Care Home: Wren House

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What the care home does well Wren House is a relaxed and comfortable place to live. People view it as their home and say they like living there. They are involved in the day to day running of the home. People living at the home have plans showing their needs, wishes and goals. Plans help staff give support people need to achieve their goals and promote their independence. Staff ensure the personal and health care needs of people living at the home are met and they have a healthy lifestyle. They also manage their medicines safely for them. People living at the home are asked for their views and feel able to talk to staff if they are worried. They choose a keyworker who gives them more individual support. People can take part in a variety of activities and go out in the community. They are supported to keep in touch with their family and to have healthy meals they choose. Wren House is an ordinary house that fits in well with the local community. It is in a good place near to shops and other places people like to go out to in Malvern. Staff are well trained to help them to support people properly and keep them safe. All new staff are checked to help ensure they are suitable to work in a care service. What has improved since the last inspection? Since our inspection completed on 8th August 2007 the following has improved: The home will not agree for new people to move in until they confirm that staff can meet their needs properly and that they would fit in with people who already live there. Peoples` plans are being reviewed and set up in a way they can understand. Plans now identify their individual wishes and goals and how they can achieve them better. People who live at the home have more opportunity to go out and take part in activities in the local community. They are also more involved in making decisions about the day-to-day running of their home and doing household tasks and cooking etc. Everyone living at the home now has a health action plan. These plans support them to be aware of their health care needs and encourages them to have a healthy lifestyle. The way people know who they should tell if they are not happy about the home has been made easier and they are actively encouraged to do so. Some people`s bedrooms have been redecorated and they have chosen the colour etc. Mencap has a better way of involving people who use their services so they can include their views in plans to make the home and support they receive better. What the care home could do better: People living at Wren House will benefit if care planning continues to develop asplanned. They would be supported to achieve their goals and heir independence promoted. There would be better hygiene and control of infection in the home if paper towels are provided in the bathrooms that everyone uses. If more staff achieve a social care qualification their skills and knowledge should improve. This would enhance staff team competence and so be good for people at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wren House 1-3 Wren Avenue Malvern Worcestershire WR14 2QB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 2 9 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Wren House 1-3 Wren Avenue Malvern Worcestershire WR14 2QB 01684574278 02076083254 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Mencap Society care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (Code 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) 8 Date of last inspection Brief description of the care home Wren House is run by the Royal Mencap Society (Mencap), which is also a registered charity. Mencap is one of the largest providers of services for people with learning disabilities in the United Kingdom. This service provides accommodation with personal care for up to eight adults. The home supports people with mild learning disabilities and its main aim is stated as being to provide a service to enable people to learn life skills working towards independence and assist in achieving their goals and aspirations. Wren House is located on a residential housing estate in the town of Malvern. There are shops, other facilities and public transport links within walking distance. The home comprises of three houses in a terraced row that have been joined up to make one house and garden. The property is owned by Festival Housing Association and is leased to Mencap. There are gardens at the front and rear, including Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home a good sized paved area. People living at the home all have single bedrooms and the only bedroom on the ground floor has en-suite facilities. Two other bedrooms have wash hand basins and there are three bathrooms and two toilets for everyone to use. The home has two sitting rooms, a dining room, kitchen, utility room, an office and staff sleeping in room. Information about the service is provided in a statement of purpose and a service user guide. The guide is called Our Promise to You and is available in an easy read format. Information about current fee levels can be obtained from the home. Additional costs include such as social activities, college fees, luxury items, some travel expenses and accommodation costs on annual holidays. 