. Each service user has a single bedroom, two of which are on the ground floor. The home has been arranged to reflect a large family type environment Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 8 3 0 0 9 2 0 0 8 Brief description of the care home and is indistinguishable in the road as a care home. The people living at Woodstock have varying care needs, some of which are complex. The fees for this home are £698.39 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for Younger Adults. Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) which is completed by the service. This document, which includes information from a variety of sources, was received in good time, was fully completed and contained the information we needed. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document is referred to throughout the report. Information received by the Commission since the last inspection was also taken into account. Surveys were sent to the home for people using the service and for care staff to complete. Seven of the surveys have been returned to the Commission. The Regulation inspector was Barbara Mulligan. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of service users and care staff. Further information was gathered from records kept at the home. A key theme of the visit was how Care Homes for Adults (18-65 years) Page 6 of 30 effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the registered manager at the end of the inspection. The management of the home, the staff and service users are thanked for their cooperation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Detailed care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. A comment received from a healthcare professional tell us, the home is a good caring environment. The staff team consists of care staff who respond to service users in a respectful and appropriate manner. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. One person using this service responded in the survey that I do like the lounge sofas Daily routines in the home are flexible and people can choose when they take part in activities. One comment received from a service user under the heading what the home does well tells us they like the games and the shopping. Comments received from staff include, residents are doing more activities inside and out of the home and all of the residents do plenty of activities that are varied and they access the community a lot. Communication between people who use the service and staff was observed to be positive and open. Comments received from staff have acknowledged recent changes under a new manager and include, the home provides a friendly, caring and supportive atmosphere for staff and service users alike. Teamwork has improved greatly under the guidance of our enthusiastic manager to ensure the service users have the best we can give them in all aspects and most of us are working together better as a team, but some staff still need to get on board and a comment from a health care professional said the home are good at, sharing information and collaborative team work. The people who live in the home enjoy a range of activities which suits their recreational and social needs. The provision of meals and mealtimes are of a good standard and meet the nutritional needs of people using this service. Comments received from staff working in the home tell us, residents are given more choices in what they would like to do and this includes what they would like for dinner and residents choose their weekly menus. There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. There is a robust recruitment procedure in place that ensures service users are protected from harm. Care Homes for Adults (18-65 years) Page 8 of 30 There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. There is a registered manager in post who has implemented changes into the home. Several comments received by staff in the surveys have acknowledged the improvements made by the manager and these include, the home has improved in many small but important ways with the new manager and some of the staff could be more supportive of the changes to the home as I feel they are all very positive changes and I think our manager needs the due respect and recognition for bringing the home up to a modern way of thinking and doing, and enabling both staff and service users to fulfill their full potential and maintain a family orientated atmosphere within the home. One comment from a healthcare professional said there is an excellent manager. Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. 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. Care Homes for Adults (18-65 years) Page 9 of 30 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 10 of 30 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 11 of 30 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. The assessment process works well and potential residents and their families have information about the home to help them decide whether their needs can be met, before they decide to move into the home permanently. Evidence: The home has an admissions procedure in place which indicates that all prospective service users are assessed prior to admission, that visits take place and that the home liaises with other professionals and families prior to accepting someone for admission to ensure compatibility with the other service users. There has been one new admission to the service in the past twelve months and the needs assessment for this person was examined. This was found to be comprehensive and the completed assessment was detailed and informative. Information contained within the file shows that the admission took place to suit to the needs of the service user. The assessment demonstrates that prospective service users, family members or Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: representatives are included in the assessment process if this is appropriate. Care Homes for Adults (18-65 years) Page 13 of 30 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 are well cared for and this is supported by good record keeping, risk assessments and support from other health care professionals in the community. Evidence: A service user care plan is in place for each person using this service and three of these were examined during this inspection. At the previous inspection a requirement was issued for person centre care plans, to be in place which take into account service users, carers and other interested parties views. The care plans examined are informative and reflect the changing needs of the individual. Some entries in the care plans are vague and require further detail. For example, in one care plan it states needs full support with washing and washing hair and another entry reads use visual aids to help X understand what is being communicated. These statements should be more detailed to provide specific guidance for staff to follow. Personal and healthcare needs are identified within the care plans. Individual preferences, likes and Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: dislikes and reference to end of life care are recorded in care plans and describes how these will be met. There is evidence that care plans are reviewed monthly and it is noted that this is a thorough process. Daily notes are informative and record the personal care received and activities that the individual has undertaken through out the day. A comment received from a healthcare proffessional tell us, the home is a good caring environment. Visual observations of people using this service showed that people were smartly dressed including jewelery, and people were seen to be wearing the aids needed. All individulas have an annual review to which families and interested parties are invited. Regular monthly residents meetings are held and minutes of these are maintained. These