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: 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 is a key inspection of the service provided by Wren House. This means that all the standards that can be most important to people using care services are assessed. As part of this inspection we, the commission, visited the home for five hours during one week day without telling staff or the people who live there beforehand. We use a range of evidence to make judgements about the quality of the service. We discussed how the home is being run and plans to develop the service with the manager Cat Haylett. We also spoke with staff on duty during out visit about their role, training, support and the care and lifestyles of people who live there. Time was spent with people who are living at Wren House discussing their experience Care Homes for Adults (18-65 years) Page 6 of 29 of the home and they had all completed our surveys, which ask for their views. We also received surveys from three of their relatives or advocates and one staff member. All their feedback is referred to in our report. The manager had completed an annual quality assurance assessment (AQAA) before our visit, as required. The AQAA asks managers to say what their service does well and could do better; what has improved in the last 12 months and about their plans for further improvements. All other information we have about the home since the last inspection is also considered. This includes events that affected the health, safety of welfare of people at the home (we call these notifications), complaints and allegations. What the care home does well: What has improved since the last inspection? What they could do better: People living at Wren House will benefit if care planning continues to develop as Care Homes for Adults (18-65 years) Page 8 of 29 planned. They would be supported to achieve their goals and heir independence promoted. There would be better hygiene and control of infection in the home if paper towels are provided in the bathrooms that everyone uses. If more staff achieve a social care qualification their skills and knowledge should improve. This would enhance staff team competence and so be good for people at the home. 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 website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 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 quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can now be more sure that Wren House will support them appropriately. This is because a full assessment would be made of their needs with the prospective person, their family and representatives involved. This means staff should know about the support they need and that their wishes and goals can be met before they move in. Evidence: Wren House has a written statement of purpose and service users guide, as required. These documents are available from the home or through Mencap and are in a userfriendly format with pictures and simple language. They include information about the aims, goals, facilities, staffing, terms and conditions and other aspects of the service. No one has moved into Wren House during the last 12 months. We found in the last inspection that an inappropriate admission had been arranged. This was because it was not confirmed the persons needs could be met by the home both in respect of staffing levels and their compatibility with people already living there. Staff support had to be increased whilst a more suitable placement was found for this person. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The homes statement of purpose says their admissions criteria is that prospective people who may like to live at Wren House will be selected depending on their own needs and compatibility with other people living in the house, whose wishes would be taken into consideration. The manager told us they will follow these procedures. The home recently received an informal referral for someone who may like to live there. The manager confirms this persons needs will be considered and they will work with Mencaps area manager, relevant professionals and other people to make sure they are suitable. This will include the person visiting the home a number of times to assess that the home could meet their needs and if the people who live there get on with them. A trial stay will then be arranged before a decision is made about them moving in. Care Homes for Adults (18-65 years) Page 12 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. Everyone living at Wren House has a plan showing their care needs, wishes and goals. Plans show staff how to support them to meet their needs and to achieve their goals. People are treated as individuals and encouraged to make choices. Possible safety risks are assessed so they can be reduced, whilst promoting their independence. Evidence: Staff recognise that people living at the home should be involved in planning their own care and make decisions about their lifestyle. Progress has been made since the last inspection to implement more person centred care planning and enable people to make choices. This means plans also identify their abilities and personal goals and how they can be supported to achieve their goals and to develop life skills. One persons relative says the home looks after the special and individual needs of residents. We looked at two peoples care records in depth. They include background information, contact details and ongoing reports made by staff about their activities, health, family Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: visits, events etc. Each person has a care plan and any risks have been assessed and the action and/or support needed to reduce them recorded. Plans cover relevant areas and had been reviewed to reflect peoples current needs and goals. One person read their plan out to us and we discussed it with them. They had specified their preferences and goals and agreed the support that they need and want. This includes one area which limits something they would like to do more but have accepted that is better not to in order to promote their well being. The AQAA and manager say that plans will all be produced up in a way that best suits the individual, which may include pictures, photographs and plain language. People will also chair their own person centred meetings when they can invite who they wish to help them set goals and decide the support needed to