use pictures and photographs to make them user friendly. These show that individuals are encouraged to air their views and be involved in decision making, whether it be about themselves, or choosing a new item for the menu,a new activity or a haircut. Annual holidays are discussed and are chosen by the residents. Residents continue to be encouraged and supported by staff in making decisions. Risk assessments have been completed for bathing, swimming, accessing the comunity, travelling, using the stairs and missing persons. All risk assessments examined were reviewed and upto date. Care Homes for Adults (18-65 years) Page 15 of 30 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. Service users have a varied and active lifestyle which reflects their interests, provides them with nourishing meals and offers them opportunity to try new experiences and have contact with family, friends and the community. Evidence: Service user files examined outline the individuals interests and activities that they enjoy. There is good regard for the diverse needs of the people living at the home and their requirements related to their disabilities, lifestyle choices and personal preferences. People who use the service attend activities that are tailored to meet their individual needs. Several people using this service attend a day care centre and have a day at home when they will choose how they spend their day. Examples of activities attended by people using this service include, swimming, cookery, trips into town, day trips out, Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: lunch and personal shopping and one person attends the gateway club. There is evidence of individuals interests, social likes and dislikes and information about how they access the community recorded in care plans. Family and social contacts were seen recorded in all files. On the day of the visit one person was out with a care worker in town having lunch. When individuals are at home they enjoy a range of interests and examples seen include watching films, baking and karaoke. There is an album of photographs which show activities taking place in and out of the home. One comment received from a service user under the heading what the home does well tells us they like the games and the shopping. Comments received from staff include, residents are doing more activities inside and out of the home and all of the residents do plenty of activities that are varied and they acces the community a lot. There are no restrictions about family and friends visiting and people who use the service are supported to maintain family relationships and have regular visits from and to their family. From observations on the day of the inspection visit, staff members were seen to treat the people living in the home with respect and patience. Records are maintained of service users diets and these demonstrate that individual needs, such as healthy eating are being met. Monthly weights are recorded monthly and nutritional screening is evident in files. There is a varied menu and residents contribute to the weekly menu planning. Fresh fruit is available in the home for residents to help themselves when they wish. The home will offer drinks and snacks throughout the day in accordance with the needs of each individual. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs outlined within their individual care plans,ensuring that the manner in which they are supported and cared for by staff is appropriate and promotes their preferences. Evidence: Service user care plans provide detailed information about the type of support and assistance people using the service need. We were told that people who use the service are supported to choose when they like to go to bed, have a bath, have their meals and take part in other activities. Choices around clothes and hairstyles remain with the individual and personal preferences are recorded within individual care plans. Comments received from staff working in the home tell us, residents are given more choices in what they would like to do and this includes what they would like for dinner and residents choose their weekly menus. There is evidence of health care screening in service user care plans. Each file contains a tissue viability assessment, a nutritional assessment and reports of visits to health care professionals. Those seen include visits to the doctors, the dentist, the optician Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: and a consultant regarding peoples Epilepsy. For individuals who have epilepsy there is a detailed support plan in place regarding the management of the individuals epilepsy. There is good information about the support people need with oral hygiene, continence care, personal care and maintaining a healthy weight and nutrition. Weights are monitored on a monthly basis and one person had their weight monitored fortnightly. All service users are registered with a GP practice and specialist services such as physiotherapy, occupational therapy, psychology and speech therapy can be accessed and there is evidence of this recorded in individual files. There was good information available for staff regarding one person with a recently diagnosed medical condition. Medication practices were examined during this visit to the home. There were no individuals who were able to self administer their own medicines at the time of this visit, although there are policies and procedures in place should anyone wish to and be able to do so. Medicines are stored in the kitchen area of the home in one large lockable medicine cabinet. Medication Administration Records (MAR) are in good order with staff signatures alongside prescribed dose times. Handwritten entries were all dated and signed by two staff. There are guidelines in place for the administration of Paracetamol for each person and for the administration of Rectal Diazepam. However, guidelines are required to be in place for all as required/as needed (PRN) medicines. The home should address this. Training records for staff expected to administer medicines were examined and it was noted that staff have completed medication training. Care Homes for Adults (18-65 years) Page 19 of 30 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. The home is able to effectively manage complaints and safeguard service users ensuring people who use this service are listened to and kept safe from harm and abuse. Evidence: There is a complaints policy and procedure, which clearly describes the way in which complaints should be handled and the deadlines that are set for response. The complaints procedure is accessible to service users and their representatives and a user-friendly version of the complaints procedure is in the service users guide. A record of all complaints is maintained, and the complaints log was viewed during this inspection. The home has not received any complaints since the last inspection and this information is recorded in the Annual Quality Assurance Assessment (AQAA). Policies and procedures are in place for safeguarding vulnerable adults (SOVA) and staff have access to a whistle blowing policy. The home has a copy of the local authority safeguarding policy. Training records demonstrate that staff have completed safeguarding training and this is regularly updated. The Annual Quality Assurance Assessment tells us that there has been one safeguarding investigation in the previous twelve months and this was dealt with in Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: line with the local authority policies and procedures. Care Homes for Adults (18-65 years) Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, comfortable and homely environment has been created for people who use the service, ensuring that they have appropriate surroundings in which to live. The home must seek advice from Environmental Health and Infection Control services regarding the siting of the laundry and safe working practices to prevent the risk of the spread of infection. Evidence: Woodstock is a large detached property located in Little Chalfont. The home is close to local shops and is accessible by public transport. There is a large enclosed garden at the rear and a front garden with parking spaces. The house is clean, well decorated and homely throughout. Thought has been given to the needs of service users throughout the home and each bedroom has been personalised to meet the needs of the person and to reflect their likes and preferences. One person using this service responded in the survey that I do like the lounge sofas The kitchen is old and shabby. Worktops are worn and many of the cupboards and Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: drawers are broken. The home would benefit from a new kitchen and the organisation should address the repairs needed in the kitchen. The home provides adequate toilets, shower and bathing areas which are spacious and contain grab rails, assisted baths and other aids. The laundry facilities for the home are sited so that washing has to be taken through the dining room and the kitchen to access the laundry. This does not ensure safe working practices to control the spread of infection. The organisation need to address this by seeking advice from Environmental Health and Infection Control services. Care Homes for Adults (18-65 years) Page 23 of 30 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 staffing numbers and skill mix is satisfactory and staff training is sufficient and up to date to ensure that people who use the service benefit from staff who are competent to do their job. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: The rotas show adequate numbers of staff are working in the home at any time to meet the needs of the people living there. Staff were observed to be accessible to and comfortable with service users. The AQAA tells us that the home employs ten permanent care staff and any vacant hours are covered by established, regular relief staff. There were no staff vacancies at the time of this visit. Comments received from staff have acknowledged recent changes under a new manager and include, the home provides a friendly, caring and supportive atmosphere for staff and service users alike. Teamwork has improved greatly under the guidance of our enthusiastic manager to ensure the service users have the best we can give them in all aspects and most of us are working together better as a team, but some staff still need to get on board and a comment from a health care proffessional said the home are good at, sharing information and collaborative team Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: work. The Annual Quality Assurance Assessment document shows us that all of the ten permanent care staff have completed and obtained NVQ level 2 or above qualification. At the previous inspection shortfalls were identified in the homes recruitment procedures and a requirement was issued for the full range of recruitment checks to be in place before staff start working at the home, to make sure that people using the service are not placed at risk of harm. The recruitment files for a selection of staff were examined, including those new to the service. All files looked at contain the necessary documentation. There is evidence that all staff CRB checks had been obtained and references had been undertaken before the care staff commence employment. On the day of the visit a newly employed care worker said they had found the organisation to be supportive and they had maintained good communication throughout the recruitment process. All staff complete an induction programme that covers the common induction standards and certificates of completion were observed in the files examined. During the initial induction to the home staff are extra to the numbers on the staff rota and work alongside more experienced staff. Training records show that staff are up to date with their mandatory training which includes moving and handling, basic food hygiene, infection control, safeguarding vulnerable adults and first aid training. There is specialist training available for staff, and an example of this seen in files includes communication and challenging behavior and epilepsy awareness. Care Homes for Adults (18-65 years) Page 25 of 30 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. The home is well managed by an experienced management team and service users are protected by safe working practices ensuring the health and safety of people using the service. Evidence: The registered manager is Kim Evans and she has been in post as manager since September 1st 2008. The manager is in the process of completing the Registered Managers Award and training completed in the last twelve months includes train the trainer for Infection Control, a managers finance course, Epilepsy and Rectal Diazepam training and all the necessary mandatory health and safety training. The Annual Quality Assurance Assessment (AQAA) sent out prior to the inspection was returned within the requested timescale and was well completed. The Annual Quality Assurance Assessment (AQAA) informed us of changes the home has made and what areas need to be improved upon. The registered manager has made significant progress in meeting standards since joining the home and practice is more professional and designed to meet individual needs. The organisation and the home has a clear and accountable management structure and the manager is supported by Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: the organisation. Staff meetings take place regularly and staff spoken to confirmed this, and copies of minutes of the meetings are held on file. Several comments received by staff in the surveys have acknowledged the improvements made by the manager and these include, the home has improved in many small but important ways with the new manager and some of the staff could be more supportive of the changes to the home as I feel they are all very positive changes and I think our manager needs the due respect and recognition for bringing the home up to a modern way of thinking and doing, and enabling both staff and service users to fulfill their full potential and maintain a family orientated atmosphere within the home. One comment from a healthcare professional said there is an excellent manager. The organisations management system includes a quality assurance module which includes sending out satisfaction surveys. The registered manager completes monthly monitoring returns and Regulation 26 monitoring visits are undertaken by service managers for the organisation. These follow a detailed format that shows speaking with staff and people who use the service is a regular feature of the visits, plus good practices such as examining a sample of individuals money and staff training records. There is a comprehensive health and safety policy in place and health and safety training is completed and up to date for all staff. Records were seen for fire safety.These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Fire training has been booked for 8th October 2009 for all staff. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment dated 02/09/2009 and this is reviewed annually. Care Homes for Adults (18-65 years) Page 27 of 30 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 30 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 30 23 The organisation are 30/12/2009 required to seek advice from Environmental Health and Infection Control services regarding the siting of the laundry. To ensure safe working practices are in place to control the spread of infection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 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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