achieve them. To help people know what is going on the home plans to use pictures of staff rotas and activities. Staff are allocated to particular people at the home as their keyworker. They are appropriately involved in helping them draw up and review their plans. They also aim to provide them with more personalised support and if necessary advocate for them. Staff understand their role as a keyworker and people we spoke with like their keyworkers and really value the input they receive from them. Risk assessments have been carried out for everyone living at the home. These identify possible safety hazards and how staff should support people when they are doing such as bathing, going out and swimming. They also show how individuals finances are managed and how they are being enabled to be involved in paying their own rent, home and personal shopping, household tasks, cooking and gardening. House meetings are held regularly when people decide on such as their activities, holidays, decor and can raise other issues such as privacy. They can also choose their meals and daily routines. The manager and deputy manager have received training in relation to issues of consent and freedom of choice and are clear that peoples rights must be considered. They have passed this information onto the staff team. Care Homes for Adults (18-65 years) Page 14 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. People living at Wren House take part in various activities they like and go out in the community. They are encouraged to take responsibility in their daily lives. Staff also support people to maintain links with their family and offer healthy meals they choose. Evidence: Staff understand that people who live at the home should be facilitated to participate in a range of activities. This is to help them to have interesting and meaningful lives and to develop their social and independent living skills. Since the last inspection the home has aimed to individualise peoples activities and increase opportunities for them to go out and be part of their local community. We looked at two residents plans and spoke with staff and some people who live at the home. Plans detail their individual interests and social and leisure activities they Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: like. They also show their goals, such as to go out using buses on their own. Everyone living at the home attends day services some weekdays and also go out shopping, to pubs, clubs etc. The manager told us staff are currently helping two people enroll on college courses and one person says he is being supported by his keyworker to attend an interview as he wants to be a community volunteer. Plans also show how people are involved with household tasks. Whilst there is not a rota as such everyone accepts that they have a responsibility for their home and share the cleaning, shopping, cooking and gardening. The AQAA says it is planned they take a more active role in the homes upkeep. People are also supported to do their own laundry, to keep their bedrooms tidy, pay their rent and with personal shopping. The home enables people to maintain links with their relatives and visitors are made welcome in the home. Mencap has produced a formal Family Charter to strengthen family connections. Most people living at the home have regular family input and they talked about their visits and how they can call their relatives whenever they want to. Family and friends are invited to parties and special occasions. One relative comments in their survey they entertain a lot at Wren House and always make you welcome. Regarding food provided by the home this is discussed in house meetings, although meals are chosen by people on a daily basis and they help staff with shopping as and when needed. The deputy manager told us staff aim promote healthy eating and relevant information was seen in the kitchen. Two people living at the home are currently having input from a Dietician to help them choose a diet to improve their health. We saw there was plenty of fresh fruit available for people to help themselves. The evenings meal was baked beans, potato wedges and fish, which looked nice. Staff and people living at the home ate together and the meal was a relaxed, social occasion. Care Homes for Adults (18-65 years) Page 16 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. People living at the home receive the personal and health care support they need and prefer. Staff ensure their health needs are met and manage their medicines safely. Evidence: Each persons plan shows the support they need and wish to have in respect of their personal care. There are instructions for staff about the assistance or oversight required. They all now also have a health action plan (HAP), which the AQAA says will help people to be aware of their health needs and feel good about themselves. HAPs cover relevant aspects of peoples physical and mental health. They are in a booklet showing What I need to do to stay healthy. HAPs also have information about peoples condition, communication, allergies and medication. There is an appointment table showing details of health care visits, advice, input and treatment, signed by those able to. They include well person checks and input from a psychiatrist. Staff also aim to encourage healthy lifestyles through diet and activity. Regarding medicines prescribed to people who live at the home the AQAA confirms Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: there are policies and processes that ensure safe working practices and help service users to control their own. Whilst no one manages their own medicines currently the manager plans to review this. Consent forms had been signed by those able to do so. Each person has a medication profile showing what they take, what for and possible side effects. Medicines are reviewed six monthly and patient information leaflets are kept along with information about particular health conditions. All staff undertake a formal training process before they are allowed to deal with medicines in the home. We saw that medications are stored, and staff hold the keys, securely. The home uses a monitored dosage system and no one living at the home has been prescribed controlled drugs. Procedures were also seen to be in place for using homely medicines (signed by a GP) and for mis-administration. Medicines received by the home are checked in and this is recorded by staff so there can be an audit trail. We saw that records of medicines kept and administered were being maintained appropriately. We were notified, as required, since the last inspection about two medication errors that were picked up by Mencaps area manager during an audit. This was dealt with properly and staff involved were interviewed and had to attend a formal error meeting. This is part of their disciplinary process and resulted in extra checks being put in place. Care Homes for Adults (18-65 years) Page 18 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 good 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 about the service there are ways to complain and people who live at the home feel able to express their views and worries. The service safeguards people from neglect and abuse and takes action to follow up any allegations. Evidence: Mencap has a formal complaints procedure, also available in a user-friendly format. They have also introduced an easy read book for complaints, which staff are going through with people living at the home and all have their own copy. Mencap also provide a record for complaints to be logged showing the actions taken with feedback. House meetings are held when people are encouraged to express their views. They are also given questionnaires by Mencap to complete about the service. Everyone confirms in their surveys that they know who to speak to if they are not happy, most saying their keyworker and/or the manager. Most also indicate that staff always treat them well and listen and act on what they say. Staff told us that they would know what to do if any concerns are raised with them. There has not been any complaints made to us about the service since the previous inspection. One complaint was made to the home and Mencap by a funding authority. They had concerns about the support one person received at the home, which they felt had been adversely affected by a negative staff attitude, lack of team work and an Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: inconsistent management approach. Whilst this matter was partly resolved by the person moving to a more suitable placement this inspection confirms that the home would be more careful about future admissions and there has also been an improvement in management support and consistency. Mencap provides policies and procedures relating to abuse, adult protection and whistle blowing. The whistle blowing policy has been revised recently and all staff had to go through this in their individual supervision and sign up to it. Staff receive training on indicators of abuse and for protection of vulnerable adults as part of their induction. They also had training recently on safeguarding and the home has a copy of Worcestershires safguarding procedures so they should know how and where to refer any suspicion or incidence of abuse or neglect to external agencies if necessary. One matter has been raised through whistle blowing since the last inspection alleging abusive or restrictive practices in the home. This was appropriately referred by Mencap through local multi-agency procedures for safeguarding vulnerable adults. It was agreed for Mencap to investigate and whilst they found no evidence of abuse as such they concluded there was a lack of structure in care planning strategies and inclusive team working due to inconsistent management cover. As already discussed this is being resolved and staff now had more training on safeguarding and whistle blowing. Another matter had been referred under safeguarding procedures. This was in relation to alleged financial abuse of one person by other people outside the home. The police dealt with the matter and gave the home advice about increasing their security. Care Homes for Adults (18-65 years) Page 20 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 who are living at Wren House have a safe, pleasant and comfortable home. The environment is kept clean and hygienic overall, although if one aspect is improved it would ensure there is better control of infection. Evidence: Wren House is located in a quiet cul-de-sac on a large residential housing estate in the town of Malvern. There are shops, pubs and other facilities and public transport links close by. The home and people living there are well integrated within and have been accepted as part of the local community. The home comprises of three ordinary terraced houses that have been converted into one house. It has an enclosed garden at the back across the whole property, which is a reasonable size. The AQAA says they work constructively with the housing provider (Festival Housing) to keep it properly maintained, furnished, decorated and equipped and equipped to a comfortable standard. This confirms our impression and most people having lived there for years clearly view it as their own home. There are two vacancies at the home and there is more communal space available for people living there. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Since the last inspection some bedrooms have been redecorated and furnished in the way people chose. The garden has also been tidied up and vegetable and herb growing areas set up. The AQAA says that they plan to decorate the other bedrooms and the hall, stairs and landing. We looked around most parts of the building and found they were clean and tidy. Staff now have more time for household tasks and are encouraging people who live there to take more responsibility for keeping the house clean, cooking and the upkeep of the garden. Staff have training and there are guidelines for promoting good infection control. The shared bathrooms have liquid soap provided, however linen towels are being used, which is not considered good for hygiene and so for control of infection. Care Homes for Adults (18-65 years) Page 22 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 living at Wren House receive safe appropriate support, as there are enough staff on duty at all times. Their needs are met by suitably trained and supported staff. People can be confident in staff because checks are done to ensure they are suitable. Evidence: Wren House only has a staff team of six and the AQAA states that we have a small, well motivated staff team and reliable relief staff. The homes relief staff have worked there for over two years and therefore know people and the home well, which is good for consistency of care. They are also completing Mencaps induction programme and training. One persons relative comments in their survey that I am pleased with the professionalism and friendliness of staff to the residents. There are always two staff on duty when people are at home and one staff member sleeps in on call during the night. In view that there are only six people living at Wren House currently this staffing level is sufficient but it is good the manager says that vacant hours will be assessed and new staff recruited if necessary. Regarding recruitment the AQAA and staff confirm Mencap operate robust procedures. This includes pre-employment checks and a six month probationary period before new Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: staff are confirmed in post. There has not been any new staff for three years and two records checked were completed a long time ago. Both had proof of their identity, satisfactory references and a CRB check. Mencap and the manager are aware that a full employment history must now be obtained with any gaps explored. Mencap have a comprehensive induction and foundation programme new staff undertake. Staff also complete all the mandatory health and safety training areas and topics relevant to care such as autism awareness, safeguarding and person centred planning. Only one of the care staff team has achieved a National Vocational Qualification (NVQ) to date, but the deputy manager says they are to start in September. There are policies and processes for staff performance, supervision and development. The AQAA states training is monitored and reviewed and there is a workforce development plan for the year. All staff receive regular supervision and team meetings are held. Management are optimistic that communication and team work has improved. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are in place to ensure the home is run appropriately in the absence of a registered manager. The quality of the service is monitored and reviewed and plans made to develop it as people living there want and for their benefit. The environment is safe because staff follow required health and safety procedures. Evidence: It is over two years since Wren House had a registered care manager. Five people have acted as manager and we were told three of them would be submitting their application to register but they did not do so for various reasons. The person appointed as manager by Mencap in May, Cat Haylett, told us she is in the process of applying and is soon to enroll on a care management course. Ms Hayletts application should be progressed as a matter of priority. Our inspection provides evidence overall that some improvements have been made to the service since the last inspection, despite issues in respect of inconsistent management support. Ms Haylett and other staff expressed commitment to the key Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: aims and objectives expected of care services and to developing person centred care. The AQAA contains clear and detailed information, which shows what the service does well and how this has resulted in good outcomes for people living there. It is positive that they have plans to further develop the service in the next 12 months. This includes person centred planning; making care plans and other documents more accessible; encouraging people to live more independently and to take a more active role in the homes upkeep; redecoration; staff doing NVQ and to implement monthly improvement plans. Mencap operates formal quality assurance and monitoring processes. There is a programme for continous improvement, which appropriately includes gaining feedback from people using their services and other stakeholders. Part of this system is an annual review of the service and monthly visits by a representative of Mencap to check how the home is being run and write a report on its conduct. This all results in targets, with comments made on progress to meet them. Regarding health and safety the home has comprehensive policies and procedures. Staff receive training in all the mandatory topics. The AQAA confirms that risk assessments and necessary checks are carried out. Other information in the AQAA states that electrical appliances; fire safety; heating systems and gas are serviced or maintained as specified. There were no environmental safety hazads identified during our visit. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 32 Staff should be supported and encouraged to achieve a National Vocational Qualification. This will help to ensure they have the skills and knowledge to do their job properly for the benefit of people who live at the home. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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